Insurance Australia Limited t/as NRMA Insurance v BZE

DETERMINATION OF REVIEW PANEL
CITATION:	Insurance Australia Limited t/as NRMA Insurance v BZE [2025] NSWPICMP 725
CLAIMANT:	BZE
INSURER:	Insurance Australia Limited t/as NRMA
REVIEW PANEL
MEMBER:	Jeremy Lum
MEDICAL ASSESSOR:	Paul Friend
MEDICAL ASSESSOR:	Matthew Jones
DATE OF DECISION:	19 September 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant was in the front passenger side of a parked utility vehicle when it was rear-ended at speed by another vehicle; claimant sustained psychiatric injury; original Medical Assessor diagnosed post-traumatic stress disorder and assessed 15% whole person impairment (WPI); Held – Review Panel confirmed the diagnosis of post-traumatic stress disorder; degree of permanent impairment assessed under the psychiatric impairment rating scale (PIRS) at 7% WPI; pre-existing psychiatric condition effectively controlled by medication warranted 2% WPI deduction; total WPI related to the motor accident is 5%; MAC revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Review Panel revokes the certificate of Medical Assessor Abhishek Nagesh dated 1 October 2024 and issues a new certificate as follows: (a) the Review Panel certifies the following injury was caused by the motor accident: (i) post-traumatic stress disorder, and (b) the Review Panel finds that the above injury results in a whole person impairment of 5% which is not greater than 10%.

STATEMENT OF REASONS

INTRODUCTION

[BZE] (the claimant) was involved in a motor accident on 19 April 2021. He was seated in the front seat passenger side of a parked car when it was rear-ended on the right side by another vehicle. The following day, he went to his general practitioner (GP) who diagnosed soft tissue injuries to his neck, back and shoulder. He also says he suffered psychological injury from the accident.
The claimant made a claim for personal injury benefits with Insurance Australia Limited t/as NRMA (the insurer), the third-party insurer of the vehicle that he says caused the accident.
A medical dispute arose about whether the degree of the claimant’s whole person impairment (WPI) is greater than 10% WPI. If there is a dispute about the degree of WPI, damages for non-economic loss[1] cannot be awarded and the dispute must be referred to a Medical Assessor for determination.
[1] See Division 4.3 of the Motor Accident Injuries Act 2017 (MAI Act).
On 1 October 2024, Medical Assessor Abhishek Nagesh found the claimant’s psychological injury to be caused by the motor accident and assessed his WPI as 15%.
The insurer lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Nagesh’s decision. This was allowed by the President’s delegate (Ms Tajan Baba) and this Panel was convened to conduct the review.

MEDICAL ASSESSMENT UNDER REVIEW

Medical Assessor Nagesh noted that the claimant has a previous diagnosis of depression and anxiety following the death of his brother in a motor vehicle accident in 1998. His GP had prescribed anti-depressant medication (Venlafaxine - Efexor), completed a mental health care plan and referred the claimant to a psychologist.
This previous diagnosis was found by the Medical Assessor to be in remission at the time of the subject motor accident. The Medical Assessor was satisfied that the subject accident caused the claimant to suffer from post-traumatic stress disorder and assessed his WPI as 15%.

SUBMISSIONS

Insurer’s submissions

The insurer says the Medical Assessor was incorrect when addressing criterion G of the DSM-5 which relates to the disturbance causing clinically significant distress or impairment in social, occupational, or other important areas of functioning. The insurer argues that there was no “occupational impairment” with the claimant returning to his pre-accident job, albeit at reduced hours. It is further submitted that there has been no adequate explanation as to what caused the claimant’s hours to be reduced from 38 to 28 at or around February 2024.
The insurer also says the Medical Assessor failed to give due consideration to “inconsistencies” in what the claimant told other doctors and Medical Assessors (Dr Keller, Dr Whetton, Medical Assessor Samuell) in relation to his level of functioning in the categories of self-care and personal hygiene and concentration, persistence and pace.
The insurer argues that the claimant’s psychiatric impairment does not exceed the 10% WPI threshold based on the opinion and report of Dr Peter Whetton dated 13 February 2024.

Claimant’s submissions

The claimant refutes that there is any error in the Medical Assessor’s diagnosis of

post-traumatic stress disorder or the impairment found in the disputed areas of function. The claimant says the Medical Assessor’s reasoning is not inconsistent with the other medical evidence and was, in any event, open to rely on the history obtained on the day of the medical assessment.

REVIEW OF THE EVIDENCE

On 21 May 2025, the Panel issued a direction to the parties requesting indexed and paginated bundles of the information they relied upon. The Panel advised that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The parties responded with the insurer’s bundle comprising of pages

1-138 and the claimant’s bundle comprising of pages 1-24.
Following a direction from the Panel, the parties provided additional information which included the complete clinical records of Earlwood Medical Centre, additional typed clinical notes of psychologist Ms Sue Boursiani, a letter from Ms Sue Boursiani and colour photographs of the claimant’s damaged vehicle.
The claimant also provided an updated report of psychologist Ms Sue Boursiani dated

17 August 2025.
The Panel conducted a comprehensive review of the documentation on file, including the additional documentation. To assist with readability, a detailed summary of the relevant documentation is provided in Appendix A. The Panel will make reference to this material in its re-examination report and findings made on causation, diagnosis and the assessment of permanent impairment.

RE-EXAMINATION REPORT

At the preliminary conference on 16 July 2025, the Panel determined that the claimant be

re-examined. The joint re-examination report of Medical Assessors Friend and Jones is below:
“Who attended the assessment
[BZE] was examined by Assessor Paul Friend and Assessor Matthew Jones by video teleconference.
[BZE] was in his home at Peakhurst Heights.
His wife was at home but did not participate in the examination and was not in the room during the examination.
HISTORY
Psychosocial history and pre-accident history
[BZE] is married. He has a son aged 20 years and a daughter aged 15 years.
He was born in Sydney and grew up in Hurstville. He completed school until the end of Year 10.
He had two younger brothers. One brother was killed at age 19 years when [BZE] was in his mid-twenties in a motor vehicle accident. His other brother is now in his forties.
He has never remembered people’s birthdays or precise ages.
[BZE], after leaving school, completed a motor mechanic apprenticeship and worked as a motor mechanic for several employers for about eight years.
He subsequently worked fabricating metal in a factory and later as a machine operator for Kellogg’s Australia.
Seven to eight years ago he commenced working for a company named Yasmin which manufactured and sold haircare products.
He started as a machine operator. He was gradually promoted to his current position of maintenance manager, which occurred a few years ago after the motor accident. He was unable to provide a precise date.
He, as the maintenance manager, has the responsibility of ‘keeping everything running.’ He organises the servicing and repairing of machines which includes him doing hands on maintenance tasks, engaging outside contractors to do maintenance and repair tasks, managing the utilities for the building and overseeing the processes in the factory and the employees.
He continues to work as a maintenance manager but has reduced his hours of work because he felt he had deteriorated and become tired, which will be addressed in more detail later in this certificate.
[BZE], after his younger brother died, which he dated as probably thirty years ago, became depressed. He was prescribed Efexor XR 150mg which he helped him to get ‘my life back on track.’ He continued to take that medication up to the motor accident and continued it after the motor accident.
He was asked specifically whether he had had any counselling or psychological treatment after his brother’s death. He thought that he probably had received such treatment but could not recall it.
Previous medical history
[BZE] believes he was treated for hypertension and gastro-oesophageal reflux prior to the motor accident.
He had a colonoscopy before the motor accident. This was probably in 2019 because there is reference to colonic and rectal polyps in August and September 2019 in the active past history of the patient health summary from the Earlwood Medical Centre dated 6 March 2024. He has only had one colonoscopy.
He had a right knee reconstruction in about 2010.
He believes that he suffered a fractured hand when he was young but could not provide further details.
At the time of the motor accident, he was taking Efexor, antihypertensive medication and Somac on and off.
Substance Use
[BZE] has never smoked cigarettes, does not consume alcohol and has never used illegal substances.
He has a couple of cups of tea and coffee each day.
He previously drank cola and energy drinks but ceased consuming them after he was diagnosed as having diabetes mellitus in 2022.

History of the motor accident
[BZE] stated that the motor accident occurred when he was sitting in the front passenger seat of his vehicle which was parked outside the facility where his son was training for soccer.
He was hit unexpectedly from behind by a vehicle which he believes did not brake. His vehicle was pushed forward and up onto the footpath.
He described it ‘as becoming like a dream.’ He can remember hearing his son scream. He remembers being taken out of the vehicle and laid on the ground. He remembers there were many people around him and he felt shocked.
An ambulance attended. He lifted into the back of the ambulance where he was examined. The ambulance officers recommended that he go to hospital. He declined because he does ‘not like hospitals.’
A second ambulance was summoned. These ambulance officers appear to have completed an ECG and/or another investigation because he described having dots put all over him.
His son telephoned his wife and she came to the site of the motor accident. She drove him home.
He remembers a police officer coming into the ambulance and saying words to the effect that he had seen fatalities from collisions like this one.
He believes that his vehicle was struck hard, as it is a 2.5 tonne utility vehicle.
His vehicle was later written off.
History of symptoms and treatment following the motor accident
[BZE] cannot remember how he felt the day of motor accident or the following day. He does recall consulting his family doctor which, according to the clinical notes of the Erskineville Medical Centre, occurred the following day on 20 April 2021.
The entry states that he was hit from behind. He was not wearing a seatbelt and was looking at his mobile telephone at the time of the impact.
He had pain in his left forearm, a sore neck, back pain, felt tight and felt as if he had been bashed. The diagnoses were concussion, whiplash injury to the neck, soft tissue injury to the back and left forearm.
[BZE] remembers that he had various investigations and physiotherapy for a period of time but cannot remember for how long.
He was referred to one or more specialists.
One specialist told him he could have surgery on his left hand but he has decided not to do so.
[BZE] stated he did not feel mentally well after the motor accident. It felt like a big shock, but he wanted to battle on.
He ceased driving for a period of time but cannot say for how long. He initially did not want to get back into a vehicle because he did not want to have another near death experience.
He was away from work for somewhere between two and six weeks. He was not fully recovered when he returned to work.
He purchased a new vehicle. He fitted cameras at the front and the back of the vehicle and apparently had a proximity sensor fitted to the front of the vehicle.
He resumed driving but only drove to and from work along the same route.
He was fearful of being involved in a further motor accident. He described going through scenarios of what could happen when he was driving to and from work.
He was very sweaty when he drove. He needed to clear his head so he could concentrate when driving. He was particularly fearful if he thought an oncoming vehicle was going to come over the centre line. This could cause him to pull over to the side of the road and stop. He would get out, walk around then resume driving.
He described having periods where he would drive and not remember what had happened or where he had been driving for the last five minutes. This would cause him to pull over and get out of his vehicle. He described this as a dream state and an out of body experience where he was not mentally ‘100 % present.’ He described at times watching himself do activities.
He worked full time when he returned to work until about December 2021.
He had a pay increase in December 2022, according to the payment record in the supplied documents. The pay increase presumably corresponds to when he was promoted to maintenance manager. [BZE] could not recall when he was promoted.
He gradually started to deteriorate, including at work. He started to become angry with others, struggled to focus and concentrate on manuals for the machinery at work, was excessively irritable, felt panicky and was so exhausted that he slept at lunchtime.
His eyesight became blurry.
He would triple check his work, just not remembering if he had done something.
Several times at work he would be so angry that he had to walk outside. He was not certain what he would do when angry. He did not do anything untoward when angry. He was not an angry person prior to the motor accident.
There were similar symptoms at home. He became more irritable and withdrawn, and spent a lot of time sitting on the couch watching ‘a bit of television.’ He lost interest and stopped going dirt bike riding and fishing with friends. His wife described him as being overprotective of his children. He remembers telling his children to be careful, and that ‘there are idiots everywhere.’ He generally had a negative attitude.
He has arguments with his children, at times, and once he had been in a fight with his son.
He has now left the management of the children and the home to his wife.
He ceased doing household maintenance duties although he still mows the lawn from time to time.
[BZE] could not recall when he started to deteriorate, but presumably this was after he was promoted to maintenance manager. He was unable to provide a reason for the deterioration or state whether it followed any particular event.
He did all the household maintenance prior to the motor accident stated that he had ‘practically built the house himself.’ He rode dirt bikes, went fishing with friends, and went to motocross and drag races, prior to the motor accident. He has always been very interested in motor vehicles.
Details of any relevant injuries or conditions sustained since the motor accident
[BZE] has not been involved in any subsequent motor accidents and has not undergone any surgery.
He is supposed to have a colonoscopy but does not want to put himself in a situation where he is put to sleep. He is scared of the outcome.
He has neglected his dental care. He has one broken tooth and may need other dental treatment.
He was diagnosed with Type II Diabetes Mellitus in 2022 and commenced on medication.
Current symptoms
[BZE] feels physically “worn out” like an old man and that he has ‘aged too much.’
He has pain in his neck. He initially stated that he had pain in both hands but later stated that the pain was in his left wrist and thumb. He gets aches and pains at the sites of his previous injuries when the weather changes and it becomes cold.
His neck is stiff.
He has headaches and blurry vision.
He has been itchy in the last six months. He has welts and rashes, sweats excessively and has body odour. He always feels tense.
Mentally, he feels much the same as described above. He feels generally ‘low’ and ‘debilitated.’ His symptoms have deteriorated. He could not explain why they had deteriorated sometime after the motor accident.
Current and proposed treatment
[BZE] is taking medication for blood pressure which is probably Coversyl.
He continues to take Efexor XR one 150mg tablet at night.
He takes a medication for diabetes mellitus which he could not name but is probably Trajentamet.
He takes Somac because he ‘chokes a lot.’
He stated that he has symptoms of reflux (gastro-oesophageal reflux). He at times feels “like food has gone down the wrong hole” which causes him to cough. This sensation is different from the gastro-oesophageal reflux symptoms.
He continues to take a medication for cholesterol, probably Crestor.
His weight has increased from 78 to 87-88kg. He was unable to say his exact height but thought it was in the 160cms.
CLINICAL EXAMINATION
Mental state examination
[BZE] was examined by video teleconference.
Assessor Paul Friend was the lead assessor and Assessor Jones asked supplementary questions towards the end of the examination.
[BZE] was able to provide a good description of his symptoms, both physical and psychiatric.
He described an ongoing fear of being involved in further motor accidents.
He described the police officer telling him words to the effect that it had been a life threatening motor accident.
He felt tense and on edge, would sweat excessively, and was fearful of a motor accident when driving.
He struggled with focus and concentration at work. He often felt exhausted at work such that he had to sleep at lunchtime.
He was very irritable and could have very angry outbursts with his children and had had to walk out of work, at times, because he felt so angry.
He restricted his driving to driving to and from work.
He was socially withdrawn and struggled to do activities at home.
[BZE] did not describe sleep disturbance and did not describe experiencing nightmares at any stage.
He described feeling tired or lazy and having little motivation.
Current functioning
[BZE] now showers every 2-3 days because he cannot be bothered to shower each day. He describes himself as lazy. His wife tends to push him to shower. She lays out his clothes for him. She sets out his medication for him.
He can never find his clothes because his wife ‘buries them.’
His wife makes him a cup of coffee, but he does not eat breakfast.
He no longer does any household maintenance at home except mowing the lawn. Even so, the lawn is not well maintained. He describes his wife pushing him outside just to get him outside.
Prior to the motor accident he was well organised and there were no problems. He ate breakfast, did physical exercise including push-ups and bench presses and ‘looked after’ himself.
It was easy to get up and get ready each day. He joked with his family and made his own breakfast.
[BZE] stated that prior to the motor accident he was the life of the party and enjoyed company. He went dirt bike riding and fishing with friends.
He now has no interest in having contact with others. Others contact him about doing activities. He makes excuses to not do activities. He only leaves home to engage in activities if his wife organises it and accompanies him.
If visitors come to the home, he sits there and says very little.

His wife takes him to watch his son play soccer. He described ‘sitting in the corner’ and watching.
[BZE] drives to and from work. He is often very sweaty and tense and often has to change his shirt 2-3 times each day as consequence of driving to and from work. He drives the same route to and from work. It is 45 minutes’ drive each way to and from work.
He otherwise avoids driving because he feels very nervous.
He described thinking about possible scenarios that might occur on the road and at times having to pull over if he thinks a vehicle is coming over the centre line or he feels he has not been aware of what has been occurring whilst driving. He sometimes has an out of body experience when driving
He checks the cameras that he has installed on his vehicle to see whether he has run over an animal or hit an object, when he arrives at work.
He has not been involved in any subsequent motor accidents and has not run off the road or become lost whilst driving.
He has arguments with his children. The relationship with his wife is not good and she sleeps in a separate room.
She has talked about living with his mother for a while. They have not separated and his wife still cares for him and pushes him to do activities.
He has contacted by friends and has several longstanding friends who keep in touch with him.
[BZE] stated that he has problems with his memory and concentration, not being able to read manuals at work although he continues to do the same type of work. He can triple check his work.
He never watched much television and now has the television turned on for ‘background noise.’ He can be upset by news items about death or a motor accident and sometimes scenes that are depicted in movies.
[BZE] works from 8.00am to 2.30pm with an hour off for lunch which is a total of 27.5 hours each week over a total of five days.
He feels exhausted and embarrassed at work and at times is angry and not happy.
He stated that it is a struggle to function.
He was promoted to the position of maintenance manager, after the motor accident. He continues to oversee the operation, maintenance and repairs in the factory. He stated that he gets more assistance from people ‘inside and outside’ the factory.
Comments of consistency
[BZE] was consistent in his presentation in that he struggled to remember when timeframes and events occurred. He otherwise provided a good pre-accident history of his functioning.
He was unable to describe the symptoms of depression prior to the motor accident.
His account of symptoms was generally consistent with the various supplied reports except there was no description of flashbacks, nightmares or sleep disturbance. His account of symptoms was generally consistent with the physical symptoms described in the supplied documents.
[BZE] was asked various questions by the Panel.
He was asked how his symptoms had deteriorated because he had initially returned to work full time work but was now working 27.5 hours each week.
He replied that it was a struggle to express himself and he could not remember what he had told his boss. He was unable to explain why his condition had deteriorated.
[BZE] was asked about his anxiety before the motor accident and he replied that it ‘goes with the depression’ but that ‘it was on the mend’ and ‘this had occurred after missing a loved one.’
He stated that he was anxious about things in life but that was a long time ago. Prior to the motor accident he was ‘100 %.’
[BZE] was asked about the Mental Health Care Plans dated 25 January 2016, 18 January 2017 and 12 February 2018 which referred to him as having anxiety. He replied that he could not recall these times.
[BZE] was asked, given his difficulty with suffering out of body experiences and dream states, whether he had self-reported this to the Roads and Maritime Services or whether others had suggested he do so.
He replied no-one suggested he should not drive.
[BZE] was asked about the performance review form dated 27 April 2023.
His self-evaluation rated himself as Above average or Excellent, and that his long term career goals were to help grow the company to its full potential, streamline and maximise his skills and remain an asset to the company. He replied that he could not specifically remember filling out that form but felt that he had probably completed it that way to obtain a better position in the company and that he tried to bluff his way through things.
He stated that he ‘was not lying 100 %’, that ‘he had a lot of experience’ and ‘too much for the job’ that he was doing.
[BZE] was asked about the entry in the Earlwood Medical Centre clinical notes dated 18 January 2017 which states that he wanted to travel overseas and trialling Valium was discussed. There is a further entry dated 8 June 2018 which states he was travelling to Greece in two weeks.
[BZE] stated he had travelled overseas. He had enjoyed the trip and he had not taken any additional medication.
He was asked if there was any time prior to the accident that he stopped doing activities even transiently because of anxiety. He replied that he could not recall any such time.
[BZE] was asked about the entry in the Earlwood Medical Centre notes dated 13 March 2024 which states that had experienced chest tightness. It is recorded that a cousin had recently collapsed on the football field and was revived with CPR and defibrillation.
It states he was referred to a cardiologist.
[BZE] replied that the cardiologist told him that he had a strong heart, younger than his stated age, and ceased one of his antihypertensive medications.
He stated that he was obviously concerned about his own heart after that event occurred and that he was reassured by the specialist. He stated that there was no ongoing effect from that event.”

RELEVANT LEGISLATION

Permanent impairment

Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (Guidelines).
Version 10 of the Guidelines, effective from 15 September 2025, applies to the review.
The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.

Permanent impairment is assessed in accordance with Chapter 6 of the Guidelines. Specifically, the assessment of psychiatric impairment draws from the chapter “Mental and behavioural disorders” which commence at cl 6.201 of the Guidelines.

Causation of injury

It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition.
Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:
“6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
Further, the provisions of the Civil Liability Act 2002 apply, in particular ss 5D and 5E.

DETERMINATIONS

The review of the medical assessment 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.[2]
[2] Section 7.26(6) of the MAI Act.
The evaluation should only consider the impairment as it is at the time of the assessment.[3]
[3] Clause 6.21 of the Guidelines.
The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[4]
[4] Section 7.26(7) of the MAI Act.
The Panel notes the above re-examination report of Medical Assessors Friend and Jones. The Panel reconvened on 10 September 2025 and discussed the re-examination report findings before collectively making the below determinations.

Diagnosis and reasons

The Panel considered all the available information in the supplied documents and the information provided by [BZE] in the examination.
The Panel noted that Medical Assessors Doron Samuell and Abhishek Nagesh and the treating psychologist Dr Boursiani, clinical psychologist, all made a diagnosis of

post-traumatic stress disorder.
Medical Assessor Peter Whetton made a diagnosis of a generalised anxiety disorder.
The Panel determined that [BZE] met criterion for a diagnosis of post-traumatic stress disorder.
He meets criterion as follows:
Category A
[BZE] was involved in what was a traumatic event and remembers being told by a Police Officer that people had died in that type of motor accident.
Category B
[BZE] has distressing memories of the motor accident which are involuntary and when driving.
He is fearful of further motor accidents.
Category C
[BZE] avoids any reminders of the motor accident by only driving to and from work and otherwise staying at home, unless he goes out with his wife.
He does not talk to others.
He feels uncomfortable if something comes onto the television about death or a motor accident.
Category D
[BZE] tends to see the world as dangerous. He tells his children that there are idiots everywhere.
He has lost interest in previously enjoyed activities, is withdrawn and detached from others, and does not experience any happiness.
Category E
[BZE] is irritable, including with his children and particularly his son.
He is hypervigilant when driving.
He has difficulty with concentration at work.
Category F
The disturbance has been present for more than one month.
Category G
The disturbance causes significant distress or impairment in his social and occupational functioning.
Category H
The disturbance is not attributable to the physiological effects of a substance or another medical condition.
The Review Panel noted, as stated previously, that [BZE] did not describe nightmares, flashbacks or sleep disturbance which had been mentioned in previous reports.

Causation and reasons

[BZE] stated that prior to the motor accident he did not have any symptoms.
He was treated for depression and possibly anxiety prior to the motor accident, since one of his younger brothers had died at age 19 years.
There are references to him being anxious in 2016, 2017, 2018 and in March 2020 but not subsequently.
Although he wanted to withdraw from his medication in the 6-12 months prior to the motor accident that had not actually occurred.
He was still working full time at work, but not as a maintenance manager.
There are no references in the supplied documents that he had impairment of his functioning prior to the motor accident.
[BZE] had not been involved in any subsequent accidents. He developed Type II Diabetes Mellitus, but he has not developed any severe or life-threatening conditions.
He was concerned when his cousin in 2024 needed to be resuscitated on a football field but that a subsequent consultation with a cardiologist reassured him and that incident had no ongoing effect on his functioning.
There is no other cause for the condition of post-traumatic stress disorder other than the motor accident on 19 April 2021.

Summary of injuries referred by the parties

The following injuries WERE caused by the motor accident:
· post-traumatic stress disorder.

PERMANENCY OF IMPAIRMENT

Permanent impairment is defined in the AMA 4 Guides (p.315) as follows:
“Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment.
A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment.”
The motor accident occurred over four years ago. [BZE] had treatment by a psychologist and continues to have treatment by a psychologist. He has continued to take the same dose of Efexor XR.
His condition started to deteriorate sometime after the motor accident but is not further deteriorating or improving.
His condition is stable and unlikely to improve in the next 12 months and not by more than 3% with or without medical treatment. His condition should be regarded as stabilised and permanent.

Degree of permanent impairment psychiatric impairment rating scale

The determination as to permanent impairment is made in accordance with the AMA 4 Guides and Part 6 of the Guidelines.

Psychiatric diagnoses

1. Post-traumatic Stress Disorder.

2.

3.

4.

Psychiatric treatment description

Treatment by a psychologist.

Treatment with Efexor XR.

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	3	Moderate impairment. [BZE] showers every 2-3 days even though he sweats excessively. His wife needs to prompt him to shower. His wife needs to put out his clothes. His wife makes him a cup of coffee and puts out his medication for him. He has ceased all household maintenance duties except he mows the lawn sometimes.
2. Social and Recreational Activities	3	Moderate impairment. [BZE] has ceased dirt bike riding and fishing with friends. He stays home most of the time. He only goes out socially if his wife has organised something and accompanies him. If people visit at home he tends not to say very much or engage with them. He makes excuses that he is not feeling well. He describes having no interest in social activities.
3. Travel	2	Mild impairment. [BZE] drives to and from work which takes about 45 minutes on the same road both ways. He continues to do this despite all his symptoms. The Panel noted that he sweats excessively when driving.
4. Social Functioning	2	Mild impairment. [BZE] has arguments with his children and one fight with his son. This was consistent with the latest August 2025 report from his treating psychologist Ms Sue Boursiani. He is contacted by longstanding friends although he does not do any activities with them. He and his wife sleep separately. He stated that she has talked about him staying with his mother for a while, but there is no evidence of separation. His wife is still engaged with, and prompts him about, his personal care. She lays out his clothes each morning. His wife “buries” his clothes when she puts them away, so that he cannot find them. His wife makes coffee for him in the morning and the evening meal at night. His wife puts out his medication each day.
5. Concentration, Persistence and Pace	2	Mild impairment. [BZE] sat through an examination which lasted almost two hours. He provided a good account of his symptoms and his loss of function since the motor accident. He provided an outline of his functioning and his history prior to the motor accident including the treatment following the death of his brother. He struggled with the names of medications and could not recall reports about anxiety symptoms prior to the motor accident. He struggled with concentrating at work, reading manuals for machines, but nonetheless he was still organising maintenance to be done. He still undertook maintenance and repairs although he needed to triple check his work. [BZE] described not remembering clearly such as what happened immediately after the motor accident. He described being shocked and in a dream state and this dream state or out of body experience recurred from time to time. He did not lose concentration in the examination and did not ask to have a break at any stage during the examination. The Review Panel felt that considering the nature of his work and all that he was required to manage and organise at work, he was functioning at a reasonable level but below his previous level.
6. Adaptation	2	Mild impairment. [BZE] is working 27.5 hours each week spread over five days in the role of maintenance manager to which he was promoted after the motor accident. He was finding it more difficult and is receiving assistance from others including outside contractors. He has nonetheless continued to work in the same position with the same responsibilities albeit with slightly reduced hours.
List classes in ascending order: 2, 2, 2, 2, 3, 3
Median Class Value: 2
Aggregate Score: 14
% Whole Person Impairment: 7 %

*%WPI ^{= Percentage Whole Person Impairment}
Psychiatric Impairment Rating Scale - Pre-existing/subsequent impairment

Psychiatric diagnoses	1. Depression.	2.
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	Treatment with Efexor and possibly treatment by a psychologist.

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	1	No deficit. [BZE] had no difficulty with his self care and personal hygiene and did household maintenance duties.
2. Social and Recreational Activities	1	No deficit. [BZE] had no impairment in this category. He went dirt bike riding, went to motor vehicle and motocross races and had an active social life.
3. Travel	1	No deficit. [BZE] had no difficulty with driving or travelling and had travelled overseas without the need to take additional medication.
4. Social Functioning	1	No deficit. [BZE] had no difficulties in interactions with family, friends or people at work.
5. Concentration, Persistence and Pace	1	No deficit. [BZE] had no difficulty concentrating, was able to read machine manuals at work and do all that was required. He never watched much television.
6. Adaptation	1	No deficit. [BZE] was working full time. He had no difficulty with his work activities. He did all the household maintenance.
List classes in ascending order: 1, 1, 1, 1, 1, 1
Median Class Value: 1
Aggregate Score: 6
Pre-existing % Whole Person Impairment: 0%

*%WPI
Apportionment – pre-existing/subsequent impairment

[BZE] had no impairment of his functioning prior to the motor accident but he was taking Efexor XR 150 mg and had taken this medication for about 30 years. He reported when asked that he had stopped taking it a few times but had withdrawal symptoms and had resumed it.
There is some evidence in 2016, 2017, 2018 and 2020 that he did have some anxiety.
The Panel determined there was a pre-existing WPI of 2% for the treatment effect of this medication in controlling his symptoms.
As far as could be determined, he still had some symptoms, or at least from time to time, so there was not a complete resolution of his pre-existing condition.

Effects of treatment

The Review Panel determined that there was no evidence that the treatment by the psychologist or the ongoing treatment with Efexor had had any beneficial effect. No allowance is made for treatment:
·        Current WPI   7%
·        Apportionment                   -2%
·        Effect of treatment             0%
·        Final WPI        7-2 = 5%

CONCLUSION – PERMANENT IMPAIRMENT

The degree of permanent impairment caused by the motor accident is 5%.

DE-IDENTIFICATION OF THE CERTIFICATE AND REASONS

Following the re-examination of [BZE], [BZE] wrote to the Commission and requested that his name be suppressed from the published Panel’s decision. [BZE] says given his ongoing mental health challenges, the public disclosure of his name may cause him significant psychological distress and negatively affect his wellbeing.
The Panel invited submissions from the insurer. None were received.
The Panel notes that [BZE] is diagnosed with a psychiatric condition with impairments to various areas of functioning. The Panel is of the view that redacting the claimant’s name would serve the proper administration of justice while protecting the safety and wellbeing of the claimant affected by the publishable decision.

The Panel therefore directs that, pursuant to Rule 132 of the Personal Injury Commission Rules 2021, the claimant’s name be redacted from its certificate and reasons before publication.

APPENDIX A – Summary of relevant documentation

The statement by [BZE] dated 30 June 2025, states he had a long history of depression and had been taking antidepressant medications for many years, following the death of his brother in a motorbike accident 1998.
In the 12 months or so prior to the accident, in consultation with his general practitioner,

Dr Danform Lim of Earlwood Medical Centre, he had begun to reduce his medication with a view to weaning off it.
In 2022, following the motor accident, his mood deteriorated.
I became aggressive, depressed, and argumentative. I wanted to withdraw from engaging with others.
I was still working, but I was struggling to continue, to the point where I stopped looking after myself physically and my appearance suffered.
My general practitioner referred me to a psychologist, Sue Boursiani, who helped me with different therapies.
After seeing Ms Boursiani for about 12 months, I believed things were not working out. I was contemplating giving up work. It was suggested I approach my employer and ask for either some time off or to cut back on my hours.
I approached the owner of the company, for whom I have worked since 2016 or 2017 as a machine operator.
I was off work for about three weeks after the accident.
I went from being a machine operator to a maintenance manager which is less hands-on.
My employer agreed to cut back my hours from 38 to 28 hours each week working

8 a.m. to 2:30 p.m.
Although this initially helped, my difficulties returned, and it is difficult now to work even the reduced hours.
I subsequently told him that this was because of my motor accident. I previously said it was for personal reasons.
My psychologist has diagnosed me with PTSD.
I do not know how much longer I will be able to continue working 28 hours each week. I lack motivation, feel hopeless, helpless and worthless.

The Personal Injury Commission Certificate by Assessor Doron Samuell dated
12 September 2023 states that following the motor accident [BZE] developed symptoms of sleeping late and trying not to lie down until he was tired.
He wakes up sweating and needs to change his shirts.
He used to have nightmares, but they have improved a lot.
He can wake up and think about things, including the accident and other things.
Most nights he sleeps about six hours.
His appetite is okay, but he overindulges a bit.
His mood is a bit dull. Matters do not excite him as much as they did previously.
He avoids driving and makes excuses not to do so.
He lacks confidence in his work and triple checks his work.
He is short fused.
He has some problems with concentration.
Medical Assessor Samuell makes a diagnosis of post-traumatic stress disorder, which is not a threshold injury.

The Personal Injury Commission Certificate by Assessor Abhishek Nagesh, psychiatrist, dated 1 October 2024 states that prior to the motor accident, [BZE] was well and weaning off antidepressant medication.
He did not use any illegal substances or alcohol. There is no history of mental illness in the family.
The motor accident occurred when his vehicle was stationary. He was sitting in the passenger seat watching his son train for soccer. The vehicle was rear-ended on the right side, which resulted in pushing his vehicle 10 metres onto the footpath. The vehicle was completely written off.
He blanked out.
He was medically examined by an ambulance officer and refused to go to hospital.
The next day he was in pain. He consulted his general practitioner.
He was mentally in shock as well as being in pain, could not sleep, developed nightmares and flashbacks. He worried about having another accident.
He ceased driving and was anxious and fearful of driving.
His mood became depressed and pain disturbed his sleep.
He became irritable. His concentration was diminished. He felt numb, emotionless, and ceased enjoying previously enjoyed activities.
He has also become hypervigilant.
He worries that something bad is going to happen.
Assessor Nagesh made a diagnosis of post-traumatic stress disorder and assigned a whole person impairment of 15%, assigning Class 2 to travel, social functioning, and adaptation, and Class 3 to the remaining three categories.
The pre-existing whole person impairment was 0%.
There is no mention of the pre-existing medication, and whether that was being taken at the time of the motor accident.
His medications at the time of the examination were Pantoprazole 40 mg, Venlafaxine 150 mg and Coversyl each day.
It states that he has diabetes mellitus, but there is no mention of treatment.

The Personal Injury Commission Certificate of Assessor Tania Rogers dated
5 June 2023 states the following conditions:
cervical spine - whiplash
left wrist - soft tissue injury
is a threshold injury for the purposes of the act.
It states [BZE] had parked his utility on the side of the road. He was sitting in the passenger seat because he had been supervising his son driving under a learner's licence.
There was a sudden impact and he felt a flash of light and a sensation of whiteness.
His son was screaming.
The passenger seat broke, causing his head to forcefully strike the seat. He was not wearing a seat belt at the time of impact, and there were no keys in the ignition.
The ambulance officers had recommended he be transported to hospital, but he declined. His wife collected him and took him home.
It states his current medication is Nurofen or Panadol for pain, Voltaren twice a month, Somac, Natrilix, Efexor, and another medication for hypertension. He was apparently taking this medication at the time of the accident.

The clinical notes of Sue Boursiani, clinical psychologist from 24 September 2022 to 22 July 2023 are all handwritten and difficult to decipher.
The Panel cannot find a statement about the diagnosis.
Typed clinical notes entries of Sue Boursiani, clinical psychologist dated 23 July 2022 and 24 September 2022 describes the motor accident collision and psychological symptoms. Administered posttraumatic stress disorder checklist. Psychological state getting worse in 24 September 2022 entry.
Report of Sue Boursiani dated 25 August 2022
described avoidance of memories relating to the accident. There was loss of enjoyment in activities and strain on relationships and daily functioning. Feelings of fear and hypervigilance when driving. Ms Boursiani diagnosed

post-traumatic stress disorder and highly recommended treatment.
Report of Sue Boursiani dated 17 August 2025 noted treatment consultations between July 2022 and August 2025. On the latest occasion (15 August 2025), claimant reported increasing aggression with physical altercation with his son. Shame from the confrontation. Excessive sweating (changing shirts two to three times daily). Further anger issues including shouting at management at work. Fears about being trapped in a coffin, ongoing paranoia when driving, disrupted sleep, thoughts about death. Reduction in work hours confirmed occurring around October 2023 from 38 hours to approximately 28 hours per week. Opined that claimant continues to present with post-traumatic stress disorder with co-occurring depression and anxiety – all caused by the motor accident. Past history of depression linked with bereavement noted but was stable, well-functioning and was preparing to discontinue antidepressant medication prior to the motor accident.
The Depression, Anxiety and Stress Scale 21 item apparently dated 4 March 2020 or
9 March 2020 has the following results:
depression - 7 - moderate
anxiety - 7 - moderate
stress - 7 - normal

The clinical records of the Earlwood Medical Centre from 29 November 2023 to
3 January 2024 includes the following.
The patient health summary dated 6 March 2024, states that the active past history includes depression. He is taking Efexor 75 mg and is currently trying to wean. He has consulted Dr Roxanas, psychiatrist.
His previous medical history includes hyperferritinaemia and polycythaemia.
He was apparently diagnosed with type II diabetes mellitus on 11 April 2020.
His current medications are:
Crestor
Efexor 150mg
Flixotide Inhaler
Natrilix
Physiotens
Prednisolone
Somac
Trajentamet

The entry dated 4 December 2023, states the psychologist considers him to have PTSD.
He wonders if this can cause non-insulin dependent diabetes mellitus.

The entry dated 3 January 2024 states his HbA1c is 6.9%. It states there was a discussion about increasing the dose of metformin.
The report of Dr Andrew Keller, occupational physician, dated 4 December 2023, regarding the motor accident on 19 April 2021, states that the physical effects of the accident have resolved in the two years that have elapsed since the accident.
He has pain in the base of his left thumb, but has evidence of severe arthritis in that joint, which would predate the accident by many years.
The recent accident caused him temporary pain in the neck and back that has resolved.
It states he has been working full time in his pre-injury role since 8 May 2021.

The report by Dr Peter Whetton, psychiatrist, dated 13 February 2024, states that [BZE] has a diagnosis of Generalised Anxiety Disorder. It states that he is withdrawn, overthinking and feels overwhelmed. He doubts his ability to drive. He double checks.
He is aggressive and is reluctant to drive to work. He has ceased riding his motorbike. He has declined in confidence, is reclusive, easily upset, intolerant, and increasingly safety conscious.
There were initial symptoms of flashbacks and nightmares but these have remitted.
Dr Whetton assigns a whole person impairment of 7%, assigning Class 1 to self-care and personal hygiene, Class 2 to travel, social functioning, and adaptation, Class 3 to social and recreational activities and concentration, persistence, and pace.

The performance review form dated 27 April 2023, includes the following:
The self-evaluation by [BZE] rates his abilities as above average or excellent.
His long-term career goals are to help grow the company to its full potential, streamline and maximise my skills and remain an asset in the company. Maybe buy shares in the company one day.

The summarised pay report for [BZE] states throughout that his hours of work are 38 or more up to including 14 March 2024.
His gross pay on 1 April 2021 was $2,384.62 but on 8 April 2021 was $1,456 and continues mostly at $1,375.51, increasing to $1,384.62 on 27 May 2021.
It increases to $1,576.92 on 15 July 2021.
It is variable thereafter. It increases to $1,693.12 on 28 October 2021 and to $1,711.08 on 18 November 2021.
It is as low as $538.43.
It increases to $2,016.92 on December 2022, but subsequently drops, but is variable.
It is $1,769.23 on 8 February 2024 and the last figure is $1,303.64 on 14 March 2024.

The statement of hours and pay, dated 8 February 2024, states [BZE]’ full-time hours are 38 and his reduced hours are 28. His weekly reduced salary on 28 hours per week is $1,036.65.
The combined certificate by Assessor Mohammed Assem dated 10 October 2024 states that the following injuries:
- Left arm - muscular ligamentous injury related to left wrist injury
- Cervical spine - soft tissue injury secondary restriction in shoulder motion
- Thoracic spine - soft tissue injury
- Scaphotrapezial trapezoidal (STT) and first carpometacarpal (CMC) joint arthropathy, marrow oedema at the base of the first metacarpal, gives rise to whole person impairment of 4 % which is not greater than 10%.

The clinical records from the Earlwood Medical Centre from 8 August 2014 to 21 June 2023 include the following:
The entry dated 8 December 2014 states he presented after a hammer injury to his right leg two weeks ago. It states he has depression, muscle cramps, needle phobia.
The entry dated 12 November 2014 includes a prescription for Efexor 75 mg, one in the evening.
The entry dated 21 January 2016 states that he cut down by 75 mg on Efexor a few months ago, having taken 150 mg for nearly 10 years. He has recently been getting more anxious.
It states that there was an explanation about a psychologist reviewing the potential charges.
Efexor XR 75 mg was ceased and he was recommenced on Efexor 150 mg daily.
The entry dated 18 January 2017 states he has an anxiety disorder and wants to go overseas. It states discussed trial of the use of Valium.
He was prescribed Efexor XR 150 mg daily after meals and diazepam 5 mg 1-2 tablets three times daily as required.

The entry dated 12 February 2018 states the diagnoses are depression and night sweats prescribed Efexor XR 150 mg, one daily.
The entry dated 8 June 2018 states he is travelling to Greece in two weeks.
The entry dated 29th May 2019 states there was a letter received from the haematologist at Royal Prince Alfred Hospital which states that his diagnoses are polycythaemia and hyperferritinaemia.
The letter from the haematologist states that he has a JAK2V617F mutation.
The entry dated 6 November 2019 states there was a long discussion about the use of an SSRI, and there was a plan to slowly reduce from Efexor by 37.5 mg every three months, but he was still prescribed Efexor XR 150 mg one daily.
The entry dated 4 March 2020 states he has a history of anxiety and depression, 15 years, and has been taking Efexor for 10 to 15 years. He feels a bit clouded taking Efexor and would like to cease it.
He would like to see a psychologist. It states that he is anxious and worrying at nighttime.
He was prescribed Efexor XR 150 mg on 10 June 2020.

The entry dated 20 April 2021 states he had a motor accident last night. He was sitting in the passenger seat of his Ute at a park and was stationary. He was hit from behind by a hatchback. It is unclear how fast she was travelling and the car was written off. He did not have his seatbelt on and was looking at his phone at the point of impact.
Ambulance officers advised to go to hospital, he declined because he was anxious.
He has pain in his left forearm, sore neck and back pain, feels tight and feels he as if hr has been bashed.
The diagnoses were: concussion, whiplash injury to the neck, soft tissue injured back and left forearm.

The entry dated 30 April 2021 states that he would like to make a CTP claim.
He continues to have the same symptoms.
The CT scan of the brain showed no bleeding, and of the cervical spine showed no vertebral fracture, cervical spondylosis or, and facet joint arthritis.
The MRI scan showed bilateral foraminal stenosis at C5/6 with bilateral C6 nerve root impingement. He continues to have bilateral upper limb numbness.

The entry dated 13 August 2021 states the MRI scan of the left wrist demonstrates dorsal mid-carpal synovitis and moderately severe STT and first CMC joined arthropathy with synovitis.
There is dorsal compartment 4 and 6 tenosynovitis.
The ECU tendinopathy is immediately related to the synovitis associated with the peripheral TFCC attachment near the ulnar styloid and fovea, in keeping with degeneration without frank tear. No ganglion noted.

The entry dated 13 October 2021 states that an MHP was developed.
The entry dated 24 November 2021 includes a prescription for Efexor XR 150 mg, one daily.
The entry dated 18 February 2022 states he has five-day history of right lower back pain, third pain to the right lower limb at the upper thigh.
He had a back injury 20 years ago. He did some car work for his son and twisted his back. He has pain in the right thigh, throbbing pain and walks with a painful gait.

The entry dated 23 February 2022 states the medical certificate for work states that he has a neuro-ortho condition and has almost recovered with the use of medications last week. He will be fit to return to work doing administrative duties and to avoid twisting his back or using his back to lift anything more than 10 kg.
The entry dated 29 April 2022 states he's feeling tense in his muscles and anxious. He is taking Efexor XR.
He had a car accident and sometimes has flashback memories. He wants a referral to a psychologist, (Cara).
The referral states to rule out PDSD. He has been feeling tense and anxious after a motor accident in April 2021.
He has muscle pain due to persistent nervous feelings and sometimes has flashbacks of what happened.

The entry dated 29 July 2022 states that psychologist note from Sue on the initial consultation on 23 September 2022 states [BZE] presents with clinically significant symptoms consistent with post-traumatic stress disorder. His responses on the post-traumatic stress disorder checklist fell into the high clinical range.
He has unwanted memories of the motor accident and avoidance of the memories, thoughts and feelings relating to the motor accident.
He has a loss of enjoyment in everyday activities, relives the experience, feels very upset when something reminds him of a motor accident.
He is experiencing strong physical reactions, in particular excessive sweating when driving.
He has strong negative feelings of fear and hypervigilance when driving and feels significant relief on weekends as there is an opportunity to avoid driving.
He has deterioration in ability to focus and concentrate.
He feels on edge and easily startled.
Since the MVA there has been a negative impact on his daily function and relationships as he is highly irritable due to his excessive fear and anxiety.
The results of the MRI of the cervical spine showed mild to moderate grade bilateral neural exit foraminal narrowing at the level of C5/C6, which may cause irritation of the exiting C6 nerve roots and so on.

The report by Dr Pradnya Dugal radiologist, dated 7 August 2021, of an MRI scan for the left wrist, states the MRI scan for the left wrist demonstrates dorsal mid-carpal synovitis. There is moderately severe STT and first CMC joint arthropathy with synovitis.
There is dorsal compartment 4 and 6 type tenosynovitis.
The ECU tendinopathy is intermittently related to synovitis associated with peripheral TFCC attachment near the ulnar styloid and fovea, in keeping with degeneration without frank tear.

The report by Associate Professor Christina Brown, staff specialist, haematologist, dated 6 June 2019, states he has hyperferritinaemia, has one copy of H63D-HFE gene mutation, which has a high frequency in the population and does not lead to significant iron load.
I suspect that the mild hyperferritinaemia has another cause. Commonest cause would be fatty liver. His brother has this condition.
It states that the JAK2V617F mutation was not detected, which largely excludes primary polycythaemia.

The Depression, Anxiety and Stress Scale (DASS) 21 item, dated 22 July 2022, has the following results:
Depression - 8 - moderate
Anxiety - 19 - extremely severe
Stress - 17 - extremely severe

The mental health care plan dated 25 January 2016 states the diagnosis is anxiety.
The mental health care plan dated 18 January 2017 states the diagnosis is anxiety and he is treated with Efexor XR 150 mg.
The mental health care plan dated 12 February 2018 states the diagnosis is anxiety.
The Certificate of Capacity/Certificate of Fitness regarding the motor accident on 19 April 2021, dated 20 April 2021 states the diagnosis was a motor accident on 19 April, hit by another vehicle while sitting on the passenger side while the vehicle was stationary.
The Certificate of Capacity/Certificate of Fitness regarding the motor accident on 19 April 2021, dated 8 May 2021, states the injuries are neck discomfort and left upper limb pain, cervical radiculopathy - MRI showed bilateral foraminal stenosis at C5-6 level with bilateral C6 nerve root impingement.
The undated Certificate of Capacity/Certificate of Fitness, which may be in July or August 2022, states the diagnosis is PTSD - post-MVA on 19 April 2021. It does not list any physical symptoms/conditions.
The clinical notes from the Earlwood Medical Centre from 13 March 2024 to 5 August 2024 includes the following:
The entry dated 13 March 2024 states he has intermittent chest tightness, is unsure of the triggers, but does feel anxious at times.

A cousin recently collapsed on the football field, revived with CPR and defibrillation. He is currently asymptomatic.
He was referred to a cardiologist for assessment.

The entry dated 25 July 2024 states he's been diagnosed with Type II diabetes for two years and takes Trajentamet.
There are handwritten notes in section AX3 where, at most, 25% of each page is visible, and therefore this is meaningless.

There are two sets of typed notes, one dated 23 July 2022 which states he has tightness in his body and is aggressive when driving. He has excessive sweating and tension.
He is not driving because he is paranoid, checks 10 times and feels aggressive.
The 45-minute drive to work is draining. He is paranoid driving work vehicles.
He is avoiding doing much to do with cars and he is taking twice as long to do cars because he is over checking things. He is questioning himself. He walks the farthest to the left side, away from the road. He is snappy and aggressive. He feels on edge at work and states he is tense. It feels like he has been run over by a semi-trailer.
He has installed a camera to review driving footage. He is second-guessing himself and feeling incredibly stressed and anxious when someone beeps.
He cannot drive and talk.
He has excessive sweating when driving. He needs to change his shirt.
He has gained weight since the accident because he has started to eat takeaway chocolate shakes, cakes, chocolates, which has led to diabetes. He was previously a super fit guy.
He did not drive for a month after the accident. He is freaking out getting in a car.
He still feels anxious and nervous in the car and feels stiff and concentrates excessively on driving.
Hearing a horn caused a panic and nearly went off the road.
He wakes once or twice during the night and is so exhausted he needs to nap to shut off his brain.
He wakes up thinking about the accident during the night.
He wakes up feeling exhausted and feels better on weekends because he does not need to drive anywhere.
He liked muscle cars, four-wheel drives and going to the holiday house.
He is not as social, does not want visitors, has lost his bubbliness, is colder and aggressive and does not enjoy the new car.

The second typed report dated 24 September 2022 states he is agitated and more aggressive. I'm on edge, hyped, and debilitating.
He does not touch the car at weekends and feels lighter and more in control.
He avoids driving on the weekends. It states that he lost his breath when the car hit him. I was in a dream state. It states “how I didn't die, I don't know. I lose my crap towards my son. I'm paranoid when driving. I'm scared I don't want go back to depression.
There is less living under a blur. It feels like he has a shield in front of him. He's stuck in a bubble and not connecting with people.
He feels very angry and annoyed about the incident and how close he came to dying.
He double checks himself, just fearful of hurting others, someone hurting him.
I could have died, I'm not safe, I'm in danger, and am I going to hurt someone.

Additional clinical notes from the Earlwood Medical Centre from August 2014 to June 2023 noted a past history of depression/anxiety from 2014. There was an entry on 4 March 2020 stating claimant had depression/anxiety for 15 years and was on Efexor for 10-15 years. Claimant wanting to come off Efexor. Worried about medication running out or having long-term effects. Depression was well managed with medication with anxiety still happening/worrying at nighttime. Mental Health Treatment Plan letter written.
The photographs in section AX5 are black and white and appear to show damage to unidentified vehicles. The additional information showed coloured photos of damage to the rear right of what appears to be the claimant’s utility vehicle. Ex

[2025] NSWPICMP 725

19 September 2025