Insurance Australia Limited t/as NRMA Insurance v Ajaj

DETERMINATION OF REVIEW PANEL
CITATION:	Insurance Australia Limited t/as NRMA Insurance v Ajaj [2025] NSWPICMP 422
CLAIMANT:	Gehan Ajaj
INSURER:	Insurance Australia Limited t/as NRMA Insurance
REVIEW PANEL
MEMBER:	Bianca Montgomery-Hribar
MEDICAL ASSESSOR:	Christopher Canaris
MEDICAL ASSESSOR:	Ankur Gupta
DATE OF DECISION:	17 June 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); dispute related to assessment of whole permanent impairment (WPI); psychological injury; claimant examined by Medical Assessors; diagnosis of post-traumatic stress disorder (PTSD); Held – degree of permanent impairment not greater than 10%; MAC revoked; new certificate issued.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel: (a) revokes the certificate of Medical Assessor Paul Friend dated 18 December 2023; and (b) issues a new certificate determining that the claimant’s psychological injury caused by the accident, being post-traumatic stress disorder, has resulted in a degree of permanent impairment of 7%, which is not greater than 10%.

STATEMENT OF REASONS

INTRODUCTION

On 10 July 2020, Gehan Ajaj (claimant) was involved in an accident at the intersection of Benera Rd and Wroxham Street / Bomaderry Drive, Prestons NSW. Another vehicle, insured by Insurance Australia Limited t/as NRMA Insurance (insurer), failed to give way to the claimant and turned in front of her vehicle as she drove through the intersection (accident).
These proceedings involve a dispute between the claimant and the insurer about the claimant’s degree of permanent impairment, for the purposes of the Motor Accident Injuries Act 2017 (NSW) (MAI Act), resulting from any psychological injury caused by the accident.
Medical Assessor Paul Friend assessed the claimant and issued a certificate dated 18 December 2023. The Medical Assessor certified that the claimant’s psychological injury caused by the accident, being post-traumatic stress disorder, had resulted in a permanent impairment of 15% being greater than 10% for the purposes of the MAI Act.
The insurer has sought a review of Medical Assessor Friend’s assessment in accordance with s 7.26 of the MAI Act. On 15 April 2024, the President’s delegate determined there was reasonable cause to suspect the assessment was incorrect in a material respect.
On 7 February 2025 this review panel (Panel) was constituted to conduct a review of Medical Assessor Friend’s assessment (Review).

RELEVANT LEGISLATION

The present dispute involves whether the claimant’s degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%. This is a medical dispute as defined in s 7.17 of the MAI Act and constitutes a medical assessment matter pursuant to Schedule 2, cl 2. It was referred to the Personal Injury Commission (Commission) for assessment under Division 7.5 of the MAI Act.
Section 1.7 of the MAI Act defines the “impairment threshold” for the purposes of the MAI Act as “whether the degree of permanent impairment of an injured person as a result of an injury caused by a motor accident is greater than 10%”. The impairment threshold is relevant to a claimant’s entitlement to damages for non-economic loss: s 4.11 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). Relevantly, it states:
“7.21 Assessment of degree of permanent impairment
(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.
(2) Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.
(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.
(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent.”
The Guidelines are issued pursuant to s 10.2 of the MAI Act. Version 9.3 of the Guidelines is effective from 6 December 2024 and replaced version 9.2, except for claims arising from motor accidents before 1 April 2023.[1] For such accidents, such as the current accident, certain clauses do not apply, and specific clauses from version 9 of the Guidelines continue to apply.
[1] The current version of the Guidelines, v9.3, applies to policies that come into effect immediately after midnight 14 January 2025. For policies that come into effect from 15 January 2024 to 14 January 2025, Part 1 of the Motor Accident Guidelines v9.2 continues to apply: see clause 1.2.
Part 6 of the Guidelines is based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment Fourth Edition (AMA 4 Guides). Part 6 of the Guidelines is definitive regarding the matters it addresses, but where it is silent on an issue the AMA 4 Guides should be followed.[2]
[2] Clause 6.2 of the Guidelines.

Causation

Clause 6.5 of the Guidelines provides that a determination of whether the injured person’s impairment is related to the accident is implied in all assessments. In addition to the relevant provisions of the AMA 4 Guides, common law principles also apply. Accordingly, it is necessary for the Panel to consider whether the accident caused or contributed to any diagnosed psychiatric condition.[3]
[3] Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75].
Clauses 6.6 to 6.7 of the Guidelines provide:
“7.21 Assessment of degree of permanent impairment
(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.
(2) Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.
(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.
(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent.”
In respect of the applicable common law principles, causation of injury is required to be established on the balance of probabilities. The claimant is not required to establish causation to the level of medical or scientific certainty.[4] As observed by Spigelman CJ (Davies AJA agreeing) in Seltsam Pty Ltd v McGuiness (2000) 49 NSWLR 262; [2000] NSWCA 29 at [143][5]:
“An inference of causation for purposes of the tort of negligence may well be drawn when a scientist, including an epidemiologist, would not draw such an inference.”
[4] Briggs v IAG Ltd (t/as NRMA Insurance) (2024) 106 MVR 203; [2024] NSWSC 3 at [43]-[44].
[5] Cited with approval by White JA (Macfarlan and Payne JJA agreeing) in Metro North Hospital and Health Service v Pierce [2018] NSWCA 11 (“Pierce”) at [138]. See also the discussion of Stern JA (Mitchelmore and Ball JJA agreeing) in Insurance Australia Limited t/as NRMA Insurance v Le [2025] NSWCA 121 at [34].
The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining causation.[6] It is therefore necessary to consider whether the accident caused or contributed to the diagnosed psychiatric condition. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[7]
[6] Sections 5D and 5E CL Act.
[7] Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50].

Psychiatric impairment

Under the Guidelines, “impairment” is defined as “an alteration to a person's health status. It is a deviation from normality in a body part or organ system and its functioning. Hence, impairment is a medical issue and is assessed by medical means”.[8]
[8] Clause 6.9 of the Guidelines.
The process by which impairment is evaluated is set out in cls 6.17 and 6.18 of the Guidelines. This provides a three-stage process which includes a review and evaluation of all available evidence, an interview and a clinical examination wherever possible, and preparation of a certificate using the methods specified in the Guidelines to determine the percentage of permanent impairment.
In respect of the third stage, the determination of psychiatric impairment is to be assessed in accordance with ‘Mental and behavioural disorders’ found in cls 6.201 to 6.228 of the Guidelines.[9]
[9] Clause 6.35 of the Guidelines.
Any psychiatric or psychological impairment must be assessed separately from any impairment resulting from a physical injury.[10] Accordingly, in determining the claimant’s impairment resulting from her psychological or psychiatric injuries, the Panel must not take into account any impairment resulting from the claimant’s physical injuries.
[10] Clauses 6.36 to 6.37 of the Guidelines.

Review Procedure

The Panel is to conduct the Review in accordance with s 7.26 of the MAI Act. Section 7.26(5A) of the MAI Act provides that the panel is to be constituted by two Medical Assessors, being specialist medical practitioners, and a Member assigned to the Motor Accidents Division of the Commission.
The Review is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[11]
[11] Section 7.26(6) MAI Act.
The Panel is required to form its own opinion on the medical question in dispute by reflecting on the panel members’ professional judgment; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[12]
[12] Insurance Australia Group Ltd t/as NRMA Insurance v Keen [2021] NSWCA 287 and Insurance Australia Ltd v Marsh [2022] NSWCA 31.
Part 5 of the Personal Injury Commission Act 2021 (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 Medical Assessor. The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[13]
[13] Rule 128 of the Personal Injury Commission Rules 2021 (PIC Rules).

MEDICAL ASSESSMENT UNDER REVIEW

On 30 November 2023, Medical Assessor Paul Friend undertook a medical assessment of the claimant and, in his certificate dated 18 December 2023, determined that the claimant’s psychological injury gave rise to a permanent impairment of 15% being greater than 10%.
The medical examination was undertaken with an Auslan interpreter. The interpreter translated the Medical Assessor’s questions using Auslan and the claimant responded in spoken word. This was translated, as the Medical Assessor could not understand the claimant’s spoken word.
Medical Assessor Friend diagnosed the claimant with post-traumatic stress disorder which was caused by the accident.
The claimant’s pre-accident and psychosocial history was recorded. The Medical Assessor reviewed and summarised the documentation before him in detail.
It was noted that the claimant struggled throughout the examination to answer questions and provided limited answers.
The Medical Assessor noted the claimant’s inconsistencies in her accounts and her previous medical history, her statements in applications for Carer Benefits and NDIS funding, and her pre-accident functioning. He also noted that, considering her limited vocabulary, limited literacy, limited life experiences and having a longstanding hearing impairment, it is understandable that she could not describe her symptoms to the same degree that others would be expected to do.
In respect of the claimant’s degree of permanent impairment in accordance with the Psychiatric Impairment Rating Scale (PIRS), the Medical Assessor opined the claimant had a whole person impairment of 15%.
The Medical Assessor found mild impairment (class 2) in respect of category 1, noting the claimant does not do many household duties, was unable to walk down the stairs to her backyard, and showers infrequently principally because of the pain she experiences. She also reports feeling dizzy and was fearful of falling if she went to do grocery shopping but could also not put objects in the trolley which was a physical problem.
In respect of category 2, the Medical Assessor found moderate impairment (class 3). He noted her social activities were restricted to going to a restaurant every one to two months with her children.
In respect of category 3, the Medical Assessor found a mild impairment (class 2), noting she can drive for short periods of time in the local area and to appointments. Travelling further afield is more difficult. It is noted there appears to be a typographical error in this part of the Medical Assessor’s reasons.
In respect of category 4, the Medical Assessor found moderate impairment (class 3). She was noted to have separated from her husband and having lost contact with all her friends. She was noted to report a good relationship with her children.
In respect of category 5, the Medical Assessor found moderate impairment (class 3). She was noted to have a limited vocabulary and limited literacy. She required questions to be clarified during the interview. There was no reference to forgetfulness or cognitive impairment noted in the documents supplied. While inconsistencies were noted between the claimant’s account and the documents, the Medical Assessor found there had been a significant deterioration in the claimant’s cognitive function since the accident.
In respect of category 6, the Medial Assessor found mild impairment (class 2), noting she had done household duties since at least 19 years of age. She cannot do household duties because of ongoing pain but does withdraw from others and spends a lot of time in her room. She is able to attend appointments and continues to check on her children.
The Medical Assessor found no pre-existing or subsequent impairment and made no allowance for effects of treatment.

MATERIAL BEFORE THE PANEL

On 10 February 2025, the Panel issued Directions to the parties which required the filing of an indexed, paginated bundle of documents. On 2 April 2025, the Panel met and issued Directions requiring the claimant to attend a medical examination before Medical Assessor Canaris and Medical Assessor Gupta on 13 May 2025 via MS Teams.
The Panel also directed that the clinical records from any general practitioner, psychologist or psychiatrist seen by the claimant from 22 September 2020 to 2 April 2025 be produced, to the extent those records were not already included in the joint bundle. The Panel notes that no documents were produced in response to this direction. Accordingly, the Panel infers that the claimant has not undergone any relevant treatment that has not been included in the joint bundle.
It is also noted by the Panel that several of the records included in the joint bundle are not relevant to the dispute before it. This is contrary to the Panel’s directions issued on 10 February 2025, which directed that only documents relevant to the issues in dispute should be included. The irrelevant documents contain sensitive health and personal information of the claimant and several of her children. In addition to increasing the risk of cyber security and privacy breaches, the inclusion of irrelevant material is contrary to the Panel’s direction and the guiding principle of the Commission.
If reference is not made to a document contained in the bundle, it should not be assumed that the Panel was unaware of that material or that the Panel failed to take the material into account.[14]
[14] See e.g., Roger v De Gelder [2015] NSWCA 211 and Dunbar v Allianz Australia Insurance Ltd [2015] NSWSC 119.

Insurer’s submissions

The insurer relies on submissions dated 3 March 2025 and submits that the claimant’s psychological injuries do not give rise to a permanent impairment greater than 10%.
The insurer submits that the claimant’s pre-accident medical history evidences long standing physical and psychological disability and restrictions. The insurer’s submissions refer to medical records regarding the claimant’s physical condition and associated treatment and assistance. This includes records from 2014 and 2015 where the claimant nominated her brother and then her husband as her carer.
The insurer says Medical Assessor Friend’s findings pursuant to the PIRS are not reflective of the claimant’s alleged psychological injury resulting from the accident. The insurer submits that the claimant would have continued to require the same level of assistance regardless of the accident and that her reported deficits in respect of self-care and personal hygiene, social and recreational activities, social functioning, travel and adaptation are not causally related to her alleged psychological condition.
Further, the insurer submits that the claimant’s pre-accident restrictions are relevant to the categorisation of her impairment on the PIRS. The insurer submits that the claimant’s reported deficits in the PIRS are a result of her physical restrictions, which it says are long-standing, arose pre-accident, and are not attributable to the claimant’s psychological injury.
In respect of the assessments before the Panel, the insurer notes it does not rely on Dr Anand’s report dated 11 November 2022. It also submits that Dr Anand’s assessment under the PIRS did not comply with the Guidelines and says Dr Anand incorrectly attributed some of the claimant’s physical restrictions to her psychological injury, resulting in an incorrect classification. The insurer further submits that Dr Anand failed to address inconsistencies between the claimant’s pre- and post- accident restrictions.
In respect of Dr Rastogi’s reports dated 22 May 2022 and 11 November 2022, the insurer submits that Dr Rastogi did not consider the claimant’s pre-accident restrictions. Accordingly, the insurer says Dr Rastogi’s PIRS assessment is not reflective of the claimant’s restrictions resulting from her alleged psychological injury resulting from the accident.
The insurer makes a similar criticism in respect of Medical Assessor Friend’s PIRS assessment and submits that it largely refers to the claimant’s pain and her physical rather than psychological impairments. The insurer also submits that Medical Assessor Friend failed to raise clear inconsistencies with the claimant as required by the Guidelines.

Claimant’s submissions

The claimant relies on her submissions dated 19 March 2024 regarding the insurer’s application for review of the certificate of Medical Assessor Friend.
Relevantly, for the purposes of the Panel’s determination, the submissions note that the clinical judgment of the Medical Assessor is the most important factor in determining which class a claimant’s impairment falls. It is submitted that the Medical Assessor adequately assessed the claimant, relying primarily on his clinical judgment, as he was required to do.

The claimant submits that, while the Medical Assessor has gone on to include the claimant’s physical impairments in his reasoning, this has not factored into his overall assessment at least in so far as adding to her psychological impairment.
The claimant submits that the claimant’s relationship with her husband broke down due to his “lack of contribution to the household and lack of support” and that this is directly related to the accident. This is because the claimant’s requirement for support and additional contribution to the household is on account of her physiological impairment.
The claimant submits that, while there is record that the claimant was receiving psychological treatment prior to the accident, there are no clinical records of those treatments that reflect this and no evidence the claimant was prescribed any psychiatric medication. She submits there is no evidence of any pre-accident impairment on which to base a diagnosis or assess a level of impairment.

EVIDENCE

Application for Personal Injury Benefits

The claimant’s application for personal injury benefits dated 12 August 2020 has been considered by the Panel. This reports her injuries to be “My neck, shoulder, arms, back and knees”. She reporting having existing back pain at the time of the accident.
She describes the accident as “I was heading north on Benera Rd, Preston, with my daughter Mariam. Coming from Edmondson Park and heading home to Busby. Approaching the intersection at Benera Rd and Bomaderry Drive, I seen [sic] the car preparing to turn right onto Wroxham St. The light was green for me so I continued to proceed and the car turned in front of me”.

Statements of the claimant

The claimant’s statements dated 7 September 2022 and 17 August 2023 have been considered by the Panel.
These statements outline the claimant’s recollection of the accident and the injuries she is said to have sustained as a result. They refer to the claimant’s living situation and pre-accident health. Relevantly, the claimant says that she had not been diagnosed with any psychological illness or injury pre-accident, nor was she undergoing any treatment or on any medication for psychological injuries. The claimant says she was happy and social before the accident.
The claimant says the accident caused significant damage and “was extremely frightening”.
Since the accident, the claimant says she has been under the care of both her general practitioner, Dr Augusto Tablante, and a psychologist, Dr Emily Kwok. She previously consulted Dr Kwok every two to four weeks, but ceased seeing her at the start of 2023 as she “did not find any benefit in doing the same treatment over and over again”.
At the time she was referred to Dr Kwok in August 2020, she was having a lot of difficulty recovering from the accident and was having recurrent flashbacks, trouble sleeping and severe mood swings. The claimant notes that Dr Kwok diagnosed her with post-traumatic stress disorder.
The claimant’s statements set out the physical and psychological impact she says the accident has had on her life and relationships. This includes hardly leaving the house, difficulties with memory and concentration, and having lost all enjoyment of things, in particular dancing and socialising. She has anxiety, trouble sleeping and constant negative thoughts.
Her relationship with her children and ex-husband has deteriorated due to her frustration and anger, and she feels like she is a burden on everyone.
The claimant reports that she feels very anxious about being in the area where the accident happened and does not like being in a car, whether as a driver or passenger. She is able to drive a vehicle for short periods.
The claimant reports that pre-accident she used to host events, went out with friends and enjoyed dancing.
She continues to have nightmares and flashbacks of the accident which keep her awake at night. She reports that she has constant negative thoughts, is scared and anxious, and her mind is always at the scene of the accident.
The claimant reports her depression is increasing with time and she sometimes has suicidal thoughts. She is self-conscious of her condition and does not want to see family or friends.
The claimant has been prescribed medication for her depression and insomnia, but she has yet to take it as she is concerned as to possible side effects.

Independent Medical Report

Dr Mohammed Assem

The independent medical report of Dr Mohammed Assem, rehabilitation specialist, dated 18 May 2022 has been considered. Dr Assem examined the claimant on 18 May 2022.
The report of Dr Assem focused on the claimant’s physical injuries resulting from the accident. He noted that she had a depressed affect. He also noted that the claimant continues to complain of chronic widespread pain that is confounded by underlying anxiety and depressive symptoms. Dr Assem noted her diagnosis of post-traumatic stress disorder.
It was noted that the claimant is independent in her personal hygiene but requires assistance with most of her activities of daily living and transport due to her injuries.

Dr Richa Rastogi

Dr Richa Rastogi, psychiatrist, examined the claimant on 26 May 2022 and provided a report dated 26 May 2022.
Dr Rastogi noted the circumstances of the accident, the claimant’s physical injuries and her psychiatric symptomology since the accident. Her current symptomology and activities of daily life functioning was noted.
Dr Rastogi reported that, at the examination, the claimant’s mood was anxious and her affect was restricted. She reported anxiety with avoidance behaviours and psychological arousal. She reported flashbacks and nightmares of the accident and feeling lost.
Dr Rastogi opined that the claimant qualified for a diagnosis of post-traumatic stress disorder. She opined that the claimant’s current functional impairments are associated with post-traumatic stress disorder with symptoms of intrusive nightmares, arousal, avoidance of driving, excessive fears and catastrophic thinking with reactivity. The claimant reported emotional dysregulation, startled responses and avoidance of high stimulus environment with high levels of irritability. Her sleep, appetite and motivation were poor. She is very aroused with avoidance and is socially restricted.
Dr Rastogi opined the claimant had a 17% whole person impairment and that she had reached maximum medical improvement.
Dr Rastogi prepared a supplementary report on 11 November 2022. Dr Rastogi was asked to opine on whether the claimant satisfied criterion G and H of DSM-V for post-traumatic stress disorder.
In respect of criterion G, Dr Rastogi noted that the claimant “has demonstrated marked impairment in her functioning as a consequence of the subject motor accident. She is socially reclusive and isolated, withdrawn form pleasurable activities, has limited driving due to anxiety and physiological arousal impacting her independence, separated from her husband post-accident due to conflict and lack of intimacy stemming from anxiety and mood dysregulation with emotional detachment.”
In respect of criterion H, Dr Rastogi noted that the claimant’s post-traumatic stress disorder is directly attributed to the accident and not attributed to a medical condition or substance abuse disorder.
Dr Rastogi also set out how the claimant satisfied the other DSM-V criteria for post-traumatic stress disorder.

Dr Ashwinder Anand

Dr Ashwinder Anand, psychiatrist, examined the claimant on 11 November 2022 and provided an independent medical examination report dated 23 November 2022.
Dr Anand opined that the claimant met the DSM-V criteria for post-traumatic stress disorder. Dr Anand opined a whole person impairment of 15%, with no adjustment for a pre-existing condition and no adjustment for the effects of treatment.
Dr Anand provided a second report dated 17 February 2023. This report also referred to the examination of the claimant on 11 November 2022. Dr Anand made an adjustment of 2% for a pre-existing condition, and opined 13% whole person impairment.

Clinical notes

Liverpool Health Service

The discharge referral of Liverpool Hospital dated 11 July 2020 has been considered.
This report notes that the claimant was admitted to Liverpool Hospital following the accident for observation. Her scans did not show any significant injuries and she was discharged on simple analgesia.
A CT of her cervical spine, a CT of her thoracic aortogram and a CT of her abdomen and pelvis were undertaken. The reports of these studies have been considered.

Dr Emily Kwok

The psychological treatment progress report of Dr Emily Kwok, psychologist, dated 16 December 2020 has been considered. The claimant was referred to Dr Kwok by her general practitioner, Dr Tablante, on 12 August 2020 for the purpose of treating post-traumatic stress disorder secondary to the accident, contributing to aggravation of her physical pain.
It is noted that the claimant had attended five sessions as at the date of the 16 December 2020 report. The claimant’s symptoms included flashbacks and intrusive memories, anxiousness when driving, stress related to the reduction in her physical capacity and functions, adjustment difficulties and panic attacks, poor concentration and memory, and physical pains from the injury.
The psychological treatment progress report of Dr Kwok dated 3 June 2022 has been considered.
The claimant had attended 24 psychological therapy sessions with Dr Kwok as at the date of the June 2022 report. The content of the report, including the presenting issues and treatment, have been considered. It is noted that Dr Kwok initially diagnosed the claimant with adjustment disorder. However, her pain condition was noted to be ongoing, and she had not returned to her pre-injury functioning. Her intrusive memories of the accident, lack of motivation to go out, and her anxiety when driving had also persisted. Accordingly, Dr Kwok opined that her symptoms now satisfy the criteria for post-traumatic stress disorder.

Dr Renata Bazina

The clinical records of Dr Renata Bazina, neurosurgeon, under cover letter dated 9 May 2022 have been considered, including the radiological imaging reports.

Dr Augusto Tablante

The clinical records of Dr Augusto Tablante, general practitioner, have been considered and evaluated.
On 7 December 2016, it is noted that counselling and antidepressants were discussed with the claimant due to issues with her partner. She declined both.
On 30 November 2018, it is noted “Patient still under a lot of stress secondary to relationship issues with partner”.
On 21 March 2019, it is noted “Patient involved in a motor vehicle accident yesterday. Hit on the side as patient was turning left on an illegally parked car. Now complaining of right of neck and upper back myalgia”. It is noted that this is not the subject accident.
On 13 July 2020, it is noted “Patient involved in a motor vehicle accident on Friday with subsequent syncopal episode. Was seen at the hospital”. This is the subject accident.
On 12 August 2020, it is recorded “patient with post-traumatic stress disorder secondary to latest motor vehicle accident contributing to the aggravation of her pain. Patient also has recurrent flashbacks, unable to sleep and has severe mood swings”.
The records include referral letters, including to the Better Mental Health Access Scheme dated 12 August 2020 regarding the claimant’s “post-traumatic stress disorder secondary to latest motor vehicle accident contributing to the aggravation of her pain”.
An “NDIS Access Request – Supporting Evidence Form” which is undated is included in the records of Dr Tablante.
(a)    Under “Social Interaction” it is noted “The patient is under the care of the clinical psychologist due to chronic depression associated with her profound deafness making it more difficult for her to look after her children”.
(b)    Under “Self-care” it is noted “The patient needs assistance from another person in the areas of the above including showering, dressing and occasional toileting during acute attacks of severe arthritis affecting her weightbearing joints as well as her lumbosacral spine making it difficult for her to mobilize making her increase her risk of falls as well as previously stated analgesics causes her to become drowsy.” [sic]
(c)    Under “Self-Management” it is noted “The patient is unable to do her normal daily activities, which include mainly housework. The patient has been unable to do garden maintenance; requires other people to help maintain her garden including lawn mowing. The patient also requires help in regard to cleaning the home due to restricted mobility secondary to pain.”
A questionnaire regarding the claimant’s separation with her husband, completed by Dr Tablante, dated 16 January 2020 has been considered. This notes that the separation took place on 16 December 2019.
The Centrelink Carer Payment and/or Carer Allowance Medical Report completed by Dr Tablante on 1 May 2015[15] has been considered. This notes that the claimant shows signs of depression “Most of the time” and “Sometimes” withdraws from social contact.
[15] The Panel notes that this date is somewhat illegible due to the scan quality and has used its best endeavours to interpret the date.

Medical Centre 2000

A note dated 23 October 2008 prepared by Dr Ismail Mohamed, general practitioner, has been considered. This refers to a motor vehicle accident on 8 November 2005, in which the claimant is reported to have suffered soft tissue injuries to her lumbar and cervical spine.

Allied Health Recovery Requests

The Allied Health Recovery Request forms have been considered. The Panel notes that all forms list the “Date of injury / accident” to be 8 November 2005, which is not the date of the subject accident. In the absence of any submissions on this issue, the Panel has assumed this is a typographical error and the “Date of injury / accident” should read “10 July 2020”.
The request form dated 9 October 2020 notes a diagnosis of “adjustment disorder with anxiety” and lists current symptoms as “poor memory and concentration; sleep disturbance; traumatic memory and flashbacks; stress from loss of function; anxiety when driving; panic attacks”.
The request form dated 16 April 2021 notes a diagnosis of “adjustment disorder with anxiety” and lists the current symptoms as “anxiety related to accident, pain interfering with daily functions and sleep, feelings of inadequacy and guilt, panic and intrusive memories of accident”.
The request form dated 24 March 2022 notes a diagnosis of “post-traumatic stress disorder” and lists the current symptoms as “intense fears of MVA; avoidance of social interactions due to fear of accident; spending a lot of time at home (which was worsened by the impact of COVID); sleep disturbance, nightmares, anxiousness in the nighttime; intrusive thoughts of accident and flashbacks, and physical pain from injury”. “Chronic pain condition” is listed as a factor that has impacted on progress.
The request form dated 15 July 2022 notes a diagnosis of “post-traumatic stress disorder” and lists the current symptoms as “Recurrent intrusive memories of the MVA; Anxiousness while driving; Sleep disturbance; Self-blame and guilt (related to perceived inability to properly look after the family due to her injuries); Impaired ability to plan and organise”.

Radiological imaging reports

The radiological imaging reports have been considered.

MEDICAL EXAMINATION

The claimant was examined by Medical Assessors Canaris and Gupta via Microsoft Teams. She was at her solicitor’s office. Medical Assessors Canaris and Gupta were in their respective offices. Elizabeth Temple, a professional Auslan interpreter, was present throughout.

Pre-accident history

The claimant is a 49-year-old single parent who is on the disability support pension.
She has six children, being four sons and two daughters, of whom the youngest is 16 years of age.
She denied any history of psychiatric illness. The Panel drew her attention to her application for the NDIS which mentioned depression and to the Centrelink carers form applications which refer to her having depression “most of the time”. She maintained she was “100%” right up to the time of the accident. She later indicated that her doctor had not understood her. She said she did not get any NDIS support.
She had been otherwise medically well.
She does not drink alcohol. She does not smoke. She does not use drugs. She does not gamble.
She denied any history of problems with the law. She had no other claims history apart from her 2005 motor vehicle accident. She said of this accident, “It wasn’t that bad… it was only a little hit in the back, and I had a little bit of pain – not like the second accident which was so terrible”.
She knew of no family history of psychiatric illness.
She has four brothers. She is the second eldest of her siblings. Her mother died of cancer in March this year and “she was my world”. Her father is still alive. Her parents had worked on a vegetable farm. Her father had an injury three years ago and “can’t move a lot”.
She was born and raised in Australia. She was born hearing but at a young age became profoundly deaf. She subsequently had surgery which restored some of her hearing.
She recalled a happy childhood and spoke of being in a signing choir.
She completed year 12 and then “went to get a man from overseas and I wish I never had”.
She said of her ex-husband, “He’s a good man but it was all about himself and when I had the car accident everything changed – he didn’t help me out at all after the accident – so I told him to leave… he wouldn’t help me at all”.

The accident

The claimant said she was involved in a motor vehicle accident about four years ago. She was driving with her daughter. She said, “I really don’t want to talk about it”. She recalled, “I didn’t know what happened… I blacked out… after about 5 minutes, I hear my daughter… I’m holding her hand – I thought it was a fire, but it was the airbag… my daughter tried to open the door… my hand was hurting – it was all black… later on I faint on the ground… later on they told me what happened…”.
She was taken to hospital “but they were so rude… it was the Covid virus… I went home… next day, I could not move my body… I been going to the doctor… later on I couldn't sleep – I call the doctor [to say] I can't sleep… he gave me a pain killer…”.

History of symptoms and treatment

She said, “I don’t sleep – it hurt – every 4 hours – 5 hours… I get up and I’m going to choke… I keep going to doctor but I hate it…”.
She has pain, dizziness, and headaches.
She nominated her problems as being unable to do the things she wanted to do. She said she could not drive, and she felt very anxious. She “can’t have fun anymore – I can’t do what I like”. She does not get on a bus or train, saying she is uncomfortable. She said that if she did not have pain she would be able to get on if she was with someone.
She said she does not want to go along the road on which the accident occurred. She still drives “but not more than 10 minutes” saying she gets scared.
She reiterated, “I wish it never happened”. She said, “I don’t want my children to be hurt – I want to be there for them”.
She said, “My children drive more than me – I can’t be by myself for a long time”.
She said of her mood, “It hurts – I feel I’m dead”.
She said, “I can’t stay in the shower more than 5 minutes – I can’t breathe – I’m in bed and I feel like I’m choking”. She hence showers twice a week whereas before she showered daily. She would change her clothes with similar frequency. She said, “I don’t want to change – I don’t go anywhere…”.
Her daughter helps her with cooking because she can only stand for brief periods. She and her daughter cook together – some of the problem is that she can’t lift anything. She would cook “just dinner”. She might cook three times a week. She would tell her daughter what to do “because I can’t do it” because “I can’t stand for more than five minutes because of the impact – I can’t use my left hand properly”.

She gets help from her daughter with cleaning – she would “only do my room a little bit”.
She does not enjoy her food and has lost about 10 kg.
She would buy only small items from the shops “because I can’t carry anything” and usually her daughter would contact her on the phone by FaceTime. She would not go out shopping “firstly because of the pain and because I’m scared – I don’t want to hurt my daughter… I don’t want to have an accident and cause anyone harm”.
She said she would “do everything” before the accident, including taking her children to school, to sport, and their activities. She said her favourite activities included ice skating and dancing which she has not been able to do since the accident “because I’m scared the people are going to hit me and bump me and I’m going to hurt myself – when it’s cold, I get a lot of pain – it really exacerbates it”.
She said, “I get panic attacks now – I can feel the tension in my chest and it’s hard to breathe”.
She said she no longer goes out socially. People ask her what is wrong or allude to their history together “but I can’t remember – I don’t have a memory – so I get embarrassed – I can’t connect with people… I stay with my kids – they protect me…”. She has not been anywhere in the last three months. She no longer associates with her deaf friends “and I can’t sign like I used to because of the injury to my left arm”. She did not do anything for her birthday – someone brought a cake to the house.
She said her husband departed the marriage after the accident. He still sees the children and lives about a ten-minute drive from the children. It was pointed out to her that her GP’s records stated he had left in 2020. She then said that there may have been an occasion that he had left for two months before the accident but had come back saying he would improve. She saw the second accident as “a test” to see if he would do anything for her which “proved that it wasn’t a good marriage”.
She would “sometimes get anxious with my children” but she is “very grateful to my beautiful children because they’re protecting me… before the accident, I did everything for my children… now the roles are reversed”. She admits to arguments but her children “understand why I’m like this… what I’m going through…” but “sometimes I’m too much – I have pain – I blame myself – I feel like I’m hurting my children – sometimes when I argue with them, I don’t want them to be depressed about me…”.
She said, “I can’t sleep – my eyes are really impacted as well – this eye gets affected… because I haven’t had in sleep” and she spoke of her right eye getting very twitchy because of lack of sleep.
Her concentration is “terrible” and “I feel like I can’t concentrate at all”. She does watch TV “only in my room – not with my children – I can’t have any distraction – I might watch for two hours – sometimes I can follow the program – sometimes I get distracted”. She reads on her phone though “only for 30 minutes because my eye gets very tried and twitches and if the light is too bright, it affects me…”. She said in relation to housework tasks, “I can’t finish anything – I get anxiety…”. She added, “I can’t remember things I did – one time I left the iron on – people said they could smell the smoke… I nearly burnt the house down because I left the stove on…”. She gets into trouble sometimes because she forgets to pay her bills and her daughter and son are always reminding her.
She was not working before the accident “because I’m a stay-at-home mum” saying she got married and had children. She had decided to do a TAFE course hoping to set up a cake making business which she was not able to do because of the accident. At the same time, her limitations in relation to her functioning as a parent and homemaker were readily apparent but these from her description were very much physical in origin.
She admitted that much of her stress related to physical problems “but I also have a lot of panic to do with memories of the accident – I was never like this before”.
Treatment seems to have been limited to some sessions with a psychologist.

Mental state examination

The claimant presented as an overweight woman who wore a hijab. She provided the history documented above. She was teary over the course of the interview and very demonstrative although the latter partly reflected her use of Auslan. There was no evidence of psychosis or of cognitive impairment. The Panel noted her capacity to maintain focus over an interview extending over 1.5 hours.

Current functioning

Her reported limitations are described above.

Comments on consistency

The Panel noted some inconsistency relating to her account of her pre-accident functioning and attempted to resolve this with the claimant without success.

Documentation

The parties’ submissions have been summarised in detail above. However, for ease of reference, their submissions regarding the PIRS assessment have been briefly restated.

Insurer’s submissions

The insurer’s submissions highlight the contribution of pain and physical problems to the claimant’s limitations in self-care and personal hygiene. The insurer also noted that it was not clear to what extent her functioning had changed following the accident, noting limitations as to self-care and self-management detailed in an earlier application for the NDIS.
It was similarly submitted, in relation to social and recreational activities, that the claimant’s contention that she was active and went out dancing, ice skating, and bowling was difficult to reconcile with her reported pre-existing musculoskeletal symptoms dated 2 June and 2 July 2020 in her GPs clinical records and in her 2019 NDIS application. The insurer submitted the claimant had restrictions in mobility and self-management prior to the accident, and that the objective evidence fails to demonstrate any change in the claimant’s social and recreational activities since the accident.
In relation to travel, the insurer submitted there was evidence that the claimant’s limitations in mobility and travel were reportedly associated with pain in her left knee.
In relation to social functioning, the insurer submitted that the claimant’s separation after the accident had arisen because of her husband’s lack of contribution to the household, rather than as a result of her psychological injury. In respect of losing contact with her friends, the insurer submits that this is because of the pain in her left side which causes her to use her right hand more, meaning she no longer sends text messages.
In relation to concentration, persistence, and pace, the insurer noted that the claimant sat through an interview lasting one hour and 40 minutes answering questions, although she required some clarification of questions.
The insurer disputed the Medical Assessor’s findings in relation to adaptation, again referring to her 2019 NDIS application. The insurer further contended that inconsistencies were not brought to the attention of the claimant and that there had been no apportionment for pre-accident impairment, despite evidence that the claimant had been under the care of a clinical psychologist because of chronic depression associated with difficulties emanating from her deafness and limitations in her ability to care for her children.

Claimant’s submissions

The Panel noted the claimant’s submissions in response. In respect of selfcare and personal hygiene, the claimant states she clearly has a deficit and one that is beyond a “normal variation”.
In respect of social and recreational activities, the claimant notes that Medical Assessor Friend did not accept the claimant’s history that she undertook Spanish and Lebanese dancing in the face of her pre-existing musculoskeletal injuries and that this was not the sole point of his determination. The claimant submits that the Medical Assessor “has correctly recorded a class 3 impairment”.
In respect of travel, the claimant submits that, while there is a relationship with the claimant’s physical injuries, she has a psychological impairment which is consequential to her physical injuries. Accordingly, the claimant submits that the purported failure to address other medical evidence is without merit.
In respect of social functioning, the claimant submits that her relationship breakdown was directly related to the accident. She says that her psychological impairment is why she required support and additional contribution to the household. The claimant submits that she does not see her friends due to her “not wanting to do anything” and because “she does not want anyone to know what has happened to her”. The claimant submits that a class 3 impairment has been correctly allocated.
In respect of concentration, persistence and pace, the claimant submits that there was no evidence of any pre-accident cognitive impairment. The claimant notes that, in Medical Assessor Friends’ assessment of the claimant, she showed difficultly with memory and answering questions and evinced a clear cognitive impairment.
In respect of adaption, the claimant submits that the reasons of the Medical Assessor suggest he is aware that the claimant’s physical injuries are not entirely relevant to the assessment of permanent impairment, and that he has correctly allocated a class 2 impairment.

Other evidence and documentation

The evidence and documentation before the Panel has been summarised in more detail above. For ease of reference aspects of the documents have been briefly restated.
The Panel noted photographs of the vehicle showing substantial damage.
The Panel noted a range of documents relating to physical issues.
The Panel noted the claimant’s statements dated 7 September 2022 and 17 August 2023. In particular, the claimant contended that she had not had any psychiatric condition before the accident.
The application for personal injury benefits makes no mention of psychological symptoms.
The Panel noted a series of treatment reports and allied health recovery requests from Dr Emily Kwok, psychologist, which refer to a diagnosis of post-traumatic stress disorder.
The Panel noted correspondence from the claimant’s GP referring to a diagnosis of post-traumatic stress disorder. It also noted her GP’s records refer to physical problems but do not refer to any pre-accident psychological history, with the exception of two entries regarding relationship issues. However, Centrelink applications for a carer payment/carer allowance in 2014 and 2015 which were supported by her GP refer to depression said to be present “most of the time”. An NDIS access request also refers to “chronic depression”.
The Panel has read and evaluated the IME report of Dr Richa Rastogi, psychiatrist, dated 26 May 2022 and her supplementary report of 11 November 2022. Dr Rastogi made a diagnosis of post-traumatic stress disorder and assessed at 17% whole person impairment rating her as Class 1 for self-care and personal hygiene, Class 2 for travel and social functioning, Class 3 for social and recreational activities and concentration, persistence, and pace, and Class 5 for adaptation. The Panel has considered the reasons provided by Dr Rastogi for her assessment. This has formed part of the Panel’s evaluation and assessment of the claimant’s impairment in accordance with the PIRS categories.
The Panel has noted and evaluated the IME report of Dr Ashwinder Anand, psychiatrist, dated 23 November 2022. Dr Anand diagnosed post-traumatic stress disorder. He rated her at 15% whole person impairment with no deduction for pre-existing impairment or adjustment for treatment effects. He rated her as Class 2 for self-care and personal hygiene, travel, and social functioning and Class 3 for social and recreational activities, concentration, persistence, and pace, and adaptation. In a subsequent report dated 17 February 2023, Dr Anand maintained a diagnosis of post-traumatic stress disorder but made a 2% deduction for pre-existing impairment yielding a final whole person impairment of 13%. The Panel has considered the reasons provided by Dr Anand and his assessment. This has formed part of the Panel’s evaluation and assessment of the claimant’s impairment in accordance with the PIRS categories.
The Panel has noted and evaluated the certificate of Medical Assessor Paul Friend dated 18 December 2023 yielding a diagnosis of post-traumatic stress disorder with a whole person impairment of 15%. He rated her as Class 2 for self-care and personal hygiene, travel, and adaptation and Class 3 for remaining categories with no adjustment for treatment effects or deduction for pre-existing impairment. The Panel has considered the reasons provided Medical Assessor Friend for his assessment. This formed part of the Panel’s evaluation and assessment of the claimant’s impairment in accordance with the PIRS categories.

PANEL’S DETERMINATION

Diagnosis

The Panel determined that the claimant’s presentation was consistent with a diagnosis of post-traumatic distress disorder.
In terms of DSM-5-TR criteria, the accident as described and as evidenced from the damage to vehicles conforms to a Criterion A event. There was evidence of involuntary, distressing, and intrusive symptoms including nightmares, anxiety driving and in cars, and flashbacks, the latter figuring prominently in other clinician reports (Criterion B). There is persistent avoidance of stimuli associated with the traumatic event manifest in her reluctance to drive other than for short distances (Criterion C) and evidence of negative alterations in cognitions and mood manifested in her statement to the effect that she felt “dead”, her teariness at the medical examination, and in her withdrawal from activities including social and recreational activities (Criterion D). There was evidence of marked alterations and arousal and reactivity manifest in panic attacks, sleep disturbance, problems with concentration, and hypervigilance (Criterion E). Her symptoms had been continuously present for almost five years (Criterion F). Her clinically significant distress was apparent at the medical examination as well as manifest in her difficulty driving, withdrawal from social and recreational activities, and problems with concentration, persistence, and pace (Criterion G). Her symptoms were not attributable to the physiological effects of a substance or to another medical condition (Criterion H). Depressive symptoms were apparent but were considered to be subsumed within the negative alterations in cognitions and mood criterion of the post-traumatic stress disorder diagnosis.

Causation

While there was evidence of prior depression as was apparent in the claimant’s NDIS application and the application for carer allowance/payment, the history on offer indicated at the very least considerable intensification of her depressive symptoms together with post-traumatic symptoms.
Accordingly, the Panel finds that the accident could have caused or contributed to worsening of her depressive symptoms and, on balance, did do so.
The Panel finds that the claimant’s post-traumatic stress disorder arises as a consequence of the accident.

Permanent impairment

The clinical judgment of the Panel’s Medical Assessors, both of whom are psychiatrists, is the most important tool in the application of the PIRS: cl 6.127 of the Guidelines. The impairment rating ascribed to the claimant is based on the Medical Assessors’ clinical experience.
Ultimately, it is the Panel’s task to assess the degree of impairment rather than settle the disputing positions of the parties.[16]
[16] Keen at [40].
As noted by cl 6.125 of the Guidelines, the PIRS must not be used to measure impairment due to pain.
In undertaking its assessment of each category of the PIRS, the Panel has considered the documentary evidence before it as summarised earlier in the reasons. Given the lengthy nature of this documentation, it has not been re-referenced under each PIRS category but has been taken into account in the Panel’s evaluation.
The Panel has considered the class descriptors for each category of functioning in the PIRS and has evaluated the history provided by the claimant when she was re-examined by the medical members of the Panel.
The Panel has used the diagnosis of post-traumatic stress disorder for the purposes of assessing the claimant’s impairment.

Psychiatric diagnoses	Post-traumatic stress disorder
Psychiatric treatment description	N/A
Category	Class	Reason for decision
1. Self-care and personal hygiene	2	The Panel finds that the impairment caused by the claimant’s psychiatric diagnosis is mild and is consistent with Class 2. This is because of the considerable contribution of her physical injuries and pain to her limitations. The claimant said, “I can’t stay in the shower more than 5 minutes – I can’t breathe – I’m in bed and I feel like I’m choking”. She hence showers twice a week whereas before she showered daily. She would change her clothes with similar frequency. She said, “I don’t want to change – I don’t go anywhere…”. Her daughter helps her with cooking because she can only stand for brief periods. She and her daughter cook together – some of the problem is that she can’t lift anything. She would cook “just dinner”. She might cook three times a week. She would tell her daughter what to do “because I can’t do it” because “I can’t stand for more than five minutes because of the impact – I can’t use my left hand properly”. The Panel notes her impairment and restrictions in respect of cooking are predominately physical in nature. She gets help from her daughter with cleaning – she would “only do my room a little bit”. She does not enjoy her food and has lost about 10 kg. She would buy only small items form the shops “because I can’t carry anything” and usually her daughter would contact her on the phone by facetime. She would not go out shopping “firstly because if the pain and because I’m scared – I don’t want to hurt my daughter… I don’t want to have an accident and cause anyone harm”. As noted above, the Panel recognises a mild impairment due to her psychiatric injuries.
2. Social and recreational activities	3	The Panel finds moderate impairment. The Panel elicited the following history: (a) She said she no longer went out socially. People ask her what is wrong or allude to their history together “but I can’t remember – I don’t have a memory – so I get embarrassed – I can’t connect with people… I stay with my kids – they protect me…”. She has not been anywhere in the last three months. (b) She no longer associates with her deaf friends “and I can’t sign like I used to because of the injury to my left arm”. She did not do anything for her birthday – someone brought a cake to the house. Notwithstanding a contribution from physical problems (her difficulties with signing), this is consistent with Class 3 impairment. The Panel notes her statements that she enjoyed Lebanese traditional dancing and would participate in such dances “all the time”. The Panel places little weight on this statement based on the medical evidence before it. In any event, even if there was evidence of the claimant undertaking these activities prior to the accident, this would not change the Panel’s assessment of a class 3 impairment for this category.
3. Travel	2	The Panel finds mild impairment. The Panel elicited the following history: (a) She said she does not want to go along the road on which the accident occurred. She still drives “but not more than ten minutes” saying she gets scared. (b) She is able to travel without a support person in familiar areas. She reported that she does not use public transport due to being uncomfortable, but noted that if she did not have pain, she would be able to get on if she was with someone. She is able to drive independently for short periods on known routes, such as to her appointments. She is reluctant to drive other than for short distances. This equates to Class 2 impairment in this category.
4. Social functioning	3	The Panel finds a moderate impairment. The Panel elicited the following history: (a) She said her husband departed the marriage after the recent accident. He still sees the children and lives “about a ten-minute drive from the children”. It was pointed out to her that her GP’s notes stated he had left in 2020. She then said that there may have been an occasion that he had left for two months before the accident but had come back saying he would improve. She saw the second accident as “a test” to see if he would do anything for her which “proved that it wasn’t a good marriage”. (b) She would “sometimes get anxious with my children” but she is “very grateful to my beautiful children because they’re protecting me… before the accident, I did everything for my children… now the roles are reversed”. She admits to arguments but her children “understand why I’m like this… what I’m going through…” but “sometimes I’m too much – I have pain – I blame myself – I feel like I’m hurting my children – sometimes when I argue with them, I don’t want them to be depressed about me…”. Notwithstanding any difficulties before the accident, the breakdown of her marriage equates to Class 3 in this category. While she reports her relationship with her children to be strained, she has sustained these relationships. The Panel has considered the impact her functioning has had on her friends and socialisation. While she reports no longer socialising with her friends and limiting visits with her father, there is no evidence of arguments, or those relationships having ended as a result. The Panel does not consider this equates to a class 4 or 5 impairment.
5. Concentration, persistence and pace	2	The Panel finds a mild impairment. The Panel elicited the following history: (a) Her concentration is “terrible” and “I feel like I can’t concentrate at all”. (b) She does watch TV “only in my room – not with my children – I can’t have any distraction – I might watch for two hours – sometimes I can follow the program – sometimes I get distracted”. (c) She reads on her phone though “only for 30 minutes because my eye gets very tried and twitches and if the light is too bright, it affects me…”. (d) She said in relation to housework tasks, “I can’t finish anything – I get anxiety…”. She added, “I can’t remember things I did – one time I left the iron on – people said they could smell the smoke… I nearly burnt the house down because I left the stove on…”. She gets into trouble sometimes because she forgets to pay her bills and her daughter and son are always reminding her. As aligned with class 2, the Panel notes that the claimant can read for up to 30 minutes and can concentrate sufficiently to watch television for up to two hours if she has no distractions. Given the claimant has not previously undertaken any paid employment, voluntary work or study, the Panel considers that constitutes intellectually demanding tasks as per the descriptor in class 2 of the PIRS. The claimant was able to engage with the Auslan interpreter for the duration of the assessment in a three-way concentration with no evidence of a lack of focus. The Panel considers that some of the examples provided, such as “one time I left the iron on” demonstrate a level of distractibility rather than a level of major impairment of concentration, persistence and pace. The level of the claimant’s functioning has been considered and her frequency of doing these deficits. Using clinical judgement, the Panel finds a Class 2 impairment.
6. Adaption	2	The Panel finds mild impairment. The Panel elicited the following history: (a) She was not working before the accident “because I’m a stay-at-home mum” saying she got married and had children. (b) She says she had decided to do a TAFE course hoping to set up a cake making business which she was not able to do because of the accident. At the same time, her limitations in relation to her functioning as a parent and homemaker were readily apparent but these from her description were very much physical in origin. The Panel determined that this equated to Class 2 impairment. Prior to the accident, the claimant had not undertaken paid employment. Due to her disabilities as evidenced in the medical records, the Panel considers it would have been problematic for her to enter the workforce. The Panel considers that the majority of her impairment is physical in nature and her pain or perceived pain is a principle contributor. Any impairment from a psychological impairment is mild.
List classes in ascending order: 2, 2, 2, 2, 3, 3
Median Class Value: 2
Aggregate Score: 14
% Whole Person Impairment: 7%

Pre-existing injuries

Although the claimant had significant impairment before the accident, this appears to have been predominantly physical in origin. Further, while the Panel notes the references to “depression” in the claimant’s Centrelink and NDIS forms, there is no evidence of the claimant receiving psychiatric or psychological treatment in the period prior to the accident. There is no evidence upon which to base a diagnosis or assess a level of impairment pre-accident. There is also no history of the claimant being prescribed psychiatric medication prior to the accident. Accordingly, the Panel makes no deduction for pre-existing impairment.

Subsequent injuries

There is no evidence of subsequent injuries. Accordingly, the Panel makes no adjustment for subsequent injuries.

Adjustment for effects of treatment

There is no evidence that the claimant is receiving treatment for her psychological or psychiatric symptoms. She has been prescribed medication but reports refusing to take it. Accordingly, the Panel makes no adjustment for the effects of treatment.

CONCLUSION AND CERTIFICATION

For the above reasons, the Panel finds that:
(a) The claimant’s psychological injury caused by the accident, being post-traumatic stress disorder, has resulted in a degree of permanent impairment of 7%; and
(b) The degree of permanent impairment of the claimant that has resulted from the post-traumatic stress disorder caused by the accident is not greater than 10%.
Accordingly, the Panel revokes the certificate of Medical Assessor Paul Friend dated 18 December 2023.
The Panel issues a new certificate certifying that the degree of permanent impairment that has resulted from post-traumatic stress disorder caused by the accident is not greater than 10%.

[2025] NSWPICMP 422

17 June 2025