Gertrude Burger v Cerebral Palsy Alliance - Accommodation Northern Sydney - [2025] NSWPIC 214

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Gertrude Burger v Cerebral Palsy Alliance - Accommodation Northern Sydney [2025] NSWPIC 214
APPLICANT:	Brenda Gertrude Burger
RESPONDENT:	Cerebral Palsy Alliance - Accommodation Northern Sydney
MEMBER:	Michael Wright
DATE OF DECISION:	16 May 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; claim for compensation for psychological injury; Paric v John Holland (Constructions) Pty Ltd, and Hancock v East Coast Timber Products Pty Ltd considered; credit and causation issues; Held – award for applicant for weekly compensation and section 66 claim referred to Medical Assessor.
DETERMINATIONS MADE:	The Personal Injury Commission determines: 1. Pursuant to s 4(b)(ii) of the Workers Compensation Act 1987 (the 1987 Act), the applicant sustained injury in the nature of an exacerbation of complex post-traumatic stress disorder with panic attacks in the course of her employment with the respondent, deemed to have happened on 18 April 2023. The applicant’s employment with the respondent was the main contributing factor to the injury. 2. The applicant has had, and continues to have, no capacity for work since 18 April 2023. 3. Respondent to pay the applicant weekly compensation, based upon pre-injury average weekly earnings (PIAWE) of $2220, as indexed: (a) Pursuant to s 36 of the 1987 Act, $2109 per week from 18 April 2023 to 17 July 2023, and (b) Pursuant to s 37, and as indexed, $1,887 per week from 18 July 2023 and continuing. 4. General order that the respondent pay the applicant’s reasonably necessary medical and treatment expenses pursuant to s 60 of the 1987 Act. 5. I remit this matter to the President for referral to a Medical Assessor pursuant to s 321 of the Workplace Injury Management and Workers Compensation Act 1998 for assessment as follows: (a) Date of injury: 18 April 2023 – Disease (deemed) (b) Body systems/parts: (i) psychological (c) Method: Whole person impairment 6. The documents to be reviewed by the Medical Assessor are: (a) Application to Resolve a Dispute and attached documents; (b) Reply and attached documents, and (c) ALAD dated 31 January 2025 and 24 February 2025 and attached documents A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

The applicant ceased work on 18 April 2023, following a meeting with her supervisor. The applicant and her supervisor had had meetings since January 2023 and the applicant alleged that she had been bullied.
The applicant claimed compensation for psychological injury and claimed lump sum compensation, weekly benefits and medical and related expenses.
The respondent disputed liability on the basis of a dispute as to injury. At issue was the nature of a pre-existing condition. The applicant claimed aggravation of that pre-existing condition.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

I am satisfied that the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied. I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.
At the hearing of this matter 27 February 2025. The applicant was represented by Mr Hanrahan of counsel, and the respondent by Mr Berin of counsel.

EVIDENCE

Documentary evidence

The following documents were in evidence before the Personal Injury Commission (Commission) and considered in making this determination:
(a)    Application to Resolve a Dispute and attached documents;
(b)    Reply and attached documents, and
(c)    Applications for leave to admit documents dated 31 January 2025 and 24 February 2025.

Oral evidence

There was no oral evidence.

Reasons

I note that in this claim for weekly compensation for psychological injury, the respondent did not rely upon a defence pursuant to section 11A of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act). The dispute was as to injury. Capacity was also notified as a dispute, as was a claim for section 60 medical and treatment expenses, although in relation to capacity and there was no divergence in the medical opinion evidence relied upon by both sides that the applicant had no capacity for work.
The applicant’s evidence, contained in her statements dated 30 January 2025, 7 November 2024 and 26 June 2023 (unsigned but adopted in her latest statement), in summary outlined what she said were her difficulties with her supervisor, Ms Isaac. The applicant said that she commenced employment as a disability support worker in 1999 with an employer entity that subsequently became the respondent in 2017. She said that she consistently performed at a high level in her work until April 2023.
She said that she transferred to a new worksite with the respondent in September 2021. The applicant said that from this time she began facing bullying and harassment by Ms Isaac. The applicant said that Ms Isaac would often speak down to her and made the applicant feel like she was just like a silly schoolgirl. The applicant said that Ms Isaac frequently directed accusatory gestures towards her, raised her voice in anger and insisted that she attend meetings without prior notice.
The applicant described meetings with Ms Isaac in January 2023 in which she felt that she had been incorrectly interrogated and she had felt demeaned and vulnerable.
The applicant said that on 18 April 2023 Ms Isaac called her into an office and threatened to remove her from her job and said to her in an aggressive manner “do you even want to work here”. The applicant said that this was so severe that she had chest pains and she called an ambulance and she was taken to the Ryde hospital. The applicant said that this was the culmination of events she stopped work and was no longer able to continue working.
The applicant said that following that meeting she had symptoms of panic attacks and of severe post-traumatic stress disorder. The applicant also described an episode in 2007 in which she said she briefly struggled with post-traumatic stress disorder in what was a
non-work related setting. The applicant said that she was always diligent in her work and had no problems with her employers previously. She said that she cherished the times that she spent with her mother previously. She also described a loving and stable childhood.
In summary, the respondent defended this matter on the basis of an attack on the applicant’s credit, and that is that her evidence could not be relied upon, and hence the histories recorded in the applicant’s medical evidence should not be accepted. The respondent also challenged the applicant’s medical evidence.
The matters referred to by the respondent in relation to credit I would broadly describe as matters in relation to a history of what were said to be delusional thoughts, false or incorrect statements in relation to prior workplace difficulties, workers compensation claims,
post-traumatic stress disorder diagnosis, cessation of consultations with Dr Jeyasingham and family history.
The respondent submitted that there was an extensive history of delusional thoughts recorded in the clinical records and treating reports, which existed before the onset of the applicant’s alleged difficulties in the workplace. The respondent pointed to clinical records and reports which it said showed that the applicant displayed delusional thoughts in respect of a prowler/stalker up until about 2022, rather than the prowler ceasing in 2017 as described by the applicant. The respondent pointed to clinical notes commencing in August 2016 which referred to a prowler, with further notes in 2017, 2018 and 2022.
As acknowledged and noted by the respondent, Mr Buttel, treating psychologist, provided a number of short treating reports, including a report dated 16 September 2019 in which anxiety issues were diagnosed, “complicated by delusional thinking which does not meet the diagnostic criteria for psychotic disorder”.
Dr George, treating psychiatrist from 2017 to 2019, provided a number of treatment reports. An earlier report dated 8 December 2017 noted “an overlay of a delusional/paranoid psychotic process (with unclear elements of a possible schizoaffective disorder spectrum)”. However, by 19 August and 23 December 2019 there was no reference to a delusional process and the latter report referred to return to work with some anxiety.
Dr Jeyasingham, treating psychiatrist, in a report dated 7 August 2023, noted a recent inpatient admission and also noted that auditory hallucinations have reduced and the applicant had only one persecutory ideation episode of note in the previous two weeks. In subsequent reports dated 27 November 2023 and 22 January 2024 he noted that there had been no further paranoid episodes although there was no insight in the applicant maintained that the previous experiences were based in reality.
In an earlier report dated 6 June 2023, he noted that past notes confirmed his suspicion of a long-standing untreated psychotic condition and that presentation on that day included discussion all distress about hearing sounds at different corners of the house. He arranged for prescription of haloperidol to help with improved thinking, among other symptoms, to be administered on an inpatient basis.
Dr Yenson, treating psychiatrist from May 2024, provided a number of treating reports. In his initial treating report of 16 May 2024 he noted a diagnosis of schizophrenia by Dr Jeyasingham, a history of stalking and the apparent belief by Dr George that there was a psychotic illness. He thought the applicant appeared to have a long-standing psychotic illness for which she was taking medication but it was unclear how much this had impacted on the work situation. He also noted that the applicant denied that she had previously been told that she had psychosis. In his later reports of 6 June 2024 and 28 January 2025, Dr Yenson thought that it was reasonable to be cautious of the past psychotic episode which was focused upon a past romantic partner, but he did not believe that there was an association between that past psychotic episode and the current situation in relation to employment.
Dr Lee, psychiatrist, in his reports to the employer dated 4 February 2019 and 20 March 2019, noted a history of a breakdown in a relationship in 2015, with subsequent stalking and referral to Dr George for feelings of anxiety and depression. He thought there was no indication of of posttraumatic stress disorder and that the applicant was delusional or fabricating stories as her preceptions could not be corroborated. He did not provide a diagnosis and noted that Dr George had not done so. Dr Anwar was unable to diagnose. I am not assisted by these reports. Dr Lee provided his reports before the events in 2023, and assumed the applicant’s stories could not be corroborated.
There were no notes of consultations between 2019 and 2022 in respect of what is described as delusional thoughts. The last recorded consultation for prowler/stalker thoughts was in June 2022.
Dr Jeyasingham recorded that in 2023 the applicant responded to medication to help with her thought processes, in the context of auditory episodes, recorded in his reports of 17 May 2023 and 6 June 2023. There was inpatient admission following the June 2023 report for the purpose of administration of haloperidol. That admission took place on 7 June 2023 with a discharge on 19 June 2023.
The discharge summary of 19 June 2023, authored by Dr Jeyasingham, provided a principal diagnosis of anxiety and depression and that the applicant had presented with an increase in depressive and anxiety symptoms in the context of workplace stressors. It was noted that the applicant was commenced on haloperidol with good effect and she was markedly less concerned about potential stalkers, although without insight into the condition.
I note at this point that a lack of insight had been noted in clinical records by a number of the treating medical practitioners, such as Dr Yenson. The applicant did not agree with the view that there were delusional thoughts. In my view, while not determinative as to the question of injury, this assists in consideration of the applicant’s credit.
In terms of what was referred to as delusional thinking, the respondent in summary pointed to clinical notes and treatment reports:
(a)    clinical notes of the general practitioner made references to a history provided by the applicant of a prowler or stalking from August 2016. References were also made in December 2016, January 2017, April 2017, May 2017, September 2017, January 2018, July 2018, August 2018 and May 2022;
(b)    Dr George, treating psychiatrist, in October 2017 noted workplace difficulties of stalking, bullying and harassment;
(c)    Mr Buttel, treating psychologist, provided a number of reports, including a final report dated 16 September 2019 in which the diagnosis was anxiety issues complicated by a delusional thinking but not meeting the diagnostic criteria for psychotic disorder, and
(d)    in June 2023 Dr Jeyasingham recorded a history of the applicant hearing sounds that could not be heard by her dog. In August 2023 he recorded a further inpatient admission and reduction of auditory hallucinations.
In respect of the history relating to the applicant’s thought processes, the respondent submitted that:
(a)    there was a long history of references in clinical notes to a prowler or prowlers, and to stalking;
(b)    this history commenced in August 2016 and continued until at least 2022;
(c)    this history was contrary to that asserted by the applicant, that is that the prowling ceased in about 2017, and
(d)    Dr Jeyasingham [DT1] identified delusional thoughts in June 2023, and possibly May 2023.
In respect of the notes of Dr Jeyasingham as to auditory hallucinations in June 2023 and possibly June 2023, there was no express medical opinion that these were of the same nature as the reference to stalking/prowlers earlier, nor was there medical opinion that these were delusional thoughts. I do not accept the respondent’s submission that such delusional thoughts extended to June 2023.
It is important then to consider other witness evidence in relation to events in 2023.
In relation to her statement, Ms Isaac:
(a)    conceded that there were no work performance issues in relation to the applicant;
(b)    conceded that there was conflict between Ms Han and the applicant;
(c)    said that she arranged a meeting or meetings with the applicant to discuss the conflict with Ms Han;
(d)    conceded that in the second of two meetings in February 2023 the applicant became upset and left the meeting and went home;
(e)    said in the final meeting that she had with the applicant, which she did not date, the applicant became aggressive and said that she could not work with Ms Han and could not work because of her. She said that the applicant called an ambulance and on arrival the paramedics said something to Ms Isaac;
(f)    conceded that in that final meeting she had asked the applicant if she would consider going to another house and there were options if she could not work with Ms Han. This to my mind does not directly contradict the applicant’s statement that she was asked whether she thought this was the right place for her to be working;
(g)    did not comment or contradict the applicant statement that the applicant heard Ms Isaac laughing in the dining room following the call for the ambulance on
18 April 2023;
(h)    conceded that the applicant had not complained about any other staff that she could recall, and
(i)    she also described where the applicant had discussed with her feelings of anxiety previously. She also described instances of overheard conversations which Ms Isaac did not think were true and of discussions of stalking.
In relation to her statement, Ms Askew:
(a)    described a clear clash of personalities between the applicant and Ms Han, although she thought there was no “targeted bullying”;
(b)    observed that the applicant appeared to be sensitive in some things that others might brush aside;
(c)    observed that the applicant had commented that she had issues with Ms Isaac and that the applicant thought that Ms Isaac was not taking her seriously;
(d)    described a mediation meeting in February 2023 between the applicant, Ms Han, Ms Isaac and herself, in which the applicant and Ms Han wanted to talk about how horrible the other person was and how they were correct. Miss Askew observed that it was not a good meeting and it was pointed, and
(e)    described a further meeting on 17 February 2023 attended by herself, the applicant and Ms Isaac in which the applicant became overwhelmed and claimed that Miss Askew was calling her a liar and that she became upset and the meeting became heated and was thereafter stopped.

33. In relation to her statement, Ms Han:

(a) provided considerable detail as to various interactions that she had with the applicant in the workplace. Having regard to the concessions by Ms Isaac and Ms Askew that there was conflict between Ms Han and the applicant, it is not necessary for me to outline the detail of this statement, and
(b) described a meeting, which she did not date, attended by Ms Han, Ms Isaac, Ms Askew and herself. Her description was in respect of her own interactions, although she did note that the applicant turned red in the face when the applicant spoke in the meeting.

I note the email of Shane Sporle dated 10 December 2024. I do not place weight on that document as it does not deal with direct observations relevant to the circumstances of this matter.
The applicant’s different statements as to her family experience were also the subject of submissions, such as in her statement dated 30 January 2025 in respect of her childhood, and in contrast notes recorded in the St John of God Hospital on 9 June 2020. It is not clear to me which statement is incorrect, nor is it clear as to the whether the differing descriptions were referring to the entirety of family life, or some shorter period or periods which may or may not have coincided, nor is it clear to me as to the context that the 2020 or other statement was made, in terms for example of mental state or use of medication. I do not accept that this was a deliberate falsehood, although it is reason for me to adopt a cautious approach and have regard to objective evidence.
There was a suggestion by the respondent that the applicant changed treating psychiatrists when told of a diagnosis of delusional thoughts or a psychotic condition. It was suggested that this was motivated by the applicant seeking a diagnosis that was favourable to her workers compensation claim. I do not accept this submission. Both Dr Yenson and Dr Jeyasingham noted lack of insight into her condition. In my view, the more likely explanation of her change in psychiatrist was that lack of insight and the non-acceptance of such a diagnosis.
A related submission by the respondent was that the applicant was not telling the truth when she said that she ceased seeing Dr Jeyasingham, as his reports indicated that he had told her that there was nothing further he could do for her. I do not accept the respondent’s submission. It is unclear from the differing accounts as to what was said in any final session and indeed both parties may well have truthfully concluded that it was their action that terminated the relationship. This is insufficient to conclude against the applicant on this point.
The respondent pointed to documentary evidence in the form of correspondence from the applicant and letters from her employer to show that, contrary to the applicant’s assertions, she had made two prior workers compensation claims since 2003, including for bullying and harassment in 2017, and that she had the subject to a formal performance review in
April 2021, that is shortly before her transfer to the new group home. I accept that the applicant’s assertions to the contrary in this regard were incorrect. This is another reason to approach the applicant’s evidence with caution and have regard to other objective evidence.

The respondent also attacked the applicant’s credit on what it said were incorrect statements made by the applicant as to being diagnosed with post-traumatic stress disorder in the past.
I do not accept this submission. Dr Balakrishnan in a referral letter dated 23 April 2007 noted, among other matters, a history on 23 April 2007 of post-traumatic stress disorder. In my view this was a diagnosis as a background for referral to another medical practitioner, Dr Chapuis regarding a separate issue. This is also significant in providing evidence to consider the diagnosis of Dr Rastogi.
It was submitted by the respondent that the applicant’s history, particularly given to Dr Yenson and Dr Rastogi, of the cessation of delusional symptoms, that is stalking, was false. It was submitted that the delusional symptoms did not stop in 2017 as alleged by the applicant.
The issue for this submission is that the applicant did not accept that she had delusional thoughts or symptoms. In any event, Dr Rastogi noted a return of the ex-partner in August 2016 and ongoing harassment. Dr Yenson recorded that psychotic symptoms regarding the ex-partner had ceased many years ago. The clinical notes of the general practitioner recorded a relevant entry in May 2022, but the last prior relevant entry was in August 2018. Although the history was incorrect, at least in terms of what was stated by treating medical practitioners as delusional thoughts, in my view this is insufficient to conclude that the applicant provided deliberately or intentionally false or misleading evidence.
I am not satisfied that the applicant in her evidence sought to mislead or to deliberately provide false information in terms of her statements to the Commission and the history provided to medical practitioners, including Dr Yenson and Dr Rastogi. It was noted by treating medical practitioners that the applicant either did not agree with the medical characterisation of certain aspects of her thought processes as delusional, or in the alternative that she lacked insight into her condition. This was noted by Dr Yenson, who thought insight into her condition was very poor. Dr Jeyasingham noted lack of insight. This is a complex psychiatric background, and I am unable to conclude that there was deliberate or intentional provision of incorrect information by the applicant in this matter.
However, as noted above, these are reasons to approach the applicant’s evidence with caution and have regard to other objective evidence.
This objective evidence includes:
(a)    the clinical notes of her general practitioner in February and March 2023 document the applicant’s feelings of anxiety in the context of workplace stress and what she described as bullying and conflict. Physical symptoms of palpitations were recorded in this regard;
(b)    the ambulance medical record dated 18 April 2023 noted chest pain as the reason for attendance. It recorded the applicant was in her workplace with her manager present. It recorded that the applicant stated that she was in a meeting with her manager that afternoon and her manager told her to find another job after taking too much time off. It was recorded that the applicant stated that she immediately started experiencing palpitations and felt as though she could not breathe. It was recorded that the applicant had a history of anxiety and panic attacks and had a panic attack in January after a similar meeting with the same manager. It was recorded that the applicant appeared to be obviously distressed and her symptoms improved with reassurance and breathing coaching. Initial assessment was recorded as a panic attack;
(c)    the discharge summary of the Ryde hospital dated 18 April 2023 advised follow up with a cardiologist and discussion with GP regarding a mental health plan and possible psychology referral for anxiety/stress management;
(d)    clinical note of the general practitioner dated 19 April 2023 noted that the applicant was taken to Ryde hospital the previous day by ambulance with chest pain after an interaction with her house manager at work and who was known to bully the applicant. A likely panic attack was noted;
(e)    report of Dr Jeyasingham dated 17 May 2023 recorded a history of the applicants first ever panic attack occurring after a workplace meeting in January 2023, with progressive workplace bullying since March 2021, and a second panic attack on 18 April 2023 relating to an argument with a supervisor that led to an ambulance transfer due to chest pains;
(f)    a progress note of a clinical psychologist of the St John of God Hospital Burwood dated 22 May 2023 recorded that the applicant reported that she had a bad panic attack at work a month ago and she had been too anxious to return to work due to interpersonal conflicts there. A mental state examination noted reactive affect and anxious mood, and nil thought delusions and good insight and judgement, and
(g)    the discharge summary of the Ramsey clinic Northside dated 28 July 2023 recorded that the applicant said she felt quite disabled by her unresolved work matters and she felt unable to return to work and felt overwhelmed with fear of panic when thinking about work duties. It was noted that the applicant would need further stabilisation to assist with day-to-day coping approaches with her struggles with anxiety and panic following workplace trauma. She was diagnosed having an adjustment disorder with an anxious and depressed mood with panic attacks and trauma syndrome with post-traumatic stress symptoms following experiences of workplace bullying.
The respondent pointed to the clinical records as demonstrating that the applicant had been taking medication for anxiety since 2003. The applicant in response said that the clinical records indicated that in 2016 she had reduced intake of anxiety medication to a quarter dose as and when required. I note that Dr Jeyasingham on 17 May 2023, that is following the meeting of 18 April 2023, recommended a trial of mirtazapine, initially 15mg and increased to 30mg, to help with sleep, reduce anxiety and improve resilience, although the applicant did not want to increase medication. I accept the applicant’s submission that there was an increase in this medication following 18 April 2023.
In my view, the matters noted in the witness statements referred to above, as well as the documentary medical evidence referred to in the preceding paragraph, establish that:
(a)    there were a series of meetings with Ms Isaac, which included meetings in which the applicant became upset or distressed;
(b)    there was significant conflict between the applicant and Ms Han;
(c)    the applicant complained of workplace bullying to her general practitioner in February and March 2023;
(d)    the final meeting on 18 April 2023 included a question from Ms Isaac as to whether the applicant thought that this was the right place to be working. The applicant also overheard Ms Isaac laughing, as noted above. Although it is the case that I have adopted caution in dealing with the applicant’s evidence, these matters were not contradicted by Ms Isaac and on balance I accept the applicants evidence in this regard;
(e)    immediately following the meeting on 18 April 2023 the applicant called the ambulance for chest pains, and
(f)    the clinical entry of 22 May 2023 of the St John of God Hospital noted anxious mood and too anxious to return to work and there were no thought delusions.
There was a history of pre-existing anxiety for a number of years prior to 2023. The ambulance report noted above is in my view evidence to support a conclusion that there was an increase in the applicant’s anxiety symptoms on 18 April 2023.
I accept that the applicant perceived the meetings from January 2023 to 18 April 2023 as representing bullying on the part of Ms Isaac. As was discussed in Attorney General’s Department v K[1], a perception of real events, which are not external events, can satisfy the test of injury arising out of or in the course of employment, and so long as the events within the workplace were real, rather than imaginary, it does not matter that they affected the worker’s psyche because of a flawed perception of events because of a disordered mind. In this case there were real events, being the meetings from January to 18 April 2023. The applicant perceived bullying from Ms Isaac. I accept the applicant’s evidence in this regard.
[1] [2010] NSWWCCPD 76
I do not accept the respondent’s submissions that the report of Dr Yenson of 23 January 2025 represented a change in opinion based on false or incorrect information from the applicant. In his earlier reports Dr Yenson was in my view appropriately cautious in respect of history taking. In his first report of 16 May 2024, Dr Yenson noted both the applicant’s history of workplace difficulties as described above, as well as the diagnosis by Dr Jeyasingham of schizophrenia. He had regard to the history taken in the reports of Dr Lee and Dr Anwar, as well as Dr Jeyasingham of 22 January 2024 and 4 March 2024, the latter report being incorrectly referred to as 3 April 2024 in my view.
Dr Yenson’s medicolegal report dated 23 January 2025 considered that there was a chronic adjustment disorder with anxiety resulting from bullying and intimidation in the workplace, while at the same time noting that the applicant had suffered from a psychotic episode in the past that was not active or had any contribution to her experience with the respondent. He was of the view that the psychotic episode had diminished over time.
Although it was the case that he also noted a history that the psychotic symptoms had ceased many years ago, and that her employment with the respondent had been otherwise unremarkable, in my view the history relied upon by Dr Yenson provided a fair climate[2] for his opinion as to the psychotic symptoms. There was no evidence of continuous psychotic symptoms from 2018 to January 2023, and the only clinical record in that regard in that period was in 2022. Similarly, unremarkable employment was noted in the context of the applicants long-standing employment with the respondent.
[2] Paric v John Holland (Constructions) Pty Ltd [1984] 2 NSWLR 505 at 509-510; Paric v John Holland (Constructions) Pty Ltd [1985] HCA 58; (1985) 62 ALR 85) (Paric)
In any event, for reasons given below, I prefer the opinion of Dr Rastogi. The difficulty for the report of Dr Yenson is the pre-existing anxiety condition, with prescription of medication from about 2003.
Dr Morgans, psychiatrist, in her reports to the respondent dated 9 October 2024 and
3 January 2025 initially provided a deferred diagnosis, although the most likely diagnosis was delusional disorder unspecified type. Dr Morgan did not agree that a delusional disorder was work related.
In her later report, Dr Morgans did not maintain a view that there was a delusional disorder, rather she made a diagnosis of schizophrenia, not work related. Dr Morgans provided reasoning that schizophrenia is not a single, uniform disorder, with a complex aetiology and is not a congenital disorder, although there was no contribution from employment in this case. She was of the opinion that the untreated symptoms of schizophrenia being the delusions of being stalked and harassed resulted in vocational impairment. Dr Morgans was on the view that the applicants pre-existing disorder resulted in delusions of being stalked, harassed and bullied in the workplace.
I do not accept the opinion of Dr Morgans. In my view, Dr Morgans implicitly assumed that there was a continuity of what she regarded as psychotic symptoms or delusional thinking up to and including 18 April 2023. The clinical records did not support this assumption. There was a gap between the records and notes from 2019 to 2022, when delusional thinking was noted, and no further such note prior to 18 April 2023. Delusional thinking was specifically excluded on 22 May 2023.
I have found that the events described by the applicant from January 2023 to 18 April 2023 were real events. Dr Morgans did not deal with this possibility in her reasoning. In my view Dr Morgans did not explain how and why such delusional thinking continued from January 2023 to 18 April 2023, having regard to the abovementioned clinical records, that is an absence of records of delusional thinking in that period. Dr Yenson raised the issue of a past and confined psychotic episode.
As noted above, the report of Dr Lee was completed in 2019, that is before the alleged events relied upon by the applicant in this matter. In his report, Dr Anwar was unable to provide a diagnosis. Both doctors discussed the possibility of psychotic illness. In my view, neither report assists.
Dr Rastogi in her report dated 8 May 2024 provided a substantial review of documentation, including reports of Dr Jeyasingham, Dr George and Mr Buttel referred to above. She noted consideration of long-standing psychotic condition and delusional thinking. She diagnosed exacerbation of complex post-traumatic stress disorder with panic attacks and disagreed that there was a pre-existing psychotic illness.
The respondent submitted that Dr Rastogi did not say why she disagreed with Dr Jeyasingham. The respondent submitted that in respect of Dr Rastogi’s diagnosis of exacerbation of post-traumatic stress disorder, there was no evidence of the applicant being diagnosed with post-traumatic stress disorder in 2007. I do not accept this submission. As noted elsewhere in this decision, Dr Balakrishnan in a referral letter to Prof Chapuis dated
23 April 2007 there was noted a diagnosis of post-traumatic stress disorder on 23 April 2007. Dr Rastogi did in my view explain her disagreement based upon her examination assessment and her reasoning in respect of the opinion of Dr Morgans, to the effect that such an untreated long standing disorder would manifest in significant ways, which were not evident in the case of the applicant.
Additionally, Dr Jeyasingham did not say that the totality of the applicant’s condition was a longstanding untreated psychotic condition. He did not say that all of the applicant’s symptoms were accounted for by that psychotic condition. He did not say that the applicant’s account of her panic attacks was explained by that psychotic condition.
His first report noted the applicant’s initial presentation on a background of a post-traumatic stress disorder diagnosis in 2007, and treatment by Dr George for anxiety and depression, a strange interaction with a group, and her first ever panic attack after the workplace meeting in January 2023 with progressive bullying at work from March 2021, the second panic attack on 18 April 2023 after an argument with her supervisor, and unable to return to work since.
Dr Jeyasingham did not return to the history of workplace difficulties or anxiety in any of his subsequent treating reports, other than a reference to an unknown “IME report” with respect to it not referring to his work in “clarification of diagnosis towards a psychotic disorder”. In my view, this does not amount to a conclusive diagnosis of a psychotic disorder. The initial somewhat firmer view of Dr Jeyasingham was in my view superseded by this later view.
In contrast, in his reports Dr Yenson recorded a brief conversation in which Dr Jeyasingham told him that he was firmly of the view that the applicant had a psychotic illness, namely schizophrenia. With respect to both doctors, in the absence of reasoning in support I am unable to place weight on this report of a short conversation.
It was also submitted that Dr Rastogi in her report of 13 January 2025 was incorrect when she stated that was no past documented history of abnormal behaviours, hallucinations, or thought disorder and there was good premorbid function.
This should be considered in context with reference to the whole of her reports. In the response to the next question in the same report, Dr Rastogi noted some delusional behaviours mentioned by Dr George in 2018, but observed they did not affect her functioning. Dr Rastogi also noted the report of Mr Buttel psychologist of anxiety symptoms complicated by delusional thinking, not meeting criteria for psychotic disorder.
She observed that the applicant “may have had some delusional thoughts and paranoia stemming from anxiety and past history of PTSD but they were encapsulated and did not assist her functioning”. Dr Rastogi acknowledged that the applicant had previous psychological vulnerabilities with a previous history of post-traumatic stress disorder and repeated exposure to trauma as well as a history of anxiety needing psychological treatment.
I do not accept the respondent’s submissions in this regard. In my opinion, her statement in relation to there being no past documented history was explained in the subsequent paragraphs of her report. Dr Rastogi also noted that
“…in the presence of trauma and PTSD, symptoms of caution, anticipatory anxiety, avoidance and fear based responses with issues of trust can be misinterpreted as paranoid ideation and deemed as having psychosis/delusions. It is not uncommon to have transient paranoid ideation or delusional thoughts in the presence of PTSD termed as having quasi psychotic phenomenon but her symptoms did not qualify for psychotic disorder or delusional disorder.
A history of long standing pre-existing psychotic disorder, untreated would manifest with significant impairments longitudinally in social, personal and vocational domain and this was not evident in the case of Ms Burger as she functioned well prior to current work incident making reasonable recovery from her previous psychological conditions.”
In my opinion, this is a pursuasive explanation of the history of the applicant’s symptoms and complaints, and of her medical history.
It was submitted by the respondent that the history recorded by Dr Rastogi in relation to the first prescription of the anxiety medication Serepax in 2007 was incorrect as the records indicated the prescription commenced in about 2002. This to my mind makes no difference to a consideration of the pre-existing anxiety condition and I do not accept the submission as it relates to an inaccurate and unreliable history. Further, the evidence indicated a change in medication following 18 April 2023, which in my view lends support to an acceptance of the opinion of Dr Rastogi.
The respondent also submitted that Dr Rastogi’s opinion in relation to disease of gradual onset was unclear and inconclusive. On the one hand it was stated that she did not agree that the current psychiatric condition was caused by a disease of gradual onset, while on the other it was stated that the experience and perceived trauma at work played a substantial part in the decline and exacerbation of symptoms. It seems to me that this opinion, when read as a whole, is that the applicant’s current condition is the result of the exacerbation of a pre-existing condition. This in my view is consistent with her opinion that the applicant has sustained exacerbation of complex post-traumatic stress disorder with panic attacks.
The respondent also took issue with Dr Rastogi’s statement that the applicant had pre-existing anxiety and had worked since 2017 but she had no work-related issues or any interpersonal challenges until the incidents in 2023. Dr Rastogi had responded to a question put to her requesting her comment on the applicant’s presentation and whether any pre-existing issues had manifested during her employment with the employer.
In my view, this response, although based on an inaccurate history, was limited to the terms of the question set, that is the applicant’s presentation and the manifestation of any pre-existing issue. In any event, even if this inaccuracy is said to apply more broadly, it is not required that there be exact correspondence between the assumed facts upon which the opinion of Dr Rastogi is based and the facts proved[3]. In my opinion, the facts and matters considered by Dr Rastogi were sufficiently similar to the matters established above so as to render the opinion of Dr Rastogi value in determining this matter[4].
[3] Hancock v East Coast Timber Products Pty Ltd [2011] NSWCA 11
[4] Paric

I prefer the opinion of Dr Rastogi. In my view, Dr Rastogi has provided the most persuasive explanation of the applicant’s condition. Dr Rastogi is in my view supported in her opinion as to an exacerbation of a PTSD condition by the letter of Dr Balakrishnan referred to above.
I find that the applicant was diagnosed with a post-traumatic stress disorder condition in 2007, on a background of prior anxiety for which medication had been prescribed since about 2003. The applicant continued working with some time off from time to time. By January 2023 conflict with Ms Han and Ms Isaac had developed and meetings with Ms Isaac and others commenced in January 2023 and continued in February, culminating in the meeting of 18 April 2023. The applicant became upset or distressed in these meetings and perceived Ms Isaac as bullying her. Following the meeting of 18 April 2023 the applicant sustained chest pains and palpitations and ceased work.
The applicant was diagnosed by Dr Rastogi as having sustained exacerbation of complex post-traumatic stress disorder with panic attacks. In my view, the panic attack that the applicant sustained on 18 April 2023 was a marked increase in her psychological symptoms. Consistent with the opinion of Dr Rastogi this was an exacerbation of a pre-existing disease condition, that is complex post-traumatic stress disorder. I accept the opinion of Dr Rastogi that the applicant’s employment with the respondent was the main contributing factor to the disease injury.
There was no medical dispute that the applicant had no capacity for work at all material times. I find that the applicant had, and continues to have, no capacity for work at all material times in relation to this claim, as a result of the injury claimed.

[DT1]CHECK. Unfinished point

Gertrude Burger v Cerebral Palsy Alliance - Accommodation Northern Sydney

[2025] NSWPIC 214

16 May 2025