Insurance Australia Limited t/as NRMA Insurance v BNR

DETERMINATION OF REVIEW PANEL
CITATION:	Insurance Australia Limited t/as NRMA Insurance v BNR [2025] NSWPICMP 705
CLAIMANT:	BNR
INSURER:	Insurance Australia Limited t/as NRMA Insurance
REVIEW PANEL
SENIOR MEMBER:	Brett Williams
MEDICAL ASSESSOR:	Steven Yeates
MEDICAL ASSESSOR:	John Baker
DATE OF DECISION:	15 September 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; review of medical assessment under section 63; Medical Assessor found persistent depressive disorder, post-traumatic stress disorder, and panic disorder caused by the accident gave rise to a permanent impairment of greater than 10%; observations made in QBE Insurance (Australia) Limited v BPO endorsed; Held – the claimant developed panic disorder and somatic symptom disorder as a result of the accident; psychiatric impairment rating scale (PIRS) must not be used to measure impairment due to somatoform disorders or pain; the panic disorder resulted in a permanent impairment of 9%; certificate revoked; the accident caused permanent impairment not greater than 10%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Part 3.4 of the Motor Accidents Compensation Act 1999 The Review Panel: 1. revokes the certificate of Medical Assessor Shen dated 14 February 2024, and 2. certifies that the degree of permanent impairment of the claimant that has resulted from the injury caused by the acccident on 16 April 2016 is not greater than 10%.

STATEMENT OF REASONS

BACKGROUND

[BNR] (claimant) was injured in a motor accident at Ryde on 16 April 2016 (accident). Following the accident she made a claim for damages under the Motor Accidents Compensation Act 1999 (MAC Act) on Insurance Australia Limited t/as NRMA Insurance (insurer), the insurer of the other vehicle involved in the accident.
There is a dispute between the claimant and the insurer as to whether, for the purposes of

s 131 of the MAC Act, the claimant’s permanent impairment as a result of psychological injury caused by the accident is greater than 10% (dispute). The dispute is a medical assessment matter for the purposes of Part 3.4 of the MAC Act: s 58(1)(d) MAC Act.
The dispute was assessed by Medical Assessor Shen. On 14 February 2024 the Medical Assessor certified that persistent depressive disorder, post-traumatic stress disorder, and panic disorder caused by the accident gave rise to a permanent impairment of greater than 10% (Assessment).
The insurer sought a review of the Assessment in accordance with s 63 of the MAC Act. The President’s Delegate subsequently determined there was reasonable cause to suspect the Assessment was incorrect in a material respect. The review application was accepted, and the application referred to this Review Panel (Panel) for review.

THE REVIEW

The Panel is to conduct the review in accordance with s 63 of the MAC Act. Section 63(3) provides that the review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Person Injury 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: s 63(3A) MAC Act. Although styled a "review", the Panel is determining afresh the medical assessment matters referred to it: Frost v Kourouche (2014) 86 NSWLR 214; [2014] NSWCA 39 at [9] per Leeming JA (Beazley P and Basten JA agreeing).
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128.

PROCEDURAL MATTERS

The Panel directed the parties to file a joint bundle that contained all material relied on by them for the purposes of the Review and written submissions. A joint bundle was subsequently filed. Neither party complied with the Panel’s direction to file written submissions for the purposes of the Review.

PANEL DELIBERATIONS

The Panel convened on 14 May 2025, discussed the evidence and the issues and determined a re-examination was required. The re-examination was scheduled to take place on 16 July 2025. At the claimant’s request the re-examination was re-scheduled and took place on 5 September 2025.
The Panel re-convened on 15 September 2025, discussed the examination findings, and determined the Review.

STATUTORY FRAMEWORK

No damages may be awarded for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%: s 131 MAC Act.
Section 132 of the MAC Act deals with the assessment of impairment. If there is a dispute about whether the degree of permanent impairment of an injured person is sufficient for an award of damages for non-economic loss, the court may not award any such damages unless the degree of permanent impairment has been assessed by a Medical Assessor under Part 3.4.
The method of assessing the degree of impairment is dealt with in s 133 as follows:
“133 Method of assessing degree of impairment
(1) The assessment of the degree of permanent impairment of an injured person as a result of the injury caused by a motor accident is to be expressed as a percentage in accordance with this Part.
(2) The assessment of the degree of permanent impairment is to be made in accordance with—
(a) Motor Accidents Medical Guidelines issued for that purpose, or
(b) if there are no such guidelines in force—the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition.
(3) In assessing the degree of permanent impairment under subsection (2) (b), 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.
Note—
See Part 3.1 for Motor Accidents Medical Guidelines”
Version 5 of the Medical Assessment Guidelines (Assessment Guidelines), effective from

12 February 2021, apply to the Review as does version 1 of the Motor Accident Permanent Impairment Guidelines effective from 1 June 2018 (Impairment Guidelines).
The Impairment Guidelines state as follows with respect to causation of injury:
“Causation of injury
1.5    An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person’s impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues.
1.6    Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
‘Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.’
This, therefore, involves a medical decision and a non-medical informed judgement.
1.7    There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
Impairment caused by mental and behavioural disorders is assessed in accordance with cl [1.201] – [1.228] of the Impairment Guidelines: Cl 1.35 of the Impairment Guidelines.

ASSESSMENT UNDER REVIEW

As recorded earlier, on 14 February 2024 Medical Assessor Shen certified that persistent depressive disorder, post-traumatic stress disorder, and panic disorder caused by the accident gave rise to a permanent impairment of greater than 10%.
The Medical Assessor’s reasons contain a description of the accident provided by the claimant. She reported that following the accident she developed pain and described shoulder, upper back, and neck issues. Her psychological symptoms, which started a couple of months after the accident, initially involved with fears going up escalators in case she fell backwards, and then a feeling of being worthless. She said these symptoms evolved as her physical symptoms progressed over time. She said she also developed panic attacks, with palpitations and chest tightness, and shortness of breath and choking, which she found “quite scary”. The panic attacks occurred once or twice a day and would lead to her avoid wanting to leave the house. She experienced nightmares and avoided the accident scene. She saw her general practitioner, and had seen a psychologist for 9 months, which she said was mildly beneficial. The claimant said she had not seen a psychiatrist for treatment, and has been on duloxetine 60mg, which was not helpful. She was on citalopram 40mg for a while, which had been partially helpful with numbing her feelings.
The Medical Assessor found that there were “no major inconsistencies”, and “suspect[ed]” that there may have been progressive worsening over time due to the chronicity of her pain and functional impairment, which had led to a deterioration in her marriage and self-confidence, leading to a worsening of her psychiatric symptoms. As these factors were caused by the accident, they were “secondary injuries” and causally related to the accident.
The Medical Assessor diagnosed persistent depressive disorder, post-traumatic stress disorder, and panic disorder that were caused by the accident.
The Panel has reviewed and evaluated the Medical Assessor’s findings and reasons with respect to the Psychiatric Impairment Rating Scale (PIRS). There was no pre-existing impairment. After adding 1% for the effects of treatment he assessed a 16% permanent impairment.

EVIDENCE

The documentary evidence relied on by the parties is contained in a joint bundle. The bundle comprises nearly 400 pages. The parties have only referred to a handful of documents in their submissions. It is not clear why the parties included a large amount of material that was not referred to in their respective written submissions. The Panel notes rule 67D(2) of the PIC Rules provides that the appropriate decision-maker for proceedings is not required to have regard to a document not specifically referred to in submissions made by a party to the proceedings.

Medico-legal reports

Dr Duckworth, shoulder and elbow surgeon, reported to the insurer on 14 February 2017 and 19 June 2019. In his June 2019 report the doctor diagnosed “a chronic pain picture affecting her shoulders and neck”. In the doctor’s opinion the claimant’s ongoing symptoms were directly related to the accident. She had attended a pain clinic and was seeing an occupational physician. In the doctor’s opinion the claimant had ongoing problems with activities of daily living which “appear to be permanent”. In a separate report of the same date the doctor assessed a 30% whole person impairment as a result of the accident.
Dr Rikard-Bell, psychiatrist, reported to the insurer’s solicitor on 3 August 2020. In the doctor’s opinion the claimant had an adjustment disorder with anxiety and depression that was caused by the accident. She had also developed a chronic pain syndrome involving her shoulders, neck and arms.
In Dr Rikard-Bell’s opinion the claimant’s presentation was consistent with the history provided. Her ongoing disabilities were described as “sleep disturbance, fear of dying, catastrophic fears, feelings of hopelessness and helplessness, panic attacks, nightmares about being chased and fear of going out.” The claimant was working full-time and was fit for post-injury employment. She would benefit from 20 sessions with a clinical psychologist over 12 months and would benefit from six sessions with a psychiatrist. Her prognosis was guarded. In the doctor’s opinion, the claimant had been “unwell for four years. The pain condition has a poor prognostic sign. The good prognostic sign is that [the claimant] has continued to work and this has maintained a level of functioning.”
Dr Rikard-Bell reported again on 17 August 2023. The doctor recorded that there was no previous history of anxiety or depression. The claimant reported panic symptoms, that her mood is constantly anxious, and that she experiences pain particularly in her neck, and shoulders. The claimant told the doctor that each day she will have panic symptoms that can last all day. She avoided going out to social events. Her mood was low, but she could enjoy her daughters, mother, and her work. She does not like to socialise or listen to bad news on the television. Her sleep is interrupted due to pain.
The doctor diagnosed a somatic symptom disorder with chronic pain and panic disorder. In his opinion, “the adjustment disorder with depressive symptoms is now less prominent but she has developed panic disorder”. The main issue was panic disorder.
The somatic symptom disorder is characterised by her fears of neck, shoulders and back being not able to function. The doctor thought that there was no clear biological explanation for why she had such severe pain and why she would have weakness in her hands, weakness in her legs, and why she would be dizzy and fall over. Despite the claim being governed by the MAC Act, the doctor was asked to provide an opinion as to whether the claimant’s injuries are “minor/threshold injur[ies]”.
Dr Rikard-Bell thought the claimant’s prognosis was guarded. She was “overly consumed with her pain and anxiety”. She required a specialised pain management approach to assist her with her treatment in coordination with psychological and psychiatric treatment. In a separate report of the same date the doctor provided a PIRS assessment and reasons. He assessed a 7% whole person impairment.
Dr Kuljic, psychiatrist, reported to the claimant’s solicitor on 14 November 2020. The doctor diagnosed major depressive disorder and panic disorder that were caused by the accident. He thought the claimant’s prognosis was very guarded, and that she needed ongoing treatment. In a separate report the doctor provided a PIRS assessment and reasons. He assessed a 17% permanent impairment. The Panel has evaluated the doctor’s PIRS assessment and the reasons he gave for the class assigned to each area of functioning.
Dr Kuljic next reported on 24 June 2022. The claimant reported no significant improvements despite using a prescribed antidepressant and anxiolytic. Her mental state had not improved; the claimant felt even more hopeless and useless. The doctor again diagnosed major depressive disorder and panic disorder and assessed a 17% permanent impairment.
Dr Kuljic reported again on 24 September 2023. He made the same diagnosis as recorded in his earlier reports.
In a report to the claimant’s solicitor dated 21 June 2022, Dr Gehr recorded that the claimant experienced symptoms, including pain, in her cervical spine, shoulders, and thoracic spine following the accident. He diagnosed cervical spine soft tissue injury with left radiculopathy, bilateral shoulder soft tissue injury, and thoracic spine soft tissue injury. The claimant reported continuing symptoms, restrictions, and disabilities. In a supplementary report the doctor assessed a 40% whole person impairment attributable to the accident caused physical injuries.
Dr Gehr then reported on 6 November 2024. He again diagnosed cervical spine soft tissue injury with left radiculopathy, bilateral shoulder soft tissue injury, and thoracic spine soft tissue injury. He thought the claimant’s prognosis was poor. She had reduced working hours and had restricted functional capacity as a result of her injuries. In a separate report the doctor assessed a 34% permanent impairment.

Records from treatment providers

Clinical records from Myhealth Medical Centre Top Ryde include details of the claimant’s pre and post-accident attendances, medication, and ailments. The records also contain various radiological reports that pre-and post-date the accident, and allied health recovery requests. The patient notes commence on 1 February 2013. Prior to the accident there are references in the notes to back pain (2013), chronic migraine, a foot injury, Type 2 diabetes, a right knee and ankle injury, and right shoulder pain.
An entry on 17 April 2016 refers to the accident, and records complaints of neck and shoulder pain. In subsequent entries in May 2016 there is reference to the claimant being in constant pain and suffering from insomnia. In June 2016 she was referred to Dr Goldberg and to the Pain Management & Research Centre at Royal North Shore Hospital.
The Myhealth Medical Centre records also include various referrals and certificates, all of which have been considered.
In a report dated 31 August 2016 it was recorded by Dr Goldberg that the claimant reported she experienced significant neck pain following the accident. He thought she “clearly has developed a well-entrenched chronic pain syndrome associated with a soft tissue whiplash injury”. She also had post-traumatic bilateral adhesive capsulitis. The doctor made recommendations with respect to further treatment.
Dr Chow reported on 5 September 2016. The claimant had been seen for bilateral frozen shoulder, chronic neck pain, and “whiplash associated disorder”. Dr Chow also reported to NRMA on 12 September 2016. In the doctor’s opinion the claimant had significant disability associated with the frozen shoulder. The doctor’s reports to NRMA dated 5 October 2016 and 26 October 2016 have also been considered, as have her reports to Dr Cho.
A report from Dr Egan records details of the claimant’s chiropractic treatment and progress.
There is a referral from Dr Cho to a psychologist for counselling dated 24 August 2019. The referral refers to the accident, and records that the claimant was feeling depressed, teary, guilty, and anxious. She had problems with sleep due to pain, experienced anxiety and panic attacks, and felt anxious.
A referral to the Chronic Pain Clinic dated 21 September 2021 records (among other things) that the claimant had re-presented two weeks before with worsening depression/anxiety symptoms. It is recorded that she had seen a psychologist but the appointments had not been frequent.
A referral to Ms Rollo dated 1 October 2021 relates to therapy for “anxiety/depression/panic disorder”. It is recorded that the claimant’s symptoms had deteriorated, that she had been referred to psychiatrists, and that her relationship with her husband had broken down. There is a referral to a psychiatrist of the same date that contains the same background.

Other evidence

In a claim form dated 8 August 2016, the claimant described a rear-end accident that occurred when her vehicle was stationary at traffic lights. The claimant recorded that she suffered injury to her neck, upper back, and shoulders as a result of the accident.

A medical certificate attached to the claim form dated 7 August 2016 records that the claimant sustained whiplash and pain in her shoulders and upper back.
There is an ergonomic evaluation report from Kairros dated 26 August 2016. Recommendations for workstation modifications and equipment were made.
On 5 March 2020 Medical Assessor Samuels certified that chronic adjustment disorder with mixed anxiety and depressed mood caused by the accident gave rise to a permanent impairment that is not greater than 10%. In his reasons, the Medical Assessor recorded that there was no pre-accident psychological history. The claimant described physical symptoms, including pain, and psychological symptoms following the accident. The Medical Assessor described the accident as being relatively minor. He recorded that since around January of 2019, the claimant had become increasingly anxious and fearful about the future, started having some panic attacks and feeling quite depressed and negative about the future. She does not like the fact that she has to rely on other people. The claimant acknowledged that pain is the “major issue”. With respect to diagnosis the Medical Assessor stated:
“… [she] certainly does have significant somatic and pain symptoms but in terms of a DSM-5 diagnosis, I would regard her as meeting criteria for a Chronic Adjustment Disorder with Mixed Anxiety and Depressed Mood. [The claimant] does have some depressive symptoms but they are not at the severity of a major depression, she does not have any posttraumatic symptoms. She does have some panic symptoms but I would see these as being a component of her Adjustment Disorder.”
The Medical Assessor made findings with respect to each PIRS area of functioning and assessed 0% permanent impairment.
Medical Assessor Wilding certified on 15 April 2020 that musculoligamentous strain and aggravation of pre-existing degenerative changes in the cervical spine caused by the accident gave rise to an impairment that is not greater than 10%.
In his reasons the Medical Assessor recorded the claimant experienced constant neck pain following the accident. She also had pain and limited movement in both shoulders, and pain in her thoracic region. The Medical Assessor was not satisfied the claimant suffered injury to her thoracic spine, shoulder, or arms as a result of the accident. He assessed a 0% impairment of the cervical spine.
On 15 April 2020 a review panel confirmed Medical Assessor Wilding’s certificate. The Panel was satisfied the claimant suffered a soft tissue injury to her cervical spine or strain as a result of the accident. That injury attracted 0% impairment. The Panel was not satisfied the claimant suffered injury to her shoulders, arms, or thoracic spine.
On 1 March 2024 Medical Assessor Home certified that soft tissue injury to the cervical spine and musculoligamentous strain/soft tissue injury of the thoracic spine caused by the accident gave rise to a permanent impairment that was not greater than 10%. In his reasons the Medical Assessor recorded the claimant complained of constant neck, right shoulder, and upper back pain. He was satisfied she suffered injury to her cervical and thoracic spine. Bilateral capsulitis was not caused by the accident. The claimant did not suffer arm injuries. There was a 5% impairment as a result of the cervical spine injury.
On 14 October 2024 a medical review panel revoked Medical Assessor Home’s certificate, and certified that the claimant’s whole person impairment was 9%. The Panel found the claimant suffered injury to her cervical spine and right shoulder and assessed impairment in each region.

SUBMISSIONS

Contrary to the Panel’s directions neither party filed submissions for the purposes of the Review. The submissions contained in the joint bundle focus on whether Medical Assessor Shen’s assessment was incorrect in a material respect. This issue was relevant to whether the assessment may be referred to a review panel: s 63(2) and s 63(2B). As pointed out by the Panel in the directions made on 12 February 2025, the Review is not limited to a review only of 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 was concerned: s 63(3A) MAC Act. It was for that reason, as the Panel explained, directions were made for the provision by the parties of submissions for the purposes of the Review.

Insurer’s submissions

The insurer relies on written submissions dated 12 March 2024. The insurer argued that Medical Assessor Shen:
(a)    incorrectly diagnosed the claimant with post-traumatic stress disorder and failed to address the inconsistencies with his diagnosis;
(b)    failed to provide a clear path of reasoning with respect to his assessment of class 3 for “concentration, persistence and pace”; and
(c)    failed to provide a clear path of reasoning with respect to his assessment of class 3 for “social functioning”.
The insurer referred at [8] – [9] of its submissions to what it says were inconsistencies in the claimant’s reported symptoms. The insurer argued “it is not clear exactly how [Medical] Assessor Shen reached the PTSD diagnosis, given that it is clear that the claimant does not exhibit the complete relevant symptoms to satisfy the PTSD criteria.” In the insurer’s submission the claimant did not report any symptoms that fit within the post-traumatic stress disorder criteria when she was assessed by Dr Kuljic and was diagnosed with major depressive disorder and panic disorder.
The insurer argued the Medical Assessor failed to comment on “the inconsistencies, and put forward any inconsistencies to the claimant to ensure procedural fairness”, and asserted that the following were examples of this failure:
(a)    the Medical Assessor failed to question the claimant about how an accident of this minor nature caused such severe reported symptoms;
(b)    the Medical Assessor failed to question why there are no clinical records of psychiatric symptoms following the accident;
(c)    the Medical Assessor failed to question the contradictory statements regarding the claimant’s social functioning, namely “having a great relationship with her friends and family but somehow reporting diminished social functioning”, and
(d)    the Medical Assessor failed to address why he reached a diagnosis that is inconsistent with the balance of the available evidence and why there were no earlier reported traumatic symptoms.
In the insurer’s submission the finding by the Medical Assessor that the claimant was a class 2 for “concentration, persistence and pace” was contradicted by the available evidence. The insurer argued the Medical Assessor failed to provide a clear path of reasoning “for how the ability to work full-time and manage a team, in addition to managing to concentrate throughout the entire duration of the assessment, is consistent with an inability to concentrate for more than 10 minutes.” In the insurer’s submission the Medical Assessor should have put this inconsistency to the claimant to confirm the history and respond to the inconsistent observations to ensure accuracy and procedural fairness.
With respect to “social functioning”, the insurer submits that:
“whilst it is unfortunate that the claimant has separated from her husband, she strongly maintains that she continues to have a supportive relationship with her immediate family members who live both in Sydney and Melbourne. She stated she does not see her cousins and friends as frequently as before, although she did see her cousins in January this year.”
The insurer submits Medical Assessor Shen failed to provide a clear path of reasoning for how the claimant’s social functioning is moderately impaired despite continuing to maintain strong relationships with her immediate and close family members. As a result, the insurer argued the certificate is incorrect in a material respect and should be referred to a medical review panel.
Many of the insurer’s submissions are not in accord with what has been said in the authorities with respect to the role and function of a medical assessor: see for example Wingfoot Australia Partners Pty Ltd v Kocak (2013) 252 CLR 480; [2013] HCA 43, Allianz Australia Insurance Limited t /as Allianz v Susak [2025] NSWCA 91, and Allianz Australia Insurance Limited v Bell [2025] NSWCA 187.

Claimant’s submissions

The claimant’s undated written submissions[1] address the merits of the insurer’s application for a review. The claimant argues there is no merit to any of the alleged errors and that the application should be dismissed. The application has, however been accepted and referred to this Panel. This again highlights why the Panel made directions for the provision of submissions for the purposes of the Review.
[1] Commencing at page 11 of the joint bundle.
With respect to the diagnosis of post-traumatic stress disorder, the claimant argued that the Medical Assessor had made the diagnosis after finding there were no inconsistencies, reviewing all the evidence and addressing each of the diagnostic criteria.
With respect to “concentration, persistence and pace” the claimant observed that the Medical Assessor was to make an assessment at the time she was examined and was not bound to reach the same conclusion as the insurer’s medico-legal expert, “previous SIRA allocated assessors” or the claimant’s treating practitioners.
In the claimant’s submission, the Medical Assessor obtained a history and reported the extent of the change as a result of the claimant’s psychiatric injury and “reading the Certificate as a whole and in [a] sequential manner makes it plain how each of the conclusions were properly arrived at”. In the claimant’s submission the Medical Assessor did not err in finding a class 3 for this area of functioning.
With respect to the finding that she was a class 3 for “social functioning”, the claimant referred to matters relevant to, and that she argued supported, that finding. In the claimant’s submission the Medical Assessor explained his path of reasoning and did not err in finding a class 3.
In the claimant’s submission the Medical Assessor undertook his assessment in accordance with the Guidelines, properly determined that her condition was stabilised on the day of the assessment, and fulfilled his function as “the independent assessor tasked with determining this dispute between the parties.”
The claimant argued that the Medical Assessor’s path of reasoning was clear, was not incorrect in a material respect, and that the application should be dismissed.

RE-EXAMINATION FINDINGS

The claimant was re-examined by Senior Medical Assessor Baker and Medical Assessor Yeates (Medical Assessors) by MS Teams on 5 September 2025 over a period of approximately 90 minutes. What follows are the findings of the Medical Assessors following the examination.

Psychosocial history and pre-accident history

The claimant was born in Afghanistan, and raised with her mother, father, and two younger brothers. Her father was an auditor, and her mother worked at the United Nations. The family was materially comfortable, with enough money, food, clothing, and housing. There was no domestic violence, and the claimant denied any external physical, sexual, or emotional abuse occurring inside or outside the family. She reflected on her early life as happy and felt she was shielded from the complexities of Afghanistan by her parents. She was a healthy child and young person. She was not exposed to war or war-like conditions, nor was she part of a persecuted religious or ethnic minority.
The claimant attended a school run by the Indian embassy until Year 3, at which point her parents left Afghanistan for India, when she was seven years old. Her memories of this time are sparse. The claimant recalled that her mother wished to move for lifestyle reasons, and she was sent to school in India for two years at a Christian school. Due to her mother having a cousin in Australia, the family relocated when the claimant was nine. While in Australia, she attended Primary School and then High School. She had a close circle of friends and completed Year 12 with above-average results. She was never suspended or expelled. She studied a Bachelor of Science degree at university, which she completed on time. Throughout her adolescence and early life, the claimant was consistently employed, including during her tertiary studies. Her first job was at Kentucky Fried Chicken, followed by work at a bookshop and in retail. Her first professional role out of university was in an insurance company. Her subsequent career has all been in the insurance industry.
The claimant is currently divorced but was previously married for 29 years. The divorce was finalised in February 2025, and she described her life as largely “perfect” with a very satisfying relationship that deteriorated after the accident. The marriage ended in 2021. The claimant has two adult daughters from the relationship. She denied any contact with psychologists, psychiatrists, mental health counsellors, or general practitioners for psychological or emotional issues prior to the accident. She has never been admitted to a psychiatric facility. She has never experienced suicidal ideation, intent, or attempts. The claimant is under the care of her general practitioner, Dr Grace Chu. Aside from a history of diabetes mellitus currently managed with Metformin and gastroesophageal reflux disease managed with pantoprazole, she is otherwise well.
There is no history suggestive of a primary psychotic disorder or bipolar disorder. There is no family history of major mental illness, addictions, or completed suicide. The claimant consumes alcohol occasionally, with no indications of heavy or dependent use. She has never used illicit drugs and does not participate in gambling. There is no forensic history.

History of the motor accident

The claimant recounted the accident: on 16 April 2016 she was driving home from her local shops in North Ryde. She was about to attend a wedding that evening, and while waiting at a red traffic light, she was rear-ended by a car that failed to stop. She was wearing her seatbelt. The airbags did not deploy. Her younger daughter was in the back seat. Her car jolted forward, and the claimant recalls her hands locked on the steering wheel and experiencing severe neck pain. The other driver emerged and asked if she was okay, to which the claimant responded that she felt fatigued, in pain, and needed to “go home.” The other driver apologised, gave his contact details, and the claimant drove the six minutes home. Neither the police nor the ambulance service attended the scene. Her main memory of the accident was pain, and her arms locked on the steering wheel. She attended the wedding that evening after spending some time at home.

History of symptoms and treatment following the motor accident

The claimant visited her general practitioner the following morning, complaining of pain and fatigue. She explained that the pain was centralised in her upper back and caused her to leave the wedding early the night before. Her GP examined her and diagnosed whiplash, prescribing painkillers and recommending several days off work. The claimant reported that the pain in her neck and upper back gradually worsened and began to affect her arms and shoulders, with her describing the pain as “horrific.” It also caused weakness, leading her to drop objects such as her phone. She mentioned experiencing balance issues and was referred to a shoulder specialist, chiropractor, pain specialist, and physiotherapist.
The claimant said she began experiencing feelings of hopelessness regarding her ongoing pain. She also reported panic attacks that started two or three months after the accident, during which she would become overwhelmed with tachycardia, experience chest tightness, and feel the need to escape, often while driving or on an escalator. At their worst, these attacks occurred on a daily basis. She avoids drinking coffee, which she previously enjoyed, because it activates panic symptoms.

The claimant mentioned that her sleep was disrupted by pain, waking her every two hours. She said sometimes she awoke from sleep due to nightmares accompanied by excessive sweating. The content of her nightmares involved fleeing from threats. Her ex-husband also noted that she would “jolt” in her sleep. The claimant expressed feeling persistently negative and hopeless about resolving her pain, but denied feeling worthless. She has guilty feelings about her abilities, perceiving herself as burdensome to her children and blaming herself for the circumstances leading to her marriage breakdown. She reported needing significant help with physical activities and relying on her parents, especially her mother, for cooking. The claimant described experiencing constant pain when writing, focused in her upper back and shoulders, radiating down her arms. She is on a waiting list for the pain clinic at the Royal North Shore Hospital. She states her pain is consistently rated four or five out of ten at the time of the assessment.
The claimant said that she had a fear of falling. She cannot hold the rails whilst travelling on public transport. She said holding the rails in a bus would aggravate her pain. She has had three falls, which she was unable to break with her arms, leading to a fracture of her right scaphoid in 2024. She can eat with a single utensil but struggles to lift her arms above 90 degrees. The claimant mentioned her general energy levels are decreased and that she relies on her daughters. She said she would need the support of her daughters for travel on public transport for physical support due to a lack of confidence and fear of falling.
The claimant has been under the care of her general practitioner. She has also seen a pain specialist and attended a psychologist for seven visits. She is prescribed and takes duloxetine 60 mg daily and diazepam 2mg daily for her panic symptoms. She was also prescribed Panadeine Forte and used this opioid analgesic medication sparingly about four times per week. She also takes pantoprazole and metformin for unrelated medical conditions. She has previously taken citalopram for psychotropic effects.

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

There are no relevant subsequent conditions or injuries sustained since the accident.

Clinical Examination

Mental state examination

The mental state examination revealed a woman of Afghan background who was neatly dressed, with a warm and engaging social manner, with whom rapport developed quite well. Her social behaviour was appropriate and polite. Her mood was low, and her affect was flattened, with only occasional moments of spontaneous levity. Her thought content was reality-oriented, with no signs of psychosis or suicidality, but she was preoccupied with references and lamentations about chronic pain in her upper back, shoulders, and arms, along with the physical limitations caused by pain. Her thought process was normal. Her speech was normal in grammar, structure, syntax, volume, and spontaneous elaboration, conveying an impression of above-average intelligence. Her judgement was not impaired, and there were no perceptual disturbances. Her cognitive functions appeared grossly normal, with no need for formal testing. Her insight was reasonable.

Current functioning

Self-care and personal hygiene