Insurance Australia Limited t/as NRMA Insurance v CHA
[2025] NSWPICMP 559
•30 July 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Insurance Australia Limited t/as NRMA Insurance v CHA [2025] NSWPICMP 559 |
CLAIMANT: | CHA |
INSURER: | Insurance Australia Limited t/as NRMA Insurance |
REVIEW PANEL | |
MEMBER: | Jeremy Lum |
MEDICAL ASSESSOR: | Christopher Canaris |
MEDICAL ASSESSOR: | Steven Yeates |
DATE OF DECISION: | 30 July 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant driving a car with daughter as passenger when an unmanned truck moved down the street and collided with the claimant’s vehicle; claimant assessed by original Medical Assessor as having 15% whole person impairment (WPI) for psychiatric injury of post-traumatic stress disorder (PTSD) caused by the motor accident; alleged failure to consider pre-existing psychiatric conditions; Held – Review Panel accepted pre-existing generalised anxiety disorder but no impairment in all areas of function; Review Panel accepted diagnosis of PTSD; current impairment assessed as 7% WPI with 1% WPI added for the effects of treatment; MAC revoked; new certificate issued. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION 1. The Review Panel revokes the certificate of Medical Assessor Atsumi Fukui dated (a) The Review Panel certifies the following injury was caused by the motor accident: (i) post-traumatic stress disorder. (b) The Review Panel finds that the above injury results in a whole person impairment of 8% which is not greater than 10%. |
STATEMENT OF REASONS
INTRODUCTION
[CHA] (the claimant) was involved in a motor accident on 5 March 2021. She was driving her car with her daughter sitting in the front passenger seat. As she turned into the street towards their home, a truck moved downed the street and collided with the claimant’s daughter’s parked car. The truck then continued in the claimant’s direction and crashed into her car. The claimant later realised it was a parked truck that started moving down the hill with no driver inside.
The claimant says she suffered musculoskeletal and psychiatric injuries as a result of the motor accident.
She made an application for personal injury benefits with NRMA (the insurer), the third-party insurer of the vehicle that she 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. This is important because if there is a dispute about the degree of a claimant’s WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
[1] See Division 4.3 of the MAI Act.
On 6 June 2024, Medical Assessor Atsumi Fukui diagnosed the claimant with chronic post-traumatic stress disorder and that it was causally related to the motor accident. The claimant’s WPI was assessed at 16%, which is greater than 10%.
The insurer lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Fukui’s decision. This was allowed by the President’s delegate (Ms Melinda Drew) and this Panel was convened to conduct the review.
MEDICAL ASSESSMENT UNDER REVIEW
Medical Assessor Fukui noted that the claimant was involved in a significant motor accident and had developed psychological symptoms from the time of the accident which have persisted. She described to the Medical Assessor intrusion symptoms, avoidance, hyperarousal, anxiety, low mood and cognitive deficits. The claimant was noted to avoid triggering her symptoms which can occur if she hears noise of a truck or the siren of emergency services vehicle.
The Medical Assessor was satisfied that the claimant met the criteria for a diagnosis of chronic post-traumatic stress disorder which was caused by the motor accident.
The Medical Assessor also noted the claimant’s past history of anxiety symptoms which were described as situational stress reactions. However, there was no prior history of any post-traumatic stress disorder. It was noted that the claimant had seen psychologists but did not have psychiatric treatment, with her symptoms being managed by her general practitioner. The Medical Assessor also noted that the claimant had maintained her occupational functioning until the motor accident.
Under the psychiatric impairment rating scale (PIRS), the claimant’s WPI was determined to be 15% (2,2,2,3,3,3), which is greater than 10%.
The Medical Assessor determined that there was no pre-existing impairment, a finding that is disputed by the insurer.
SUBMISSIONS
In its review application submissions and original reply submissions, the insurer maintained that there needed to be adequate engagement with the claimant’s pre-existing psychiatric history and diagnosis of depression and bipolar disorder. In this regard, the insurer warned against accepting the claimant’s given history at face value and to address competing medical opinions such as that expressed by psychiatrist Dr Vickery, who diagnosed a generalised anxiety disorder with a WPI of 0%.
The insurer further took issue with the Medical Assessor’s assessment under the various categories in the PIRS, arguing that the Medical Assessor failed to properly consider the pre-existing factors, or had erred in her fact finding with regards to the claimant’s current presentation.
The insurer also indicated that there could be additional relevant material about the claimant’s pre-accident psychiatric history in her consultations with a psychologist. There was also mention of counsellor that the claimant saw as part of the Employee Assistance Program (EAP), following a work injury.
The claimant disagrees with the insurer’s submissions. The claimant refers to the Medical Assessor’s reasons and argues that the claimant’s pre-existing psychological history was adequately considered by the Medical Assessor with no evidence of any errors made. The claimant further says there can be no error in the Medical Assessor’s classification of the claimant under the PIRS, having regard to the reasons provided by the Medical Assessor.
REVIEW OF THE EVIDENCE
General observations
On 2 April 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 1-699 and the claimant’s bundle comprising of pages 1-278.
Following its initial teleconference, the Panel issued further directions requiring the insurer to obtain the following:
· clinical records/reports of the EAP counsellor the claimant saw at work due to her workplace injury, and
· clinical records/reports of Ms Skye Steele, psychologist, for consultations both pre-and-post subject motor accident of 5 March 2021.
On 3 July 2025, the insurer advised that it did not have details regarding the EAP counsellor the claimant consulted with.
On 9 July 2025, the insurer uploaded the clinical records of Ms Skye Steele.
The Panel has read the clinical records of Ms Skye Steele and the documentation relied upon by the parties. A summary of the relevant documents is contained in the Panel re-examination report below.
RE-EXAMINATION REPORT
At the initial teleconference on 28 May 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessors Canaris and Yeates is as follows:
“Psychosocial history and pre-accident history
The claimant is a 49-year-old early childhood teacher/director at a pre-school and has been with that employer for almost 30 years.
[CHA] admitted to having anxiety dating back to her early 20s which started with having children and worrying for their safety and later ‘more around big stressful events’ saying, ‘This feels very different from anything I had before’. The Panel drew her attention to an earlier diagnosis of bipolar disorder and to prescriptions for valproate. She maintained the diagnosis was erroneous and based on her family history of bipolar. According to [CHA], her valproate was prescribed for pain rather than for bipolar disorder.
[CHA] had seen a psychologist in relation to her anxiety.
[CHA] saw herself as ‘functioning really well’ having moved into a director’s role but had had time off because of a right knee injury at work for which she has had conservative treatment. Her knee now would ‘very rarely’ be a problem. She was often going out socially and getting on well with her family. She had no difficulties with self-care and denied any difficulties with concentration. She had no difficulties with driving or travelling. Moreover, at the time of the accident, she had been studying part-time towards a psychology degree.
The Panel noted her family history including her father’s bipolar diagnosis and her mother’s alcohol use disorder. Her father’s situation is much better now that he is medication compliance. Her mother’s alcoholism seems not to have been an issue as she was growing up.
[CHA] has eosinophilic oesophagitis and sees a gastroenterologist.
[CHA] drinks very little. She does not use drugs. She does not gamble.
[CHA] went from school to uni and into the workplace. She worked 30 years in the one job.
Her parents separated when she was 5 years old. She has one brother. Money was tight because her mother raised her as a single parent with a pension and help form her grandmother and child support. Her mother died in 2015. She had normal developmental milestones and was a well child. She enjoyed her schooling.
[CHA] is many years married and has 2 children.
History of the motor accident
On the day in question, she was in her car with her daughter having turned into a street close to home. A runaway truck came down the street and hit her daughter’s car and then kept going hitting her vehicle on the driver’s side.
[CHA] experienced “shock” while her daughter and people gathered round while the truck ran into another home at the end of the street.
[CHA] was very upset and upset for her daughter. Multiple ambulances attended and words were exchanged between her husband and the truck driver.
History of symptoms and treatment following the motor accident
[CHA] had ‘the worst panic attacks’ that night. She did not sleep, and she startled in response to noise. She saw her GP the next day. She was given sleeping tablets and a referral to a psychologist. She was also referred to a physio for her shoulder and neck. She has been ‘progressively worse’ over the ensuing years saying, ‘It’s getting harder, not easier’ despite therapy with a psychologist whom she sees fortnightly. She is also on melatonin for sleep and escitalopram which she started a year ago which ‘helped for a little bit’.
Physical problems have largely resolved and have taken a back seat to her mental health issues. She has had a flare-up of her eosinophilic oesophagitis, and she was diagnosed at some point fibromyalgia.
She has been in ‘survival mode’ and ‘I tend to feel safe only at home’ and ‘getting to and from home is difficult because of where the accident happened’.
Her mood is low, and she relives the accident ‘every single day’ for example when she is driving home and ‘I get a complete flashback every time I get back in the street’.
She wakes repeated through the night and has unpleasant dream sometimes of her daughter and her safety and wellbeing and sometimes of the accident. She would wake 2 or 3 times a night and a full night’s sleep is rare.
Details of any relevant injuries or conditions sustained since the motor accident
There were no further injuries.
Current symptoms
As above.
Current and proposed treatment
As above.
Mental state examination
The claimant was examined in the Personal Injury Commission medical suites in Darlinghurst by Assessors Canaris and Yeates. She presented as an overweight woman who was appropriately clad. She was highly anxious and teary from the outset of the consultation although she became calmer as the interview progressed. However, her overall mood was dysphoric with a congruent affect. She was a cooperative historian who provided the history documented above. Her narrative was coherent and consistent. Evidence of psychosis or cognitive impairment did not emerge.
Current functioning
[CHA] reduced her working hours to 4 days a week. She has faced pressure from her employer to go back full time and has struggled to work full time, saying, ‘My workplace relationships are strained by my agitation… also there have been grievances raised against me…’ with concerns about her amount of personal leave. She has found herself taking off 3 or 4 days a month and on one occasion had a 9.5-day absence over a 4-week period. Additionally, she has had a file note related to her relationships with staff in that she is overly reactive and hypervigilant making her irritable. She struggles with admin, emails, rosters, and the like.
[CHA] does not manage her self-care saying, ‘Everything is about survival’. She would wear the same clothes a couple of days in a row and sometimes more. Her husband would run her bath to prompt her to bathe, and she would do so ‘every day or 2’ but with prompting from her husband. She does not attend to grooming such as shaving her legs or putting on makeup. Her appetite has been “extremely poor and my diet is poor – Tim [her husband] does all the cooking” and she would miss a lot of meals especially if feeling overwhelmed. Her weight has been steadily increasing as she has become less physically active.
[CHA] no longer has the space to socialise and has stopped her Zumba and going to her aqua class. She says she has not been out socially once in the last 3 months save for sometimes with her father for whom she had been carer (a role taken over by her husband). Getting and getting ready to drive to work is difficult. She finds the drive very stressful ‘especially if there’s any trucks on the road or sirens’ and has to settle herself down as she gets to work. She came up driven by her husband. She is a very anxious driver saying, ‘No one will be my passenger anymore’ because of her hypervigilance. She is very hypervigilant as a passenger. She can manage the drive to work which takes 30 minutes. She avoids the scene of the accident coming into her street from a different direction. She cannot make a longer journey on her own.
The relationship with her husband is ‘extremely strained’ as he has picked up a considerable workload and she senses increases resentment and frustration on his part. Arguments are frequent and she sleeps separately partly because she wants to avoid the balcony overlooking the street in which the accident occurred and partly because of the strain in the marriage. The relationship with her daughter Ella is strained partly because she has her own difficulties and she is ‘constantly in her room and rarely interacts’. There has not been any violence, although they have come close to separation and she occasionally has slept in her dad’s home to have time away. She would have done this 5 or 6 times ‘just for the night’.
[CHA] is doing ‘really poorly’ with concentration. At work, she tends to have ‘multiple tabs open on my computer’ and she finds it ‘really tricky to stay on task’. She “used to love reading” and has tried to use audio books ‘but I can’t get through a page – there’s so many thoughts in my head’. She tends to watch the same shows over and over again on TV. She relegates her finances to Tim whereas they previously did this together.
Comments on consistency
There was no inconsistency.
REVIEW OF DOCUMENTATION
Summary of relevant documentation
The Panel noted the application for personal injury benefits which listed physical problems as well as ‘shock/trauma’.
The Panel noted photographs of the vehicles involved in the subject accident and newspaper articles.
The Panel noted the claimant’s statements dated 10 August 2021 and 13 May 2025.
The Panel noted general practice progress notes which refer to physical issues and to a diagnosis of posttraumatic stress disorder. She was noted to have started on Lexapro (escitalopram – an antidepressant). There were referrals for psychologists.
The Panel noted documentation from the Lakeside Medical Practice including referrals to and correspondence from a psychologist, a referral to the Black Dog Institute dated 6 March 2015, a referral to South Coast Private Hospital dated 29 October 2015 secondary to anxiety, and DASS 21 on 19 September 2016 in which she generated scores in the severe range for depression and the extremely severe range for anxiety and stress. She was noted to have ‘severe anxiety and depression’ against the background of a father with poorly controlled bipolar disorder and a mother who was an alcoholic and abusive. There was correspondence in 2012 and 2013 from a psychologist relating to assistance with the management of pain from an ankle injury sustained at work. In the time prior to the accident, she contended with a workplace injury to her left knee, and the Panel noted presentations for anxiety in early 2020, the coronavirus situation, as well as her father being unwell in Queensland. Anxiety again featured in consultations in 2019 linked to family stressors such as her father being unwell, concerns about the emotional health of her daughter and her brother’s marriage breaking down. There were entries in 2018 referring to her being on Epilim (valproate – a mood stabiliser). Entries related to anxiety, to reactive depression, and to her seeing a psychologist were present in 2014 with references to her father being acutely unwell.
The Panel noted sundry certificates of capacity.
The Panel noted the claimant’s statement dated 13 May 2025 which related to her perceived psychological symptoms following the motor accident and their effects on her functioning.
The Panel noted the report of Dr Melissa Barrett, psychiatrist, dated 6 May 2015. Dr Barrett noted her long-standing history of anxiety including panic attacks which had been exacerbated in the context of her mother’s death some 8 weeks previously. Dr Barrett considered that she may have a mild bipolar 2 illness with generalised anxiety and separation anxiety. Dr Barrett recommended a trial of a mood stabiliser such as lamotrigine, and interventions such as fish oil, and cognitive behaviour therapy for her anxiety.
The Panel noted the report of Dr Peter Anderson, IME psychiatrist, dated 7 April 2022. Dr Anderson took a history of prior motor vehicle accidents and particularly an accident some 4 years prior to his examination in which she witnessed a motor bike accident in which the injured person had lost a leg and died later that night. She had held the injured person while her friend applied tourniquet. This accident, however, gave rise to only transient upset. He took a history of workplace injuries and an injury in 2020 in which she had injured her knee complicated by later ankle injury as a result of which she had been off work and on the point of returning to work at the time of the subject accident. She had a history of physical problems including eosinophilic oesophagitis, a heart condition, and fibromyalgia. He additionally took a history of mental health symptoms with anxiety coming on in her late twenties which had intermittently troubled her. However, following the subject accident, she developed physical and mental symptoms with overwhelming anxiety attracting a diagnosis of posttraumatic stress disorder. He assessed her at 17% whole person impairment with no deduction for pre-existing impairment or adjustment for treatment effects. He rated her as Class 2 for travel and concentration, persistence, and pace, and Class 3 for self-care and personal hygiene, social and recreational activities, social functioning, and adaptation.
The Panel noted correspondence from Shoalhaven Psychology Services dated 30 July 2021 relating to consultations between 8 April 2021 and 27 July 2021 and further correspondence dated 20 December 2024 reporting on consultations from 6 August 2021 to 27 November 2024. The diagnosis of posttraumatic stress disorder and generalised anxiety disorder was made. She was noted also to have been referred for EMDR which made her more anxious. She had reduced her work to 4 days per week over the preceding 2 years and to be struggling with socialisation.
The Panel noted the report of Dr Graham Vickery, IME psychiatrist, dated 6 March 2023. Dr Vickery noted also that she had been stood down at work shortly before her accident as her employer considered her to be at risk. He recorded a fundamentally unremarkable mental state examination apart from appearing emotional and stressed when discussing the accident and its sequelae and noting the absence of any apparent incapacitating cognitive impairment. He diagnosed generalised anxiety disorder and assessed her whole person impairment as 0% rating her as Class 1 for all categories except for travel which he rated as Class 2.
The Panel noted the certificate under review of Assessor Atsumi Fukui dated 6 June 2024. Assessor Fukui diagnosed chronic posttraumatic stress disorder noting some improvement with escitalopram and rated her whole person impairment at 16% with no deduction for pre-existing impairment and a 1% adjustment for treatment effects. She rated her at Class 2 for self-care and personal hygiene, travel, and concentration, persistence, and pace and Class 3 for social and recreational activities, social functioning, and adaptation.”
RELEVANT PROVISIONS
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 9.3 of the Guidelines 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 s 5D and 5E.
FINDINGS
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 refers to the above re-examination report of Medical Assessors Canaris and Yeates. The Panel reconvened on 23 July 2025 and discussed the re-examination report findings before collectively making the below determinations.
Diagnosis and reasons
The claimant’s presentation is consistent with a diagnosis of post-traumatic stress disorder. In terms of DSM-5-TR criteria, the accident which involved serious danger to her daughter was a Criterion A event. There is evidence of involuntary and distressing intrusion symptoms including vivid memories of the accident and high anxiety in response to cues associated with the event as well as dysphoric dreams (Criterion B). She avoids the scene of the accident as best as she can (Criterion C). There is evidence of negative alterations and cognitions and mood manifested in low mood and withdrawal from activities she once enjoyed (Criterion D). There is also evidence of marked alterations and arousal and reactivity manifest in irritability, hypervigilance, insomnia, and sleep disturbance (Criterion E). Her symptoms have now been continuously present since March 2021 (Criterion F). Her symptoms cause her clinically significant distress and psychosocial impairment manifest in her social withdrawal, her irritability, her hypervigilance, and her avoidance of the scene of the accident coupled with problems with concentration and difficulties at work (Criterion G) and are not attributable to the physiological effects of a substance or to another medical condition (Criterion H).
The Panel noted a pre-accident history of anxiety which would warrant a diagnosis of generalised anxiety disorder.
The Panel found itself in respectful disagreement with Dr Vickery. While it accepted that his diagnosis of generalised anxiety disorder would have captured pre-accident problems, it considered that his formulation of her presentation did not consider what on balance are post-traumatic symptoms. It further considered that his assessment of 0% whole person impairment significantly underestimated what had been documented in his report and was not consistent with the Panel’s assessment.
Causation and reasons
Her post-traumatic stress disorder comprises symptoms very much specific to the subject accident which is noted above was an event carrying a substantial probability of precipitating such a condition. It was not present before the accident which on balance is very much a course of her current presentation.
Her pre-existing generalised anxiety disorder has been overtaken by her post-traumatic symptoms.
Permanency of impairment
Her symptoms have been continuously present since March 2021. Over this time, she has had appropriate psychological treatment and appropriate psychotropic medication.
Degree of permanent impairment – Psychiatric Impairment Rating Scale
| Psychiatric diagnoses | 1. Posttraumatic stress disorder | 2. |
| 3. | 4. | |
| Psychiatric treatment description | She sees a psychologist and is on escitalopram. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 3 | She does not manage her self-care saying, “Everything is about survival”. She would wear the same clothes a couple of days in a row and sometimes more. Her husband would run her bath to prompt her to bathe, and she would do so “every day or 2” but with prompting from her husband. She does not attend to grooming such as shaving her legs or putting on makeup. Her appetite has been “extremely poor and my diet is poor – Tim [her husband] does all the cooking” and she would miss a lot of meals especially if feeling overwhelmed. Her weight has been steadily increasing as she has become less physically active. Comment: She would struggle to live independently without her husband’s support. |
| 2. Social and Recreational Activities | 3 | [CHA] no longer has the space to socialise and has stopped her Zumba and going to her aqua class. She says she has not been out socially once in the last 3 months save for sometimes with her father for whom she had been carer (a role taken over by her husband). |
| 3. Travel | 2 | Getting and getting ready to drive to work is difficult. She finds the drive very stressful “especially if there’s any trucks on the road or sirens” and has to settle herself down as she gets to work. She came up driven by her husband. She is a very anxious driver saying, “No one will be my passenger anymore” because of her hypervigilance. She is very hypervigilant as a passenger. She can manage the drive to work which takes 30 minutes. She avoids the scene of the accident coming into her street from a different direction. She cannot make a longer journey on her own. |
| 4. Social Functioning | 2 | The relationship with [CHA]’s husband is “extremely strained” as he has picked up a considerable workload and she senses increases resentment and frustration on his part. Arguments are frequent and she sleeps separately partly because she wants to avoid the balcony overlooking the street in which the accident occurred and partly because of the strain in the marriage. The relationship with her daughter Ella is strained partly because she has her own difficulties and she is “constantly in her room and rarely interacts”. There has not been any violence, although they have come close to separation and she occasionally has slept in her dad’s home to have time away. She would have done this 5 or 6 times “just for the night”. Comment: Her relationships are fundamentally intact even if strained and there is no violence. While there were occasions in which she has slept over in her father’s home, these do not comprise separations in that they do not represent a rupture in the marital relationship. |
| 5. Concentration, Persistence and Pace | 2 | [CHA] is doing “really poorly” with concentration. At work, she tend stop have “multiple tabs open on my computer” and she finds it “really tricky to stay on task”. She “used to love reading” and has tried to use audio books “but I can’t get through a page – there’s so many thoughts in my head”. She tends to watch the same shows over and over again on TV. She relegates her finances to Tim whereas they previously did this together. Comment: The Panel noted her capacity to provide a coherent and consistent history despite her anxiety while keeping track of what she had imparted to us over the course of an interview lasting 1.5 hours. |
| 6. Adaptation | 2 | [CHA] reduced her working hours to 4 days a week. She has faced pressure from her employer to go back full time and has struggled to work full time saying, “My workplace relationships are strained by my agitation… also there have been grievances raised against me…” with concerns about her amounts of personal leave. She has found herself taking off 3 or 4 days a month and on one occasion had a 9.5-day absence over a 4-week period. Additionally, she has had a file note related to her relationships with staff in that she is overly reactive and hypervigilant making her irritable. She struggles with admin, emails, rosters, and the like. Comment: While she is undoubtedly finding her work difficult leading to a reduction in working hours, she is managing a role which involves significant complexity. The Panel respectfully disagrees with Dr Anderson’s assessment of Class 3 as Dr Anderson took matters relevant to Adaptation and factored its impacts into family life, an area that warrants separate categorisation under the PIRS. As the claimant continued to work in her pre-accident employment, Adaptation should be assessed by reference to her functioning to work under clause 6.221 of the Guidelines. |
| 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. Generalised anxiety disorder | 2. |
| 3. | 4. | |
| Psychiatric treatment description | She had seen a psychologist. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 1 | [CHA] denied difficulties in this area of functioning and there was no evidence of impairment in the documentation on hand. |
| 2. Social and Recreational Activities | 1 | [CHA] denied difficulties in this area of functioning and there was no evidence of impairment in the documentation on hand. |
| 3. Travel | 1 | [CHA] denied difficulties in this area of functioning and there was no evidence of impairment in the documentation on hand. |
| 4. Social Functioning | 1 | [CHA] denied difficulties in this area of functioning and there was no evidence of impairment in the documentation on hand. |
| 5. Concentration, Persistence and Pace | 1 | [CHA] denied difficulties in this area of functioning and there was no evidence of impairment in the documentation on hand. |
| 6. Adaptation | 1 | [CHA] denied difficulties in this area of functioning and there was no evidence of impairment in the documentation on hand. |
| 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 impairment
She had 0% by way of pre-existing impairment. As stated in the above reasoning,
[CHA]’s history and the documentation described various pre-accident worries, stresses and anxiety but without any evidence to suggest difficulties in her functioning in all areas of function.
Effects of treatment
The Panel added 1% by way of adjustments for the effects of treatment.
CONCLUSION
The Panel concludes that the claimant’s injury caused by the motor accident results in a whole person impairment of 8% which is not greater than 10%. The Panel is in respectful disagreement with Medical Assessor Fukui in that it considered the claimant’s impairment for social functioning and adaptation to be Class 2 rather than Class 3.
The certificate issued by Medical Assessor Atsumi Fukui dated 6 June 2024 is therefore revoked. A new certificate is issued at the front of this determination.
DE-IDENTIFICATION OF THE CERTIFICATE AND REASONS
At the re-examination by the two Panel Medical Assessor’s, [CHA] was significantly distressed upon hearing that the Panel’s decision would be published on the Commission’s website. The claimant has requested that the decision be de-identified before it is published.
The Member on the Panel notes that [CHA] is diagnosed with a psychiatric condition with impairments to her areas of functioning which include her functioning at work. The Member is of the view that de-identification of the decision and redaction of any identifying features serves the proper administration of justice while protecting the safety and wellbeing of the claimant affected by the publishable decision.
The Member on the Panel therefore directs that, pursuant to Rule 132 of the Personal Injury Commission Rules 2021, its certificate and reasons be de-identified before publication.
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