Insurance Australia Limited t/as NRMA Insurance v McBride

DETERMINATION OF REVIEW PANEL
CITATION:	Insurance Australia Limited t/as NRMA Insurance v McBride [2025] NSWPICMP 772
CLAIMANT:	Alan George McBride
INSURER:	Insurance Australia Limited trading as NRMA Insurance
REVIEW PANEL
MEMBER:	Terence O’Riain
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Himanshu Singh
DATE OF DECISION:	7 October 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; permanent impairment; review; insurer disputed causation and permanent impairment; alleging psychological injuries before accident; Commission referred psychiatric condition to assess permanent impairment; Medical Assessor (MA) certificate assessed 19% permanent impairment; referred for review; re-examination; claimant was cooperative and consistent; accident was capable of causing referred injuries; 19% permanent impairment with different clinical findings; Held – different clinical findings to original assessment; Review Panel revoked original medical assessment certificate; permanent impairment greater than 10%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. Revokes Medical Assessor Yu-Tang Shen’s certificate dated 20 March 2024. 2. Certifies that the claimant’s permanent impairment resulting from the injury caused by the accident is 19% permanent impairment arising from post-traumatic stress disorder caused by the accident, which is greater than 10%.

REASONS

Background

On 25 January 2021 Mr Alan George McBride (the claimant) was driving his vehicle on the M5 when the insured vehicle rammed his vehicle at a speed of 80 to 90kmph (the accident).
Mr McBride has brought a claim for common law damages under the Motor Accident Injuries Act 2017 (the MAI Act).
Insurance Australia Limited trading as NRMA Insurance (the insurer) is the relevant insurer with liability to pay any damages to Mr McBride under the MAI Act.
Section 4.11 of the MAI Act provides that there is no entitlement to damages for

non-economic loss unless the degree of permanent impairment of the injured person because of the injury caused by the accident is greater than 10%.
This dispute is in relation to whether the degree of permanent impairment sustained by

Mr McBride because of injuries caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1]
[1] Section 7.20 of the MAI Act.
The dispute as to permanent impairment in respect of the claimant’s psychological injury was referred to Medical Assessor Yu Tang Shen. He issued a certificate dated 20 March 2024 finding the claimant’s psychological permanent impairment arising from the accident was greater than 10%.
The insurer sought a review of Medical Assessor Shen’s assessment on 15 April 2024 within 28 days of the date on which the certificate of Medical Assessor Shen was made available to the parties.[2]
[2] Section 7.26(1)(b) of the MAI Act.
On 1 July 2024, the delegate of the President – being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect – referred the medical assessment to the Review Panel (the Panel).[3]
[3] Section 7.26 of the MAI Act; claimant’s bundle p 9.
The review is by way of a new assessment of all matters with which the medical assessment is concerned.
The Review Panel issued a direction to the parties on 7 March 2025 requiring each party to file an indexed, paginated bundle of documents.
The insurer’s solicitor submitted a bundle of documents paginated from pages 1 to 2,195. After viewing the documents, the Panel formed the view many of the documents were not relevant to this dispute.
The Panel directed the insurer is to either file an indexed and paginated bundle limited to the documents relevant to the review or alternatively to direct the Panel to those documents in the bundle already uploaded which the insurer submits are relevant. On 16 April 2025, the insurer uploaded an indexed bundle of documents paginated from pages 1 to 1,361 (insurer’s revised bundle).
The solicitor for the claimant uploaded a bundle of documents paginated from pages 1 to 337 (claimant’s bundle).
The Panel met on 27 May 2025. It became necessary to reconstitute the Panel with Member O’Riain because Member McTegg became unavailable.
The Panel considered it was necessary to re-examine the claimant and Medical Assessors Baker and Singh would conduct this examination on behalf of the Panel via MS Teams on

1 August 2025.

Legislative framework

Schedule 2(2)(a) of the MAI Act declares:
“the degree of permanent impairment of the injured person that has resulted from the injury caused by the accident (including whether the degree of permanent impairment is greater than a particular percentage)is a medical assessment matter.”
If there is a dispute about the degree of permanent impairment of an injured person being sufficient to award non-economic loss damages i.e. greater than 10%, then those damages may not be awarded unless the degree of permanent impairment has been assessed by a Medical Assessor under Division 7.5: s 4.12(1) MAI Act.
Division 7.5 of the MAI Act provides for the Commission to assess declared medical disputes including provisions relevant to an original medical assessment and for appointing Panels to review those medical assessments.[4]
[4] Sections 7.20, 7.24 and 7.26.
Parties may apply to the President of the Commission for review of a medical assessment on grounds that the assessment “was incorrect in a material respect (sub-s (1)).” If the President, or his delegate is satisfied “there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect” then the President refers the application to a review panel consisting of a member of the Commission and two Medical Assessors (sub-ss (2) and (2B)) to reassess the dispute.
The review is not confined to the issues raised in the application (or the reply) but is “a new assessment of all the matters with which the medical assessment is concerned (sub-s 3A).”
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.
Rule 128 permits the Panel to determine its own proceedings and the rules of evidence do not bind the Panel, which may inquire into relevant matters as it thinks fit, while observing procedural fairness.
The method of assessing the degree of impairment is dealt with in s 7.21, which is in the following terms:
“7.21 Assessment of degree of permanent impairment
(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines.[5] The assessed degree of permanent impairment is to be expressed as a percentage.
(2) Impairments that result from more than one injury arising out of the same accident are to be assessed together to assess the degree of permanent impairment of the injured person.
(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment, or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.
(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent.”
[5] Version 10 since 15 September 2025. Referred to as the Guidelines.
Pre-existing impairment is addressed in cls 6.31-6.33 of the Guidelines. Clause 6.34 deals with subsequent injuries.
The Guidelines state as follows with respect to causation of injury:
“Causation of injury
6.5 An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.
6.6 Causation is defined in the Glossary at page 316 of the AMA 4 Guides as follows:
'Causation means that a physical, chemical, or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2.The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.
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 accident. The 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.”
It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychiatric condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular

ss 5D and 5E.

Degree of psychiatric impairment rating scale (PIRS)

Impairment is assessed following the Guidelines which include a chapter entitled “Mental and behavioural disorders.” The assessment is to be undertaken in accordance with the PIRS and the AMA 4 Guides are to be used as “background or reference only.”[6]
[6] Clause 6.203 of the Guidelines.
The PIRS requires a psychiatric diagnosis to be undertaken first in accordance with the current editions of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD).[7]
[7] Clause 6.213 of the Guidelines.
The PIRS provides[8] for the consideration of any psychiatric condition present before the accident in question:
“In order to measure impairment caused by a specific event, the medical assessor must, in the case of an injured person with a pre-existing psychiatric diagnosis or diagnosable condition, estimate the overall pre-existing impairment using precisely the method set out in this part of the Guidelines, and subtract this value from the current impairment rating.”
[8] Clause 6.218 of the Guidelines.
The PIRS provides in cl 6.219 for six areas of function:
·        self-care and personal hygiene;
·        social and recreational activities;
·        travel;
·        social functioning (relationships);
·        concentration persistence and pace, and
·        adaptation.
The PIRS then provides at cl 6.220 for five classes of impairment with a descriptor for each which is “illustrative rather than literal criteria” and which is based on:
“… a history of the injured person’s pre-accident lifestyle, activities and habits, and then [an assessment of] the extent to which these have changed as a result of the psychiatric injury.”
The impairment may be adjusted for treatment,[9] that is treatment such as medication being taken to treat the psychiatric condition.
[9] See cls 6.222 – 6.223 of the Guidelines.
Once all six areas of function have been categorised into a particular class, the median class score is determined, the aggregate score is determined and the median and aggregate is converted to provide a whole person impairment (WPI) percentage.[10]
[10] See cls 6.225 – 6.228 and table 17.

CERTIFICATE OF MEDICAL ASSESSOR SHEN[11]

[11] Insurer’s bundle p 9.

The injury referred to Medical Assessor Shen for assessment was:
· psychiatric condition - post-traumatic stress disorder.
Medical Assessor Shen assessed the claimant and issued a certificate dated 20 March 2024 in which he certified the claimant had sustained a permanent impairment of 20% in respect of the following injuries caused by the accident:
· post-traumatic stress disorder, and
· persistent depressive disorder.
Whilst Medical Assessor Shen noted Dr Bisht’s opinion that the claimant had previous psychological symptoms arising from past traumatic experiences from being a police officer and from a 2020 inquest, the history from the claimant did not support finding psychiatric injuries before this accident.
Medical Assessor Shen diagnosed post-traumatic stress disorder where he found the accident was sufficient to meet criterion A and the claimant’s symptoms met criterion B to E with sufficient duration lasting longer than a month causing significant distress and impairment. He also diagnosed persistent depressive disorder where the claimant had experienced persistent depressive symptoms for more than two years. He was satisfied causation was established given the temporal and thematic association between the symptoms and the accident.
Medical Assessor Shen found class 3 for self-care and personal hygiene, class 3 for social and recreational activities; class 2 for travel, class 4 for social functioning, class 3 for concentration, persistence, pace, and class 2 for adaption. Medical Assessor Shen assessed a current permanent impairment of 19% making an adjustment of 1% for the effects of treatment.
Medical Assessor Shen assessed the claimant’s pre-existing impairment which he assessed at 0% permanent impairment. He found class 1 for self-care and personal hygiene, class 1 for social and recreational activities; class 1 for travel, class 1 for social functioning, class 1 for concentration, persistence, pace, and class 1 for adaption.

Evidence before the Panel

Medical evidence

The Panel considered the parties’ revised bundles. The relevant contents are summarised in the parties’ submissions and the Medical Assessor’s examination report.

SUBMISSIONS

Claimant’s submissions

The claimant provided submissions dated 10 July 2023 in support of the application to assess permanent impairment.
Consultant psychiatrist Dr Ashwinder Anand, in his report dated 2 May 2023, opined that the claimant’s injuries are stable and have reached maximum medical improvement; and subsequently assessed a permanent impairment of 19% (WPI).
Psychiatrist Dr Yajuvendra Bisht, in his report dated 2 June 2023, opined that the claimant’s injuries were not stable and required a further six months of treatment to reach maximum medical improvement.
Dr Bisht did not assess permanent impairment.

Insurer’s submissions

The insurer provided submissions dated 15 April 2024 in support of the application for review.[12]
[12] Insurer’s documents p 3.
The insurer submitted that the Medical Assessor:
·        failed to respond to the insurer's clearly articulated arguments relating to causation, namely, the effect of the claimant's past traumatic experiences, in his role as a police officer, on his ongoing symptoms and whether there should have been a deduction for pre-existing impairment arising from those past traumatic experiences;
·        in reaching his conclusion of class 1 (nil impairment) for adaptation in paragraph 24 for pre-existing impairment, the Medical Assessor failed to consider the objective evidence relating to the claimant's pre-existing impairment for employment;
·        the Medical Assessor failed to engage with Dr Bisht’s expert opinion that the claimant's psychological injury had not stabilised and that the motor accident was only 50% responsible for the claimant's psychiatric impairment, and
·        the Medical Assessor failed to put inconsistencies to the claimant.
The insurer also submitted Medical Assessor Shen incorrectly allocated a class 3 for concentration, persistence, and pace when the evidence including the claimant’s own account better fit a class 2 “mild” impairment.
The insurer provided submissions dated 26 July 2023 in response to the substantive application.[13]
[13] Insurer’s documents p 30
The insurer submitted the claimant's psychological injury has not yet stabilised because he required further treatment, such as ECT and a post-traumatic stress disorder program to improve his symptoms in light of the report of the claimant’s treating psychiatrist

Dr Ranasinghe and Dr Bisht’s opinion.
Assuming the claimant’s condition is found to have stabilised the insurer submitted a deduction for pre-existing impairment is required for the following reasons:
·        the Psychology Perspective clinical records confirm the claimant already suffered from psychological symptoms when the accident happened, such as a decline in confidence and ability to perform his job at a high standard, doubtfulness, negativity, and difficulties in seeing the positive side of things, arising from past traumatic experiences in his role as a police officer which are unrelated to the accident;
·        psychologist Dr Toni Metelerkamp’s report dated 26 July 2021 records the claimant has not been functioning well since an inquest in 2020, and
·        the insurer submitted the claimant’s work ability was already impaired before the accident due to pre-existing psychological symptoms. Given this, a deduction is required from any assessment of permanent impairment.

MEDICAL EXAMINATION

Who attended the assessment

Medical Assessors Baker and Singh examined Mr McBride (the claimant) on

1 August 2025 by MS Teams. The claimant was unaccompanied. The claimant did not have a support person present during the re-examination.

History

Psychosocial history and pre-accident

The claimant was born at the Nepean Hospital. He was 40 years of age at the time of this assessment. The claimant said that his father was 68 years of age and was a retired signal electrician. His mother worked part time as a factory worker and was 65 years of age. The claimant was the eldest of three brothers. He had two younger brothers, aged 37 and 35 years. Both his brothers were fully employed. The middle brother was a qualified mechanic, and his youngest brother was a qualified horticulturalist for a local council.
The claimant said that the family lived on the Central Coast, NSW. He attended his primary school education at Chittaway Bay Public School. He then progressed to Berkeley Vale High School. Then completed his high school education with the completion of his Higher School Certificate (HSC).
The claimant said that he was involved in the sport of BMX bicycle racing and was ranked second in Australia when he retired before the Sydney Olympic Games. He said he also enjoyed playing cricket. He was a batsman/ wicketkeeper. He said that he had played representative football (soccer) for his region as a youth.
The claimant reported breaking his nose whilst participating in a BMX bicycle race. The nose fracture was treated conservatively and healed without impairment. At about

18 years of age the claimant had his appendix removed. He recovered from this surgery without impairment.

The claimant said that his childhood was enjoyable and his parents supported him in his sports activities and interests. He said that he was never exposed to any trauma, abuse, or neglect during his childhood. He did not have any developmental disabilities.
The claimant said that after leaving school, he enjoyed playing golf, riding motorbikes, boating, and surfing with his friends. He had a gym membership and would attend the gym most days. He said that his goal was to join the NSW Police Force and work as a police officer for his career.
The claimant said that he was physically fit and psychologically fit before commencing work as an NSW Police officer. He said that he has never smoked tobacco. He has never used illicit substances. He does not gamble. He said he would drink alcohol about two beers most days. He now drinks alcohol four days a week and about three beers with dinner.
Before commencing employment with the NSW Police Force the claimant worked in a variety of roles. He said his first employment was working as a night fill casual worker at a local Coles supermarket. He would work two to three shifts per week, between 5.00pm and 10.00 pm, from about 15 years of age. He said that he also would referee for the local indoor volleyball competition and he received a gratuity for this assistance.
The claimant then moved to greater western Sydney. He worked with his uncle at a local chicken farm. He was directed to manage the security gate as well as to work on the weighbridge. He said that he was a junior labourer in these roles. He was not required to perform any specific skills training to work in these casual jobs. He was not injured whilst working as a labourer.

NSW Police Officer career

The claimant applied to the NSW Police Force and was successful in being accepted to the Goulburn Police Academy. He completed nine months of training and was attested on

31 January 2007.
The claimant was working in various roles whilst an NSW Police Officer. He said that he had worked in the detectives’ unit at various police stations in the NSW Police local area commands. He said he had worked in and out of uniform.
He worked also as a uniformed training officer assisting more junior officers develop the necessary skills to work independently as a police officer. He said that he would have one new probationary officer every three months when he first commenced this role. As time progressed, he became the second most senior uniform training officer for NSW and he had multiple officers he had trained or would seek his assistance and advice.

Traffic offences

The claimant said that the only driving offence he had was “driving too close to a vehicle in front of him” whilst he was a p-plate driver.

Prior motor accidents

The claimant said that before the subject accident he had never been in a motor accident either working as an NSW Police Officer or as a civilian driving his private vehicle.

Hurt on duty claims

The claimant said that in about 2008 he was working as a police officer and was arresting a person of interest. During the arrest he injured his right shoulder.
The claimant said he has had two operations to repair the right shoulder injury . He said whilst he has had repeated surgery on his right shoulder, he was still able to work in his role as a police officer before this accident which did not happen until 25 January 2021.

Coronial inquest 2020

The claimant said that during his work as a police officer he was driving when he and his coworker identified a person of interest who had warrants for his arrest. He said that the man quickly fled after he saw the police car. He said that he followed the man's vehicle. The vehicle went to private land in a semi-rural location. He said that without appropriate permission he was not permitted to enter the private property so he ceased pursuing the person of interest.
The claimant said that a male body was later discovered, which had fallen from a cliff. The deceased was identified as the person of interest that the claimant had been following some weeks earlier
The claimant said that he was required to provide evidence at the coronial inquiry. He said that he provided evidence to the court. He said he volunteered to provide more evidence to assist the court in relation to details the claimant knew regarding the deceased.
The claimant said there were no complaints about his police practice and conduct in relation to this death. He said he was always anxious prior to providing important evidence to senior decision makers. He said he was never impaired in his capacity to work as a police officer before this accident.
The claimant said that he had experienced the usual tension and pressures of working as a NSW Police Officer. He said that he was not expecting to be separated or estranged from his wife before this accident. He said he had never spoken to any psychologist, psychiatrist, or a general practitioner in relation to his work as an NSW Police Officer before this accident. He said:
“While police work was demanding I was not impaired psychologically from my job or career as a police officer, husband or father to my children.”
The claimant said that he had completed about 3,000 hours as an acting sergeant. He said that he was hopeful of applying for a promotion to sergeant before the January 2021 accident. He said that he was a high-ranking leading senior constable who was broadly experienced and eligible for promotion before this accident.
The claimant was asked about a note made by the treating clinical psychologist Dr Toni Metelerkamp’s report dated 26 July 2021 regarding any deterioration he might have experienced psychologically due to the inquest in 2020 or due to a decline in his psychological functioning prior to this accident.
The claimant said he was not psychologically impaired before this accident. He said that because of his desire for promotion he had applied for and been interviewed for a promotion in April 2021. He said this was about two–three months after the motor accident and about the same length of time before the clinical note.
The claimant said that it was at this interview that he first became aware that his capacity to work had declined because of the accident on 25 January 2021. He said he was not impaired in his capacity for work until after this accident.
The Medical Assessors agree that there was no treatment for a psychological condition diagnosed before this accident. The Medical Assessors note that in compliance with DSM-5-TR criteria for any psychological condition, the presence of psychological symptoms alone is insufficient to diagnose a DSM-5-TR defined psychological disorder.
The Medical Assessors agreed that the referred to documents do not provide any other supporting evidence for a pre-existing psychological injury. The claimant stated he had not deteriorated because of his role in the 2020 coronial inquest.
The Medical Assessors note that in Dr Gregory Cameron’s report to EML Workers Compensation – NSW TMF dated 2 September 2021 he documented:
“Alan was involved in a motor vehicle accident on 25 January 2021 initially requiring
[14] Page 240 insurer’s revised bundle.
3 days off work for a soft tissue injury. Alan has been certified fit for pre-injury duties from 01 February 2021 however having ongoing treatment for a right wrist injury which recently required CT guided aspiration and ongoing physio…On 14 July 2021, Alan was downgraded in his capacity for work due to a psychological injury as a result of the MVA. A diagnosis has not yet been provided. Referral has been made for a psychologist and exercise physiologist.”[14]
The Panel also reviewed Dr Anand’s report dated 2 May 2023[15] for the claimant’s lawyers. That report records the claimant with specificity recalling attending many events before the accident that were inherently emotionally taxing. However, that specialist noted that the claimant’s behaviour before the accident was markedly different to his psychological condition after the accident.
[15] Page 125 claimant’s bundle.
Dr Bisht, in his report dated 2 June 2023, documented, “From the day of the accident, Alan started to show psychological symptoms…”.[16]
[16] Page 828 insurer’s revised bundle.
The Medical Assessors note that whilst Dr Bisht documented: “My diagnosis remains the same as before i.e. post-traumatic stress disorder and major depressive disorder, as per DSM 5.”
Dr Bisht does not state that either of his diagnosed conditions were exacerbated or aggravated by the motor accident.
He does not provide a pre-existing diagnosis or explain how the claimant’s earlier workplace experiences could “contribute 50%” to his assessed impairment when he had not provided a DSM-5-TR defined diagnosis, which is the current required diagnostic manual.
The Medical Assessors agree that Dr Bisht had not provided a pre-existing PIRS Assessment worksheet with a pre-existing diagnosis where he could assess and document each table of functioning as required by the current motor accident Guidelines.
The Medical Assessors reviewed the handwritten note dated 26 July 2021. The Medical Assessors agree that note does not refer to the claimant having any psychological symptoms before this accident. There is a reference to his wife having become psychologically injured in her role as a police officer in 2019. The claimant stated his wife was much improved since ceasing work as an NSW Police Officer, and there was no record of separation or estrangement from his wife or child in this note.
The Medical Assessors agree that there is no pre-existing psychological injury that had been diagnosed, treated, or identified prior to the motor accident on 25 January 2021.

History of motor accident

The claimant said that he was working alone before the accident on 25 January 2021. He was driving a police car and he was the supervisor of the shift. He said that he had left the police station to fill the car with fuel. He said this was a common duty to be performed by the overnight shift which he was working. The claimant said that he saw a car driving erratically in the street. The driver of the car at fault suddenly did a U-turn and fled the scene.
The claimant notified other police officers on the radio that he was pursuing the offender. The offender's car went out of town, up a mountain and towards a semi-rural area. The offender’s car came to a section of road where the tarmac ceased and the road continued as an unsealed road. The offender's car stopped after turning around. The claimant said that he expected that the pursuit had ended.
Unexpectantly, the offending driver accelerated towards the claimant's car and struck his car on the driver’s side, ramming into his car and making a heavy impact into the police car. The glass in the windows of the police car shattered. The claimant hit his head. The offender then reversed back away from the police car. The driver’s side door of the police car was split open and was unable to be opened safely. The claimant exited his police car on the passenger side of the vehicle.
The claimant then drew his weapon. He said that he was panicking and the first thought that came into his head was, “I can't defend myself!” He said that he ran to a house near the road and hid behind a sandstone wall. He said the panic continued and he had little memory of what happened next until a fellow police officer took his equipment belt and firearm from him. He said his next memory was waking up in the ambulance. Then waking up again in the emergency department.
The claimant was told later that he had not discharged his weapon in the motor accident. He said that the offender drove his car about another 200m down the road before abandoning it on foot. The offender was pursued by the other police officers and arrested.
The claimant said he was told that the offender was charged with using a vehicle as a weapon causing actual bodily harm. He said the offender pleaded guilty to the offence. The claimant was not required to give evidence because of the offender pleading guilty. He said he was told that the offender was convicted with a five-year prison sentence. He said he has had no further contact with the offender in any way since the night of the motor accident.
After being treated in hospital, the claimant was discharged home to be followed by his general medical practitioner. He said he had a few days off work, because he was aware of the upcoming promotion interviews, he wanted to participate in and be promoted to sergeant. He continued at work but began to change his behaviour in relation to how he travelled when in a police car.
The claimant said that he was working as the mobile acting sergeant when he first asked his partner to drive the police car. He said that he would have never invited his co-worker to drive instead of himself prior to the motor accident. The claimant also requested a change of police stations from Gosford to Woy Woy. He said that he had requested the change of police stations so he would avoid anyone related to the motor accident.
He said that when he was in the police car as a passenger and there were calls for the car’s “lights and sirens” to be used. The police car would have to stop as the uncredited driver would have to leave the driver's seat and the claimant as the fully qualified driver under emergency driving provisions would have to drive in these emergency circumstances. The claimant said he began to feel ashamed and he did not wish to explain to his junior co-worker why he had engaged in this unusual behaviour.
The claimant said that he was successful in being granted an interview in relation to the promotion to sergeant. He failed the interview. The senior officer in the interview told him that he was too agitated and preoccupied, He was not able to answer the questions in the correct manner. The claimant then was visited for the first time in his career by the welfare officer.
The welfare officer provided feedback to the claimant that since the motor accident, his colleagues had noted he had changed in his behaviour. The claimant said he became distressed when hearing that his colleagues knew that he was psychologically impaired for the first time. He confirmed that he was suffering from anxiety when travelling to work most days from home. He said he would have nausea, vomiting, and diarrhoea. He said he had never experienced such strong physiological reactions because of psychological distress at any time before the motor accident.
The claimant attended his local medical general practitioner and was referred for psychological treatment for the first time.
The claimant was asked what the difference was between this motor accident and other events, such as the death of the person who was the focus of the coronial inquiry, and the man whom he had arrested when he injured his right shoulder that required two bouts of surgery.
The claimant said that the motor accident was the first time he had been alone and at a real risk of dying, because he had no partner to help him when the offender started to ram his car with the claimant fleeing for his life.
The claimant said that he had never had his life directly threatened like it was on

25 January 2021.

Psychological injury symptoms

The claimant developed the following psychological symptoms because of the motor accident.
The symptoms that met DSM-5-TR F 43.10 post-traumatic stress disorder are listed below.
The claimant meets criterion A for post-traumatic stress disorder because the offender directly rammed his car, seriously damaging his vehicle, which resulted in the claimant drawing his weapon in self-defence to protect his own life.
The claimant immediately assessed that his life was then in imminent danger and fled the car accident scene to hide behind a stonewall that was nearby. The nature of this motor accident and the consequences immediately associated with the motor accident met Criterion A for severity of traumatic event.
The claimant described recurrent distressing dreams and ongoing nightmares about the motor accident which distress him most nights and had caused him to experience repeated daily fatigue with loss of interest in his essential important areas of functioning such as self-care, personal hygiene, and participation in the home with daily chores.
The claimant increased avoidance of his Gosford Police Station. He had made efforts to avoid working at Gosford and organised to work at Woy Woy to give him a break from the distressing memories, thoughts, feelings, and people who would remind him about the accident. The claimant also attempts to avoid thinking about the accident and that his life was in immediate danger, which caused him to flee and protect himself at the time of the motor accident, as the driver of the other car had threatened his life.
The claimant reported experiencing ongoing anger whenever he was reminded about the offender, whom the claimant blames for losing his career and ruining his life.
The claimant reported no longer participating in the gym, motorcycle riding, golf or boating with his friends. His interest in his children’s sport and school progress is reduced.
The claimant reports hypervigilance whilst driving with reduced capacity to drive, since the accident and reduced range of movement to within his local area and children’s school. He also reported hypervigilance at night with him checking if his house was secure before attempting to sleep.
The claimant reported frequent startling from sleep in response to unexpected noise or frightening nightmares.
The claimant has difficulty with concentration whilst reading and loss of interest with him no longer persisting with complex tasks as he would have before the accident.
During the assessment, his concentration persistence and pace was slow. His concentration was disrupted by emotional responses to him remembering what had happened in the accident and the consequences to himself, his career and his relationships with his wife, children, and friendship circle because of the accident.
The claimant has difficulty in initiating sleep, remaining asleep and when he wakes from sleep and he had difficulty returning to sleep once awake for more than two hours, most nights.
The claimant has since the onset of this psychological injury, been unable to experience happiness and satisfaction, having separated from his wife, as well as there being ongoing tension in his relationship with his wife, and an inability to be intimate with his wife.
The claimant had also had symptoms of depressed mood and panic symptoms (anxiety) since the motor accident. These symptoms were included within the diagnosis of

post-traumatic stress disorder as the presence of other core symptoms of suicidal intent and anhedonia were not present whilst the other symptoms that might be used defined major depressive disorder were better explained as part of the claimant psychological injury where his life was directly threatened because of the motor accident.

Treatment

Physical injury

The claimant had sustained a hand injury. He attended a wrist specialist for his wrist injury. He said that the treatment of physiotherapy and surgical treatment failed to improve his hand function.
His right-hand wrist function was reduced at the time of this assessment. He said he was right hand dominant. He said a surgical attempt to “remove a disc” from his wrist to improve his mobility in his wrist was unsuccessful.

Psychological treatment

The claimant was referred by his general practitioner to attend a clinical psychologist and psychiatrist. He had attended his clinical psychologist about once every two to four weeks. He had been treated with cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing therapy (EMDR), mindfulness training as well as relaxation skills training.
The claimant said that he had not been referred for admission to a private psychiatric hospital for an inpatient post-traumatic stress disorder or mood disorders inpatient programme.

The claimant was referred to a private psychiatrist for treatment. He was prescribed evidence based psychiatric medication which included Prazosin 5mg at bedtime and Temazepam 10mg at night. He reported that he suffered significant dizziness and had postural hypotension due to Prazosin 5mg. This is a known clinical side effect from using this anti-hypertensive medication to treat severe autonomic arousal symptoms in post-traumatic stress disorder.
The claimant was prescribed an anti-depressant medication Vortioxetine 5mg which was increased to 10mg. He reported nausea with this medication and the medication was ceased before this re-examination. The claimant reported he had also trailed Reboxetine 4mg twice daily without benefit. He reported having ceased all his evidenced-based psychiatric medication at the time of this re-examination.

Mental state examination

The claimant presented as a dishevelled and unkempt man who had not groomed himself before the re-examination. He said he had lost interest in his self-care and personal hygiene and he no longer maintained the same standard of self-care and personal hygiene he had prior to the accident.
The claimant reported that he had negative emotions and inability to experience happiness (depressed mood) and that his panic symptoms (anxiety) had persisted most days with him quickly becoming agitated and have angry outbursts towards others including his wife.
The claimant was observed to become irritable and distressed when talking about his lost career and the threat to his life. He said he was so frightened at the time of the accident that he had difficulty remembering who took his equipment belt and his gun and who had double locked his gun locker, so he could not regain access once his gun was permanently removed from him.
The claimant’s speech was slow and he required increased time to talk about the aspects of the motor accident that had caused him the most distress. He would avoid the more distressing aspects of the injury and he required prompting to described what had led up to him been approached by the welfare officer to seek assistance for this psychological injury, as he was unfit to continue his work as a police officer.
The claimant said without prompting he often feels angry and distressed and then “numb” whilst remembering what happened to him and this causes him more distress as he had never had the “numbing” of his emotions before the accident. He said he found this numbing of his emotions very distressing as he could not control the severity or when it would occur.
The claimant described ongoing negative emotions of inappropriate guilt, that he should have been able to act differently and not have fled for safety at the scene of the accident.
The claimant’s concentration was impaired when he spoke about his emotionally distressing memories and losses because of the accident. The re-examination was slow in pace and took about 90 minutes as the claimant required time to pause and use his cognitive behaviour skills to settle his agitation and continue his recall of the distressing accident. The claimant required to be prompted to remain present when he would drift off track or avoid talking about details of the motor accident, such as the moment he thought he could not defend himself and his life was directly threatened by the other driver.
The claimant was orientated in time place and person. His rate of speech would change from a slow when agitated to a rapid pace when angry during the assessment. He would change his volume of speech when angry. He did not report delusional ideas or psychotic symptoms.
He did describe partial absence of his memory about important aspects of routine police practice such as having his equipment belt removed and his gun removed from him at the scene of the motor accident. He said, “no one touches my gun” and he said he could not remember who took these essential pieces of police equipment from him.
The claimant did not report suicidal or homicidal thoughts or plans. He did report that he could not write his victim’s statement as his concentration, persistence and pace made writing this document slow, and that he required assistance from others to complete his process, as he would become overwhelmed with emotions.
The claimant was insightful about his condition. His judgment was fair.

Diagnosis

The claimant met the minimum necessary criteria for post-traumatic stress disorder, DSM-5-TR F 43.10 post-traumatic stress disorder as listed below.

Criterion A. Exposure to actual or threatened death, serious injury or sexual violence in one ([BG1] or more closed parentheses of the following ways):

Directly experiencing the traumatic event(s)

The claimant meets this criterion because his car was directly rammed by the offender causing serious damage to the vehicle, which resulted in the claimant drawing his weapon in self-defence. The claimant immediately assessed his life was in danger and fled the car accident scene to hide behind a stonewall that was nearby. The nature of this motor accident and the consequences immediately associated with the motor accident met Criterion A severity of traumatic event.

Criterion B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic events occurred

Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
This criterion is met as the claimant reports ongoing nightmares about the motor accident, which distress him most nights.

Criterion C. Persistent avoidance of stimuli associated with the traumatic events, beginning after the traumatic events occurred as evidenced by one or both of the following:

Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts come up or feelings about or closely associated with the traumatic event(s).
This criterion is met as the claimant sought to actively avoid working at Gosford and organised to work at Woy Woy in an attempt to decrease his arousal, distressing memories, thoughts, feelings, and people who would remind him about the motor accident. The claimant also attempts to avoid thinking about the accident and that his life was in immediate danger which caused him to flee and protected himself at the time off the accident.

gCriterion D. Negative alterations in cognitions and mood associated with the traumatic events, beginning or worsening after the traumatic events occurred, as evidenced by two (or more) of the followin

Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame)

The claimant makes this criterion as he experiences shame and guilt that he was unable to use his gun safely to protect himself. The claimant also experiences ongoing anger towards the offender who he blames for losing his career.

Markedly diminished interest or participation in significant activities

The claimant reported no longer participating in the gym, motorcycle riding, golf or boating with his friends. His interest in his children sport and school progress is reduced.

Criterion E. Marked alteration in arousal and reactivity associated with the traumatic events, beginning or worsening after the traumatic events occurred, as evidenced by two (or more) of the following:

Hypervigilance

This criterion is met as the claimant hypervigilant whilst driving with reduced capacity to drive, since the motor accident.

Exaggerated startle response

This criterion is met as the claimant is frequently startled from sleep.

Problems with concentration

This criterion is met as the claimant has difficulty with concentration whilst reading and loss of interest. He can no longer persist with complex tasks as he would have before the accident.

Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)

This criterion is met as the claimant has difficulty in initiating sleep, remaining asleep and when he wakes from sleep and he had difficulty returning to sleep once awake for more than two hours, most nights.

Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings)

This criterion is met as the claimant is unable to experience happiness and satisfaction with having separated from his wife repeatedly as she was unable to accept his inability to work as a police officer.

Criterion F. Duration of the disturbance, (criteria B, C, D and E) is more than one month

This criterion is met as the claimant’s onset for this psychological injury was 25 January 2021. The claimant continued to be psychologically disturbed from the date of the motor accident to the date of the re-examination. The claimant’s symptoms because of the motor accident have never entered full remission from the date of injury to the date of this re-examination.

nCriterion H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical conditio

This criterion is met as the claimant as the claimant does not have a documented history of any condition which could present in a similar way as this psychological injury.
For the above reasons, the claimant’s psychological injury was best defined as DSM-5-TR F43.10 post-traumatic stress disorder.

Current functioning

Self-care and personal hygiene