Idris v AAI Limited t/as AAMI
[2025] NSWPICMP 811
•22 October 2025
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Idris v AAI Limited t/as AAMI [2025] NSWPICMP 811 |
| CLAIMANT: | Mohammed Idris |
| INSURER: | AAI Ltd t/as AAMI |
| REVIEW PANEL | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Gerald Chew |
| MEDICAL ASSESSOR: | Alan Doris |
| DATE OF DECISION: | 22 October 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; motor accident; assessment of whole person impairment (WPI) for psychiatric impairment; partial amputation of finger; symptom validity testing not definitive; claimant appeared consistent in his complaints and admitted to a variety of activities; suggesting of malingering rejected; claimant’s assessed at 9% for impairment of psychological condition; no issues of principles; Held – original assessment revoked; claimant assessed at not greater than 10%. |
| DETERMINATIONS MADE: | Medical Assessment – Permanent Impairment WHETHER THE DEGREE OF PERMANENT IMPAIRMENT OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10% THE ASSESSMENT MADE BY THE REVIEW PANEL UNDER S 7.23(1) OF THE MOTOR ACCIDENT INJURIES ACT 2017 IS AS FOLLOWS: 1. The Panel revokes the certificate dated 31 July 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a whole person impairment which is NOT GREATER THAN 10%: · post-traumatic stress disorder, and · persistent depressive disorder with anxious distress. |
STATEMENT OF REASONS
BACKGROUND
Mr Mohammed Idris (the claimant) suffered injury in a motor accident on 28 August 2021. The claimant was riding a scooter when the insured vehicle reversed colliding with the scooter.[1]
[1] Claimant’s bundle, p 69.
AAI limited t/as AAMI (the insurer) insured the owner and/or driver of the motor vehicle for liability to pay to Mr Idris any damages and/or statutory benefits under the Motor Accident Injuries Act 2017 (the MAI Act).
The present dispute is whether the claimant’s “degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%”. This constitutes a medical dispute within the meaning of the MAI Act.[2]
[2] See Division 7.5 and Schedule 2 cl 2 of the MAI Act.
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be made in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines are issued pursuant to s 10.2 of the MAI Act. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fourth edition (AMA 4). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]
[3] Clause 6.2 of the Guidelines.
This is a review of a medical assessment pursuant to s 7.26 of the MAI Act. The medical assessment the subject of this review was conducted by Medical Assessor Canaris and dated 31 July 2024. The Medical Assessor concluded that the motor accident caused a
post-traumatic stress disorder and somatic symptom disorder with predominant pain and assessed the degree of permanent impairment at 7%.The details of the medical assessment certificate are set out later in these reasons.
THE REVIEW
The application for referral of the medical assessment to a Review Panel (the Panel) was made by the claimant within 28 days after the parties were issued with the original certificate for the medical assessment for which the review is sought.[4]
[4] Section 7.26(10) of the MAI Act.
The delegate of the President referred the medical assessment to the Panel as they were satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application.[5]
[5] Section 7.26(5) of the MAI Act.
Pursuant to s 7.26(5A) of the MAI Act and Schedule 1, cl 14F(2) of the Personal Injury Commission Act 2020 (the PIC Act), the Panel consists of two Medical Assessors and a Member of the Motor Accidents Division of the Personal Injury Commission (Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Merit Reviewer or a Medical Assessor.[6]
[6] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[7]
[7] Rule 128 of the PIC Rules.
The review is by way of new assessment of all matters with which the medical assessment is concerned.[8]
ASSESSMENT UNDER REVIEW
[8] Section 7.26(6) of the MAI Act.
The Medical Assessor provided a medical assessment certificate determining that the motor accident caused a post-traumatic stress disorder and somatic symptom disorder with predominant pain as a direct consequence of the motor accident.
The Medical Assessor concluded that the motor accident caused mild impairment (class 2) in self-care and personal hygiene, travel, social and recreational activities and social functioning and moderate impairment (class 3) in the categories of concentration, persistence and pace and adaptation.
The Medical Assessor noted self-care and personal hygiene was affected by physical symptoms. In respect of social and recreational activities, the Medical Assessor recorded that the claimant purchased groceries and sees his friend for refreshment once or twice a week.
The Medical Assessor noted that the claimant does not drive his car but sometimes used the train and also travelled with a close friend. It was also noted that the claimant had travelled overseas twice to visit family members since the accident.
The Medical Assessor noted that the claimant lives with three friends in a flat, has a wife and son overseas who he has seen twice since the accident.
The Medical Assessor noted the claimant’s concentration was poor and expressed reservations with the findings of Dr McMahon which suggested exaggeration of memory impairment.
MATERIAL BEFORE THE REVIEW PANEL
The parties provided separate bundle of documents.
PRE-ACCIDENT RECORDS
There was no evidence of any prior psychological condition.
POST MOTOR ACCIDENT
General practitioner and treating records
The ambulance record refers to the claimant riding a scooter which collided with the car in front. The ambulance officer noted left hand with obvious deformity and partial amputation of left ring finger and deep laceration to left middle finger.[9]
[9] Claimant’s bundle, p 78.
The claimant was discharged from St Vincents Hospital following left middle finger terminalisation and insertion of a K wire of the left ring finger.[10]
[10] Claimant’s bundle, p 72.
A certificate of capacity dated 1 September 2021 noted the motor accident causing a degloving injury of the hand with associated fracture.[11]
[11] Claimant’s bundle, p 105.
The claim form dated 14 September 2021 referred to the motor accident causing a comminuted fracture, partial amputation of the left middle finger and psychological sequelae.[12]
[12] Claimant’s bundle, p 69.
The initial clinical record of the general practitioner (GP) dated 20 September 2021 noted the motor accident causing the hand injury with ring finger amputation. The claimant was in quarantine following hospital discharge.[13]
[13] Claimant’s bundle, p 122.
On 24 October 2021 the claimant reported to the GP symptoms including difficulty sleeping, easily angered or irritated, trouble concentrating and easily startled.[14]
[14] Claimant’s bundle, p 139.
The claimant commenced psychological treatment in November 2021.[15] An Allied health recovery request dated 24 November 2021 prepared by the psychologist noted a provisional diagnosis of post-traumatic stress disorder.[16] Reported symptoms included broken sleep, reduction in appetite, diminished concentration, reduced interest, decreased energy levels, withdrawn from social network, constant flashbacks, nightmares and triggered by cues of the accident.
[15] Claimant’s bundle, p 187.
[16] Claimant’s bundle, p 191.
In August 2022 the psychologist noted symptoms including poor sleep, nightmares, avoidance of driving, overeating, headaches, anxiety, scared and angry and quite emotional.[17]
[17] Claimant’s bundle, p 182.
An ultrasound of the left thumb dated 4 January 2023 was reported as showing no abnormality or cause for the patient’s pain.[18]
[18] Claimant’s bundle, p 277.
On 20 June 2023 the GP noted persistent left finger pain, still depressed and sad with sleep problems.[19]
[19] Insurer’s bundle, p 47.
In June 2023 the psychologist noted there was no change in the claimant who continued to feel depressed.[20]
[20] Claimant’s bundle, p 196.
On 30 June 2023 Dr Nabarro removed the plate and screws from the left ring finger. The clinical findings were that the fracture of the distal phalanx was solidly united.[21]
[21] Claimant’s bundle, p 271.
On 20 November 2023 the GP noted persistent finger pain, sleep problems with bad dreams and difficulty concentrating.[22]
[22] Insurer’s bundle, p 49.
Various certificates of capacity noted that the claimant had no current capacity for work in 2023 associated with both physical and psychological injuries.[23]
[23] Insurer’s bundle, pp 55-73.
Mr Rababi, psychologist, provided a report dated 4 July 2024.[24] The initial session was on
10 August 2022, and 32 sessions had been completed to date. It was noted that the claimant maintained a close relationship with his parents and siblings. He maintained daily contact with the Sepp family through phone and video calls.[24] Claimant’s bundle, p 303.
The claimant reported extreme difficulties with day-to-day activities including self-care, social activities, travel, interpersonal relationships, concentration and task completion. The relationship with his family had become strained due to the inability to provide financial support.
The psychologist diagnosed post-traumatic stress disorder, major depressive disorder and generalised anxiety disorder. He opined that the claimant suffered significant impairment of his earning capacity being unable to return to his previous work roles including those involving roles that involve physical labour or high levels of concentration and attention such as positions in driving or delivery.
Dr Eddie So, psychiatrist provided a report dated 7 August 2024.[25] The psychiatrist noted some improvement in sleep since the increase of Zoloft dosage, although sleep remained broken due to recurrent nightmares and chronic pain. Mood was described as tense with hypervigilance and prone to become agitated with poor concentration and low stress tolerance.
[25] Claimant’s bundle, p 380.
Dr So diagnosed post-traumatic stress symptoms, chronic with moderate to severe symptoms. This was complicated by social isolation, lack of psychosocial support chronic limb pain and loss of function.
Updated records from the GP recorded no capacity for work, post-traumatic stress disorder, and chronic pain post amputation.[26]
[26] Claimant’s bundle, p 313.
Qualified opinions
Dr Aman Suman, psychiatrist, was qualified by the claimant and provided a report dated
29 August 2022.[27] The doctor noted that the claimant was doing well in terms of physical and mental health prior to the motor accident in August 2021.[27] Claimant’s bundle, p 39.
Dr Suman noted the claimant was living in shed accommodation with a group of friends in Waterloo and the recent presentation indicated ongoing post-traumatic stress disorder symptoms. The doctor opined that the claimant had partially responded to the psychological therapy although not had a trial of psychotropic treatment and recommended further psychological therapy.
Dr Suman opined that the claimant remained unfit for any for work in response to psychotherapeutic input. The doctor opined that the psychological condition had not stabilised and recommended further treatment and further assessment in six months after the claimant had an adequate psychotherapeutic treatment.
Dr Suman provided a further report dated 7 August 2023.[28] The doctor noted that the claimant continued to struggle with his mental health issues with nil significant change since the last review in August 2022. The claimant continued on antidepressant treatment under the care of the GP, continued to receive monthly input from the GP, and was receiving fortnightly psychological therapy sessions. Dr Suman opined that the claimant continued to struggle with post-traumatic stress disorder symptoms and was also experiencing significant depressive symptoms.
[28] Claimant’s bundle, p 27.
Dr Suman noted that the claimant continued to receive “much support from his friends he shares his accommodation with” and was struggling with motivation and energy. The doctor opined that the claimant remained unfit for any form of work considering his response to the psychotherapeutic input and was guarded about recovery in future work capacity.
Dr Suman provided the following assessments for the various psychiatric impairment rating scale (PIRS) categories:
(a) self-care and personal hygiene – class 2 noting that the claimant showered every day although struggled with household chores;
(b) social and recreational activities – class 3 noting that the claimant avoided social interaction which causes him significant anxiety, felt conscious of any social setting due to his hand injury and refused to go out with his friends;
(c) travel - class 2 noting that the claimant has not been able to return to driving but was able to go to the local shop if required;
(d) social functioning – class 2 noting that the claimant’s relationship with his wife was restrained, he has lost touch with most of his friends apart from the ones he is staying with at his flat;
(e) concentration, persistence and pace – class 3 noting that the claimant struggled with his concentration and recall and was able to complete simple tasks although it takes much longer, and
(f) adaptation – class 5 noting that the claimant remains unfit to take on any job considering his struggle with ongoing complex mental health stressors.
Dr Suman allowed 1% for the treatment effect related to the response to the psychotropic medication and psychological therapy pursuant to cl 6.223 of the Guidelines. The overall assessment of permanent impairment was 20%.
Dr John McMahon, psychologist, was qualified by the insurer and provided a report dated
29 June 2023.[29] The doctor administered the Test of Memory Malingering and found the claimant’s pattern of responding was consistent with suboptimal effort and efforts to appear overly symptomatic.[29] Insurer’s bundle, p 21.
The doctor otherwise opined that there was feigning spectrum behaviour detected on psychometric testing which cast significant doubt on the claimant’s self-reporting. In light of this conclusion, the doctor did not make a diagnosis or provide an assessment of whole person impairment.
Dr Keller, occupational physician, was qualified by the insurer and provided a report dated
7 August 2023.[30] The doctor diagnosed a fracture requiring surgical fixation to the left ring finger and partial amputation of the left middle finger through the distal interphalangeal joint.[30] Insurer’s bundle, p 32.
Dr Keller opined that there was some pain and restrictions in heavy manual tasks with the left-hand.
Dr Shahzad, occupational physician, was qualified by the claimant and provided a report dated 16 August 2024.[31] The doctor assessed impairment of the cervical spine, a substantial impairment of the left upper limb including assessments for the left shoulder and left elbow. A small assessment was made in relation to the scarring.
[31] Claimant’s bundle, p 372.
SUBMISSIONS
Claimant’s submissions dated 16 October 2023[32]
[32] Claimant’s bundle, p 65.
The claimant alleged that the motor accident caused various physical injuries. He referred to the reports of Dr Suman who assessed 20% whole person impairment for the psychological condition.
Claimant’s submissions dated 12 September 2024[33]
[33] Claimant’s bundle, p 3.
These submissions sought leave to review the medical assessment certificate. The claimant alleged error with respect to various PIRS categories.
The errors with respect to social and recreational activities were alleged to be:
· erroneously applying class 2 where the evidence supported a class 3 rating;
· the opinion of Dr Suman in the report dated 7 August 2023 provided a class 3, and
· the only possible finding that was open to the Medical Assessor on the above evidence was a class 3 assessment.
The errors with respect to the assessment for class 2 for travel where a class 3 rating was most appropriate and the only possible finding that was open to the Medical Assessor noting the assessment by Dr Suman.
The error with respect to the assessment of adaptation were:
· Medical Assessor had “egregiously” fallen into error by applying the class 3 assessment and submitted that the Medical Assessor;
· such a finding was not open on the evidence and breached the fundamental established principles in relation to the assessment of medical causation, and
· this was a clear case of a class 5 assessment.
The claimant submitted that the Medical Assessor had fallen into error and breached cl 1.21 [sic] of the Guidelines as he found that the claimant had not returned to work as a direct result of both the physical and psychological injuries. It was submitted that the mixture of contribution of both significant physical and psychological deficits which were caused and materially contributed to by the motor accident meant that the assessment by the Medical Assessor was not open.
The claimant relied on the “correct and compliant approach demonstrated by Dr Suman”.
Insurer’s submission dated 3 November 2023[34]
[34] Insurer’s bundle, p 16.
These submissions addressed both the physical and psychological injuries caused by the motor accident. The insurer accepted that the applicant underwent an amputation of the middle finger of the left hand, there was no injury to the left thumb and there was little or no present-day impairment from injury to any other fingers.
In respect of the alleged psychological problems, the insurer noted that Dr McMahon administered symptom validity testing which suggested the claimant was malingering. It submitted that the material does not support a finding that there was a greater than 10% whole person impairment for any psychological injury.
Insurer’s submissions dated 17 September 2024[35]
[35] Insurer’s bundle, p 18.
These submissions opposed leave to review the medical assessment.
The insurer submitted that the Medical Assessor reviewed and considered the reports of
Dr Suman including his assessment of permanent impairment. The Medical Assessor was not required to reach the same conclusion as the claimant’s qualified psychiatrist.In relation to social and recreational activities, the insurer referred to Table 6.12 of the Guidelines and noted the extract from the report of Dr Suman was “irrelevant as the medical assessor was not required to follow the doctor’s opinion”. Furthermore, the history provided by the claimant to the Medical Assessor was entirely consistent with the class 2 rating.
In respect of the assessment of travel, the insurer submitted that the claimant had placed undue weight on driving in circumstances where the assessment related to travel as a whole. It referred to the history that the claimant sometimes used the train, he can get to most places and had travelled twice overseas to see his family since the accident.
In respect of the assessment of adaptation, the insurer submitted that the Medical Assessor’s approach was correct in the class 3 rating was clearly justified noting the claimant’s complaints of an inability to use his hand.
RE-EXAMINATION
The Panel determined that the claimant be re-examined by both Medical Assessors. The examination report is as follows:
“Who attended the assessment
The interpreter engaged by the Commission, Mohammed Haroon, National Accreditation Authority for Translators and Interpreters number 96502, was present for the duration of the assessment.
HISTORY
Psychosocial history and pre-accident history
Mr Idris was born and brought up in Myanmar as one of five children to his parents. His parents now live in Bangladesh and his siblings in Bangladesh and Saudi Arabia. Mr Idris and his family are of the Rohingya ethnic group.
Mr Idris denied knowing of any history of mental disorders in his family.
Mr Idris described a good upbringing in his family. He denied any serious health problems during his childhood or adolescence and did not experience significant trauma. He enjoyed school and had plenty of friends. He enjoyed playing sport, particularly soccer.
In 2011 at the age of 16 Mr Idris left Myanmar and travelled initially to Bangladesh then on to Malaysia, Indonesia and Australia over the following two years. He denied experiencing significant trauma during this time.
At the age of 18 Mr Idris was residing in a detention centre and studying English. After gaining a visa he travelled to Brisbane and then Rockhampton. He worked in a meat factory as a cleaner for approximately 15 months. In 2016 Mr Idris arrived in Sydney which has been his principal residence since.
In 2016 Mr Idris went to Bangladesh to marry and spent 2 ½ months there. Mr Idris’s wife resides in Myanmar with their son who is now aged 8 years. Mr Idris speaks to his wife and son four or five times each week on the phone. He last saw them in person two years ago. He last travelled to Bangladesh to visit his parents in March 2025 when he spent nine days there.
On return to Sydney after his marriage, Mr Idris worked in construction for 8 months. He lived with three other young men who he had known for several years and came from the same village in Myanmar. He subsequently obtained work as a driver for a company delivering linen and laundry to hotels. To supplement his income Mr Idris worked as a driver for Uber Eats. He was working in these roles at the time of the accident.
Mr Idris said that before the accident he was independent in his self-cares. It was during COVID so socialising was restricted though he would play cards with his housemates. He would attend Friday prayers regularly and associate with other members of the Rohingya community. He would socialise and have dinner with friends.
Mr Idris denied consulting with a health professional about a mental health problem before the motor accident. He denied smoking, drinking alcohol or using illicit drugs. He said that when playing cards with his friends they would gamble with tokens though not money.
Mr Idris denied any previous accidents or serious illnesses.
History of the motor accident
Mr Idris was driving a scooter to deliver food for Uber Eats. A car stopped and reversed into him knocking him from his scooter. He sustained a crush injury to his left hand.
History of symptoms and treatment following the motor accident
Mr Idris was taken to St Vincent’s Hospital for assessment and treatment for his injury. He had treatment with left middle finger terminalisation and k-wire inserted into left ring finger. He spent four days in hospital before being discharged home. Mr Idris had surgical follow-up for his injury and has had three procedures in total since the accident.
Mr Idris developed psychological symptoms including depressed mood with self-blame, disturbed sleep, reduced concentration and recurrent intrusive recollections of the trauma. He was unable to return to driving. His GP, Dr Mohamed Keritam, referred him for psychological treatment. He was commenced on the antidepressant/antianxiety medication paroxetine as well as analgesic medication.
Details of any relevant injuries or conditions sustained since the motor accidentThere are no relevant further injuries or conditions sustained since the motor accident.
Current symptoms
Mr Idris described his predominant mood as sad and depressed. There is no diurnal variation of mood. At times Mr Idris has had thoughts that it would be better for his life to be over. He said that he is able to ‘control’ these thoughts when they occur and thoughts for his family are protective against him taking any action to end his life. He has a general reduction in his enjoyment of previously enjoyed activities.
Mr Idris describes having frequent unpleasant recollections of the accident with images which come to mind. Pain in his hand can precipitate these recollections. Mr Idris experiences persistent pain which is partially alleviated by medication.
He has had persistent problems with his sleep. He said that when he wakes in the night he will experience ‘flashbacks’ by which he meant sudden intrusive mental images relating to the motor accident which caused him emotional upset. He has a changeable sleep pattern with reduced structure in his day. His energy levels during the day are low.
Mr Idris has an interest in history and will read material of interest online. He said that he reads for up to 10 minutes at a time though is distracted by intrusive recollections of the traumatic incident. He can watch movies, though not all the way through.
Mr Idris finds it difficult to be around other people and to socialise, so he spends most of his time at home. He finds that noise cause him to feel emotionally upset. He is self-conscious about the deformity in his hand and when people see it, he feels sad.
Mr Idris said that he has not driven a motor vehicle since the day of the accident due to fear of further injury.
Current and proposed treatment
Mr Idris meets with his psychiatrist Dr Soo every six weeks. He is currently prescribed Quetiapine Modified Release 150mg daily, Sertraline 75mg daily and Prazosin 2mg each evening. He also takes analgesic medication Celebrex, Pregabalin and Norflex.
He has a monthly meeting with psychologist Mr Rababi for psychotherapy.
CLINICAL EXAMINATION
Mental state examination
At the time of examination Mr Idris was at his solicitor’s office in Liverpool. His self-care appeared reasonable. He was appropriately attired and was neat in his appearance. There were no abnormal movements or behaviours, and Mr Idris tolerated a lengthy interview well. He provided short answers to questions relayed through the interpreter. Mr Idris’s affect was rather downcast and lacked reactivity. His mood was objectively and subjectively low. He denied any current suicidal ideation. He retained hope for improvement in the future. His thought form was normal. His thought content revealed self-critical cognitions and embarrassment with respect to his hand injury. There were no abnormal beliefs in the form of delusions and no abnormal perceptions. Mr Idris was fully alert and interview. He attended adequately for the purpose of the interview. A formal cognitive assessment was not carried out.
Current functioning
Mr Idris lives with three flatmates he has known since childhood. He is impaired in some of his self-cares due to his physical problems with his left hand - he is right-handed. He is less motivated to self-care though showers two or three times each week without prompting. He does not cook as he does not know how and believes that he would not be able to remember recipes. His friends generally cook for him. Mr Idris does some housework during the day. He occasionally goes to shops with his housemates.
Mr Idris occasionally goes for a walk in a local park or will watch a soccer game in the park with friends. He prefers to go when the park is quiet. He rarely goes to the mosque.
Mr Idris has not driven since the motor accident. He is able to travel as a passenger in a vehicle driven by a friend or by public transport. He travelled on his own to Bangladesh to visit his parents in March 2025.
Mr Idris has maintained positive relationships with his housemates, and they are supportive of him. He is in frequent contact with his parents, wife and son by telephone or video, though less frequently than before the accident and the calls are shorter.
Comments on consistency
Mr Idris was internally consistent in his account at interview. The report of Dr McMahon is noted. He administered the Test of Memory Malingering (TOMM), a symptom validity test. Dr McMahon concluded that this indicated feigning behaviour by Mr Idris making assessment difficult.
The symptoms complained of at interview are consistent with those in assessments of treating clinicians.
DETERMINATIONS
Diagnosis and reasons
Following the DSM-5-TR diagnostic system, Mr Idris has developed post-traumatic stress disorder (PTSD) and persistent depressive disorder due to the motor accident.
Diagnostic Criteria – Post-traumatic Stress Disorder in Individuals Older Than 6 Years
A: Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Mr Idris directly experienced an event in which he sustained a serious injury.
B: Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
Mr Idris has recurrent, involuntary, and intrusive distressing memories of the traumatic event.
He experiences intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C: Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
Mr Idris has not driven since the motor accident due to fear of further trauma. He attempts to avoid reminders of the accident as this causes distressing memories.
D: Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Mr Idris has a persistent low mood with self-consciousness and shame with respect to his injured left hand. He has a diminished interest in previously significant activities such as attending for religious worship and socialising with friends.
E: Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Mr Idris has persistent problems with reduced concentration and a disturbed sleep pattern.
F: Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
The disturbance has been present for several years.
G: The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Mr Idris has not returned to work or study due to his symptoms.
H: The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
There is no indication that the disturbance is due to the physiological effects of oa substance or another medical condition.
Persistent Depressive Disorder
A: Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years.
Note: In children and adolescents, mood can be irritable and duration must be at least 1 year.
Mr Idris has depressed mood for most of the day on more days than not for a period in excess of two years.
B: Presence, while depressed, of two (or more) of the following:
Mr Idris has low energy, low self-esteem, and poor concentration.
C: During the 2-year period (1 year for children or adolescents) of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time.
There has not been a period of more than two months at a time free of symptoms.
D: Criteria for a major depressive disorder may be continuously present for 2 years.
This is the case for Mr Idris.
E: There has never been a manic episode or a hypomanic episode.
There is no evidence of a manic or hypomanic episode.
F: The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.
There is no evidence of a schizophrenia spectrum or other psychotic disorder.
G: The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
There is no evidence that symptoms are attributable to a substance or other medical condition.
H: The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Mr Idris experiences significant distress and impairment in social and occupational areas.
With persistent major depressive episode: Full criteria for a major depressive episode have been met throughout the preceding 2-year period.
Causation and reasons
Mr Idris has no relevant pre-existing condition. He developed psychological symptoms in the weeks following the motor accident and these have persisted.
The following injuries WERE caused by the motor accident:
·Post-traumatic Stress Disorder; Persistent Depressive Disorder with anxious distress.
Mr Idris’s condition is well stabilised over a prolonged period of time. It is not likely to change substantially and by more than 3% in the next year with or without medical treatment.
Degree Of Permanent Impairment Psychiatric Impairment Rating Scale
Psychiatric diagnoses
1. – Post-traumatic Stress Disorder
2. Persistent Depressive Disorder with anxious distress
3.
4.
Psychiatric treatment description
Medication – Quetiapine Modified Release 150mg daily, Sertraline 75mg daily, Prazosin 2mg each evening
Psychiatry review with Dr Soo every six weeks
Psychotherapy – Monthly meeting with psychologist Mr Rababi
Category
Class
Reason for Decision
Self Care and Personal Hygiene
Table 6.11
2
Mr Idris is able to live independently. He is less motivated to shower, though does not require prompting, and showers two or three times each week. He does not cook as friends generally cook for him. He attends health appointments and takes medication prescribed for him.
Social and Recreational Activities
Table 6.12
2
Mr Idris will occasionally go for a walk in a local park. He occasionally watches soccer in the park with friends. He plays cards with his housemates. He does not need a support person to leave home for a social or recreational purpose. He socialises with family when he visits.
Travel
Table 6.13
2
Mr Idris has not driven since the motor accident. He can travel independently by public transport or when driven by a friend.
Mr Idris has travelled to Bangladesh on three occasions since 2016, the last time being in March 2025. He has travelled alone and is driven to the airport in Sydney by a friend and travels by train when he arrives in Bangladesh.
Social Functioning
Table 6.14
2
Mr Idris lives with housemates that he has known since childhood. He maintains telephone contact with his parents in Bangladesh two or three times each week. Calls are shorter and less frequent compared to before the motor accident. He last visited his parents in Bangladesh in March 2025.
Concentration, Persistence and Pace
Table 6.15
3
Mr Idris has an interest in history and will read material of interest online. He said that he reads for up to 10 minutes at a time though is distracted by intrusive recollections of the traumatic incident. He can watch movies, though not all the way through. Concentration throughout the examination was adequate for the purpose of the examination.
Adaptation
Table 6.16
5
Mr Idris has not worked since the accident. He has not participated in formal study. He finds his concentration limits his ability to focus on tasks, including work-related. He is totally incapacitated for work due to his psychological condition.
List classes in ascending order: 2,2,2,2,3,5
Median Class Value: 2
Aggregate Score: 16
% Whole Person Impairment: 9%
Apportionment – pre-existing/subsequent impairment
There is no apportionment for a pre-existing or subsequent impairment.
Effects of treatment
This is discussed later and no allowance is made.
CONCLUSION – PERMANENT IMPAIRMENT
Degree of permanent impairment caused by the motor accident - 9 %.”
FINDINGS
The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[36]
The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[37] and Insurance Australia Ltd v Marsh.[38] Contrary to the claimant’s submissions on review, we are not bound to accept opinion from other doctors and particularly in circumstances where they are somewhat outdated.,
We have met following the provision of the joint examination report. The Panel adopts the detailed examination findings made by both Medical Assessors with the additional further short observations. The following represents the findings of the Panel. These findings are to be read as supplementary to and in addition to the contents of the examination report.
Clauses 6.214 and 6.215 of the Guidelines note that the assessment of psychological injury does not include any allowance for “impairment due to physical injury” and “impairments due to somatoform disorders or pain”. The claimant’s ongoing physical restrictions have not been considered in assessing the impairment due to psychological injury.
The impairment is based on the evaluation at the time of the medical assessment (cl 6.21 of the Guidelines) and we have relied on the combined clinical expertise of the Medical Assessors when examining the claimant.
We are satisfied, particularly based on the clinical expertise of the Medical Assessors, that the impairment is permanent within the meaning of cls 6.19 and 6.20 of the Guidelines because the condition is well stabilised and is unlikely to change by more than 3% within the next 12 months with or without treatment.
We have not allowed anything for the effects of treatment. Clause 6.222 to 6.224 of the Guidelines relates to the effects of treatment for psychiatric impairment. We are not satisfied that there is clear clinical evidence that the treatment has been effective (cl 6.222.3). There has been a marginal improvement in functioning and symptoms as recorded by the Medical Assessors. However, we do not accept that there is clear evidence of the effectiveness of treatment as the passage of time will normally result in some improvement. Otherwise, in the clinical expertise of the two Medical Assessors, ceasing treatment will not result in a deterioration of symptoms or a worsening of function (cl 6.222.4). No allowance is made for the treatment effects.
We note that the symptom validity testing is not definitive of whether someone is exaggerating. The claimant appeared reasonably consistent in his complaints and admitted to a variety of activities such as going to parks, socialising with friends and travelling overseas. It is the clinical experience of the Medical Assessors that the claimant was not malingering.
CONCLUSION
The certificate issued by Medical Assessor Canaris dated 31 July 2024 is revoked. The new certificate is attached at the commencement of these Reasons.
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