Hasoon v Insurance Australia Limited t/as NRMA Insurance

DETERMINATION OF REVIEW PANEL
CITATION:	Hasoon v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 684
CLAIMANT:	Wameidh Hasoon
INSURER:	Insurance Australia Limited trading as NRMA Insurance
REVIEW PANEL
SENIOR MEMBER:	Susan McTegg
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Christopher Canaris
DATE OF DECISION:	8 September 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; assessment of whole person impairment (WPI); the claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) assessed 3% whole person impairment (WPI) as a result of an exacerbation of a major depressive disorder caused by accident after deducting 19% WPI for a pre-existing condition; claimant sought review; Held – certificate of MA revoked; claimant had sustained somatic symptom disorder with predominant and persistent pain, major depressive disorder, and opioid use caused by the accident; pre-existing condition of adjustment disorder with anxiety and post-traumatic stress disorder in full remission; current WPI 22% but after deduction pre-existing WPI 15%; impairment caused by accident 7% WPI.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION ASSESSMENT OF PERMANENT IMPAIRMENT Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Sidorov dated 9 May 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a whole person impairment of 7%: · somatic symptom disorder with predominant and persistent pain; · major depressive disorder, and · opioid use disorder.

REASONS FOR DECISION

INTRODUCTION

On 23 July 2022 Mr Wameidh Hasoon (the claimant) was driving his motor vehicle. Whilst it was stopped at a red light the insured vehicle collided with the rear of his motor vehicle (the accident).
Mr Hasoon was 43 years of age at the date of accident and is now 46 years of age.
Mr Hasoon has brought a claim for common law damages under the Motor Accident InjuriesAct 2017 (the MAI Act).
Insurance Australia Limited trading as NRMA Insurance (the insurer) is the relevant insurer with liability to pay any damages to Mr Hasoon under the MAI Act.
Section 4.11 of the MAI Act provides that there is no entitlement to damages for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%.
This dispute is in relation to whether the degree of permanent impairment sustained by
Mr Hasoon as a result of the injury caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1]
[1] Section 7.20 of the MAI Act.
Mr Hasoon filed an application in the Personal Injury Commission (Commission) in respect of the permanent impairment dispute.
The dispute as to permanent impairment in respect of the claimant’s psychological injury was referred to Medical Assessor Sidorov. He issued a certificate dated 9 May 2024.

DOCUMENTS CONSIDERED BY THE REVIEW PANEL

The Review Panel issued a Direction to the parties on 5 May 2025 (the Direction) requiring each party to file an indexed, paginated bundle of documents comprising the evidence relied upon in the review.
On or about 3 June 2025 the solicitor for the claimant uploaded to the portal a bundle of documents paginated from page 1 to 285 (claimant’s documents).
On or about 11 June 2025 the solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 104 (insurer’s documents).

RELEVANT LEGAL AUTHORITY
Permanent impairment

Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines were issued pursuant to Division 10.2 of the MAI Act. Clause 6.213 of the Guidelines requires the impairment to be attributable to a psychiatric diagnosis recognised by the current edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5) or the current edition of the International Statistical Classification of Diseases & Related Health Problems (ICD). The assessment of mental and behavioural disorders must be undertaken in accordance with the psychiatric impairment rating scale (PIRS) as set out in the Guidelines.
Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:
“6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1.The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2.The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.
6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”

CERTIFICATE OF MEDICAL ASSESSOR SIDOROV

Medical Assessor Sidorov provided a certificate dated 9 May 2024. He certified the accident caused exacerbation of a major depressive disorder which gave rise to a 3% whole person impairment (WPI).[2]
[2] Insurer’s documents p 13.
Medical Assessor Sidorov reported Mr Hasoon left Iraq in 2005 due to the war. He had been shot in the lower right part of his abdomen and had undergone surgery in Iraq. He also reported shrapnel had to be removed from his shoulder after a rocket fell near him. After leaving Iraq he stayed in Syria for 14 years before arriving in Australia in 2019. In Australia he sustained an injury in the gym where he dropped weights on his knees. He reported he had been very fit and involved with bodybuilding and training.
Medical Assessor Sidorov reported Mr Hasoon appeared to generally minimise his psychiatric history prior to the accident. He attributed all his depressive symptoms to the accident despite the fact he was seeing Dr Rastogi prior to the accident. Dr Rastogi in a letter dated 8 July 2022 diagnosed an adjustment disorder with anxiety associated with a physical injury.
Medical Assessor Sidorov concluded Mr Hasoon initially developed a major depressive disorder following his injury at the gym and related to traumatic events he experienced in Iraq and Syria and to the difficulty adjusting to life in Australia. He considered as a result of the accident there was an exacerbation of the major depressive disorder.
Medical Assessor Sidorov diagnosed an exacerbation of major depressive disorder and assessed the claimant with 3% WPI. His current level of impairment was rated at 22% with a rating of Class 2 for travel, Class 3 for social and recreational activities, social functioning, concentration, persistence, and pace, and Class 4 for adaptation. However, he noted a pre-existing major depressive disorder rated at 19% WPI with a rating of Class 2 for self-care and personal hygiene and travel, Class 3 for social and recreational activities, social functioning, and concentration, persistence, and pace, and Class 4 for adaptation. There was no adjustment for treatment effects for either pre-or post-accident impairment.

REVIEW PROCEDURE

The claimant has sought a review of the medical assessment of Medical Assessor Sidorov.
The application was lodged on 7 June 2024 within 28 days of the date on which the certificate of Medical Assessor Sidorov was made available to the parties.[3]
[3] Section 7.26(1)(b) of the MAI Act.
On 22 July 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Review Panel (the Panel).
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[4]
[4] Rule 128 of the PIC Rules.
The review is by way of a new assessment of all matters with which the medical assessment is concerned.
On 9 July 2025 the Panel agreed an examination was necessary.

EVIDENCE BEFORE THE PANEL

Other medical assessment certificates

Certificate of Medical Assessor Gerald Chew[5]

[5] Claimant’s documents p 5.

In a certificate dated 3 October 2023 Medical Assessor Chew diagnosed a persistent depressive disorder which was not a threshold injury for the purposes of the MAI Act.
Medical Assessor Chew reported the claimant migrated to Australia from Iraq on 1 February 2019 because of persecution. Not long after his arrival in Australia the claimant was noted to have post-traumatic stress disorder symptoms related to being shot at in Iraq. He was treated by STARTTS and the flashbacks and nightmares reportedly resolved.
Medical Assessor Chew reported in 2019 the claimant injured his knee in a gym and developed an adjustment disorder. He was treated by Dr Rastogi with medication. His symptoms were improving at the time of the accident.
Medical Assessor Chew reported following the accident he developed a worsening of depressive symptoms with poor sleep, anxiety and poor concentration. He started drinking alcohol every night.
On examination he reported the claimant was irritable and tearful. He engaged freely. He was reactive but his affect was restricted to dysphoric. His mood was depressed. There was no evidence of psychosis, cognition was grossly intact, and he was oriented to time, place and person. He found no formal thought disorder.

Certificate of Medical Assessor Kenna

Medical Assessor Kenna issued a certificate dated 15 November 2023 in which he certified the following injuries caused by the accident were threshold injuries for the purposes of the MAI Act:
·        cervical spine – soft tissue injury;
·        thoracic spine – soft tissue injury;
·        lumbar spine – soft tissue injury;
·        left shoulder – soft tissue injury, and
·        right shoulder – soft tissue injury.[6]
[6] Insurer’s documents p 90.
Medical Assessor Kenna reported Mr Hasoon presented with a massive physical presentation noting he had obviously been into body building over his lifetime. He reported during most of the assessment Mr Hasoon was fairly non-cooperative and just stood and leant against the couch.
Medical Assessor Kenna was unable to establish any definable pathology and considered that any initial soft tissue injury had since resolved. In his view the overall current condition was not consistent with the alleged injuries and disabilities. He considered the claimant’s prognosis to be poor noting he presented with a high level of functional disability.

Certificate of Medical Assessor John Garvey

Medical Assessor Garvey issued a certificate dated 6 May 2024 in which he certified as follows:
· endoscopic gastric balloon insertion does not relate to the injury caused by the accident and is not reasonable and necessary in the circumstances, and
· ozempic injections relate to the injury caused by the accident and are reasonable and necessary in the circumstances.[7]
[7] Insurer’s documents p 56.
Medical Assessor Garvey reported Mr Hasoon worked overseas in Iraq and Syra as a personal trainer. He had a master’s degree in physical education from the University of Baghdad. He reported Mr Hasoon ran a gym for 14 years in Syria. He came to Australia in 2019 but has not worked after sustaining injury to his legs six months after his arrival.
Medical Assessor Garvey reported Mr Hasoon received assistance from his sister, a nurse and from a niece and nephew with housework, cooking and washing. He also reported he has a paid carer who comes daily. He required help with bathing and self-hygiene, would walk for five minutes and drive a car for 10-15 minutes.
Medical Assessor Garvey reported the claimant was in obvious discomfort and could not sit down. He stood during the history taking and held onto the examination couch. He reported the claimant had severe unbearable back pain and had experienced a weight gain of 50kg.
Medical Assessor Garvey noted Ms Hasoon also suffered from chronic obstructive pulmonary disease, right deep venous thrombosis, obesity, major depression, recurrent cellulitis both legs, gout, lipid disorder and hypertension.
Medical Assessor Garvey reported the current symptoms following the accident were severe unbearable back pain and weight gain of 50kg.
This certificate was subject to review by a Review Panel.

Certificate of Review Panel re certificate of Medical Assessor Garvey

A Review Panel comprising Medical Assessor Margaret Gibson, Medical Assessor David Gorman and Member Susan McTegg issued a certificate dated 10 December 2024.[8]
[8] Insurer’s documents p 69.
The Review Panel revoked the certificate of Medical Assessor Garvey and determined that endoscopic gastric balloon insertion and Ozempic injections relate to the injury caused by the accident but were not reasonable and necessary in the circumstances and will not improve the recovery of the claimant.

Certificate of Medical Assessor Gothelf

Medical Assessor Gothelf issued a certificate dated 2 June 2024.[9]
[9] Insurer’s documents p 45.
Dr Gothelf assessed a 5% WPI of the cervical spine, 0% WPI for the thoracic spine and 5% WPI for the lumbar spine. He assessed 8% WPI for the right upper extremity and 10% WPI for the left upper extremity resulting in a total WPI of 25%.

Certificate of Review Panel re certificate of Medical Assessor Gothelf

A Review Panel comprising Medical Assessor Margaret Gibson, Medical Assessor David Gorman and Member Susan McTegg issued a certificate dated 6 December 2024.[10]
[10] Insurer’s documents p 21.
The Review Panel revoked the certificate of Medical Assessor Gothelf dated 2 June 2024 and issued a new certificate determining that the following injuries were caused by the motor accident and gave rise to a WPI that is not greater than 10% and which is 5%:
·        cervical spine – soft tissue injury;
·        thoracic spine – soft tissue injury;
·        lumbar spine – soft tissue injury;
·        left shoulder – soft tissue injury secondary to cervical spine injury, and
·        right shoulder – soft tissue injury secondary to cervical spine injury.

Pre-accident treating medical evidence

Clinical notes of Bankstown/Lidcombe Hospital record the claimant’s attendance on
[11] Claimant’s documents p 238.
20 November 2019 after a barbell fell onto his lower legs in the gym at Fairfield Leisure Centre.[11] He was diagnosed with soft tissue injuries.
On 4 July 2022 Dr Hasam referred the claimant to Dr Richa Rastogi, psychiatrist noting the claimant had presented with “anxiety, depression, chronic pain, lost interest, lost motivation, insomnia, poor concentration”.[12]
[12] Claimant’s documents p 24.
On 8 July 2022 Dr Rastogi reported:
“He stated he was a body builder by profession. On arrival to Australia he was in shock with cultural changes. He was attending the gym on daily basis and sustained ACL tear that hindered him to continue exercising. He feels disrobed and displaced with loss of identity and has no outlet for his anxiety. He reports the ongoing pain is causing poor sleep, poor memory and cognition, anhedonia, tiredness, fatigue and helplessness. He feels loss of control and very irritable and is very sedentary. He has thoughts going over and over and overthinking. He stated he is fearful of going outside and his safety. He has poor sleep and is socially reclusive. He feels nihilistic and hopeless with his future. He is disappointed and reports having suicidal thoughts questioning his existence.”[13]
[13] Claimant’s documents p 26.
Dr Rastogi reported the claimant was shot in Iraq, his car was blown up during the political dispute and after he moved to Syria he was accidentally hit by a rocket. She diagnosed an adjustment disorder with anxiety associated with the physical injury.

Application for personal injury benefits

In the Application for personal injury benefits dated 28 July 2022 relating to the accident the claimant described his injuries as “back pain, neck pain, shoulder pain, leg pain/swelling, bruising, back/shoulders”.[14]
[14] Claimant’s documents p 17.

Post-accident treating medical evidence

The NSW Ambulance Service attended the scene of the accident on 23 July 2022. The report states:
“… pt standing w/bystander, alert and oriented. … At approx. 2000 this pm, pt was involved in a 2 car MVA, pt was driver of stationary vehicle and was rear-ended by another car … Headstrike on steering wheel and car seat. … Seatbelt worn and airbags not deployed. …Nil obvious injuries. Pt c/o generalised pain – pain to C-spine, back, sternum and all limbs. …”[15]
[15] Claimant’s documents p 84.
In a Certificate of capacity/certificate of fitness dated 1 August 2022 Dr Sabri Hasam of Fairfield Chase Medical and Dental Centre reported the accident on 23 July 2022 caused “right and left leg pain and oedema, bilateral and (cervical and lumbar), generalised body pain, bilateral arms, anterior chest wall, midline vertebral”. He noted pre-existing back pain and bilateral knee pain (meniscal tear).
On 9 September 2022 Dr Sanki reported Mr Hasoon’s condition was worse.[16] He reported he wept throughout the consultation due to severe pain; he appeared depressed, had lost weight and was worried about the musculature in his upper and lower limbs.
[16] Claimant’s documents p 55.
In a Certificate of capacity/certificate of fitness dated 14 September 2022 Dr Hasam recorded:
“MVA, right and left leg pain and oedema, neck and back pain, anterior chest wall pain, bilateral shoulder pain.”
Dr Rastogi reviewed Mr Hasoon on 28 October 2022. Surprisingly there was no mention of the accident in her report which was nearly identical to her earlier report.[17] However, her clinical notes of that date record:
“He was involved in a car accident on 22/7/2022 and has developed neck pain and is in hard neck collar. He has back and leg pain. He stated that he was [sic] his condition has wrosend [sic]. …his mental [sic] condition has worsened since then due to pain and deconditioning, he feels more depressed and crying … his state of mind is poro [sic] and he is hopeless and worthless, he is pesismistci [sic] about future and thoughts…”[18]
[17] Claimant’s documents p 30.
[18] Claimant’s documents p 276.
In a Certificate of capacity/certificate of fitness dated 14 November 2022 Dr Magdy Girgis of Royale Medical Centre provided the following diagnosis:
“severe neck, back, shoulders associated with tingling sensation hands after MVA on 23.08.2022. MRI (Multi-level C + L spines disc bulge – grade 1 spondylolisthesis L4 on L5).”[19]
[19] Claimant’s documents p 49.
Mr Hasoon commenced physiotherapy treatment with Rehab Solutions following an assessment on 5 October 2022.[20] He reported pain in the neck and lower back and chest and arms. Physiotherapist Mr Lau diagnosed severe whiplash, cervical and lumbar discogenic pain with referred pain/symptoms into the limbs. It was reported the claimant frequently moved position because it was painful for him stay in a stationary position. He was unable to perform a single leg stance. He had to use both hands on his knees or arm rest to push himself up.
[20] Claimant’s documents p 52.

On 13 January 2023 Dr Rastogi confirmed the diagnosis of adjustment disorder with anxiety associated with physical injury. She also noted chronic pain.[21]
[21] Claimant’s documents p 32.
On 27 March 2023 Dr Sanki reported severe pain in all his body, affecting his spine, upper limbs and lower limbs.[22] He put the claimant on an Endone trial and recommended he continue to consult his psychiatrist Dr Rastogi.
[22] Claimant’s documents p 56.
On 20 April 2023 Dr Sanki reported Mr Hasoon was suffering from severe pain in the palms, the thumbs and metacarpophalangeal joints. He could not walk long distances due to pain in the heels.
On 29 May 2023 Dr Sanki administered an injection of Tramadol 100mg for severe back pain.
Dr Andrew Kanawati, orthopaedic surgeon saw the claimant on 17 July 2023. He reported the MRI scan revealed multilevel spinal stenosis. He reported congenitally narrow pedicles predisposing him to severe spinal stenosis occurring at multiple levels L3/4, L4/5 where there was also a subtle spondylolisthesis and mild spinal stenosis at L5/S1. He reported severe neuropathic discomfort in both legs and lower back pain. He recommended surgery subject to weight loss.
On 4 August 2023 Dr Antoine Sanki reported Mr Hasoon continued to experience moderate pain. Noting his request for gastric stapling to help him lose weight had been refused he recommended Ozempic injections for weight loss.
The clinical notes of Dr Magdy Girgis consistently report both physical and psychological symptoms between 14 November 2022 and 16 April 2025. On 19 December 2022 Dr Girgis recorded:
“MVA 23.7.2022
c/o pain /depressed
History noted
Anxious
depressed mood –
limited physical activities after the accident
missing his life before the accident
been drinking 1/2 bottle of schotch of sat+sunday as he is getting depressed
-lack of interest
Lack of motivation Insomnia --mood fluctuations
Frustrated –
For counselling.”[23]
[23] Claimant’s documents p 170.
On 11 January 2024 Dr Magdy Girgis reported the claimant’s depressed mood, limited physical activities; noted he had stopped drinking alcohol, he had a lack of interest, lack of motivation, insomnia, mood fluctuations and was frustrated. [24] Counselling was recommended.
[24] Claimant’s documents p 144.
On 7 June 2024 Dr Girgis reported the claimant was in pain all the time, unable to work, unable to enjoy life, anxious, depressed mood, lack of appetite, poor energy level, avoiding going out and socialising, feeling worthless, lacking motivation, insomnia, poor concentration and mood fluctuations.[25]
[25] Claimant’s documents p 108.
On 13 January 2025 Dr Girgis reported near identical complaints and diagnosed depression.[26]

Medico-legal evidence

[26] Claimant’s documents p 108.

Dr Nagesh, psychiatrist

The claimant relies on the opinion of Dr Nagesh who assessed the claimant and provided a report dated 13 February 2023.[27]
[27] Claimant’s documents p 60.
Dr Nagesh obtained a history of depression and anxiety in the context of the pre-accident gym injury. Following the accident, he alleged his symptoms had been exacerbated. His ongoing symptoms included depressed mood, anxiety, insomnia, fluctuating appetite, lack of energy and motivation, social withdrawal, diminished ability to concentrate and feelings of worthlessness. Mr Hasoon reported he spent the majority of the time at home and had become completely socially withdrawn.

Dr Nagesh recorded the following history of the claimant’s pre-accident injury:
“On review Mr Hassoon [sic] alleges having become depressed and anxious in the context of his chronic pain, his inability to be active because of the knee injury, having to rely on others, and the accident itself.”
Following the gym accident Dr Nagesh reported Mr Hasoon was referred to a psychiatrist where he was prescribed antidepressant medication Paroxetine.
Dr Nagesh diagnosed a major depressive disorder of moderate degree with anxious distress. He concluded the injury arose out of the incident at the leisure centre which was further exacerbated by the accident on 23 July 2022.
Dr Nagesh assessed self-care and personal hygiene as Class 3 moderate impairment on the basis the claimant cannot cook, clean, and shop and relies upon his sister.[28] He reported the claimant relied on take-away meals and at times requires prompting to have a shower.
[28] Claimant’s documents p 64.
Dr Nagesh assessed social and recreational activities as class 3 moderate impairment on the basis the claimant was socially withdrawn, had lost contact with his friends and did not attend any group recreational activity.
Dr Nagesh assessed travel as class 2 mild impairment on the basis since the accident the claimant was anxious to drive and whilst he could drive local distances, he required a support person to travel far away to unfamiliar places.
Dr Nagesh assessed social relationships as class 2 mild impairment on the basis the claimant has no capacity to form a new relationship having regard to his ongoing depressive and anxiety symptoms.
Dr Nagesh assessed concentration, persistence and pace as class 3 moderate impairment on the basis the claimant’s attention and concentration remains poor. He reported he could not read a book, read newspapers articles, or browse the internet. He had no capacity to undertake a retraining course.
Dr Nagesh assessed adaptability as class 5 totally impaired on the basis the claimant could not work at all.
Dr Nagesh assessed a current WPI of 22%. He assessed the pre-existing condition at 8% WPI. He assessed class 2 for self-care and personal hygiene, class 2 for social and recreational activities, class 1 for travel, class 2 for social relationships, class 3 for concentration, persistence and pace and class 5 for adaptability. After subtracting 8% for the pre-existing condition, he arrived at a WPI of 14%.

Dr T Mastroianni, occupational physician

Dr Mastroianni assessed the claimant and provided two reports dated 14 September 2023.[29] He reported Mr Hasoon was a difficult historian and had psychological issues. He complained of constant neck pain, back pain, shoulder pain, knee pain and ankle pain. He reported pain in both legs, pins and needles and pain in the wrists and pins and needles in the feet. He reported difficulties walking.
[29] Claimant’s documents p 67.
On examination Dr Mastroianni reported Mr Hasoon had a muscular physique consistent with one who did body building. He reported Ms Hasoon stood leaning on the couch as he was uncomfortable sitting. Mr Hasoon walked with a wide based gait, stooped posture and shortened stance. Mr Hasoon said he used a walking stick but did not have it with him.
On examination Dr Mastroianni reported the claimant’s spinal movements were very restricted and he noted on casual observation that as he moved onto the couch Mr Hasoon’s spinal movements were still very restricted and there was dysmetria.
Dr Mastroianni concluded Mr Hasoon sustained injuries to the neck, back and shoulders and exacerbated pre-existing injuries of the knees and ankles. Dr Mastroianni noted he could not see any evidence which demonstrated Mr Hasoon had aggravated the pathology to his knees and ankles arising out of the 2019 gym accident.
Dr Mastroianni said in his opinion the claimant was not a surgical candidate for injuries to the cervical or lumbar spine. Dr Mastroianni noting tenderness and dysmetria found the claimant met the diagnosis-related estimate (DRE) cervical category II and assessed 5% WPI. Similarly, he assessed 5% WPI for the lumbar spine, noting tenderness and dysmetria. He found a 10% WPI of the right shoulder and 8% WPI of the left shoulder.

SUBMISSIONS
Claimant’s submissions

The claimant provided submissions dated 7 June 2024.[30]
[30] Claimant’s documents p 1.
The claimant relies on the opinion of Dr Nagesh who assessed the claimant and provided a report dated 13 February 2023.
The claimant submits Medical Assessor Sidorov did not provide adequate reasons for coming to a different finding to Dr Nagesh. The claimant refers to the observations of Patten AJ in Rahme v Bevan & Anor:
"While I accept the insurer's submission that the Review Panel was not obliged to provide reasons for excluding all possible diagnosis which it identified, I do think it was, at least, bound to give brief reasons for excluding the diagnosis actually made by
[31] Rahme v Bevan & Anor [2009] NSWSC 528 at 33.
Dr McClure, beyond referral Mr Rahme's presentation to two members of the panel. It needed to do no more than list the diagnostic criteria for post-traumatic stress disorder and explained why Mr Rahme's symptoms did not meet those criteria."[31]
The claimant also referred to the observations of Hamill J in Sadsad v NRMA Insurance Ltd & Ors[32] as follows:
“47 It is one thing to give a ‘beneficial construction’ to the reasons of an administrative decision-maker. It is another to fill in the gaps in the path of reasoning by reference to an assumption that the decision was made according to the relevant law… [48]
48.Further, while to ‘fulfil a minimum legal standard, the reasons need not be extensive,’ ‘where more than one conclusion is open, it will be necessary for the [decision-maker] to give some explanation of its preference for one conclusion over another’.”
[32] Sadsad v NRMA Insurance Ltd & Ors (2014) 67 MVR 601 at 47.
The claimant submits where there was medical controversy about the level of WPI it was incumbent on the assessor to provide reasons with respect to the opinion of Dr Nagesh.

Insurer’s submissions

The insurer provided submissions dated 11 June 2025.[33]
[33] Insurer’s bundle p 2.
The insurer relies upon the Certificate and Reasons of the Review Panel undertaking a review of the certificate of Medical Assessor Garvey where the Panel stated:
“The Panel believes that the explanation for his unusual presentation is “somatisation” of his psychological distress in association with the deconditioning and “fear avoidance” behaviours associated with his chronic pain. There is not a physical explanation for his gross limitations in spinal movement and shoulder movement.”
The insurer also relies upon the Certificate and Reasons of the Review Panel undertaking a review of the certificate of Medical Assessor Gothelf where the Panel stated:
“However, there were significant pain behaviours evident throughout the assessment which the panel was unable to explain on the basis of an organic medical injury/condition.”
The insurer submits care must be exercised with respect to the claimant’s subjective report of pre-accident and post-accident function and argues inconsistencies between the claimant’s subjective reporting and medical reports should be brought to his attention.
The insurer notes Medical Assessor Sidorov commented:
“Mr Hasoon appeared to generally minimise his psychiatric history prior to the subject accident. He generally appeared to avoid questions around his mental health prior to the subject accident and appeared to attribute all his depressive symptoms to the subject accident, despite the fact that he was seeing Dr Rastogi prior to the subject accident, which I pointed out to him, however, he could not provide a satisfactory explanation to this.”
On 2 June 2024 Medical Assessor Gothelf recorded the claimant “stated he was not able to stand without support due to his pain. There were no walking aids present.”
The Review Panel undertaking a review of the certificate of Medical Assessor Gothelf reported:
“The Panel cannot find a physical explanation given the available imaging or on clinical assessment as to why Mr Hasson could not sit, as to why he needed to lean on his niece whenever he walked and why he had variable and limited shoulder movements.”
However, an Allied health recovery request dated 6 October 2022 indicates a walking capacity of 10 minutes.
The insurer notes the claimant alleged he had gained significant weight following the accident, however, the Review Panel undertaking a review of the certificate of Medical Assessor Garvey opined that at most the claimant had gained 15kg since the accident.
The insurer notes the following past history:
·        the claimant had been shot in Iraq;
·        the claimant was close to an explosion and his right shoulder was injured by shrapnel, and
·        the claimant was involved in a gym accident resulting in significant lower limb injuries. The reports indicate the claimant did not return to work or gym or other recreational activities prior to the accident. No particulars have been provided with respect to this injury or details of any litigation arising, noting the claimant appears to have brought proceedings against Technogym Australia.
The insurer submits the claimant meets the pain disorder F45.1 Somatic symptom disorder, or F45.8 other specified somatic symptom and related disorder, or F45.9 unspecified somatic symptom and related disorder.
The insurer submits the present level of functional incapacity is due to the alleged physical injuries, extensive pain throughout the whole body, fear avoidance behaviours and somatoform features as recorded by Medical Assessor Kenna, Medical Assessor Gothelf and the Review Panel undertaking a review of the certificate of Medical Assessor Gothelf.
The insurer refers to the report of Dr Rastogi dated 8 July 2022 where she highlights the extent of the claimant’s symptomatology about two weeks before the accident.

MEDICAL EXAMINATION

Medical Assessors Canaris and Baker assessed Mr Hasoon on two occasions. The first occasion was on 11 August 2025, and the second occasion was on 27 August 2025. The total time of the assessment was about two hours with the assistance of an Arabic interpreter organised through the Commission. The reason for the two sessions was because the claimant had difficulty talking about his significant prior experiences, which included being shot in Iraq and having rocket shrapnel damage his car, in Syria.
The Medical Assessors noted the claimant had attended STARRTS in Fairfield. This service is for people who are new arrivals in Australia and have left regions where they have been exposed to trauma.

Psychosocial history and pre-accident history

Mr Hasoon is a 46-year-old single man who was not working at the time of the accident. Before his accident, he said he was “like an athlete – body building” which stopped “after the accident.”
Mr Hasoon said he had sustained an injury before the accident when a barbell fell onto his legs. He was noted to have sustained a soft tissue injury. He attended Bankstown Public Hospital and was discharged for follow up with his local doctor. His local doctor referred him to Dr Rastogi for treatment of depressive symptoms and related anxiety. Dr Rastogi was the treating psychiatrist who had attended the claimant before and after the accident.
At the time of the re-examination the claimant confirmed he had maintained his attendance at the gym prior to the accident. He said he would attend the gym for about one hour each day to continue his body building regimen even though he had been in an earlier accident in 2019.
Mr Hasoon was asked about the injuries sustained in the 2019 gymnasium accident. He said, “the cable of the machine snapped and the handle ricocheted, and it hurt my [right] knee.” He had sustained “strong bruises” damaging his knee and he saw a specialist “but it went away.” He spontaneously said, “the gym was no good” and the machines were of inferior quality and safety far below the standard.
Mr Hasoon became agitated when further questions were asked about his attendance with Dr Rastogi. He said, “I am here to talk about the car accident, not this one.” It was difficult to obtain a pre-accident medical history from the claimant because of his agitation.
However, Medical Assessor Sidorov documented his general medical treatment as being on Entresto and Nebivolol (both medications used for treating high blood pressure), Atorvastatin (a lipid-lowering drug), Rivaroxaban (an anticoagulant), Furosemide and Spironolactone (diuretics used in the treatment of high blood pressure), Allopurinol (used for gout), Aspirin (used as a blood thinner), and Endep (amitriptyline – an antidepressant). We noted references in the documentation to his having had a problem with blood clots. He is on Ozempic “and my weight is not going down.”
Mr Hasoon was asked how he received an income. He said he was not employed. He said prior to his arrival in Australia he had worked in the gym as a “trainer / coach.” At the time of the accident, he had been on Centrelink which he had been receiving “since I came to this country.” He was unable to report whether he was receiving Job search or a disability support pension (DSP).
The claimant said his father is deceased, while his mother is in Baghdad, Iraq. He has only his sister in Australia. He is the third of six children. He attended government schools. He did not do national service after leaving school.
The claimant came to Australia in 2019 from Syria although he is an Iraqi national. He left Iraq in 2005, and he went to Jordan and then to Dubai. He returned to Iraq and then went back to Jordan before entering Syria. He said he worked as a body building trainer, and this was his sport and employment.

Mr Hasoon was asked how he had felt in himself before his accident. He said,
“I came here, and I had a lot of thoughts and ideas, and I thought this country would support sports, but I was very surprised by the conditions of gyms, but the worst thing was when a drunk driver hit me without any brakes – it made me feel like a disabled person.”
The claimant was shot while in Baghdad. Apparently, there was random shooting, and he got hit. He said it was a “robbery.” He was asked about his attendance with STARRTS at Fairfield on arrival in Australia. He initially said he could not recall how long he attended this service. He then said, he “may have attended for 5 or 6 months”. The Medical Assessors noted the claimant told Medical Assessor Sidorov that he had had a bullet in his abdomen for which he had undergone surgery.
At the second interview the Medical Assessors asked Mr Hasoon how the shooting affected him. He said, “This was in 2004, and I can’t recall much”. He said it had been an armed robbery.
The Medical Assessors prompted him as to how emotionally the gun shot and the car been hit by rocket shrapnel might have affected him. He said, “I was not in the car.” He said he did not know why any of these events happened to him. He was reminded of Dr Rastogi’s report (also documented by Medical Assessor Sidorov) that he had been “hit by a rocket in Syria”. The claimant then said, “nothing like that happened.” He became angry and asked why the re-examination was inquiring about what had happened in 2004 when he had been in an accident in 2020. The Medical Assessors explained that understanding how traumatic events may have emotionally injured him in the past was an important part of understanding how much the accident had injured him.
The claimant effectively declined to answer any further questions about his earlier experiences outside Australia before the accident saying, “There was no government – no safety – that was the situation in my country… all the Iraqi people lived this life - not just me”.
The Medical Assessors asked for a second time about his involvement with STARTTS. He said, “Maybe someone sent me.” The claimant was reminded that he said at the first examination that he had been involved with them for about five or six months. The claimant then became upset and angry stating, “Don’t put words in my mouth”. He denied he had said he had spent five or six months at STARRTS.
Mr Hasoon said he had been shocked when he came to Australia because he was a trainer and he used a machine which broke, and an ambulance took him to hospital. He then shifted back to the accident and said, “I was hit by a car, and I was paralysed, and I could not go to the toilet like other people.” He became agitated saying, “My life was destroyed by this drunk person.” He said, “I want to live my life – I want to go to the gym – I don’t look at the mirror – if I look at the mirror, I might commit suicide… I can’t go to the toilet – I live on painkillers – I didn’t have a shower for 25 days”.

Mr Hasoon was tearful as he imparted this history. He was asked how the accident at the gym affected him. He said, “I used to go to the gym – to walk to the gym – I was happy going to the gym.” He said,
“if this had happened in our country, they would have closed the gym.” He then changed back to talk about the accident and said, “I had traumas, and I had to relax and have rest… I was standing at the traffic lights, and my eyes were open, but it was dark – then I got back my vison which I lost – I looked, and I saw this car next to me, and this traffic light was still red… I saw smoke behind me….”
The Medical Assessors reminded the claimant that we had asked him about the accident at the gym. He said, “I was able to walk – come and go – this [car] accident made me paralysed….” We reminded him that he had seen a psychiatrist, Dr Rastogi before the accident. He admitted that he had attended this psychiatrist, and she prescribed medication for him. He again reverted to talking about the accident saying, “Because of the accident, I wasn’t able to move my neck – I couldn’t sleep….”
The claimant repeated “I used to go out to the gym and train daily. He would do it for an hour a day”. He continued, “I am a trainer – I used to train people… I am the gym.”
Mr Hasoon was asked what else he did with his day before the accident. He used to go to the sauna or for a swim after gym and then come home and follow the news. The Medical Assessors explained to the claimant that Medical Assessor Sidorov had documented that the claimant had worked about four or five weeks prior to the accident. The claimant could not provide any specific information about his capacity to work before the accident. The Medical Assessors noted the claimant remained unclear about the details of his daily activities before the accident other than the information provided above. It was noted, however, that he had informed the Medical Assessors that he had been on Centrelink ever since his arrival in Australia – however he was unable to describe what his reporting duties to the Australian Government were.
Mr Hasoon said he would prepare his own meals. He did not admit to any difficulties with travel, relationships, or concentration, persistence, and pace.
The Medical Assessors noted that the claimant’s report of his functioning before the accident was at odds with the available documentation. Importantly Dr Rastogi had treated the claimant for an adjustment disorder with anxiety associated with physical injury as documented in her 8 July 2022 report which was about two weeks (15 days) before the accident on 23 July 2022.

History of the motor accident

Mr Hasoon was asked to describe the accident. He said, “I was stopped behind another car at traffic lights and I heard a big bang and even though my eyes were open I could not see.” He said, “My heart was about to explode.” Airbags did not deploy. He tried to open his door “and I felt like something hit me and the door was going backwards and forwards” as he hung onto the door. Police and ambulance attended, and he was taken to Liverpool Hospital where he was kept overnight.
Mr Hasoon alleged that the other driver was intoxicated and that he could smell alcohol on him. He became upset when talking about the accident and said that the other driver had paralysed him and ruined his life.

History of symptoms and treatment following the motor accident

The claimant was discharged from hospital to the care of his local doctor. He went home after hospital. He saw his local doctor who referred him to both physical and psychiatric specialists. He said he had seen a specialist who told him his weight was too large, and he could not do surgery on him “and so I stayed without operation.” He was prescribed Endone “and they gave me an apparatus for breathing [a sleep apnoea machine]” and “they put a stent in my arm.”
The claimant was asked about his physical condition. He responded, “My whole-body aches – I can’t explain the pain – even the Endone – it helps a bit but it’s like someone is grabbing you.” He has pain in his back, his shoulders, and “my thighs – I feel like there is fire coming out of them – some days I can’t walk because of that.” The claimant said he also had been prescribed other pain related treatment “and they gave me this injection in my back – I had one last week.” He said he remained in pain and that he still takes “a lot” of Endone most days.
When asked how he felt in his emotions Mr Hasoon reported that the pain would “paralyse him on some days.”
The claimant was directly asked if he felt anxious or depressed. He replied, “I have it all” saying “I can’t do anything myself.” He said he relied on his sister and his niece and nephew to help. He said that his sister and niece attended his unit most days to cook, clean and wash his clothes.
Mr Hasoon was asked about his personal hygiene. He said that he had gone for 25 days without showering. When asked why he did not shower for so long the claimant said the water from the shower made his pain worse.
Mr Hasoon was asked how he spent his average day. He said he was in pain every day and he could not do anything that he enjoyed because of his pain. He said he spent most of his day in bed.
Mr Hasoon complained several times about his inability to go to the toilet saying he could not pass water or faeces (constipation). He would “sometimes pass urine in the sink.” He said that the Edone caused him constipation.

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

There were no further injuries.

Current symptoms

The Panel noted the following.

Pain

The Medical Assessors noted the claimant reported marked loss of daily functioning because of the severe pain he experienced. The Medical Assessors noted Dr Rastogi had recommended increasing the claimant’s Endep (amitriptyline) up to 100mg at night, “in view of pain” he was experiencing. The Medical Assessors agreed that the claimant’s pain experience and clinical presentation related to pain is consistent with DSM-5-TR F45.1 somatic symptom disorder with predominant and persistent pain.
The Panel noted the following:
·        chronic pain that was highly distressing and had resulted in significant disruption of his daily life;
·        excessive thoughts, feelings, or behaviours related to his pain manifest in disproportionate and persistent thoughts about the seriousness of his symptoms, persistently elevated levels of anxiety about his symptoms, and excessive time and energy devoted to his pain, and
·        persistent pain had been continuously present for over three years.
The Medical Assessors also noted the claimant reported the following symptoms consistent with DSM-5-TR F 11.20 criteria for opioid use disorder:
·        ingestion of up to 20 Endone 5mg tablets daily which would equate to 100 mg of oxycodone daily. This is clinically an excessive dosage of pain medication that is likely to cause physical symptoms of constipation as reported by the claimant as well as daytime drowsiness with episodes of daytime sleep;
·        the Medical Assessors noted that the claimant reported taking two tablets every hour whilst awake (i.e. 10 hours awake x 2 tablets = 20 tablets (one bottle) per day);
·        the claimant was seen during the re-examination taking medication towards the end of the first session. He was directly asked if he had taken Endone 5mg tablet. He replied had taken this medication and he was drowsy about 30 minutes after ingestion. This self-report resulted in the first session terminating at this time with a plan communicated to the claimant that the Medical Assessors would reconvene as quickly as possible and when he was not drowsy;
·        there was evidence of tolerance with a reportedly markedly diminished effect on pain levels despite high doses of Endone consistent with opioid use disorder;
·        the claimant did not report symptoms of opioid withdrawal. In the opinion of the Medical Assessors the use of opioid medication every two hours as reported by the claimant is behaviour consistent with an effort to avoid withdrawal symptoms by frequent use of the opioid;
·        the Medical Assessors agree that the large dose of Endone (opioid) has continued despite the claimant having knowledge of a persistent physical side-effect of constipation due to constant use, and
·        the Medical Assessors agree that the large dose of Endone (opioid) has continued despite the claimant being aware of depressed mood and suicidal thoughts which he experienced “if I should look in a mirror”.
The Medical Assessors noted the claimant reported symptoms consistent with DSM-5-TR F32.0 major depressive disorder.
These symptoms were consistent with Criterion A and satisfied seven out of the nine symptoms described under this criterion as follows:
·        depressed mood for most the day nearly every day since the onset of the psychological injury caused by the accident;
·        the presence of markedly diminished interest and pleasure in all or almost all activities most of the day nearly every day, as evidenced by his self-report of ceasing going to the gym;
·        hypersomnia nearly every day. These symptoms had never been absent for any significant period since the onset of the psychological injury;
·        psychomotor agitation was apparent over the course of the interview;
·        constant fatigue and loss of energy with reduced self-care and personal hygiene;
·        feelings of worthlessness having lost his identity as a trainer, and
·        he reported poor concentration.
The claimant’s depressive disorder symptoms cause clinically significant distress and impairment in psychosocial functioning as evident in his social withdrawal, loss of self-care, poor concentration, and inability to work consistent with Criterion B of the DSM-5-TR F 32.0 description of major depressive disorder.
The claimant’s symptoms were not attributable to the effects of a substance or to another medical condition in keeping with a Criterion C of the DSM-5-TR description of major depressive disorder, as the claimant had a clinically diagnosed adjustment disorder by
Dr Rastogi 15 days before the accident and the accident increased the number of symptoms experienced by the claimant before the onset of the two co-existing conditions described above.
There was no evidence of a schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorder in keeping with Criterion E of the DSM-5-TR description of major depressive disorder.
There had never been a manic or hypomanic presentation in keeping with Criterion D of the DSM-5-TR description of major depressive disorder.
The claimant reported some symptoms consistent with post-traumatic stress disorder during the assessment however the claimant’s opioid use disorder clinically indicated that criterion H for DSM-5-TR F43.10 post-traumatic stress disorder is not met and for this reason the claimant does not have post-traumatic stress disorder.
The Medical Assessors noted that the claimant had previously told other clinicians that his symptoms from earlier life experiences had resolved. From the inconsistent history provided by the claimant it cannot be clinically established whether the claimant had pre-existing psychological condition due to his life experiences outside of Australia, as reported by the claimant at the time of this re-examination.
The diagnosis of Dr Rastogi of adjustment disorder with anxiety associated with physical injury as documented in her 8 July 2022 report is convincing evidence for a pre-existing psychological condition before the accident which occurred 15 days later on 23 July 2022.

Current and proposed treatment

The claimant provided an inconsistent history of his medication usage during the re-examination. The Medical Assessors noted from the available documentation that he had been seeing a psychiatrist, Dr Rastogi, and that he had been on Duloxetine and Paroxetine for his psychological injury symptoms and Amitriptyline (Endep) as well as Endone for his pain.

Mental state examination

The Medical Assessors interviewed the claimant on two separate occasions 11 August 2025 and 27 August 2025. A good audiovisual connection was established on each occasion. The claimant was at his home and Medical Assessors Canaris and Baker were in their respective offices. At the first interview, Mohamad Nahas, an Arabic interpreter was present throughout. Olivia Obaid, a professional Arabic interpreter was present at the second interview.
On each occasion, Mr Hasoon presented as a man who looked older than his stated age with a long and bushy untidy grey streaked beard.
At the first interview he took two tablets which he said were Endone. He said he felt drowsy because of taking the two Endone tablets. At the second interview he said that he would take two tablets every hour and that he could take up to 20 a day using prescriptions from his doctor. He was asked whether he got these tablets from a pain clinic but replied that he could not say.
The claimant provided the account documented in this report.
The claimant was asked whether he was engaged with a disability employment service but could not say and the Medical Assessors were unable to clarify whether Centrelink required him to look for work.
Mr Hasoon was not forthcoming with information as to his background including his trauma exposure in Iraq, his involvements with STARTTS, and his injury at the gym. He demonstrated psychomotor agitation and anger when asked about these matters.
The claimant’s overall account was much dominated by his complaint that he was in severe pain with persistently elevated levels of anxiety about his symptoms and depressed mood. He was very teary at a number of points in both consultations. He was frustrated, agitated and angry in response to questions inquiring into more detail than he was able to offer. His mood was depressed and his affect was congruent with his reported mood.
Mr Hasoon spoke about depressive themes and suicide should he look at himself in a mirror. He did not report any suicidal plans. He reported his sister would attend his unit most days. His judgment appeared fair. He was insightful into his condition.
The claimant reported poor concentration. He was orientated in time place and person. He did not report psychotic symptoms or delusional ideas. He did not talk about craving the use of his opioids.

Assessment of current functioning

The Guidelines

In accordance with cl 6.214 impairment due to physical injury is assessed using different criteria outlined in other parts of the Guidelines.
In accordance with cl 6.215 the PIRS must not be used to measure impairment due to somatoform disorders or pain. In the current assessment this means that any loss of function due to somatic symptom disorder with predominant and persistent pain is excluded for the assessment of WPI.
In accordance with cl 6.223 the Medical Assessor may increase the percentage of WPI by:
(a)     0% WPI (no or negligible treatment effect);
(b)     1% WPI (a mild treatment effect);
(c)     2% WPI (a moderate treatment effect), and
(d)     3% WPI (a full remission).
However, in accordance with cl 6.224 this clause does not apply to the use of analgesics, anti-inflammatory or antidepressant drugs for analgesia or pain management.
This means when assessing whether there should be any adjustment for the effects of treatment the effects of Endone and Amitriptyline are excluded.

Self-care and personal hygiene

Assessment of pain and somatic symptoms

Mr Hasoon said, “Everything is difficult for me – I can’t stand for more than 10 minutes – like someone with disability – even sitting down - it’s the same – it’s the pain”. He said he reduced his showering due to pain caused by the shower water. He said his sister and niece would attend his home most days and cook food, clean the house, and do his laundry. He said he did not do these activities as he was in too much pain. He said, “I don’t move” because of “severe pain” which travelled down both his legs. He had severe pain when he stood.
These complaints are not assessed under the PIRS where they constitute pain and somatic symptoms which are excluded under cl 6.215 of the Guidelines.

Physical effects of Ozempic

Mr Hasoon said he is on Ozempic “and my weight is not going down.” He said he eats less, and his appetite was less because of his Ozempic. The reason for the use of Ozempic was to reduce weight and increase his opportunity for surgical treatment, not because of his psychological injury caused by the accident. Under cl 6.214 this is not assessable under the PIRS.