Insurance Australia Limited t/as NRMA Insurance v Li
[2025] NSWPICMP 762
•3 October 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Insurance Australia Limited t/as NRMA Insurance v Li [2025] NSWPICMP 762 |
CLAIMANT: | Yan Li |
INSURER: | Insurance Australia Limited t/as NRMA Insurance |
REVIEW PANEL | |
MEMBER: | Alexander Bolton |
MEDICAL ASSESSOR: | Himanshu Singh |
MEDICAL ASSESSOR: | Christopher Canaris |
DATE OF DECISION: | 3 October 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of decision of Medical Assessor (MA) who assessed the claimant as having 17% whole person impairment (WPI) and diagnosed a post-traumatic stress disorder; claimant involved in an accident on 22 November 2021; insurer disputed psychiatric impairment rating scale (PIRS) assessments; claimants post-accident recovery complicated by over use of traditional Chinese medicine in combination with excessive alcohol intake; claimant had demonstrated pre-accident anxiety and panic attacks but not evident for some time before the accident; claimant had also used excess alcohol pre-accident but Review Panel satisfied that post accident she used this in excess to self-medicate; Held – Review Panel assessed the claimant as having a 22% WPI and diagnosed a post-traumatic stress disorder and alcohol use disorder in remission; certificate of MA revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Determination 1. The Panel revokes the certificate of Medical Assessor Ng. 2. The Panel has diagnosed the claimant as having a post-traumatic stress disorder with alcohol use disorder in remission. 3. The Panel has assessed the claimant as having a whole person impairment of 22%. |
STATEMENT OF REASONS
INTRODUCTION
This is an application by the insurer for a review of a certificate and reasons of Medical Assessor Ng (the Medical Assessor) dated 26 June 2024.
There is a dispute between the claimant and the insurer about the degree of permanent impairment under Schedule 2, s 2(a) of the Motor Accident Injuries Act (the Act).
The following injuries were referred by the Personal Injury Commission (the Commission) for assessment:
(a) post-traumatic stress disorder.
The Medical Assessor assessed that the following injuries caused by the motor accident gave rise to a whole permanent impairment (WPI) of 17%:
(a) post-traumatic stress disorder.
The accident
The accident occurred on 22 November 2021. The claimant was driving to collect her daughter from school. The insured car came from her left while she was driving straight ahead. A“T-bone” collision occurred. The front of the insured vehicle hit her left front. The claimant was wearing her seat belt. The airbags were activated. It is understood that the claimant’s car was written off for insurance purposes.
The claimant was transported to St George Hospital and discharged later that night. She complained of neck and low back pain.
Bundles of documents
The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
The fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned – see WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46].The Panel is not required to “analyse every piece of information from every opinion contained in a document with which he [it] was provided” – see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel has come to its own conclusion and has taken its own history.
The Panel notes the High Court judgment in Gamestar Pty Ltd v Lockhart [1993] HCA 79. The Court observed in the absence of submissions referring to specific documents that a tribunal is not required to search for references within documents where the submissions do not specifically address the materials. The Panel also notes the comments of Bellew J in Bevan v Bingham [2023] NSWSC 19 concerning the obligation of legal practitioners to place only the necessary evidence before the decision-maker.
Insurer’s submissions
The insurer submits that the best evidence before the Medical Assessor consisting of the available documents, the history provided by the claimant, and the Medical Assessor's own clinical examination, does not support allocation of a Class 3 for social and recreational activities.
The insurer disputes, having regard to the claimant’s ability to drive and go to the supermarket independently, that a Class 3 impairment of social and recreational activities would be the best fit in circumstances where there is no mention that the claimant requires a support person in her travels to these locations.
The insurer submits the Medical Assessor has erroneously applied Class '2' for social functioning on all the evidence.
The insurer submits that the Medical Assessor has taken into account an irrelevant consideration when assessing self-care by having regard in his psychiatric impairment rating scale (PIRS) rating to the claimant's ability to go to the shops and do housework, as this is more properly a matter for assessment under social and recreational functioning.
The insurer submits the Medical Assessor has erroneously applied Class 3 for Concentration, Persistence and Pace.
The insurer submits that the best evidence before the Medical Assessor, being the available documents, the history provided by the claimant, and the Medical Assessor's own clinical examination, does not support allocation of a Class 3 for concentration, persistence and pace.
The insurer submits that the claimant's self-reported capacity to play on her phone for large parts of the day and her ability to sustain her attention for the duration of the assessment is not consistent with a greater than Class 2 impairment of concentration, persistence and pace.
The insurer submits that the Medical Assessor seems to suggest under “consistency” that the claimant was uncooperative during the assessment which made it difficult to accurately assess her condition, but then in the PIRS blames it on reduced cognition which the insurer submits is contradictory.
The insurer submits the Medical Assessor's failure to clearly differentiate between the claimant being uncooperative and accident-related cognitive decline is itself a material error capable of having a material outcome on the previous assessment.
Regarding adaptation, the insurer says it is not apparent from the Medical Assessors certificate whether the claimant would meet a Class 5 impairment, noting that the Medical Assessor only mentioned that the claimant was no longer working and did not identify within the assessment the specific barriers to return to work.
The insurer submits that the reasons noted by the Medical Assessor in his certificate do not justify a Class 5 impairment where there is no suggestion from the assessment that the claimant is completely incapacitated for employment.
The insurer has provided its submissions going to the claimant’s original application for assessment of WPI.
The insurer acknowledged that on the available medical evidence, Ms Li had developed psychological symptoms requiring treatment and was diagnosed with post-traumatic stress disorder from the effects of the subject motor accident.
The insurer submitted that, with reference to ss 6.213 and 6.220 of the Motor Accident Guidelines 2023 (the Guidelines), a psychological impairment must be attributable to a psychiatric diagnosis recognised by the current edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM) or the current edition of the International Statistical Classification of Diseases & Related Health Problems (ICD).
Additionally, the insurer says that as per ss 6.220 & 6.221 and tables 6.11- 6.16 of the PIRS Motor Accident Guidelines 2023, the evaluation of the psychological impairment sustained from the accident assesses six specific areas of functioning with consideration to how those areas have altered from the injured person’s pre-accident state.
The insurer relied on a report by Dr Hall dated 22 December 2022 who said that improvement was expected with further treatment.
The insurer in its submissions referred to the report of Dr Hong, relied upon by the claimant. The insurer noted that Dr Hong relied on the history provided by the claimant that, since the accident, she had developed symptomology consistent with a diagnosis of post-traumatic stress disorder and had developed acute hepatitis as a result of excessive use of traditional chinese medicine and alcohol.
The insurer also noted that in the claimant's Application for assessment, it was also indicated that the claimant did not suffer from any pre-existing injuries or medical conditions prior to the accident including post-traumatic stress disorder and substance abuse.
The insurer submits that the following extract of clinical notes from Healthpac Medical Centre is inconsistent with that assertion:
29 April 2013
Prescription for Stilnox (treatment for sleeping concerns and insomnia).
16 August 2014
Prescription for Kalma (treatment for anxiety and panic attacks).
13 January 2015
Referral to Ms Joanna Woo for persistent anxiety, poor sleep, depressed feeling and bereavement.
19 May 2015
Prescription for Kalma (treatment for anxiety and panic attacks).
8 October 2015
Surgery consultation note from Dr Mon-Chieh (Jessy) Wu. Insomnia in context of depression; seeing psychologist
8 October 2015
Prescription for Kalma (treatment for anxiety and panic attacks).
5 December 2016
Prescription for Kalma (treatment for anxiety and panic attacks).
3 March 2017
Prescription for Kalma (treatment for anxiety and panic attacks)
The insurer has referred to the serum chemistry test on liver enzymes of the treating records of Healthpac Medical Centre and submits that the results are relevant to the assessment of accident-related liver impairment in circumstances where the claimant submits that excessive alcohol intake and liver disease occurred only after the motor vehicle accident.
The insurer also refers to the records of Diligence Family Practice at which time the claimant undertook an AUDIT-C test (alcohol use disorders identification test). The insurer has submitted that it would be unusual to administer this test in the absence of concerns the patient already had an active alcohol use disorder.
The insurer submits that the Panel would have due regard to the pre- accident indications of possible alcohol abuse and would question the claimant about any psychological component to this apparent excessive alcohol intake.
Claimant’s submissions
The claimant disputes that the Medical Assessor is in error about his assessment.
The claimant submits that the Medical Assessor has considered all information that was before him in undergoing his assessment. The claimant submits that the Medical Assessor has also complied with the Guidelines in particular cls 6.217 and 6.220 in undergoing his medical assessment and determination and has provided a proper path and reasoning in coming to his determination.
The claimant submits that the insurer’s submissions are based on its application of a medical opinion and have not identified that the certificate was incorrect in a material error.
Medical evidence
The Medical Assessor provided a certificate of 26 June 2024. He assessed WPI at 17% and concluded that as a result of the accident, the claimant had a diagnosis of post-traumatic stress disorder.
The claimant informed the Medical Assessor that she had occasional nightmares about the accident.
The claimant was not on any psychiatric medication. There were no medication trials proposed. Her family doctor had referred her to a psychiatrist, but there was no appointment made. The claimant had not followed up on that appointment. When asked about barriers of returning to work, she stated: “I don’t know.” She was not looking for work.
The Medical Assessor noted that the claimant was a distinctly uncooperative person. The interpreter also confirmed this.
Regarding a diagnosis, the Medical Assessor said that the DSM IV/V diagnosis was
post- traumatic stress disorder, chronic. He said that it was characterised by cognitive problems, reclusiveness, anger, depressive symptoms, sleep disturbance and traumatic memories. The claimant’s condition was stable and permanent and had reached maximum medical improvement. As it had been more than two and a half years since the motor vehicle accident, the Medical Assessor did not envision any further improvement.
The PIRS assessment was as follows:
| Psychiatric diagnoses | Post-Traumatic Stress Disorder (PTSD), chronic |
| Psychiatric treatment Description | Previous therapy, previous medication trials |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 2 | Ms Li indicated that she did go to the shops. She did indicate that she did some housework. She presented wearing makeup today. This is consistent with mild impairment. |
| 2. Social and Recreational Activities | 3 | Ms Li is very withdrawn. She barely spent time with her family. She has withdrawn from friends. She engages in some activities at home, but nothing outside the home. |
| 41. She might walk the dog. This is all consistent with moderate impairment. | ||
| 42. 3. Travel | 43. 1 | 44. Ms Li indicated that she did drive. She used public transport to attend today’s assessment. She has travelled a few times to and from China in the last two years. There is no gross impairment. |
| 45. 4. Social Functioning | 46. 2 | 47. There is marked irritability towards her family and she is socially isolated, consistent with mild impairment. |
| 5. Concentration, Persistence and Pace | 48. 3 | 49. There are reported deficits. Her cognitive problems contributed to some difficulty that was seen in today’s assessment with lots of: “I don’t know”. This is consistent with moderate impairment. |
| 50. 6. Adaptation | 51. 5 | 52. Ms Li is not working at all and it is difficult to see her working in the near future in any capacity. |
| 53. List classes in ascending order: 1, 2, 2, 3, 3, 5 | ||
| 54. Median Class Value: 3 | ||
| 55. Aggregate Score: 16 | ||
| 56. % Whole Person Impairment: % 17 | ||
The claimant obtained a report from Dr Hong of 3 August 2023. Dr Hong concluded:
“Ms Li had no prior psychiatric disorders and reported that she was reasonably successful in managing all aspects of her business and was in the process of expanding the business in Australia.
After the accident, she suffered severe anxiety and sleep disturbance, and symptoms consistent with Post-traumatic stress disorder. Unfortunately, she turned to excessive alcohol and combined with regular use of TCM, she developed acute hepatitis and had an admission in May 2023. She has since remained abstinent from alcohol and does not use TCM now.
She has regular treatment with a psychologist and a psychiatrist and there is no plan to change her treatment at this point. Given that it has been about two years since the accident, my view is that her condition has now stabilized.”
Regarding her ability to work, Dr Hong noted the claimant tried to return to work in her business, however, could not perform. Her investor deemed she was not capable of performing and replaced her and took control of her business. She has not performed work or engaged in work-like activities since.
Dr Hong said that the claimant had not responded to psychological/psychiatric treatment and her psychopathology remained severe, and she had no work capacity.
Dr Hong assessed 22% WPI and added an adjustment for treatment effects of 1%, giving a total WPI assessment of 23%.
Clinical notes of Dr Lam record the following:
(a) Recorded on: 06/12/2021
Cannot drive at all
Recurrent nightmares and thoughts of death.
Feels that "every night as I go to sleep, I have died, and my family and friends were holding a memorial service."
Constant thoughts of death- of self-dying, having died, or killing others.
Feels that there is no point working hard, even though she's worked hard and built good success in life, through business and work -> now doesn't see the point, since there is no future.
Sleep disturbed+++ -> cannot initiate sleep, and wakes frequently from nightmares- all with a death theme.
17/01/22
Sleep is still disrupted.
Didn't end up starting escitalopram but instead has been self-medicating with EtOH!
States that if she drank "about a bottle of wine" -> she would fall asleep v easily, and have less nightmares!
But sleep v disturbed with EtOH- would wake every 3 - 4 hours, but feels that with EtOH returning to sleep is easier! Daytime flashbacks still present- about accident, about death, "all sorts of stupid messy negative things".
24/01/22
Is severely depressed and traumatized.
States that she wants to die, and if not for her daughter would just die.
Cannot sleep.
Crying constantly.
11/04/22
Trial amitrriptyline nocte
Chase approval for psychiatrist -> previously referred to Dr David Hall
Cont. escitalopram
Advised to limit EtOH intake!
05/07/22
??Some tachyphylaxis effect with escitalopram
Initially found that escitalopram reduced negativity but after a while felt that daytime negativity is exactly the same And also feels that emotions are v labile throughout the day -> would suddenly become v v depressed.
Daughter has also noticed and would ask her what is wrong And is losing temper v easily.
States that nightmares have become quite vivid.
But also noted that Pt is taking escitalopram at night along with amitriptyline (which she is currently taking 20mg of).
23/11/22
Psychologically remains v impaired.
Is drinking less but sleep remains an issue -> cut down on EtOH not because sleep had improved but is concerned re. l/t effects of excessive EtOH.
Still having EtOH 2 - 3 nights per week, half to one full bottle of wine each time.
States sleeps well with it!
Dr Hall still trying to manage medications -> doesn't feel that Pt is ready for EMDR
Is on escitalopram 30mg
But now ?has run out of sessions.
The claimant was admitted to Royal North Shore Hospital in May 2023 for treatment consequent on her use of traditional chinese medication and excessive alcohol intake which adversely affected her liver.
Dr Hall, psychiatrist, in a letter of 23 August 2022 diagnosed post-traumatic stress disorder with secondary depression.
Ms Mou In Li, psychologist of LL Counselling, provided a report of 6 February 2022. She diagnosed the claimant as initially having an adjustment disorder with mixed anxiety and depressed mood. However, at the time of this assessment she said the claimant had post-traumatic stress disorder because her post-traumatic stress related symptoms persisted after 1 month.
The claimant provided the following analysis of criteria for meeting the diagnosis:
(a) criteria A: The claimant had directly experienced the traumatic event motor vehicle accident;
(b) criteria B: The claimant has recurrent distressing dreams in which the content and/or affect of the dream are related to the motor vehicle accident. The claimant is scared of cars on the sides (left and right) when driving;
(c) criteria C: The claimant avoids driving and only drives when it is necessary or emergency;
(d) criteria D: The claimant has persistent and exaggerated negative beliefs or expectations about oneself, others, or the world. The claimant has persistent negative emotional state. The claimant has markedly diminished interest or participation in significant activities. The claimant has feelings of detachment or estrangement from others. The claimant is persistent inability to experience positive emotions;
(e) criteria E: The claimant has irritable behaviour and angry outbursts. The claimant has exaggerated startle response. The claimant has problems with concentration. The claimant has sleep disturbance;
(f) criteria F: The claimants’ symptoms are more than one month;
(g) criteria G: The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, and
(h) criteria H: The disturbance is not attributable to the physiological effects of a substance or another medical condition.
In a subsequent report of 13 July 2022 Ms Li noted that the claimant reported having anxiety and depression symptoms which were both in the severe levels. Her reported symptoms include depressed mood, excessive worries, insomnia, feelings of hopelessness, diminished motivation to do things, easily intolerance to people, socially isolated, lack of appetite, self-hatred, feelings of worthlessness, nightmares, motor vehicle accident-related bad dreams, tiredness, and low energy.
Ms Li said:
“In her AHRR 1, we have focused on the reduction of her PTSD related symptoms.
Her PTSD symptoms reduced after AHRR 1, but her anxiety and depression symptoms are still in the severe levels which require medical treatment from a psychiatrist.”
In a certificate of capacity of 28 December 2021, the claimant’s general practitioner (GP), Dr Lam, diagnosed post-traumatic stress disorder. The claimant was said to have no capacity to drive but it was not stated if this was because of physical or psychological injuries.
An Allied Health Recovery Request (AHRR) of Ms Li dated 26 June 2022 noted that the claimant had a diagnosis of major depressive disorder with anxious distress.
Handwritten clinical notes of Dr Hall, only identified by the pagination of the insurers index to its bundle of documents, are extremely difficult to read, if not impossible without a typed transcript. The Panel is not able to rely on this.
In a letter of 22 December 2022 Dr Hall said the claimant had post-traumatic stress disorder.
A psychological worksite assessment dated 6 July 2022 of ReCare Services, concluded after testing that the claimant had scored in the "extremely severe" range for depression, "extremely severe" range for anxiety, and the "extremely severe" range for stress.
Whilst certificates of Medical Assessor Berry and Medical Assessor Cowlishaw did not form the bundles of either the insurer or the claimant, these certificates were within the portal for the availability of the Panel. These certificates were for the assessment of soft tissue injuries to the claimant’s cervical and lumbar spines and her acute liver damage due to alcohol and traditional Chinese medicine.
The WPI assessment for the soft tissue injuries amounted to 10% and the WPI for the liver damage amounted to 0%.
Medical Assessor Berry, the claimant attributed her inability to return to work to a continuation of suffering pain in her neck and back.
Panel examination and adoption of findings
The claimant was examined by Medical Assessor Singh and Medical Assessor Canaris on 17 September 2025. Their report follows:
The claimant is a 43-year-old single woman who has not worked since her motor vehicle accident. In the past, she had a business wholesaling sanitary products.
She denied any history of psychiatric illness. She had been otherwise medically well.
She does not smoke. She does not use drugs. She does not gamble.
She knew of no family history of psychiatric problems.
She denied any other claims history. She denied any history of problems with the law.
She hails from a city in northeast China. She has one younger brother. Her parents are alive, well, and together.
Her father was a police officer, and her mother had been a warehouse worker for a car production company.
She described a happy childhood free of trauma. She completed a bachelor’s degree in mechanical engineering.
She came to Australia in 2005 after completing her studies and seizing an opportunity to move here. She worked initially in hospitality in housekeeping as well as being a barista. She also worked as an overseas purchaser for Chinese buyers. She started her own brand of sanitary products in 2016. Business was difficult at the start but later all went well and she had a partnership with over 130 IGA stores and pharmacies. At the time of her motor vehicle accident, she was negotiating a partnership with Woolworths, but this fell through as she was not in a good state.
She had married in 2009 but separated in 2012 and could not remember when she divorced. Her ex-husband had had an affair. She had not had any romantic partners after her divorce though she might have dated once or twice.
She has a 16-year-old daughter who lives with her. Her daughter is in year 10 or year 11. Her daughter sometimes works casually at Coles.
Before the accident, she enjoyed building up her company and hanging out with friends.
History of the motor accident
On the day of the accident, she was driving. A car suddenly came out from the left and hit her vehicle. Airbags deployed. A passerby “carried me out of the car”. She said of this, “I felt really terrified at the time – a passerby came and carried me out of the car”. She said she had “nothing significant” by way of injuries. She was taken by ambulance to St George hospital where she remained until evening. She had “very severe pain in my neck and back” and thought she may have had an ultrasound and blood tests. She was not sure what had been done saying she felt confused.
She could not remember what happened after she got home after being picked up by a friend but recalled being “really scared”.
Her vehicle was written off.
History of symptoms and treatment following the motor accident
Since then, “It’s been awful and it’s getting worse”. When asked to clarify, she said, “The worst part is I have very bad sleep quality… every night I wake up 5 to 8 times – I have nightmares… my spirits are very low, and I have no energy… occasionally I get into the car, and I feel huge pressure on my chest and my heart is beating fast… I was shaking… when I was driving, I would think the car on the left is going to hit me… I would have this urge to hit other cars… my mood is very low, and my memory is getting worse and worse…”.
She admitted to a time when she drank a lot of alcohol because she could not fall asleep. She said she was “hospitalised for about one month” because of hepatic toxicity. She still drinks “but not as much as I used to” and would now drink “once or twice a week if my sleep quality is really bad” and would then consume at least a bottle of red wine or 250ml of Chinese liquor.
She had been on something for pain, but said it made her “nerve pain” worse.
Because she was a vague historian, it was difficult to establish what treatment interventions she had had. However, a number of antidepressants were identified in the documentation on hand as well as documentation from her treating psychiatrist and psychologist.
Details of any relevant injuries or conditions sustained since the motor accident
She has not had any further injuries.
Current symptomsShe reports high anxiety, rapid heart rate, difficulty breathing, chest pain, and tremor with fear of traffic, coupled with insomnia and irritability. She reported depressed mood with suicidal ideation and threatened suicide.
Current and proposed treatment
She is on escitalopram 20mg daily, taking 1 or 2 tablets in the morning and mirtazapine 15 mg at night.
She also takes amitriptyline 10mg at night for nerve pain and sleep. Her nerve pain is “in my back” which would “spread to my front area especially to my tummy… it was so painful I would be bedridden for 3 days”. This would come and go and would “just make me miserable”.
All this is prescribed by her GP. She had seen a psychiatrist “in the past”. There was talk of hypnosis “but I was scared of that treatment” and so did not go ahead with this. She could not remember how long ago this was.
She had seen a psychologist “in the past” but no longer “since they didn’t really help much”. She could not recall how long other than that it had been “a while”.
Mental state examination
The claimant was interviewed via Microsoft Teams. A good audiovisual connection was established. A professional Mandarin interpreter, Candice Wang, was present throughout. The claimant was at her home in Gordon. Medical Assessors Canaris and Singh were in their respective offices.
She presented as a woman of appearance consistent with her stated age and Chinese ethnicity who appeared well-groomed with some make up and well-manicured nails. She provided the history documented above. Her narrative was at times quite vague, with frequent statements on the lines of not being able to remember.
At one point in the interview, she was noted to be looking down, and when asked what she was doing, said she was cutting skin around her nails and showed us a pair of cuticle scissors.
Her demeanour was depleted and her affect restricted.
No evidence of psychosis or cognitive impairment emerged.
Current functioning
She was asked how she spent her day. She would play with her dog and her cat or turn the TV on and watch some videos. She would be in the living room if no one is at home – if someone is there, she would be in her room.
She lives in rented premises. She is dependent on her parents for financial support. She has some money from the CTP insurer.
Her complaints of pain were noted. However, she did not provide a history indicative of pain-related impairment, which would not be assessable for WPI.
She is “OK” with showering and changing her clothes, which she might do “once a week – sometimes 2 or 3 times a day”. She was asked why she showered infrequently in some periods and frequently in others. She replied, “I didn't know – I feel like suddenly doing so”. She relies on “my parents or my daughter” for cooking and cleaning. She does no laundry or dishes. Her parents cook and clean for her when they are in Australia “but sometimes they get angry with me” and go back to China. They might stay with her “sometimes a few months – sometimes a year – there's no set pattern”. The Medical Assessors asked what stopped her from cooking or cleaning. She replied, “No obstacles – I just don’t feel like it”. If her daughter did not do this, she would “not eat – if it’s a mess, I would just leave it”. Her appetite fluctuates in that sometimes she does not feel like eating and at other times she “can’t stop eating”. She does not pay attention to her weight “but last time I did, I think I lost a few kilos”. She did not know her current weight. She did not regularly go to a salon but said that her daughter had recently taken her. She did not go to a nail artist. That said, the Medical Assessors noted that she appeared well-groomed with neat hair, some make up, and well-manicured nails. She said when asked about this that she attended to her nails on her own.
She does not go out socially and does not have any visitors. She takes her dog out for a walk once a day, which she would do for “about 5 minutes – it just needs to go downstairs and do its business”, “and when there's nothing I have to attend to, I don’t go out”. She would sometimes go to the supermarket and occasionally her daughter would ask her to pick her up. She might also go out to get her medications. She would relegate shopping to her parents or her daughter, but “if neither of them can do it, I do it”. She could not say how often she actually went out, saying there was no pattern. She had no interest in anything.
She drives “occasionally” but says “the process of driving really makes me miserable”. She said that she gets “chest heaviness” as though “there is a large stone on my chest” and “I can’t breathe”. She is afraid other cars would hit her “and sometimes I have this strong urge to hit other cars”. She was asked about her travel to China, which was “probably last year”, where she remained “1 or 2 weeks”, staying with her brother. She flew with her daughter. She could not remember how many times she had been to China since the accident, but it might have been a “4 or 5 times”.
The Medical Assessors asked how she got on with her daughter. She replied, “We can’t stay together for more than 10 minutes – I get very emotional, and I lose my temper but she’s a good girl and doesn’t take it to heart but I get grumpy quite often”. She gets on “even worse” with her parents, who “quite often get angry with me and just leave”. They get angry with her because “quite often I would lose my temper with them for no reason – I would be grumpy and irritable and just looking for trouble”. She said of her parents, “I couldn't control myself – they showed the utmost understanding of me”. She “used to have many friends but now I don't keep in contact”. She would not respond to phone calls and would only occasionally respond to messages. She has been violent towards her daughter and had “hit her – kicked her”. This had happened “once or twice” both here and in China. Her daughter had never reported her because “after hitting her, I was on the verge of jumping from the building to kill myself – why would she report me?”.
She feels her concentration is “very poor” and “I don't feel like doing anything”. She said she would “leave the TV on and watch it for a few minutes and then do something else and then I watch it for a few minutes and then do something else”. “Something else” might include “making a cup of tea” or “cutting the skin around my nails with scissors” or “playing with my dog”. She does not read. She had never been a one to read much. She says her memory has been getting “worse and worse”, speaking of making a cup of tea and forgetting to put a tea bag in, or sometimes going to the toilet and forgetting to clean herself. She does not do her taxes and was unsure if she had to pay any tax on her income from CTP.
She tried to go back to work after her accident, but she was “unsteady in my emotions” and “grumpy”. She found it was difficult to focus as before. She said “the investors who invested in my company” thought she was “not suitable” because of this. She could not say if the company were still in existence even though she was the owner. She did not have any business partners but “just investors”. She has not tried any other kind of work. When asked, she said, “I don't really want to meet with anybody – I don't want to go out either”.
Comments on consistency
Her narrative was at times very short on detail with repeated claims that she could not remember. This has been a consistent problem across a range of assessments.
Her level of grooming at interview was at odds with her reported functioning. While the Medical Assessors noted her claim that she attended to her nails on her own, they determined her rating for self-care and personal hygiene in keeping with her presentation at interview.
REVIEW OF DOCUMENTATION
Summary of relevant documentation
The discharge summary from St George Hospital Emergency Department was noted.
The Medical Assessors noted the allied health recovery request for physiotherapy dated 7 September 2023. This details psychological symptoms and limitations including frequent nightmares of car accident scenes, extremely poor sleep quality (due to physical symptoms), fear of being outside her house and loss of interest with a preference to stay at home in bed or on the couch.
The Medical Assessors noted the allied health recovery request for psychology dated 15 December 2021 providing a diagnosis of adjustment disorder with mixed anxiety and depressed mood which details excessive worries about her work because she cannot work following the accident, sleep disturbance with inability to fall asleep because of flashbacks of the accident, nightmares and motor vehicle accident related dreams, depressed mood, low motivation to do anything including house work, intolerance of people and especially of strangers, negative thinking, flat mood through the day, and avoidance of driving because of fear of cars coming from her left side. These were reiterated in subsequent allied health recovery requests.
Correspondence and progress notes from Mou In Li, treating psychologist, were noted.
A referral to and correspondence from Dr David Hall, treating psychiatrist providing a diagnosis of post-traumatic stress disorder was noted.
Progress notes of Alliance Medical Healthcare Centre were noted. A note on
26 June 2023 referred to using large amounts of alcohol as well as traditional Chinese medicine to help her sleep with consequent derangement of her liver function tests. A discharge summary from Royal North Shore Hospital dated 19 May 2023 relating to acute hepatitis was included in these notes.A worksite assessment report – psychological dated 6 July 2022 was noted. Scores in the extremely severe range for depression, anxiety, and stress were recorded.
The report of Dr Michael Hong, IME psychiatrist, dated 31 August 2023 was noted.
Dr Hong diagnosed post-traumatic stress disorder and noted that she was on escitalopram – an antidepressant, seeing a psychologist, on amitriptyline (another antidepressant) and that she had been using alcohol to sleep. He assessed her with 23% whole person impairment inclusive of a 1% uplift for treatment effects rating her as Class 2 for self-care and personal hygiene and travel, Class 3 for social and recreational activities, social functioning, and concentration, persistence, and pace, and Class 5 for adaptation.The Medical Assessors noted the combined certificate of Medical Assessor Cowlishaw dated 20 December 2024 incorporating the certificate of Medical Assessors Berry and Cowlishaw determining that the claimant’s soft tissue injuries to the cervical and lumbar spines and liver damage because of alcohol and traditional Chinese medicine was 10%. The assessment of Medical Assessor Cowlishaw dated 19 November 2024 was particularly relevant in that he determined that her acute liver damage had resolved thus giving rise to no assessable impairment.
The Medical Assessors noted the certificate of Medical Assessor Ng dated
26 June 2024 determining a diagnosis of post-traumatic stress disorder and that the claimant had a WPI of 17% with no deduction for pre-existing or subsequent impairment. Medical Assessor Ng rated the claimant at Class 1 for travel, Class 2 for self-care and personal hygiene and social functioning, Class 3 for social and recreational activities and concentration, persistence, and pace, and Class 5 for adaptation.Medical Assessor Ng’s certificate also referred to a report by Dr Michael Prior, IME psychiatrist dated 13 March 2024. This report was not in the bundle, but we noted the diagnosis of chronic post-traumatic stress disorder with alcohol use disorder in remission and a WPI rating of 22% with no deduction for pre-existing impairment or uplift for treatment effects. In terms of PIRS ratings, Dr Prior assessed her as Class 2 for travel in social functioning, Class 3 for self-care and personal hygiene, social functioning, and concentration, persistence, and pace, and Class 5 for employability (adaptation).
DETERMINATIONS
Diagnosis and reasons
Her presentation is consistent with a diagnosis of post-traumatic stress disorder. In terms of DSM-5-TR criteria. The accident as described was consistent with a Criterion A event involving exposure to threatened death and serious injury and directly experiencing the traumatic event. There was evidence of recurrent, involuntary, and intrusive memories of the accident in the form of nightmares and high anxiety on the road (Criterion B). There was persistent avoidance of stimuli associated with the traumatic event manifest in limited driving (Criterion C) with negative alterations and cognitions and mood manifested in depressed mood and marked withdrawal from activities and pursuits she once enjoyed and cessation of work (Criterion D). There was evidence of marked alterations and arousal and reactivity manifest in insomnia, irritability, and problems with concentration (Criterion E). Her symptoms had been continuously present since November 2021 (Criterion F) and had caused clinically significant distress and psychosocial impairment manifest in her loss of self-care, social withdrawal, limited driving, violence towards her daughter, and cessation of employment (Criterion G). Finally, her disturbance was not attributable to the physiological effects of a substance or to another medical condition (Criterion H). In relation to Criterion H, the Medical Assessors noted her earlier excessive alcohol use but also noted that she had used alcohol in an attempt to self-medicate symptoms. Importantly, her symptoms had persisted well after she had ceased excessive drinking. The persistence of her symptoms after she had ceased excessive drinking indicates that they are unlikely to be attributable to her use of alcohol.
The Medical Assessors noted that the claimant satisfied all the Criteria A-H required for the diagnosis of post-traumatic stress disorder.
Her earlier excessive alcohol use warranted a diagnosis of alcohol use disorder which was now remission. To this end, the Medical Assessors were particularly mindful of the certificate of Medical Assessor James Cowlishaw dated 19 November 2024 determining that her acute liver damage had resolved. This would be consistent with her alcohol use disorder being in remission.
Causation and reasons
There was no evidence apart from the accident of any other factors that would have given rise to post-traumatic stress disorder which had come on in the aftermath of the accident. As noted above, her alcohol use disorder had arisen in the setting of attempted self-medication of her post-traumatic dysphoria.
Permanency of impairment
Her symptoms have been continuously present for almost four years. Over this time, she has had treatment from a psychologist and a psychiatrist (both now discontinued), and she remains on an appropriate psychotropic regime. Her level of impairment is consequently unlikely to change substantially or by more than 3% over the next year.
Degree of permanent impairment PIRS
| Psychiatric diagnoses | 1. Post-traumatic stress disorder | 2. Alcohol use disorder in remission |
| 3. | 4. | |
| Psychiatric treatment description | She has been prescribed escitalopram, mirtazapine, and amitriptyline. She no longer sees a psychiatrist or a psychologist. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 2 | She is “OK” with showering and changing her clothes which she might do “once a week – sometimes 2 or 3 times a day”. She was asked why she showered infrequently in some periods and frequently in others. She replied, “I didn't know – I feel like suddenly doing so”. She relies on “my parents or my daughter” for cooking and cleaning. She does no laundry or dishes. Her parents cook and clean for her when they are in Australia “but sometimes they get angry with me” and go back to China. They might stay with her “sometimes a few months – sometimes a year – there's no set pattern”. We asked what stopped her from cooking or cleaning. She replied, “No obstacles – I just don’t feel like it”. If her daughter did not do this, she would “not eat – if it’s a mess, I would just leave it”. Her appetite fluctuates in that sometimes she does not feel like eating and at other times she “can’t stop eating”. She does not pay attention to her weight “but last time I did, I think I lost a few kilos”. She did not know her current weight. She did not regularly go to a salon or nail artist and would attend to her nails on her own. That said, the Medical Assessors noted that she appeared well-groomed with neat hair, some make up, and well-manicured nails. Comment: In view of her well-groomed appearance, the Medical Assessors concluded using clinical judgment that she had Class 2 impairment in this category. |
| 2. Social and Recreational Activities | 3 | She does not go out socially and does not have any visitors. She takes her dog out for a walk once a day which she would do for “about 5 minutes – it just needs to go downstairs and do its business”. “And when there's nothing I have to attend to, I don’t go out”. She would sometimes go to the supermarket and occasionally her daughter would ask her to pick her up. She might also go out to get her medications. She would relegate shopping to her parents or her daughter but “if neither of them can do it, I do it”. She could not say how often she actually went out saying there was no pattern. She had no interest in anything. Comment: The Medical Assessors were mindful of the insurer’s submissions in relation to this category contending that her capacity to drive to the shops independently was consistent with Class 2 impairment. It is true that the PIRS descriptors for Class 3 impairment contained the phrase, “Will not go out without a support person”. However, other descriptors include, “rarely goes out to such events [social activities], and mostly when prompted by family or close friend” as well as “Not actively involved, remains quiet and withdrawn”. The Medical Assessors noted that the PIRS descriptors are not criteria but merely illustrative examples. Moreover, the category of social and recreational activities relates to engagement in such activities and is separate from the category of travel which relates to the capacity of a person to make journeys for whatever reason. Consequently, the ability to make a short journey on her own does not place her in Class 2. |
| 3. Travel | 2 | She drives “occasionally” but says “the process of driving really makes me miserable”. She said that she gets “chest heaviness” as though “there is a large stone on my chest” and “I can’t breathe”. She is afraid other cars would hit her “and sometimes I have this strong urge to hit other cars”. She was asked about her travel to China which was “probably last year” where she remained “1 or 2 weeks” staying with her brother. She flew with her daughter. She could not remember how many times she had been to China since the accident, but it might have been a “4 or 5 times”. Comment: As she did not travel overseas on her own, her reported functioning in this category was consistent with Class 2 impairment. |
| 4. Social Functioning | 3 | The Medical Assessors asked how she got on with her daughter. She replied, “We can’t stay together for more than 10 minutes – I get very emotional, and I lose my temper but she’s a good girl and doesn’t take it to heart but I get grumpy quite often”. She gets on “even worse” with her parents who “quite often get angry with me and just leave”. They get angry with her because “quite often I would lose my temper with them for no reason – I would be grumpy and irritable and just looking for trouble”. She said of her parents, “I couldn't control myself – they showed the utmost understanding of me”. She “used to have many friends but now I don't keep in contact”. She would not respond to phone calls and would only occasionally respond to messages. She has been a violent towards her daughter and had “hit her – kicked her”. This had happened “once or twice” both here and in China. Her daughter had never reported her because “after hitting her, I was on the verge of jumping from the building to kill myself – why would she report me”. Comment: The presence of domestic violence places her in Class 3 in this category. |
| 5. Concentration, Persistence and Pace | 3 | She feels her concentration is “very poor” and “I don't feel like doing anything”. She said she would “leave the TV on and watch it for a few minutes and then do something else and then I watch it for a few minutes and then do something else”. “Something else” might include “making a cup of tea” or “cutting the skin around my nails with scissors” or “playing with my dog” or “scrolling on my phone”. She does not read. She had never been a one to read much. She says her memory has been a getting “worse and worse” speaking of making a cup of tea and forgetting to put a tea bag in or sometimes going to the toilet and forgetting to clean herself. She does not do her taxes and did not know if she had to pay any tax on her income from CTP. Comment: Her account of herself was often frustratingly vague with striking inability to provide specific information. This is consistent with Class 3 impairment in that poor concentration is readily apparent to the observer. The Medical Assessors were mindful of the insurer’s submissions that the claimant could scroll on her phone for long periods were inconsistent with Class 3 impairment. However, Class 3 impairment is described as follows, “unable to read more than newspaper articles. Finds it difficult to follow complex instructions (e.g. operating manuals, building plans) make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting”. The illustrative examples in this category go to an injured person’s capacity to perform intellectually demanding tasks. Scrolling on one’s mobile phone for however long a period is not an intellectually demanding task but rather a mindless activity which makes no demands on a person’s capacity for concentration, persistence, and pace. It was clear that the claimant was not up to performing the activities described in this category. |
| 6. Adaptation | 5 | She tried to go back to work after her accident, but she was “unsteady in my emotions” and “grumpy”. She found it was difficult to focus as before. She said “the investors who invested in my company” thought she was “not suitable” because of this. She could not say if the company was still in existence even though she was the owner. She did not have any business partners but “just investors”. She has not tried any other kind of work. When asked, she said, “I don't really want to meet with anybody – I don't want to go out either”. The claimant experienced irritability, labile emotions, social withdrawal and a lack of focus, all of which affect her inability to work. |
| List classes in ascending order: 2, 2, 3, 3, 3, 5 | ||
| Median Class Value: 3 | ||
| Aggregate Score: 18 | ||
| % Whole Person Impairment: 22% | ||
*%WPI = Percentage Whole Person Impairment
Psychiatric Impairment Rating Scale – Pre-existing/subsequent impairment
There was no evidence of any pre-existing impairment.
Apportionment – pre-existing/subsequent impairment
There was therefore no apportionment.
Effects of treatment
There was no adjustment for treatment effects.
Degree of permanent impairment caused by the motor accident
24%.
The Panel met on 30 September 2025 to discuss the Medical Assessors findings on examination. The legal Member of this Panel did not participate in the medical examination but prior to the Panel meeting on 30 September 2025, the legal Member has had the benefit of reading and considering the Medical Assessors examination report. On
30 September 2025, when the Panel met, the examination findings and the issues going to causation and assessment of WPI were all discussed. It is from this preliminary conference of the Panel that the Panel has agreed and reached its final conclusion and determination.
The Panel adopts the findings of Medical Assessor Singh, and Medical Assessor Canaris.
Causation/reasons
Prior to the accident the claimant was not undergoing any treatment for a psychiatric disability. She was running a business importing goods and on selling to retailers in Australia, with business backers or partners.
The claimant has not worked since the accident.
Since the accident the claimant has treated herself with traditional chinese medicine and alcohol which she takes to induce sleep. As a consequence of this combination, the claimant suffered liver damage requiring a lengthy stay and recovery in hospital.
Whilst certificates of Medical Assessor Berry and Medical Assessor Cowlishaw did not form the bundles of either the insurer or the claimant, these certificates were within the portal for the availability of the Panel. These certificates were for the assessment of soft tissue injuries to the claimant’s cervical and lumbar spines and her acute liver damage due to alcohol and traditional Chinese medicine.
The WPI assessment for the soft tissue injuries amounted to 10% and the WPI for the liver damage amounted to 0%.
The Panel is satisfied that it was only after the accident that the claimant demonstrated a clear inability to lead a normal daily life such that she would rarely leave home, was incapable of continuing her business, has considerable difficulty sleeping, has demonstrated violence to her daughter and has involuntary and intrusive memories of the accident in the form of nightmares and high anxiety when travelling in a car, amongst other things.
The Panel is satisfied that its diagnosis of post-traumatic stress disorder and alcohol use disorder in remission has been caused by the accident which occurred on
22 November 2021.
Conclusion
The claimant was involved in a motor vehicle accident on 22 November 2021. As a result of this the claimant suffered physical injuries and liver damage for which she has been assessed as having 22% WPI.
The claimant has also suffered psychiatric disability requiring the prescription of medication. She has been treated by a psychiatrist.
The Panel has diagnosed claimant is suffering from a post-traumatic stress disorder with an alcohol use disorder in remission.
Determination
The Panel revokes the certificate of Medical Assessor Ng.
The Panel has diagnosed the claimant as having a post-traumatic stress disorder with alcohol use disorder in remission.
The Panel has assessed the claimant as having a WPI of 22%.
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