Insurance Australia Limited t/as NRMA Insurance v Awada
[2025] NSWPICMP 754
•5 September 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Insurance Australia Limited t/as NRMA Insurance v Awada [2025] NSWPICMP 754 |
CLAIMANT: | Ali Awada |
INSURER: | IAG Limited trading as NRMA Insurance |
REVIEW PANEL | |
MEMBER: | Alexander Bolton |
MEDICAL ASSESSOR: | Paul Friend |
MEDICAL ASSESSOR: | Alan Doris |
DATE OF DECISION: | 5 September 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; Personal Injury Commission Rules 2021; review of decision of Medical Assessor (MA) who assessed the claimant as having 18% whole person impairment (WPI) and diagnosed a persistent depressive disorder and a social anxiety disorder; claimant involved in an accident; issue of whether the claimant’s psychiatric disability was affected by his physical injuries and disabilities; claimant examined by the Review Panel following which the insurer sought to rely upon a medical report without having previously sought the claimant’s consent and notifying the Review Panel that the claimant was being medically examined; Review Panel determined that it would not accept the late reported in evidence; Review Panel assessed the claimant as having a 7% WPI and diagnosed a persistent depressive disorder with anxious distress; certificate of MA revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Determination: 1. The Panel revokes the certificate of Medical Assessor Shen dated 6 June 2024. 2. The Panel has examined the claimant and determined that he has a Persistent Depressive Disorder with Anxious Distress. 3. The Panel has assessed the claimant as having 7% whole person impairment. |
STATEMENT OF REASONS
INTRODUCTION
This is an application by the insurer for review of a certificate and reasons of Medical Assessor Shen dated 6 June 2024. The Medical Assessor assessed the claimant as having a whole person impairment (WPI) of 18%.
The Medical Assessor diagnosed the claimant as having a Persistent Depressive Disorder and a Social Anxiety Disorder.
The following injuries were referred by the Personal Injury Commission (the Commission) for assessment:
(a) psychological condition, and
(b) psychological injuries.
Bundles of documents
The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
The fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned – see WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46].The Panel is not required to “analyse every piece of information from every opinion contained in a document with which he [it] was provided” – see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel has come to its own conclusion and has taken its own history.
The accident
The accident occurred on 14 November 2019. The claimant was driving down a sloping street at 40-50kmph when a car entered the road from his left, and a collision occurred. Police and ambulance officers attended. The claimant was taken to hospital by ambulance.
Insurer’s submissions
The insurer submits that the Medical Assessor has applied the incorrect test for causation of injury and asked himself the wrong question. The insurer submits the Medical Assessor has applied the wrong test for causation in that he considered there was a plausible mechanism of injury when the correct test is whether the injury was caused or materially contributed to by the subject accident.
The insurer referred to the Medical Assessors assessment of class 5 for Adaptation under the Psychiatric Impairment Rating Scale (PIRS).
The insurer submits that the Medical Assessor has not delineated between the claimant’s alleged left shoulder pain and emotional distress with regards to the claimant’s capacity to work. The insurer says that the Medical Assessor appears to combine the effects of both pain in the left shoulder and the claimant’s emotional distress to say that the claimant is totally impaired from work and cannot work at all. The insurer says that the reasons for the extent to which Assessor Shen’s finding of emotional distress has contributed to what he says is the claimant’s inability to work in any capacity are non-existent.
Additionally, the insurer referred to a handwritten clinical record dated 4 December 2019, a few weeks after the subject accident. The insurer says that this noted the claimant was working and was self-employed.
The insurer says that the Medical Assessor appears to have overlooked that and accepted the claimant’s incorrect history provided at the assessment that he has not returned to work after the subject accident. The insurer says that appears to have been overlooked by the Medical Assessor and that inconsistency was not put to the claimant.
The insurer also notes a reference by Mr Zhao that the claimant saw a psychiatrist every month and yet to the Medical Assessor he said that they had not seen a psychiatrist and had not been on medication. The insurer says that this inconsistency should have been put to the claimant.
Regarding any pre-existing condition of the claimant, the insurer says there is evidence the claimant sustained a prior psychological injury. The insurer says that Dr Lee, psychiatrist, on 3 November 2014 diagnosed the claimant with an adjustment disorder with depressed mood and assessed 19% WPI.
Claimant’s submissions
The claimant submits that the Medical Assessor correctly noted that the claimant’s physical and psychological injuries impact on his ability to work.
The claimant says that the evidence indicates that the claimant does not work as a result of his symptoms arising from his injury caused by the motor accident. The claimant says that the Medical Assessor asked the claimant whether he was working or not and was satisfied with the claimant’s answer.
The claimant says that there is no evidence contrary to the Medical Assessor’s findings that the claimant is employed. The claimant submits that accordingly, the Medical Assessor has correctly considered the criteria for a class 5 impairment.
Regarding the adaptation classification, the claimant submits that the Medical Assessor noted that the claimant suffers from pain and restriction of movement in his left shoulder and suffers from emotional distress caused by the accident resulting in inability to work.
The claimant submits that there are no inconsistencies as the claimant did not undergo psychological treatment. The claimant has been referred to counselling treatment by his general practitioner (GP), however, he has not been able to obtain treatment despite trying to arrange an appointment with two different psychologists and/or counsellors approximately 14-18 months after the accident.
Claimant’s statement
The claimant provided a statement which appears to have been signed on 14 April 2025. The claimant noted that he suffered from anxiety and depression in 2007 and had treatment until his condition resolved around 2010.
Regarding other conditions, he said:
“I was involved in a previous motor vehicle accident on 20 April 2013, where I suffered an injury to my right rotator cuff which required surgery. I also strained my neck, injured my lower back, right knee and pelvis in that accident.
Further to my physical injuries, I sustained a psychological injury as a result of the motor accident in April 2014. I was diagnosed with depression in late 2013 as a result of the motor accident on 20 April 2013. I was required to take medication for my psychological injury, and I was receiving counselling.
I was assessed by MAS for psychological injuries caused by the motor accident on
20 April 2013 and was diagnosed with Adjustment Disorder with Depressed Mood. Both Assessor Samson Roberts and the Assessor Lorraine Dennerstein for the Medical Panel agreed in respect of my diagnosis and I was assessed at 7% whole person impairment in respect of my psychological injury as per Panel Certificate dated 12 November 2015.I did not suffer from psychological injury at the time of the subject accident, and I did not experience any limitations as a result of psychological symptoms at the time or prior to the subject motor accident.”
Following the accident, the claimant said:
“At the time of the subject accident, I considered myself to be working on a part-time basis, as I would only be able to work whenever a customer would contact my business for my services. I estimate that I would work at least one or two times every two to three weeks, earning a monthly amount of approximately $500.00 to $800.00.
As a result of the subject accident however, I have not been able to make a return to my previous working capabilities, by virtue of the injuries and disabilities sustained in the subject accident.
In terms of my physical injury, I primarily have difficulty with moving my left shoulder, as I feel like I currently have weakness and a loss of strength in my left arm, being unable to lift nay items of weight. I also feel like I cannot stretch my left arm out too much or hold it up for too long without feeling any pain, discomfort, and restriction of movement.
I also experience ongoing lower back pain, and pain in my right knee, which affects my ability to stand up for extended periods of time. I therefore was required to stop work. I tried to continue with my business and made attempts working a couple of days, when I was able, however I could not attend to my duties. I stopped my business as a sole trader as well in about 2023.”
Medical Evidence
The Medical Assessor provided his certificate of 6 June 2024.
The claimant said that he sustained pain in his left shoulder, which has escalated over time. He said within a few weeks after the subject accident, he developed psychological symptoms, including insomnia, with recurrent wakening, poor appetite, and mood swings.
Regarding the claimants pre-existing injury, he informed the Medical Assessor that prior to the subject accident, he had no issues. The Medical Assessor pointed out that there was reference to him being depressed in 2007 and requiring treatment. The claimant said in response that he did not know if that was the case, as it was a long time ago. He said he was depressed after the first accident, and there were days when he was upset and depressed, but it had improved over time, but not completely in remission prior to the subject accident, as he was still experiencing distress 10% of the time. He said he was having psychological therapy but had had stopped prior to the subject accident. He could not recall for certain if he was on medication, but thought he was on some form of medication treatment, but not on any medication at the time of the subject accident.
The Medical Assessor diagnosed the claimant as having:
(a) Persistent Depressive Disorder, as he has persistent depressive symptoms which exceed 2 years, and
(b) Social anxiety disorder, due to his fears of negative evaluation from others leading to his avoidance of social interactions and situations.
The Medical Assessor said that the circumstances of the subject accident did not meet Criterion A for the purposes of a diagnosis of post-traumatic stress disorder, as he was not in fear of serious injury or death at the time.
The PIRS assessment was as follows:
| Psychiatric diagnoses | 1. Persistent Depressive Disorder | 2.Social Anxiety Disorder |
| 3. | 4. |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 2 | Since the subject accident, he said he has been showering 3-4 times a week due to reduced motivation, and he is no longer cooking, and relies on his mother instead, and he said he is not doing any shopping at all. |
| 2. Social and Recreational Activities | 3 | Since the subject accident, he said he has no friends now, and he said he has lost friends. I asked when he last communicated with any friends about a month ago. I asked when he last saw a friend, and he said he saw one 2-3 months ago, and they went for a coffee locally. I asked if he no longer consider them friends, and he said he no longer considers anyone a friend anymore. Since the subject accident, he said he no longer enjoys anything. Then he said he sometimes watches football on TV, but he no longer goes out to any social events. |
| 3. Travel | 2 | He said he has been driving once a week, taking his mother shopping sometimes, while he waits in the car. He said he does not drive anywhere alone. |
| 4. Social Functioning | 2 | Since the subject accident, he said his relationship with his -and- and bad-tempered, and they have been having more fights, and he sees her once a week. He said he sees his son daily and less with his daughter, with some good days and bad days, like what it was like prior to the subject accident, though he has been more irritable. His relationship with his siblings remains much the same. His relationship with his mother has remained the same as prior to the subject accident. He said while he was irritable with his family at |
| times prior to the subject accident, it was not as bad as it is now. Since the subject accident, he said he has no friends now, and he said he has lost friends. I asked when he last communicated with any friends about a month ago. I asked when he last saw a friend, and he said he saw one 2-3 months ago, and they went for a coffee locally. I asked if he no longer consider them friends, and he said he no longer considers anyone a friend anymore. | ||
| 5. Concentration, Persistence and Pace | 31. 3 | Since the subject accident, he said his concentration has been poor, and he no longer reads anything, and he can watch the Footy and some fishing shows for up to an hour, and he can watch for the whole duration. He was alert, appeared grossly cognitively intact and was able to sustain his concentration for the duration of the assessment. |
| 6. Adaptation | 32. 5 | Since the subject accident, he is currently not working, and did not return to work after the accident, due to constant pain in the left shoulder, and his emotional distress. |
| List classes in ascending order: 222335 | ||
| Median Class Value:2.5=3 | ||
| Aggregate Score: 17 | ||
| % Whole Person Impairment: 19% | ||
The Medical Assessor assessed 1% WPI for the earlier accident and treatment, giving a total of 18% WPI.
In a discharge summary from St George Hospital, dated 14 November 2019 to
15 November 2019, it was reported that the claimant presented following the accident with no evidence of significant injury.Regarding the claimants earlier psychiatric injury, in an undated letter by psychologist Hichang Khcheich, and clinical notes from 2014, noted the claimant presenting with one year of depressive symptoms with low mood, low concentration, insomnia and multiple pain issues. He was provided with supportive counselling with poor response to therapy and on antidepressant therapy with limited benefit.
Concerning the earlier accident, the claimant was assessed by Medical Assessor Roberts, who gave a certificate dated 19 March 2015. The claimant was diagnosed with an Adjustment Disorder with depressed mood.
It was reported that the claimant had a previous depression in 2007 without any precipitant. He was unemployed and was on medication briefly. Before the accident in 2013, the claimant was treated with Escitalopram and did not respond. He continued to be on Loxalate 10mg daily. Self-care was moderately impaired as he dressed daily and showered daily requiring motivation by his girlfriend and his mother. Social and recreational activities was moderately impaired as he had diminished desire to engage in social activities. Travel was not impaired. Social functioning was mildly impaired as he had a close relationship with his family and a supportive relationship with his girlfriend. Concentration was mildly impaired as he had diminished ability to attend to his movies. Adaptation was mildly impaired. The claimant was assessed by Medical Assessor Roberts as having a 7% WPI.
The claimant sought a review of the certificate of Medical Assessor Roberts which led a certificate of Motor Accident Review Panel dated 12 November 2015. The Review Panel diagnosed the claimant with an Adjustment Disorder with depressed mood. Self-care was mildly impaired. Social and recreational activities was moderately impaired. Travel was not impaired. Social functioning was mildly impaired. Concentration was mildly impaired. Adaptation was mildly impaired. The claimant was assessed as having a WPI of 7% accounting for a 1% impairment for effective treatment.
Dr Lee, psychiatrist, provided a report dated 3 November 2014. The claimant was diagnosed with an Adjustment Disorder following a motor vehicle accident with injuries to his right shoulder, neck, lower back and anxiety. The pain caused him to feel depressed. He was on antidepressant therapy and was seeing a psychologist. Self-care was mildly impaired as he ate irregularly. Social and recreational activities were moderately impaired as he rarely socialised or attended functions. Travel was mildly impaired as he could travel alone locally. Social functioning was mildly impaired as he was more argumentative. Concentration was moderately impaired as he was very slow doing things. Adaptation was totally impaired.
Dr Lee assessed the claimant has having 19% WPI.
A number of reports from the claimant’s bundle of documents and pertaining to his physical injuries.
On 18 May 2020 the claimant was seen by Dr Biggs, orthopaedic surgeon, who had operated on the claimant’s right shoulder six years earlier. He noted the claimant as presenting with "painful and weak left shoulder that dates back to an MVA", with reference to the accident of November 2019. There was acknowledgement of an ultrasound showing a full thickness tear of the supraspinatus tendon, for which surgical intervention was recommended.
On 19 October 2020 Dr Biggs operated on the claimants left shoulder with the Operation Report referring to full thickness retracted delaminated supraspinatus tendon tear, impingement lesion, long head of biceps tendon rupture and intra-articular effusion.
On 19 November.2020 the claimant saw Dr AI-Kawaja, Neurosurgeon, who noted that the claimant "developed lower back pain one week after the accident and that he has been suffering from low back pain without any radicular pain during this time. "Mention was made, of the occasional feeling of paraesthesia in the lateral right thigh.
Dr. AI-Kawaja reviewed an MRI scan, finding no evidence of nerve root impingement. A Bone Scan was, however, requested.
On 14 January 2021 Dr Al-Kawaja reviewed the claimant, noting "possible sacral fracture" seen on the bone scan for which no further treatment was recommended at this stage but there was suggestion for bilateral L3-4 and L4-5 facet joint injections. These were performed on 21 April 2021.
Dr Endrey-Walder, general surgeon, in a report of 4 July 2022, confirmed that the claimant suffered injury to his left shoulder and lower back in the accident of 14 November 2019. He said that early radiology identified significant pathology at the left rotator cuff, as well as rupture of the long head of biceps tendon. He believed that these injuries were caused or significantly contributed to by the accident.
Dr Endrey-Walder assessed WPI for physical injuries at 12%.
Handwritten clinical notes of Dr Awada GP, have been provided. These notes are not referred to in the claimant’s submissions and are very difficult to accurately read, if at all.
Dr Machart, orthopaedic surgeon, provided a report for the insurer, dated 14 October 2022.
The claimant reported that at the time of the accident, he had a job polishing concrete and marble. He worked part-time averaging 20 hours per week. He said that he was unable to obtain a full-time job. There was not enough work available. The claimant said that since the accident, he has not worked, reporting that he was unable to return to the same employment.
Dr Machart said that the severity of disability, no work for 3 years, was not in keeping with the medically defined limitation on his work. He said that the claimant may not be 100% fit for substantially strenuous labouring type of work although given his body build, even that was said to be surprising.
WPI was assessed at 3% for the claimant’s left shoulder injury.
Neither the claimant nor the insured have provided any psychiatric medico-legal reports obtained by them.
Medical Examination
The claimant was examined by Medical Assessor Doris and Medical Assessor Friend on
24 July 2025. Their report follows:
Brief Personal Details
Mr Awada is a 54-year-old single man who lives with his mother and brother. He is in receipt of a carer’s payment as he provides care to his brother who has chronic health problems. He is not currently employed.
Family History
Mr Awada was born in Lebanon and grew up there for the first 14 years of his life. He is one of six children in his family having three brothers and two sisters. He is aware that one brother has chronic mental health problems, though not aware of any other family history of mental health problems. There was some conflict between his parents when he was young, and his parents separated. His father is now deceased. The rest of the family is now resident in Sydney.
Personal History
Mr Awada described a generally positive upbringing in his family though his schooling was disrupted by the war in Lebanon. He sustained a laceration to the forearm in a motor vehicle accident at the age of 6 years when travelling with family to a beach in Kuwait. Other than this, he does not recall any significant health problems during his childhood or adolescence.
Mr Awada came to Sydney with his family at the age of 14 years. He described this move as going well and he felt very positively about settling in Australia. He described making friends easily and enjoying school. He described an active social life in his teenage years, and he enjoyed sports, particularly soccer.
After completing school, Mr Awada worked as a motor mechanic and attended TAFE to gain qualifications in this area. After the business he was working in closed, he worked in a kitchen manufacturing business and then for some time for a commercial cleaning company. He has also worked as a welder and a driver. Approximately 10 years ago Mr Awada joined his brother in a business polishing marble and other stone. He was working part time in this business at the time of the motor accident.
From 1993 or 1994, Mr Awada was in a relationship with a woman for approximately
15 years and has two children from that relationship. He has a daughter who is aged 29 years and his son who is aged 27 years. Since this relationship ended, he has had some other intimate relationships the last one being from 2011 until the end of 2023.
Past Medical History
At the age of 6 years Mr Awada was involved in a motor accident in Kuwait. He suffered a laceration to his forearm.
Mr Awada was involved in a previous motor accident on 30 April 2013. He injured his right shoulder and had rotator cuff surgery on 10 January 2014.
Past Psychiatric History
Mr Awada acknowledged that he had suffered from and been treated for depression from around 2006 until 2010. This is reflected in Job Capacity Assessment reports at that time.
He explained the context was that in 2008 there was conflict between himself and his 13-year-old daughter. At one point she had left home against his wishes and on locating her he assaulted her. The police were involved, and he was given a sentence of weekend detention for a period of three months.
He described developing a depressive syndrome during this time and receiving treatment from his GP. He recalls attending specialist mental health services and participating in a group treatment programme in Bankstown. He said that these interventions were helpful, and with resolution of family difficulties his symptoms resolved.
Mr Awada was involved in a previous motor accident in April 2013. On that occasion he was a passenger in a vehicle driven by his mother. He injured his right shoulder, back and neck. He had surgery to his shoulder.
Mr Awada described developing psychological symptoms following this accident. He recalled being persistently low in his mood, finding it hard to get along with people, and preferring to stay at home. He was not working at the time of the motor accident.
Mr Awada had psychological treatment at that time with psychologist Dr Khcheich who made a diagnosis of adjustment disorder, depression, and chronic pain. He was prescribed the antidepressant medication escitalopram 10mg.
The insurance claim for this motor accident was settled in 2015.
Mr Awada described his mental health as progressively improving and returning to normal from 2017. He estimated that he made a 95% recovery from this motor accident and that his psychological symptoms were improved when he “snapped out of it”.
Substance Use History
Mr Awada is a non-smoker. He does not drink alcohol. He denied the use of cannabis or any illicit substance. He usually has one or two cups of coffee per day and no other caffeinated drinks. He does not gamble.
Forensic history
Mr Awada was convicted of an assault on his daughter in 2008 and served three months of periodic weekend detention.
He has lost his driving licence on more than one occasion. The last occasion being noted in the psychology report from January 2024. Mr Awada explained that on that occasion his son had been borrowing his vehicle and acquiring penalties. Mr. Awada’s drivers’ licence was suspended. He had his licence restored in April 2024.
He denied any other forensic matters.
Current Medication
Ibuprofen and codeine; Panadol Osteo
Pre-accident Functioning
Mr Awada said that before the accident in November 2019 “my life was on track”. He was living with his mother and brother and doing occasional work polishing marble. He said that his mental health was good and that he would socialise often. He said that he would often meet friends for coffee and had had trips away with his girlfriend to Newcastle, Fiji, Wollongong and Queensland.
He had no difficulty in taking care of himself, in relationships with others, or focusing his attention on matters when needed.
History of the Motor Accident
The motor accident occurred after Mr Awada and his girlfriend had stopped at McDonald's for something to eat. They had left the restaurant and were driving towards the beach when a car emerged from a side street on the left and ran into the midsection of the passenger side of Mr Awada’s vehicle.
Mr Awada said at the time of the impact he had put his arm over to protect his girlfriend which may have caused an injury to his shoulder. He said that he got out of the vehicle to assist his girlfriend who was very upset.
Police, ambulance, fire service, and a tow truck subsequently arrived. Mr Awada and his girlfriend were transported to St George Hospital where they were assessed over several hours and then discharged home. Mr Awada’s vehicle was written off.
History of Symptoms and Treatment Following the Accident
Over the following days Mr Awada developed increasing pain in his left shoulder. He consulted with his GP and was referred to an orthopaedic surgeon. He had physiotherapy for his shoulder injury and subsequently rotator cuff surgery in October 2020. He had physiotherapy for several months following the surgery.
Mr Awada said that his mood changed in the weeks following the motor accident. He said that he became increasingly irritable which affected relationships with family and friends. He developed increasing symptoms of anxiety and on one occasion required medication to have an MRI scan due to this.
Mr Awada was referred by his GP for psychological treatment though appointments were made and then cancelled by the clinician on more than one occasion. Mr Awada did not have any psychological treatment following the motor accident. He was not prescribed any pharmacological treatment for his psychological condition.
Injuries or Conditions since the Motor Accident
There have been no new injuries or conditions since the motor accident.
Current Symptoms
Mr Awada described ongoing pain in his left shoulder since the motor accident. He said that he must rest it on a pillow when he is in bed to avoid exacerbation of pain, and he finds this annoying.
Mr Awada described his principal mood state as angry and irritable. He described himself as impatient with others. His mood is low much of the time and he has low energy. He described himself as often feeling restless.
Mr Awada obtains little enjoyment from previously enjoyable activities. He has low motivation. He denied ever having active thoughts to harm himself or to end his life and said that “my daughter is my lifeline” and she is protective against him attempting
self-harm.Mr Awada described a disturbed sleep pattern with unpleasant dreams. He described experiencing recurrent dreams in which he is trapped in a tunnel or a pipe and unable to escape.
He experiences middle insomnia including wakening every one or two hours during the night, and then finally wakening to start the day from around 3:00 or 4:00 AM. At that time, he may get out of bed and watch some television. He sometimes later returns to bed at around 10:00 AM.
During the day Mr Awada spends most of his time at home. He said that he may sit in his backyard under a tree to relax, and he may have a nap. He has gained approximately 10 kg in weight since the motor accident which he believes is most likely due to inactivity. He sometimes eats the meals prepared by his mother, but she uses a lot of pepper in the cooking which causes Mr Awad to experience various gastrointestinal symptoms. He prepares his own meals.
Mr Awada will meet a friend for a coffee every two or three weeks. He attends his doctor's surgery every two weeks. Mr. Awada goes to a gym occasionally.
He can drive independently in his local area. He sometimes drives with his brother as a companion. He avoids driving if he can as he is reminded of the motor accident and his anxiety increases. He has flown to Cairns for a few days, on one occasion and to southern Queensland for two days on another occasion with his ex-partner.
Mr Awada can travel independently by train and had done so to attend a medical appointment two days before our interview. He said that he had enjoyed the experience of being on the train.
Current and Proposed Treatment
Mr Awada is not currently receiving any psychiatric/psychological treatment.
Mental State Examination
Mr Awada joined the video conference assessment from his home. He was alone at the time of interview. He was casually dressed in jeans, a bomber jacket and wearing a beanie hat. He was clean shaven and explained that he had done this two days previously so that he would look better groomed in public when travelling by train to a medical appointment on that day.
Mr Awada appeared tense throughout the interview. On two occasions he asked permission to stand and stretch to ease physical discomfort, which he did.
His affect conveyed intensity and irritability and he angered easily when asked to comment on some points from the documents with which he did not agree. At times he displayed humour. His mood was objectively and subjectively irritable. There were no active suicidal ideas.
He described a low mood and low level of energy. He described often feeling restless.
His thought form was normal. There were no delusions and no abnormal perceptions.
Mr Awada was fully alert and orientated. He attended adequately throughout a lengthy interview and provided a comprehensive account or history demonstrating a good recall for events.
Current Functioning
Mr Awada lives with his mother and brother. He receives a carer’s payment as he is the carer for his brother who has chronic health problems. He described a reduction in his self-care and personal hygiene compared to before the accident and said that he does not change his clothes as often as he used to. He had made an effort to be smart when travelling to a medical appointment two days before our meeting and looked tidy at interview.
Mr Awada sometimes cooks for himself and sometimes eats the food cooked by his mother otherwise.
He drives to appointments for himself and will accompany his brother to his appointments.
He occasionally meets a friend for a coffee and occasionally goes to a gym.
He has maintained relationships with his children, continues to live with his mother and brother as he did before the accident, and has contact with some friends.
The relationship with his partner, ended in 2023.
Mr Awada is able to watch television programmes and drive for up to an hour. He attended adequately during an interview of almost two hours and had good recollection for past events.
He has not worked since the motor accident.
Consistency of Presentation
Mr Awada denied using anabolic steroids which is recorded in the entries in his GP, Dr Camille Awada’s, records on 22nd and 25 September 2021.
Mr Awada denied having multiple sexual partners which is recorded in Dr Camille Awada’s clinical records on 1 October 2022.
Mr Awada agreed that he had been receiving Newstart Centrelink allowance since 2014 which was changed to Jobseeker allowance in 2020.
Mr Awada agreed that he had been receiving a Centrelink carer payment and a carer allowance from July 2023 and that the Jobseeker allowance had been cancelled.
Summary
Mr Awada is a 54-year-old single man who lives with his mother and brother. He has had prolonged periods of depressed and anxious mood earlier in his life with reduced function at those times.
Before the motor accident of 14 November 2019, Mr Awada was in good mental health and unimpaired having recovered from a psychological injury in a previous motor accident in April 2013.
The motor accident of 14 November 2019 caused a left shoulder rotator cuff injury which was surgically repaired in October 2020. Mr Awada continues to have pain from this. He has had persistent psychological symptoms since the motor accident with functional impairment secondary to those.
Diagnosis and Reasons
Following the DSM 5 TR system, Mr Awada has a persistent depressive disorder with anxious distress.
Mr Awada has had a depressed mood for most of the day, for more days than not, as indicated by his account, and supported by information in medical notes, for at least two years. When depressed he has insomnia and hopelessness. He has not had a period in excess of two months during the last two years when he has been free of these symptoms. He has never had a manic or hypomanic episode, or a schizophrenia spectrum disorder. The symptoms are not attributable to the physiological effects of a substance or another medical condition. The symptoms cause clinically significant distress and impairment in important areas of functioning.
Psychiatric Impairment Rating Scale
| Name | Ali Awada | Claim Reference Number | M22781/24 |
| D.O.B. | 25 September 1970 | Age at time of injury | 49 |
| Date of Injury | 14 November 2019 | Occupation before injury | Stone polisher |
| Date of Assessment | 25 July 2025 | Marital Status before injury | Long term relationship |
| Psychiatric Diagnosis | 1. Persistent depressive disorder with anxious distress | 2. | |
| 3. | 4. | ||
| Psychiatric Treatment | Nil | ||
| Has Maximal Medical Improvement Been Reached? | Yes | ||
| Is Impairment Permanent? | Yes | ||
| Category | Class | Reason for decision | |
| Self-care and Personal Hygiene | 2 | Mr Awada can live independently and looks after himself adequately. He may look unkempt occasionally. He attends to his appearance in anticipation of public situations. He provides personal care and assistance to his brother. Mr Awada changes his clothes less often compared to before his injury. He sometimes cooks for himself, and sometimes eats food cooked by his mother. He was neatly presented at interview. | |
| Social and Recreational Activities | 2 | Mr Awada describes being less socially active compared to before the motor accident. He occasionally meets with a friend for a coffee. He joined a gym for social reasons and occasionally will go. | |
| Travel | 2 | Mr Awada is anxious when driving and so avoids this at times. He can drive in his local area for up to one hour. He can travel by public transport including the train and has flown to Queensland twice with a friend. | |
| Social Functioning | 3 | Mr Awada describes severe strain in relationships due to his irritability. The relationship with his girlfriend ended 18 months ago. He continues to live with his mother and brother and maintains contact with his children and some friends. | |
| Concentration, Persistence and Pace | 2 | Mr Awada is able to watch television programmes and drive for up to an hour. He attended adequately during an interview of almost two hours and had good recollection for past events. | |
| Adaptation | 3 | Mr Awada was doing occasional work as a stone polisher before the accident. He has not resumed working after the motor accident. He currently receives a carer’s allowance for providing care to his brother. His irritability affects relationships and would be an impediment in the workplace. He has a moderate impairment and can perform less than 20 hours work per week in a qualitatively lesser position. | |
List Classes in Ascending Order Median Class Value
| 2 | 2 | 2 | 2 | 3 | 3 | 2 |
Aggregate Score Total imp %
| 2 | 2 | 2 | 3 | 2 | 3 | 14 | 7% |
Pre-existing Impairment (If yes, determine % as above) Median Class Value
| nil |
Aggregate Score Total imp %
| nil |
Final % WPI
| 7 % |
Apportionment – pre-existing/subsequent impairment
At the time of the motor accident Mr Awada had recovered from the psychological injury sustained in the accident of April 2013. He had no impairment due to that or any other re-existing condition. There are no subsequent injuries or conditions.
Effects of treatment
There has been no significant treatment for the psychological injury.
Degree of permanent impairment caused by the motor accident.
Mr Awada has a permanent impairment of 7% caused by the motor accident.
The Panel met on 21 August 2025 to discuss the Medical Assessors findings on examination. The legal Member of this Panel did not participate in the medical examination but prior to the Panel meeting on 21 August 2025, the legal Member has had the benefit of reading and considering the Medical Assessors examination report. On 21 August 2025 the Panel met, and all discussed the examination findings and the issues going to causation and assessment of WPI. It is from this teleconference of the Panel that the Panel has agreed and reached its final conclusion and determination.
The Panel adopts the medical examination report of Medical Assessor Doris and Medical Assessor Friend.
Causation/reasons
In its submissions, the insurer said that the Medical Assessor had not delineated between the claimants alleged left shoulder pain and emotional distress with regard to his capacity to work. The Panel was satisfied that the claimant’s psychiatric condition has not been impacted upon by his physical condition. He is managing his pain, and his psychiatric condition is independent of that.
The Panel must ask itself in considering whether the accident contributed to the claimant’s injuries as referred to it by the Commission, whether the claimant’s condition was caused by or materially contributed to by the accident. The Panel is satisfied that this can be answered affirmatively. While the claimant may have had a pre-accident psychiatric condition, at the time of the accident, the claimant described his mental health as progressively improving and returning to normal from 2017.
In the claimant’s statement, he said that he did not suffer from psychological injury at the time of the subject accident, and that he did not experience any limitations as a result of psychological symptoms at the time or prior to the subject accident
The claimant estimated that he had made a 95% recovery from his earlier motor accident and that his psychological symptoms were improved. He reported to the Medical Assessors that before the accident in November 2019 that “my life was on track.” He was living with his mother and brother and doing occasional work polishing marble. He said that his mental health was good and that he would socialise often. He said that he would often meet friends for coffee and had had trips away with his girlfriend including interstate and internationally.
The claimant had no difficulty in taking care of himself, in relationships with others, or focusing his attention on matters when needed.
Following the subject accident, the claimant’s psychiatric condition worsened.
On the balance of probabilities, can it be said that the claimant suffered a recognisable psychiatric injury? For the reasons discussed above in the report of the Medical Assessors, the Panel does find that this can be answered in the affirmative. The Panel is satisfied that the claimant has suffered a Persistent Depressive Disorder with Anxious Distress, a condition which he was not suffering from at the time of the accident based on the records sighted by the Panel. The Panel has not been made aware of any other incident which might have resulted in this condition, other than the subject accident.
Would the impairment have occurred, if not for the accident? The Panel is satisfied that the accident and impact has had a more than negligible effect on the claimant’s psychiatric condition suffered following the accident. This is because up to and at the time of the accident he was working part time, socialising, taking care of himself, and was in no distress. Following the accident, these activities were curtailed.
The Panel must examine the claimant and perform its assessment on the basis of its discussions with the claimant on the day of assessment. A psychiatric symptom might evolve over time and disappear over time for that matter. In this case, while the Medical Assessor diagnosed the claimant as having a Persistent Depressive Disorder and a Social Anxiety Disorder, the Panel was satisfied that the claimant at the time of examination had a diagnosis of Persistent Depressive Disorder with Anxious Distress.
Late documentation
The claimant was examined by the Medical Assessors on 24 July 2025. On 20 August 2025 the insurer lodged an application to rely on a medico-legal report of Dr Prior dated
24 July 2025. Only at that time had the insurer’s solicitors sought the consent of the claimant to rely on this report and as far as the Panel understands, no consent has been provided.
At no stage had the insurer informed the Panel that it was obtaining a report from Dr Prior and that it intended to rely on this. The lodgement of the insurer’s application for late admission of a document on 20 August 2025 was the first notice of this, to the Panel.
If this report was to be allowed into evidence and to be considered, then the claimant would need the opportunity to respond to the report and possibly obtain further evidence in reply. This would only cause an additional and unnecessary delay, particularly noting that the claimant was involved in the accident on 14 November 2019, nearly six years ago. This would not facilitate the just, quick and cost-effective resolution of the claim. The insurer says that an earlier examination of the claimant was not possible because it was not satisfied the claimant’s psychiatric disabilities had stabilised. And yet it seems this was not an issue for the Medical Assessor when he examined the claimant over 12 months ago. Only now does it seem that the insurer took the view that it should obtain a medico-legal report about the claimant.
Rule 67C (4) of the Personal Injury Commission Rules 2021 stipulates that:
“The appropriate decision maker may give leave if satisfied the introduction of the document is necessary to facilitate the just, quick and cost effective resolution of the real issues in the proceedings.”
For the insurer’s solicitors to seek to rely on a document, where no notice has previously been given that a medico-legal report was being obtained, two days before the claimant was being examined by the Panel, for an accident that occurred nearly six years ago, is not consistent with their professional obligations.
A determination was made, and the Panel informed the insurer that it would not allow the late report into evidence. Unsolicited, the insurer responded by way of a message in the portal making further submissions why the report should be allowed.
The Panel has provided its reasons why it will not consider the report of Dr Prior of
24 July 2024. At no stage during this review process was the Panel informed that a further report would be obtained by the insurer. It is inconceivable that the insurer would not have previously sought the consent of the claimant about this earlier, and that the Panel would have been put on notice about another report. The examination of the claimant by the Panel took place and before the report of Dr Prior was prepared. The Panel did not have the opportunity to consider this and to ask the claimant about anything that might have arisen from the report. The circumstances in which the report has been provided and sought to berelied on are, as the Panel has said, not consistent with the professional obligations of the insurers solicitors.
The insurer has said that if the Panel does not reconsider its decision about the report then it will consider judicial review of that decision. So be it.
The Panel suggests to the insurer that it is not up to it to assert to the Panel about any action it might take in an attempt to coerce the Panel to reconsider its decision.
Conclusion
The Panel is satisfied that consequent upon the motor accident which occurred on
14 November 2019, the claimant developed a psychiatric disability of a Persistent Depressive Disorder with Anxious Distress.
Determination
The Panel revokes the certificate of Medical Assessor Shen dated 6 June 2024.
The Panel has examined the claimant and determined that he has a Persistent Depressive Disorder with Anxious Distress.
The Panel has assessed the claimant as having 7% WPI.
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