Insurance Australia Limited t/as NRMA Insurance v Ullah

DETERMINATION OF REVIEW PANEL
CITATION:	Insurance Australia Limited t/as NRMA Insurance v Ullah [2025] NSWPICMP 609
CLAIMANT:	Sami Ullah
INSURER:	Insurance Australia Limited t/as NRMA Insurance
REVIEW PANEL
SENIOR MEMBER:	Brett Williams
MEDICAL ASSESSOR:	Paul Friend
MEDICAL ASSESSOR:	Surabhi Verma
DATE OF DECISION:	14 August 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment under section 7.26; whether permanent impairment resulting from accident caused psychological injury greater than 10%; Medical Assessor found post-traumatic stress disorder caused by the accident gave rise to a permanent impairment greater than 10%; impact of subsequent accident on impairment; State Government Insurance Commission v Oakley, and Slade v Insurance Australia Ltd t/as NRMA applied; Held – the accident caused a post-traumatic stress disorder and permanent impairment; subsequent accident made a material contribution to the worsening of the post-traumatic stress disorder; second category applies from State Government Insurance Commission v Oakley; accident gave rise to an 8% permanent impairment; certificate of assessment revoked; degree of permanent impairment as a result of the psychological injury not greater than 10%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Barrett dated 2 June 2024 and certifies that the degree of permanent impairment of the claimant that has resulted from the injury caused by the acccident on 24 February 2021 is 8% and is not greater than 10%.

STATEMENT OF REASONS

BACKGROUND

There is a dispute between Sami Ullah (claimant) and Insurance Australia Limited t/as NRMA Insurance (insurer) about whether, for the purposes of the Motor Accident Injuries Act 2017 (MAI Act), his degree of permanent impairment as a result of a psychological injury caused by a motor accident on 24 February 2021 (accident) is greater than 10% (dispute). The dispute is about a medical assessment matter[1] and is a medical dispute, as defined by s 7.17 of the MAI Act.
[1] Sch 2 cl 2(a) of the MAI Act.
The medical dispute was referred to Medical Assessor Barrett for assessment. On 2 June 2024, the Medical Assessor certified that post-traumatic stress disorder caused by the accident gave rise to a permanent impairment (15%) that was greater than 10% (Assessment).
The insurer sought a review of the assessment under s 7.26 of the MAI Act. The President’s Delegate subsequently determined that there was reasonable cause to suspect that the Assessment was incorrect in a material respect. The review application was accepted and referred to this Review Panel.
The Review Panel (Panel) has been constituted by the President of the Personal Injury Commission (Commission) to conduct the review of the Assessment (Review).

THE REVIEW

The Panel is to conduct the Review in accordance with s 7.26 of the MAI Act. Section 7.26(5A) provides that the panel is to be constituted by two medical assessors and a member assigned to the Motor Accidents Division of the Commission.
The Review is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) MAI Act. Although styled a "review", the Panel is determining afresh the medical assessment matters referred to it: Frost v Kourouche (2014) 86 NSWLR 214; [2014] NSWCA 39 at [9] (Leeming JA; Beazley P and Basten JA agreeing).

Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). The Panel determines how it conducts and determines the proceedings: Rule 128.
Version 9.3 of the Motor Accident Guidelines (Guidelines), effective from 6 December 2024, apply to the Review.

DIRECTIONS AND CASE MANAGEMENT

On 7 March 2025, the Panel directed the insurer to file a joint bundle that contained all material relied on by the parties for the purposes of the Review, and the submissions it relied on for the purposes of the Review. The claimant was also directed to file the submissions he relied on for the purposes of the Review.
The parties did not comply with the Panel’s directions and the proceedings were listed for case management before Senior Member Williams on 30 April 2025. It was raised with the parties that the bundle filed by the insurer was not a joint bundle and the insurer had not filed submissions for the purposes of the Review, instead relying on its written submissions dated 20 June 2024. Further, although the insurer relied on Dr Whetton’s opinion, no reference was made to the doctor’s opinion in those submissions.
The claimant also filed a separate bundle that contained duplicate material, including medical reports, together with material that was not relevant to the issues in dispute or not referred to in his submissions. The written submissions filed by the claimant addressed purported errors in Medical Assessor Barrett’s assessment. Whether Medical Assessor Barrett’s assessment was incorrect in a material respect is relevant to ss 7.26(2) and (5).
The parties were reminded that the review being conducted by the Panel is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) MAI Act.
Further directions were made for the insurer to file a joint agreed bundle that contained all material relied on by the parties for the purposes of the Review, and the submissions it relied on for the purposes of the Review. The claimant was directed to file the submissions he relied on for the purposes of the Review.
A joint bundle and submissions were subsequently filed by the insurer. No further submissions were filed by the claimant.

APPLICATIONS TO LODGE ADDITIONAL DOCUMENTS

On 16 June 2025, the claimant filed an application to lodge an additional document. The document in question was a statement from the claimant’s wife, Raheela Gull, dated 26 May 2025. For the reasons given by the Panel on 26 June 2025, the claimant was given leave under rule 67C to introduce the statement in the proceedings.
On 10 July 2025, the claimant filed a second application to lodge the following additional documents:
(a) report of Ms Shumaila Khan dated 4 July 2025, and
(b) updated records from Ramsay Psychology.

For the reasons given by the Panel on 17 July 2025, the claimant was given leave to introduce these documents in the proceedings.
Although they were given leave to do so, neither party filed submissions addressing the additional documents that were the subject of the applications to lodge additional documents filed by the claimant[2].
[2] See determinations relating to the applications to lodge additional documents dated 26 June 2025 and 17 July 2025.

PANEL DELIBERATIONS

The Panel convened on 28 May 2025. The Panel discussed the issues in dispute and the evidence. The Panel determined that a re-examination of the claimant was required. It was agreed the re-examination would be conducted by the medical members of the Panel on 21 July 2025.
The Panel re-convened on 11 August 2025. The members of the Panel discussed the re-examination findings and the evidence, and agreed on the outcome of the assessment as recorded in the certificate and these reasons.

STATUTORY FRAMEWORK

Permanent impairment

If there is a dispute about whether the degree of permanent impairment of an injured person is sufficient for an award of damages for non-economic loss, 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.
The method of assessing the degree of impairment is dealt with in s 7.21 as follows:
“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. 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 motor 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.”
Clause 6.35 of the Guidelines states that psychiatric impairment is assessed in accordance with ‘Mental and behavioural disorders’, found in clauses [6.201]-[6.228] of the Guidelines.
In order to measure impairment caused by a specific event, a 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 the Guidelines, and subtract this value from the current impairment rating: cl 6.218.
Subsequent impairment is dealt with in cl 6.34. As will be seen, this clause and the common law principles that apply to the situation covered by cl 6.34 are relevant to the Review.

Causation

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 motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.
6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.’
6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
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, various provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

ASSESSMENT UNDER REVIEW

On 2 June 2024, Medical Assessor Barrett certified that post-traumatic stress disorder caused by the accident gave rise to a permanent impairment of 15% and that the impairment was greater than 10%.
In her reasons the Medical Assessor recorded that the claimant denied any pre-accident medical or psychiatric history. His pre-accident functioning was recorded. The claimant provided the following description of the accident:
“He saw a car in his review [sic] mirror, “flying” through the roundabout. He clutched his steering wheel and braced himself and was hit from the rear. He was pushed to the left and hit a parked car which was then pushed onto the footpath. His car spun and then hit another parked car. The airbags did not deploy…He reports that passers-by came to help. He states, “I was in shock” and passers-by opened the door and encouraged him to get out of the vehicle. Police, ambulance, and fire brigade were called. He stated, “body feeling like someone shake it”….”
Following the accident the claimant reported physical symptoms, including pain in his neck and back. The pain has persisted and impacts his functioning. Psychiatric symptoms began the day after the accident. He had two weeks off work and then returned to work “about” 25 hours a week. He stated that if his pain resolved he would return to normal work hours, complete normal household tasks and support his family.
The claimant reported nightmares, anxiety, flashbacks, irritability, and mood swings. He had been treated by a psychologist and psychiatrist. The claimant reported being involved in a minor accident three months before the assessment when he hit a parked car. He did not report any significant change in symptoms.
Details of the claimant’s functioning at the time of the assessment were recorded. The Medical Assessor Barrett recorded that there were no inconsistencies and that the claimant’s symptoms were consistent with the mental state examination findings. The Medical Assessor found the claimant fulfilled the diagnostic criteria for post-traumatic stress disorder and that he developed that condition as a result of the accident. Each of the diagnostic criteria were addressed.
The Medical Assessor addressed the Psychiatric Impairment Rating Scale (PIRS) and provided reasons for the class she assigned to each area of functioning. A 15% impairment was assessed. There was no adjustment for treatment effects.

EVIDENCE

The documentary evidence before the Panel consists of the joint bundle filed by the insurer on 13 May 2025[3], the statement from the claimant’s wife dated 26 May 2025, a report of Ms Khan, psychologist, dated 4 July 2025 and updated clinical records from Ramsay Psychology.
[3] The bundle is dated 9 May 2025 and comprises 265 pages.

Claim form

In his application for personal injury benefits dated 11 March 2021 the claimant provided the following description of the accident:
“I was the driver of a vehicle on Lindersay Street Campbelltown situated between Dumaresq and Allman Street. The at fault vehicle collided with me heavily from behind. This caused my vehicle to spin out of control, hitting 2 other cars.”
The claimant described injuries to his neck, back, and ribs together with psychological injury.

Statement from the claimant’s wife

In her statement made on 26 May 2025, the claimant’s wife provided a description of his pre-and post-accident behaviour and functioning. Prior to the accident he was socially active with friends and family. She states that there have been a lot of changes since the accident; he is “always complaining of pain” and has difficulty sitting which affects his mood. The claimant’s wife describes the claimant as being frustrated, anxious, and depressed. His relationship with his children has been adversely affected.
The claimant’s wife states that his physical and psychological injuries have made him “completely incapacitated at home”. He no longer helps clean, cook, or attend to the children. His appetite has been affected, and his self-care has diminished. The claimant no longer sleeps as much as he used to and wakes up multiple times during the night from nightmares and severe pain. It is stated that the claimant’s memory and concentration has deteriorated, he has difficulty controlling his emotions, and her relationship with the claimant has “broken down”. The claimant avoids people and no longer attends social events or school events.

Medico-legal reports

Dr Whetton, psychiatrist, reported to the insurer’s solicitor on 26 July 2023. In the doctor’s opinion as a result of the accident the claimant developed symptoms of a post-traumatic stress disorder with flashbacks, nightmares, sleep disturbance, avoidant behaviour, social withdrawal, loss of interest and motivation and with significant depression of mood. His concentration had been impaired, and this has further impacted on his ability to manage taxi driving.
Dr Whetton noted that while the claimant returned to work two weeks after the accident his ability to function at work had been limited both by his physical pain and his psychiatric state. He was certified to work 10-15 hours a week and “this appears to be his limit”. Continuing treatment was recommended. The claimant’s prognosis was guarded. The doctor assessed each of the PIRS areas of functioning and provided reasons for the classes he allocated. Dr Whetton assessed a 15% permanent impairment to which he added 1% for the effects of treatment, resulting in a 16% permanent impairment.
At the request of the insurer’s solicitor, Dr Whetton provided a further report dated 11 October 2023 in response to the following:
“We understand the claimant has returned to his pre-accident employment as a taxi driver working 15 hours per week. However, your WPI assessment in respect of Adaptation (employment) has assessed the claimant as a Class 3, moderate impairment.
With respect to your assessment, the Motor Accident Guidelines provides that the claimant ought to have been more appropriately assessed as a Class 2, mild impairment:
Can work in the same position, but no more than 20 hours per week
Could you please provide a supplementary report re-assessing Adaptation (employment) in accordance with the Motor Accident Guidelines.”
The doctor “acknowledge[d] that [c]lass 2 is appropriate for Employability”. He re-calculated the claimant’s permanent impairment with the result that an 8% impairment was assessed.
The doctor’s reasons for assigning each area of functioning as he did in each of his reports have been evaluated.

In a report dated 15 August 2023 Dr Machart, orthopaedic surgeon, expressed the opinion that as a result of the accident the claimant suffered soft tissue injury to paraspinal muscles and sub-radiological rib fractures that had healed. Reasons for the extent of pain reported by the claimant and limitation on activities of daily living were “not defined by objective evidence of pathology of injury.” There was, in the doctor’s opinion, evidence of extensive “pain behaviour”, physical signs not being consistent with injury pathology or with contemporaneous evidence of assessment in casualty, and not consistent with commercial driving. There was no definable injury that “rated” a whole person impairment.
Dr Keller, occupational physician, reported to the insurer’s solicitor on 14 September 2023. The claimant reported constant neck pain radiating to his shoulder and down his arms, and constant lower back pain radiating to the right leg. The doctor diagnosed healed left rib fractures and soft tissue strains of the neck and back. He stated:
“It is not clear to me that he has evidence of lasting physical injuries that would continue to cause any restriction in hours or duties after 2021. I am unable to find objective evidence of physical injuries that cause him any current work restrictions.”

In the doctor’s opinion the claimant had recovered the physical capacity to work full-time without restrictions.
In a report addressed to the claimant’s solicitor dated 17 March 2023 Dr Chow, psychiatrist, expressed the opinion that as a result of the accident the claimant suffered a “psychiatric injury of a traumatic nature” and continued to suffer moderate disabilities as a result. He needed ongoing treatment. The claimant was working 10-15 hours per week, driving locally. His capacity for work is likely to remain at that level at least in the short and medium term. In a separate report of the same date the doctor provided a PIRS assessment and assessed a 17% permanent impairment. The classes assigned by the doctor to each PIRS area of functioning and his reasons for doing so have been evaluated.
Dr Dias, occupational physician, reported to the claimant’s solicitor on 15 February 2022. After the accident the claimant reported ongoing symptoms in his neck and back, including radiating symptoms. His prognosis was poor. Further treatment was required, including supervision by a pain specialist. In a separate report the doctor assessed impairments of the claimant’s cervical spine, thoracic spine, lumbar spine, right and left shoulder. There was a combined 21% permanent impairment.

Commission medical assessments

On 14 December 2023, Medical Assessor Wallace certified that as a result of cervical, thoracic and lumbar spine injuries caused by the accident the claimant has a permanent impairment of 10%. In his reasons the Medical Assessor recorded that the claimant exhibited no pain behaviour when he was assessed. He diagnosed musculoligamentous injury to the cervical, thoracic and lumbar spine. Shoulder symptoms were referred from the neck. There was a 5% impairment of both the right and left shoulder.
On 9 February 2024, Medical Assessor Grainge certified that fractures to the left 5^th, 6^th, 7^th, and 8^th rib caused by the accident gave rise to no assessable impairment.
On 21 March 2024, Medical Assessor Wallace issued a combined certificate certifying that the injuries to the claimant’s cervical, thoracic, and lumbar spine, and the rib fractures caused by the accident did not give rise to an impairment that was greater than 10%.
On 31 October 2024, a differently constituted review panel revoked Medical Assessor Wallace’s assessment (including the combined certificate) and certified that the claimant’s permanent impairment as a result of injuries caused by the accident was 5%. In its reasons, the panel recorded its finding that as a result of the accident the claimant suffered soft tissue injuries to his cervical, thoracic and lumbar spine. The panel was not satisfied the claimant injured his shoulders. The lumbar spine injury was the only injury that attracted a permanent impairment (5%).

Material from treatment providers

The records from Campbelltown Hospital include an Emergency Department discharge referral related to an attendance on 27 February 2021. The claimant had been referred by his GP “3/7 post MVA” with neck swelling and bilateral rib pain. The claimant reported having been “rear ended by a car at 40-50km/h and that his car rotated “180 deg”. Radiological investigations were performed. The claimant was discharged as “medically stable”.
Royal Medical Centre records were generated on 14 October 2021. The records contain notes made by doctors and chiropractors. The first entry relates to an attendance on

5 August 2017. The notes include references to unrelated complaints and illnesses. An entry on 4 March 2021 contains a history that on 24 February 2021 the claimant had been “hit hard from behind by another vehicle travelling at high speed…his car pushed forward – lost control hit another vehicle”. He reported neck, back and rib pain with symptoms in his feet and hands. Subsequent entries in the clinical notes refer to similar complaints. There is reference to interrupted sleep due to pain. On 29 June 2021 it was recorded the claimant was “feeling down bec [sic] of pain and limitations”. There are notes in the same terms made on 13 July 2021, 27 July 2021, 10 August 2021, 24 August 2021, 7 September 2021,

21 September 2021, and 5 October 2021.
The records from Dr Rastogi include the doctor’s reports and clinical notes. The claimant was referred to the doctor by his GP, Dr Girgis. In her report of 19 October 2022, Dr Rastogi recorded that there was no pre-accident psychiatric history reported. The claimant reported ongoing pain and symptoms that included being scared of driving, that he was “aroused and vigilant and fearful of having an accident”, loss of confidence, anxiety, and being on edge. He reported negative thoughts and “bad dreams of accident.”
Dr Rastogi diagnosed both adjustment disorder with predominant anxious distress and

post-traumatic stress disorder. She recommended further treatment, including medication.
The doctor subsequent reports have been evaluated. Among other things, they include reference to the claimant struggling with intrusive dreams, anxiety, hypervigilance, avoidance behaviours and being continually agitated. He reported poor sleep and waking up with nightmares and finds “socially things very challenging and is nervous and agitated all the time.”
The Allied health recovery request (AHRR) dated 3 June 2022 refers to adjustment disorder and post-traumatic stress disorder. Signs and symptoms included severe depression, agitation, nightmares, flashbacks, hypervigilance and panic attacks.
An AHRR dated 22 November 2023 records a diagnosis of post-traumatic stress disorder and anxiety symptoms. The signs and symptoms referred to have been considered.
Dr Rastogi’s progress notes generated on 22 May 2024 have been considered. The notes record the medication prescribed to the claimant. The first attendance was on 19 October 2022. The reason for contact recorded was major depressive disorder and insomnia. Subsequent notes include reference to the claimant reporting problems sleeping, anxiety, struggling with pain, flashbacks, and nightmares.
The doctor’s progress notes generated on 29 April 2025 commence on 15 June 2023. In November 2024 there is reference to mood fluctuations, disturbing memories, flashback and nightmares. The last entry is dated 11 April 2025. The matters referred to in that entry have been considered.
The clinical records of Peter Tingle, psychologist, include various reports and clinical notes. Mr Tingle thought the claimant presented with clinically significant symptoms of anxiety and depression “associated with changes in his life that had occurred because of his injury limitations and ongoing pain stemming from the severity of the MVA and the circumstances in which it occurred.”[4] His capacity to work had been affected.
[4] Report of Mr Tingle dated 3 June 2022.
The claimant reported “symptoms synonymous with trauma such as hypervigilance, hyper arousal, fearfulness, flashbacks, nightmares and extreme panic situations that were reminiscent of when he was rear ended.[5]”
[5] Report of Mr Tingle dated 9 February 2022.
The claimant’s Depression Anxiety Stress Scale (DASS) scores have been considered. He scored 20 for depression, 17 for anxiety and 16 for stress. He scored 38 on the Beck Depression Inventory. On the post-traumatic stress disorder checklist, he scored 73.
The progress notes commence on 23 February 2022. The notes record the claimant’s symptoms and his social and work circumstances. He reported pain, anger, depression, hypervigilance, nightmares, and anxiety driving.
In addition to the progress notes there are also case notes that commence on 22 November 2023. The symptoms recorded in the case notes have been evaluated by the Panel. The notes include reference to pain, anxiety and depressive symptoms. On 13 March 2024 it was recorded the claimant was working and met with friends in the local area. On

27 March 2024 it was reported that he was trying to be more sociable. On 13 April 2024 it is recorded that he went to a park with family and friends to celebrate Eid.
A photograph of the accident scene depicts the damage to the front of the taxi and the rear of the Ford sedan.
The evidence before the Panel also includes a report from Ms Shumaila Khan, psychologist, dated 29 April 2024. The report contains the DASS scores, Back Depression Inventory scores and post-traumatic stress disorder checklist scores.
In her report of 4 July 2025, Ms Khan recorded details of the accident, the claimant’s symptoms and treatment. The matters described under the heading “Presentation” have been considered. The claimant reported worsening chronic pain in his lower back, neck, shoulders, and right leg over the prior six months. He reported a range of symptoms related to post-traumatic stress disorder. He had nightmares, anxiety, depressive symptoms, hypervigilance, and fear when driving. He had become socially withdrawn. In Ms Khan’s opinion the claimant presented with post-traumatic stress disorder. The DASS 21, BDI-II, and “PTSD checklist” scores are recorded and have been considered. The claimant presented with “complex mental health issues” and required ongoing treatment.
Records from Ramsay Psychology contain Ms Khan’s clinical notes for consultations on

27 May 2025, 3 June 2025, 13 June 2025 and 20 June 2025. The Panel has considered the claimant’s reported symptoms and behaviour. There is reference to symptoms including driving related anxiety, avoidance of social gatherings, pain, disturbed sleep, and nightmares.

SUBMISSIONS

Insurer’s submissions

The insurer relies on written submissions dated 20 June 2024. The insurer argues that Medical Assessor Barrett’s assessment was incorrect in a material respect because her reasoning in the PIRS assessment in relation to self-care and personal hygiene, social and recreational activities, and adaptation, is inconsistent with evidence provided by the claimant on examination. The insurer submits that “the appropriate class has not been awarded when assessing whole person impairment of the claimant’s alleged psychological injuries.”
With respect to self-care and personal hygiene, the insurer argues the claimant’s history suggests he is able to live independently and accords with him having been able to return to his pre-accident employment, although in a reduced capacity, and that the Medical Assessor ought to have found mild impairment, class 2.
In relation to social and recreational activities, the insurer argues that in light of the history provided by the claimant to Medical Assessor Barrett she ought to have found a mild impairment, class 2.
As to adaptation, the insurer argued the Medical Assessor “has erred” in finding a moderate impairment, as that finding is inconsistent with the history provided by the claimant that he is working in the same position as he did before the accident, “just for less hours than what he worked before the accident.”
In the insurer’s submission, correction of the errors it identified would result in the claimant’s impairment being assessed as not greater than 10%.
In correspondence addressed to the Commission in response to a direction made on 7 March 2025, the insurer agreed that: when seen by Medical Assessor Barrett and Dr Whetton the claimant was diagnosed with post-traumatic stress disorder; Dr Chow stated the claimant suffered a psychiatric injury of a traumatic nature and continues to suffer moderate disabilities as a result of the psychiatric injury; and Dr Rastogi diagnosed adjustment disorder with predominant anxious distress and post-traumatic stress disorder.
In brief written submissions dated 13 May 2025 the insurer confirmed it relies on Dr Whetton’s reports. The insurer notes “the claimant has alleged to various doctors a number of physical restrictions affecting the neck and shoulders which may impact on his ability to shower independently, prepare meals, travel or work.” Reference is made to the following history recorded by Dr Rastogi:
“[The claimant] continues to feel pain in the back, neck and shoulders. The chronic pain is noted to limit what Sami can do in his daily life (ie. driving, household chores with his wife doing a majority of it, playing with the children). Furthermore, the pain is intensified during the colder months. When driving, Sami continues to feel discomfort from the chronic pain in the back, neck and shoulders”.
In the insurer’s submission any restrictions arising from the claimant’s physical injuries ought be excluded when considering the appropriate PIRS classes for each area of functioning.
Implicit in the insurer’s submissions is that the claimant’s psychological injury does not give rise to an impairment that is greater than 10%.

Claimant’s submissions

The claimant relies on written submissions dated 24 April 2025. The submissions record he opposed the insurer’s application for review. That issue is spent; the President’s delegate has allowed the application and referred it to the Panel for review: s 7.26(5). His case is that he suffers from post-traumatic stress disorder as a result of the accident and that he has a permanent impairment that is greater than 10%.
More generally, the claimant emphasises that the PIRS examples should not be assessed in an overly literal manner, and that a Medical Assessor's clinical judgement is the most important tool in determining the class of impairment. In this regard the claimant refers to cl 6.217 of the Guidelines. The submissions also refer to cls 6.220 – 6.221 of the Guidelines.
The claimant addresses the insurer’s submissions about Medical Assessor Barrett’s findings with respect to self-care and personal hygiene, social and recreational activities, and adaptation. He argues the insurer's submissions are unsupported by any expert evidence, and “merely quibble with the findings of the Assessor which are well reasoned and justified on the evidence”. In the claimant’s submission there is nothing approaching error in the Medical Assessor's findings.
With respect to self-care and personal hygiene, the claimant argues in support of the finding that he has a moderate impairment. The claimant argues that the Medical Assessor’s acceptance that his poor motivation is a symptom of post-traumatic stress disorder, and that it impacted on his engagement in chores and results in reduced frequency of showering and shaving, was critical. He also supports the Medical Assessor’s finding that with the need for prompting and assistance with activities of daily living, there is a moderate impairment when the psychiatric symptoms alone are considered. The claimant argues that the Medical Assessor “has plainly excluded [his] physical disability in assessing his impairment in the area of self-care and personal hygiene.”
In relation to social and recreational activities, the claimant refers to his pre and post-accident functioning as recorded by Medical Assessor Barrett, and submits that “[c]learly, [he] was living a very active life in the domain of social and recreational activities before the accident, and [this] demonstrates an immense disparity on [his] pre- versus post-accident lifestyle.”
At [3.7] the claimant emphasises the Medical Assessor’s application of clinical judgment, and at [3.8] refers to cl 2.220 of the Guidelines. He argues that “just because [he] is able to go out on his own does not invalidate the use of a support person in being encouraged to go out in the first place.”
As to adaptation, the claimant argues in support of the finding by Medical Assessor Barrett that he has a moderate impairment. He notes that her finding in this regard was consistent with Dr Chow’s assessment of adaptation. The claimant submits that he has significantly restricted his hours and the fares he is able to take on and argues that his inability to work at least 20 hours per week would preclude a finding of class 2 impairment in this area of functioning.

RE-EXAMINATION FINDINGS

The claimant was re-examined by Medical Assessors Friend and Verma (Medical Assessors) by MS Teams on 21 July 2025. Their re-examination findings follow.

History

Psychosocial history and pre-accident history

The claimant lives with his wife and sons. He was born in Pakistan. He grew up with four brothers and one sister, ranking third in his family. His father was a farmer, and his mother was a stay-at-home mum. His father passed away in 2011, and his mother still lives in Pakistan. One of his brothers resides in Sydney, while the rest of his family remain in Pakistan. The claimant reported no traumatic incidents or adverse events during his childhood and described his childhood as pleasant.
He started to live in a city at a young age to complete his schooling and pursue further education. He recalls holiday visits to his village and enjoyed those years, stating he was not exposed to any war-like situations. He completed Year 12 and subsequently a Bachelor of Commerce degree at university. The claimant migrated to Australia in 2007 on a student visa, subsequently completing a two-year diploma in hospitality management at a private college. He worked at grocery stores and service stations until 2015. He then obtained a taxi licence and worked as a taxi driver.
The claimant reported that he no longer works. The Medical Assessors drew his attention to the history recorded by Medical Assessor Barrett that he was working as a taxi driver. The claimant replied that he has “problems and has decided to take rest”, stating that he has not worked since August 2024. He receives “Centrelink payments for family support and low income.”
He denied any history of mental or physical health issues, alcohol or illicit drug use, CTP or Workers’ Compensation claims, or any forensic history. He indicated that before the accident he worked around 10 to 12 hours a day, six days a week. On weekends, he went to the beach and took his children to the park with neighbours once or twice, enjoying cricket games with them. He also visited friends’ homes and attended the mosque two to three times daily for prayer. He often helped his wife with cleaning, vacuuming, laundry, and other household chores, and was able to manage most chores independently. He denied experiencing any particular difficulties at work or home.

History of the motor accident

The claimant was involved in a motor vehicle accident on 24 February 2021. He was driving his taxi in the Campbelltown area. He was in a roundabout and then saw a car in the rear-view mirror “flying through the roundabout at a very high speed.” He placed his hands on the steering wheel and sat up as he felt it was going to hit him. He tried to accelerate as fast as he could, but the other car rear-ended his vehicle. The claimant’s car then hit another car parked on the road, spun around, and hit yet another vehicle. The airbags did not deploy.

The claimant reported that he was in shock, and many people came to help and took him out of the car. He reported that those around him called an ambulance, police, and fire brigade. One of his friends who was driving past, saw the taxi had stopped, came to help him, took pictures, and sent them to his wife. He then called a mechanic, who was also his friend. His friend arrived and removed the belongings from the car. His car was later deemed a write-off.
The ambulance officers assessed him. He reported feeling shaky and in pain but was advised not to attend the emergency department, as he might face significant delays before being assessed and treated. His friend then drove him home, and the car was towed away.

History of symptoms and treatment following the motor accident

The claimant reported that soon after the accident he started experiencing pain and felt as if someone had shaken him up. He described having “pain everywhere” when he returned home. After returning home, he placed a pillow on his back and slept, but when he woke up after 4-5 hours, he had intense pain in his neck, shoulder, upper back, nape of the neck, radiating to his lower back. He said that he had sustained injuries from whiplash and was unable to even cough because of the pain. He then went to his GP and underwent investigations such as a chest X-ray, which was normal, and later a CT scan, which showed fractures of the 5th, 6th, and 7th ribs. He attended a chiropractor and physiotherapist and engaged in hydrotherapy. The physiotherapy increased the pain. He also saw Dr. Darwish, a neurosurgeon, who recommended steroid injections. He has received several injections since the accident. The last injection was around two weeks ago and has had minimal effect, as he still experiences pain in his right leg and groin. He said that if he does not rest, then the pain is exacerbated. He also completed at least 60-70 chiropractor sessions in 2021 with limited benefit. The claimant reported that physiotherapy worsened his pain, but chiropractic treatment provided only slight relief. Despite some improvement in his movement, he said that the pain “did not improve.”

He was unable to perform activities such as “helping his wife at home in the kitchen” with cooking, laundry, showering independently, and walking for long durations. He also couldn't drop his children at school.
He reflected that after the accident “when his body was in pain he was in so much stress.” He started having intrusive thoughts about the incident and felt quite helpless. However, his friend would come and offer emotional support. He began to realise that his “whole body had been affected because of pain.”
He experienced other psychological symptoms. He reported that the pain affected his mental health, making him feel stressed due to “body pain, failing to do business, feeling worthless and loss of self-identity.”
He was referred to a psychologist. The psychologist told him that he has “PTSD”, and that he needs to keep working to recover quickly, which he has tried to do.
He recalls that his mood was often “stressful and anxious.” He had intrusive thoughts and was unable to control them. He had trust issues and often thought that something might happen to him on the road. His sleep was also disturbed, and he usually only slept about three to five hours, which he attributed to “pain and dreams about the incident and about the blood.” He was also often worried about the safety of his wife and children and would have these repeated “unwanted memories about the accident.”
He began feeling useless as he was no longer working. He also experienced “physical reactions like feeling trembly in his legs and racing heart. If he saw any news about the accident, he would start “avoiding the place and take other streets."
He said that he didn't drive at all for two weeks, but then his mate found a second-hand taxi and encouraged him to drive. He then started driving and worked about 20 to 22 hours per week. He added that his doctor suggested he work less as he had negative thoughts, felt irritable, and started to take risks and would speed at times. He also felt quite irritable on a day-to-day basis.
He recalls being unable to “concentrate much” and experiencing “negative feelings of shame, anger and feeling horrible,” as well as someone hitting him.
He said that later he reduced his working hours to 10 to 12 hours as his mental health and pain worsened. The claimant agreed that this occurred after the chiropractic, physiotherapy and later hydrotherapy treatments were ceased.
However, he continued to push himself because he also experienced “unwanted distressing memories and felt upset and stressful.” He reported feeling “stubborn, irritable and aggressive with his wife, not connecting with his friends and withdrawing from his friends who were overseas.” He also felt worthless and thought he was “weak and not strong enough,”. He at the same time, took more risks when driving and pushed himself, taking unnecessary chances.
He previously enjoyed helping his wife with household chores but could no longer do so as he lost interest in nearly everything.
He said that when his stress levels increased, he also started smoking more, about 10 cigarettes per day. He felt quite “triggered and reacting very strongly.”
The claimant reported that he later stopped working altogether when he experienced “intense pain and too many thoughts, especially when driving, and he had started driving quite aggressively and taking unnecessary risks.” He was not very polite with the customers and decided not to drive anymore.
He would also feel triggered when he “see[s] a knife,” but he has never self-harmed or attempted suicide. He was very insightful and asked his wife to hide the knife. He said he feels “hopeless and helpless and is unable to handle things,” but he has a safety plan in place with his psychologist.
On a typical day, he mostly doesn’t do many activities and sits on his sofa or in the backyard. He has two to three chickens and feeds them. Later, he checks the mail and puts it inside. Sometimes, he watches TV or sits on his bed, and at other times, he “watches the fan on the roof” and doesn’t want to get out of bed.
He has been pushing himself to go out and has been making an effort to spend more time in the backyard. He goes to bed at varying times from 8:00 to 10:00pm and wakes up at different times, often lying there because he can’t sleep until around 3:00am. His sleep continues to be interrupted by intrusive thoughts of the accident and physical pain.
He has intrusive thoughts related to reminders of the accident, like watching accidents on TV. He said that even when he gets up at 10:00 or 11:00am, he prefers to stay in bed as he keeps “thinking and procrastinating”.
He eats “a little bit and has only one meal." He has “belly fat because of the medication” and experiences constipation, for which he takes Movicol. His clothing size has increased from M to XL.
He previously saw Mr Peter Tingle, a psychologist, and later began seeing Ms Shumaila Khan, also a psychologist, and used to see her weekly.

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

The claimant reported that he was involved in a minor accident in 2024, where he rear-ended another vehicle. He said the other vehicle was a ute, and his car was damaged. At the time, he was driving his taxi. He mentioned that the accident affected him deeply, leading to increased worries and difficulty concentrating and focusing. He also reflected on what might have happened if he had been driving at high speed. Additionally, he was particularly concerned about his safety, thinking that if a fight occurred, he might not be strong enough to run away.
The claimant said he has completely stopped working since August 2024 because he felt at risk to himself and others. He stated he was unable to handle his mental health, focus, and concentration, and he was not particularly generous or respectful to the customers. He often felt “people are dangerous, and the world is dangerous too”.

Current Symptoms

The claimant reported that he continues to experience the same symptoms as he used to before, and there has only been some improvement in being able to cut down his cigarette consumption to 5-6 cigarettes a day. He continues to experience intrusive symptoms including distressing memories, disturbed sleep, concerns about his and his wife’s safety, feelings of worthlessness, physiological distress in response to being triggered, difficulties in concentrating, negative feelings of shame and anger, feeling stubborn, irritable, and aggressive, impulsivity and aggressive behaviours along with avoidance of things reminding him of the accident.

Current and proposed treatment

The claimant continues to see Ms Khan. He saw her a few weeks ago and has had about 34 sessions, with eight more approved. They used to discuss cognitive distortions, mindfulness techniques, managing post-traumatic stress disorder, and chronic pain. He also sees Dr Rastogi, a psychiatrist, once a month. He is currently on Seroquel 300 mg, Lithium 500 mg, and Pristiq 200 mg. Additionally, he takes Celebrex 200 mg and Panadeine Forte for pain. However, he has not yet seen a pain specialist.

Clinical Examination

Mental State Examination

The claimant was re-examined by video. He engaged well during the assessment and was cooperative. He presented as a middle-aged male of Pakistani background, had a beard, and was casually dressed. He was not overly dishevelled. He reported his mood as sad and irritable, and his affect was reactive with a range of facial expressions and gestures. The claimant was over-inclusive at times and had to be redirected to the question asked.

The Medical Assessors at one point enquired if he was reading the DSM-5 criteria, as he was using the same terminology as in DSM-5 and at times in the same order as it appears. He, however, denied reading it.
His speech was spontaneous and of normal volume, occasionally over-inclusive. His thoughts were logical and goal directed. He reported ongoing intrusive thoughts, flashbacks, low mood, and irritability.
There was no evidence of any manic, psychotic, or perceptual abnormalities. He demonstrated reasonable insight into his condition and has continued engaging with his healthcare providers.
He continues to experience the accident in the form of intrusive memories, nightmares and has avoidance symptoms, changes in cognition and mood, along with alterations in arousal and reactivity.
He did not report any thoughts of harming himself or others, suicidal ideas, plans, or intent. He was able to focus, pay attention, and concentrate throughout the entire assessment and was not distracted.

Current Functioning

In assessing the claimant’s functioning for the purposes of the PIRS the Medical Assessors have only taken into consideration the impact of the claimant’s psychological injury. The claimant’s functioning in all domains has been affected by pain. The Medical Assessors have reminded themselves that the PIRS must not be used to measure impairment due to pain: cl 6.215 Guidelines.
In addition to the matters reported by the claimant when he was re-examined, the Medical Assessors have considered the statement from the claimant’s wife and the records from his treatment providers and have evaluated the assessments of Medical Assessor Barrett, Dr Rastogi, Dr Whetton and Dr Chow with respect to the claimant’s functioning.
Self-care and Personal Hygiene: The claimant reported that he showers once a week and shaves during his shower. He said he is not bothered about his self-care. He mentioned feeling quite lazy and being impacted both physically and psychologically, which makes him feel limited. He has to use a chair when showering. He does not do any household chores due to ongoing pain, and they had to hire a person to mow the lawn. His wife does most of the household chores “because of the pain in his body and mentally he is stuck." He recognises that engaging in chores like cooking or cleaning causes his pain to worsen. The claimant’s daily activities, self-care, personal hygiene, and involvement in household chores, such as cooking, are impacted by both his psychological symptoms and pain.
The Medical Assessors determined that the claimant has impaired functioning as a result of pain and his psychological injury. Exercising their clinical judgment the Medical Assessors assessed the claimant’s impairment in this area of functioning as a result of his psychological injury as mild.
Social and Recreational Activities: The claimant used to enjoy playing cricket with his children and friends, as well as playing football and going to the beach. He also used to hold parties at his own place and at his friend's place. He mentioned that he can no longer play cricket and football because he “physically and mentally can't.” He’s now staying away from these activities. He explained that his friend has gone to Adelaide and has recently returned, so he had no one to support him during that time. Now that his friend is back, he visits him at home every two to three weeks. However, he is not in touch with most of his friends—he gave an example of how his friends plan hikes, but he can't join them because of his physical pain. He has one other friend who visits at least once a month. Still, the claimant remains sceptical about his ability to have long conversations with him.
His wife invites one or two families, and they come to see him. He said he feels there is no point in them seeing him in pain. When they visit, he tries to sit with them but is not actively involved in the conversation and continues to sit in the same room with his wife's encouragement. Sometimes, he tells his friends that he is in pain and apologises to them. He also visits another friend, a 65-year-old man who “drinks and smokes” and lives near him. He visits him once or twice a week and smokes with him. However, he does not go there as often because he does not want to smoke more. He still socialises both at his home and outside. The Medical Assessors note that his ability to engage in recreational activities, including cricket and football, is limited due to both pain and mental health symptoms.
The Medical Assessors determined the claimant has mild impairment in social and recreational activities when the impact on his functioning as a result of his psychological injury alone is considered.
Travel: He leaves his house to see his GP for physiotherapy appointments, to see the neurosurgeon, and to visit his friend, and he is able to drive there. His wife sometimes drops him off. He drives in the local area but does not venture further, as he feels scared. He experiences anxiety when in a car, especially if his children ask to talk to him. He worries about “drunk people coming and getting into an accident with his car.” He travelled to Bali in January 2025 and stayed there for six days. However, he found that stressful and did not particularly enjoy it. He can travel alone without a support person.
The Medical Assessors determined that the claimant’s impairment in this area of functioning was mild.
Social Functioning: The claimant reported that his relationship with his wife is strained because he is verbally abusive and has conflicts with her. He has reduced frustration tolerance due to his mental health symptoms. He sleeps in a different room because he has to get up due to his pain and does not want to disturb his wife. There have been no periods of separation or divorce. He also feels irritable with his children and is quick to snap at them. Despite this, he has maintained contact with his friends and his brother, and there have been no periods of separation. The Medical Assessors determined that he has a mild impairment.
Concentration, Persistence, and Pace: The claimant reported that his attention is “very poor." He said he is unable to focus and often forgets things, struggles to concentrate on tasks and has to remind himself of upcoming appointments. He becomes distracted when people talk to him and loses track of conversations, requiring him to ask others to repeat questions. However, during the assessment, the claimant was able to focus and pay attention, and in fact, was over-inclusive. He mentioned that he used to read religious books but stopped last year because he can no longer concentrate. When he turns on the TV, he cannot persist in watching one channel and does not play any video or mobile games.
The claimant did not describe difficulties in this domain when he returned to taxi driving before the 2024 accident and was able to undertake the duties associated with that work prior to the 2024 accident.
In addition to the claimant’s reported deficits in this domain, the Medical Assessors carefully considered the other evidence, including his wife’s statement, the records from treatment providers and the assessments of Medical Assessor Barrett and the medico-legal psychiatrists.
The claimant is impaired in this area of functioning as a result of pain and his psychological injury.
The Medical Assessors determined that the claimant has a mild impairment in concentration, persistence, and pace as a result of his psychological injury.
Adaptation: The claimant was able to initially return to taxi driving after the subject accident, working about 20-22 hours per week. He subsequently reduced his hours to 10-12 hours a week when the physical treatments were ceased. The claimant was unable to continue working after the 2024 accident, when his psychological symptoms worsened.
Having evaluated the evidence the Medical Assessors were satisfied that prior to the 2024 accident, and as a result of the psychological injury caused by the subject accident, the claimant had a mild impairment of functioning in this area.
The Medical Assessors agree that the claimant has been totally impaired in this area of functioning since the 2024 accident and is rated as class 5.
Other than with respect to adaptation, the claimant did not report a decline in his functioning in the other PIRS areas of functioning following the motor accident in 2024. Each domain of functioning is independent in nature; one domain can be made worse without the other domains being affected. In the opinion of the Medical Assessors the claimant’s functioning in the other PIRS domains have not been made worse by the 2024 accident.

Comments of Consistency

The claimant’s presentation was consistent with the history given. The Medical Assessors asked him during the assessment if he was reading the DSM-5 criteria as he was using the exact symptoms and terminology. He denied he was doing so.
The Medical Assessors also noted that although the claimant reported that he is not able to hold conversations for 5 to 10 minutes and has to ask others to repeat questions, he was able to focus and pay attention during the assessment without any difficulties.

Diagnosis and reasons

The claimant was involved in a motor vehicle accident on 24 February 2021. At the time of the re-examination, he reported experiencing symptoms consistent with the diagnosis of post-traumatic stress disorder. The diagnosis is based on the DSM-5 criteria highlighted in bold.
PTSD
Note: The following criteria apply to adults, adolescents, and children older than 6 years. For children 6 years and younger, see the DSM-5 section titled “Posttraumatic Stress Disorder for Children 6 Years and Younger” (APA, 2013a).
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
Directly experiencing the traumatic event(s).
Witnessing, in person, the event(s) as it occurred to others.
Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s). Note: In children older than 6 years, repetitive play may occur in which themes or aspects of the traumatic event(s) are expressed.
Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s). Note: In children, there may be frightening dreams without recognizable content.
Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.) Note: In children, trauma-specific reenactment may occur in play.
Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia, and not to other factors such as head injury, alcohol, or drugs).
Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad,” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
Markedly diminished interest or participation in significant activities.
Feelings of detachment or estrangement from others.
Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
Irritable behaviour and angry outbursts (with little or no provocation), typically expressed as verbal or physical aggression toward people or objects.
Reckless or self-destructive behaviour.
Hypervigilance.
Exaggerated startle response.
Problems with concentration.
Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
Duration of the disturbance (Criteria B, C, D and E) is more than 1 month.
The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

Causation and reasons

The claimant’s current presentation is a result of the 24 February 2021 accident. He does not have any past history of mental health issues or other risks for psychiatric illness that could explain his current symptoms. The Medical Assessors agreed that the accident could have caused a post-traumatic stress disorder and are satisfied that the accident did cause the claimant to develop post-traumatic stress disorder. The nature and timing of his symptoms are consistent with the condition being caused by the accident.
Further, weight has been given to the opinions of the claimant’s treating psychologist and psychiatrist, together with the opinions of Medical Assessor Barrett and Drs Chow and Whetton, all of whom found the claimant has post-traumatic stress disorder that was caused by the accident.
The 2024 accident would not have caused a post-traumatic stress disorder; criterion A is not satisfied, and the claimant did not report specific trauma related symptoms in relation to that accident. The 2024 accident has, however, resulted in a deterioration in the claimant’s post-traumatic stress disorder that is more than negligible.

Permanency of impairment

The claimant has received treatment with two different psychologists and has been receiving ongoing psychological treatment with Ms Khan based on trauma-based cognitive therapy and mindfulness. He has also been seeing his treating psychiatrist and has been trialled on various medications, including amitriptyline and melatonin, with no additional benefit. The Medical Assessors agree that even with any additional treatment or any treatment like EMDR, there is low likelihood that his whole person impairment will change by more than 3% in the next year. The Medical Assessors agree that his condition is currently stable.

Degree Of Permanent Impairment - Psychiatric Impairment Rating Scale

The claimant’s impairment has been assessed in two tables. The first reflects his accident caused impairment prior to the 2024 accident. The second is his current impairment.

Psychiatric diagnoses	1. Post-traumatic Stress Disorder
Psychiatric diagnoses	Psychiatric treatment description	Psychologist, psychiatrist and medication

Category	Class	Reason for Decision
Self Care and Personal Hygiene	2	The claimant reported that he showered once a week and shaved during his shower. He said he is not bothered about his self-care. He mentioned feeling quite lazy and being impacted both physically and psychologically, which makes him feel limited. He used a chair when showering. He did not perform any household chores due to ongoing pain. His wife did most of the household chores “because of the pain in his body and mentally he is stuck." Engaging in chores like cooking or cleaning causes his pain to worsen. The claimant’s daily activities, self-care, personal hygiene, and involvement in household chores, such as cooking, were impacted by both his psychological injury and pain. The claimant’s functioning was impaired as a result of pain and his psychological injury. Exercising their clinical judgment the Medical Assessors assessed a mild impairment in this area of functioning as a result of his psychological injury.
Social and Recreational Activities	2	The claimant used to enjoy playing cricket with his children and friends, as well as playing football and going to the beach. He also used to hold parties at his own place and at his friend's place. He mentioned that he can no longer play cricket and football because he “physically and mentally can't.” He stayed away from these activities He did not spend as much time with friends, giving an example of how his friends plan hikes, but he can't join them because of his physical pain. He has one friend who visits at least once a month. His wife invites one or two families, and they come to see him. He felt there was no point in them seeing him in pain. When they visited, he tried to sit with them but was not actively involved in the conversation and continued to sit in the same room with his wife's encouragement. Sometimes, he told his friends that he was in pain and apologised to them. He visited another friend, who “drinks and smokes” and lives near him. He visited once or twice a week and smoked with him. However, he does not go there as often because he does not want to smoke more. He still socialises both at his home and outside. The claimant’s ability to engage in recreational activities, including cricket and football, was limited due to both pain and mental health symptoms. The Medical Assessors determined there was a mild impairment in this area of functioning when the impact of his psychological injury alone is considered.
Travel	2	He left his house to see his GP, for physiotherapy appointments, go to the neurosurgeon, and to visit his friend, and was able to drive there. His wife sometimes drops him off. He drove in the local area but did not venture further, as he felt scared. He experienced anxiety when in a car, especially if his children ask to talk to him. He worried about “drunk people coming and getting into an accident with his car.” He could travel alone without a support person. The Medical Assessors determined that there was a mild impairment in this area of functioning.
Social Functioning	2	The claimant reported that his relationship with his wife was strained because he is verbally abusive and has conflicts with her. He reported reduced frustration tolerance due to his mental health symptoms. He slept in a different room because he has to get up due to his pain and did not want to disturb his wife. There have been no periods of separation or divorce. He felt irritable with his children and was quick to snap at them. Despite this, maintained contact with his friends and his brother, and there have been no periods of separation. The impairment in this area was mild.
Concentration, Persistence and Pace	2	The claimant reported that his attention was “very poor." He said he was unable to focus and forget things, struggled to concentrate on tasks and has to remind himself of upcoming appointments. He became distracted when people talk to him and lost track of conversations, requiring him to ask others to repeat questions. During the re-examination, the claimant was able to focus and pay attention. He mentioned that he used to read religious books but stopped last year because he can no longer concentrate. When he turns on the TV, he cannot persist in watching one channel and does not play any video or mobile games. In addition to the claimant’s reported deficits in this domain, the Medical Assessors carefully considered the other evidence, including the statement from the claimant’s wife, the records from treatment providers, and the assessments of Medical Assessor Barrett and the medico-legal psychiatrists. The Medical Assessors determined that there was a mild impairment in concentration, persistence, and pace.
Adaptation	2	The claimant was able to initially return to taxi driving after the subject accident, working about 20-22 hours per week. He subsequently reduced his working hours to 10-12 hours a week, after physical treatments were discontinued. The claimant was unable to continue working after the 2024 accident, when his psychological symptoms worsened. The Medical Assessors were satisfied that prior to the 2024 accident, and as a result of the psychological injury caused by the subject accident, the claimant had a mild impairment in this area of functioning.
List classes in ascending order: 2, 2, 2, 2, 2, 2
Median Class Value: 2
Aggregate Score: 12
% Whole Person Impairment: 6 %

Psychiatric Impairment Rating Scale – current impairment

Psychiatric diagnoses	1. Exacerbation of post-traumatic stress disorder.
	Psychiatric treatment description	Psychologist, psychiatrist and medication

Category	Class	Reason for Decision
Self Care and Personal Hygiene	2	The claimant reported that he showers once a week and shaves during his shower. He said he is not bothered about his self-care. He reported feeling quite lazy and being impacted both physically and psychologically, which makes him feel limited. He uses a chair when showering. He does not do any household chores due to ongoing pain, and they had to hire a lawn mower. His wife does most of the household chores “because of the pain in his body and mentally he is stuck." He recognises that engaging in chores like cooking or cleaning causes his pain to worsen. The claimant’s daily activities, self-care, personal hygiene, and involvement in household chores, such as cooking, are impacted by both his psychological symptoms and physical pain. The claimant has impaired functioning as a result of pain and his psychological injury. The claimant’s impairment in this area of functioning as a result of his psychological injury is mild.
Social and Recreational Activities	2	The claimant used to enjoy playing cricket with his children and friends, as well as playing football and going to the beach. He also used to hold parties at his own place and at his friend's place. He can no longer play cricket and football because he “physically and mentally can't.” He stays away from these activities. His friend had gone to Adelaide and recently returned, so he had no one to support him during that time. Now that his friend is back, he visits him at home every two to three weeks. He is not in touch with most of his friends—he gave an example of how his friends plan hikes, but he can't join them because of his physical pain. He has one other friend who visits at least once a month. The claimant remains sceptical about his ability to have long conversations with him. His wife invites one or two families, and they come to see him. He said he feels there is no point in them seeing him in pain. When they visit, he tries to sit with them but is not actively involved in the conversation and continues to sit in the same room with his wife's encouragement. Sometimes, he tells his friends that he is in pain and apologises to them. He also visits another friend, who drinks and smokes and lives in the same area. He visits him once or twice a week and smokes with him. However, he does not go there as often because he does not want to smoke more. He still socialises both at his home and outside. The claimant’s ability to engage in recreational activities is limited due to both pain and mental health symptoms. The claimant has a mild impairment when the impact of his psychological injury alone is considered.
Travel	2	He leaves his house to see his GP for physiotherapy appointments, go to the neurosurgeon, and visit his friend, and he is able to drive there. His wife sometimes drops him off. He drives in the local area but does not venture further, as he feels scared. He experiences anxiety when in a car, especially if his children ask to talk to him. He worries about “drunk people coming and getting into an accident with his car.” He travelled to Bali in January 2025 and stayed there for six days. However, he found that stressful and did not particularly enjoy it. He can travel alone without a support person. The Medical Assessors determined that the claimant’s impairment in this domain was mild.
Social Functioning	2	The claimant reported that his relationship with his wife is strained because he is verbally abusive and has conflicts with her. He has reduced frustration tolerance due to his mental health symptoms. He sleeps in a different room because he has to get up due to his pain and does not want to disturb his wife. There have been no periods of separation or divorce. He also feels irritable with his children and is quick to snap at them. Despite this, he has maintained contact with his friends and his brother, and there have been no periods of separation. The Medical Assessors determined that the claimant has a mild impairment.
Concentration, Persistence and Pace	2	The claimant reported that his attention is “very poor." He said he is unable to focus and often forgets things, struggles to concentrate on tasks and has to remind himself of upcoming appointments. He becomes distracted when people talk to him and loses track of conversations, requiring him to ask others to repeat questions. During the assessment, the claimant was able to focus and pay attention. He mentioned that he used to read religious books but stopped last year because he can no longer concentrate. When he turns on the TV, he cannot persist in watching one channel and does not play any video or mobile games. The Medical Assessors determined that the claimant has a mild impairment in concentration, persistence, and pace as a result of his psychological injury.
Adaptation	5	The claimant was able to initially return to taxi driving after the February 2021 accident, working about 20-22 hours per week. He subsequently reduced his working hours to 10-12 hours a week. The claimant was unable to continue working after the 2024 accident, when his psychological symptoms worsened. Having evaluated the evidence the Medical Assessors agree the claimant has been totally impaired in this domain since the 2024 accident.
List classes in ascending order: 2, 2, 2, 2, 2, 5
Median Class Value: 2
Aggregate Score: 15
Current % Whole Person Impairment: 8 %

Apportionment – subsequent impairment

There has been no apportionment to take into account the increase in the claimant’s impairment as a result of the 2024 accident because that impairment has been treated as being caused by the subject accident. Further reasons in this regard are provided by the Panel below.

Effects of treatment

The Medical Assessors did not make any adjustment for any treatment effect as the claimant denied experiencing any improvement in his symptoms.

Degree of permanent impairment caused by the motor accident

Final permanent impairment = 8%

DETERMINATION

The Panel finds that:
(a)    the claimant did not have a post-traumatic stress disorder, or any other psychological condition, prior to the accident and did not have any pre-existing impairment;
(b)    the claimant satisfies the diagnostic criteria in DSM-5 for post-traumatic stress disorder and suffers from that condition;
(c)    the accident could have caused post-traumatic stress disorder;
(d)    the accident was a necessary condition of the occurrence of the claimant’s post-traumatic stress disorder;
(e)    the accident did cause the claimant’s post-traumatic stress disorder, and
(f)    as a result of the accident caused post-traumatic stress disorder the claimant has a permanent impairment.
In making these findings the Panel has given weight to the history given by the claimant to the medical members of the Panel when they re-examined him, the symptoms he reported at that time, the opinions of Medical Assessor Barrett, Dr Chow and Dr Whetton, and the symptoms recorded in the records of the claimant’s treatment providers, including Dr Rastogi, Mr Tingle and Ms Khan. The Panel agrees with and adopts the reasons given by its medical members for finding the claimant has a post-traumatic stress disorder that was caused by the accident.
The medical members of the Panel, both of whom are psychiatrists, re-examined the claimant on 21 July 2025, have assigned classes to each of the PIRS areas of functioning, and given reasons for the classes they assigned to each area of functioning in their re-examination findings. The Panel notes that the evaluation of current impairment should only consider the claimant’s impairment as it is at the time of the assessment: cl 6.21 Guidelines.
The Panel agrees with and adopts the re-examination findings of its medical members, including their findings with respect to each PIRS area of functioning and permanent impairment. The Panel provides the following further reasons.
In assessing the claimant’s impairment under the PIRS the Panel has reviewed and evaluated all the evidence, including what the claimant reported to the medical members of the Panel when they re-examined him.
The documentary evidence before the Panel includes the PIRS assessments undertaken by Medical Assessor Barrett and Drs Whetton and Chow. Dr Chow assessed the claimant in March 2023. Dr Whetton assessed him in July 2023. He was assessed by Medical Assessor Barrett in May 2024. There is evidence available to the Panel that was not available to these doctors. Further, the re-examination of the claimant undertaken for the purposes of the Review involved both medical members of the Panel and the classes assigned to each area of functioning were agreed by both medical members of the Panel.
In her statement dated 26 May 2025 the claimant’s wife provided a description of his pre-and post-accident functioning. Her evidence is that his functioning after the accident has deteriorated as a result of both his psychological symptoms and pain. For example, she states at [9] that “[he] is always complaining of pain in his shoulders and neck.” At [10] she refers to difficulty he experiences with sitting and states that this impacts his mood. At [13] she stated that:
“We no longer go out because [he] is afraid that his pain will get worse even with the smallest amount of physical activity, such as walking. He no longer feels safe. He begins experiencing pressure in his legs and back even from standing for a couple of minutes…”.
At [20] in her statement the claimant’s wife refers to the claimant not sleeping as much as he used to and that he wakes up “multiple times during the night from nightmares or from the severe pain.”
The Panel has given weight to the statement provided by the claimant’s wife with respect to both the impact on his functioning as a result of his psychological injury and the impact on his functioning caused by pain. The statement is recent and detailed.
The reports and records of Dr Rastogi, the claimant’s treating psychiatrist, have been evaluated by the Panel. In addition to the impact on the claimant’s functioning as a result of his psychological injury, the doctor recorded that he needs frequent breaks in driving due to pain,[6] that barriers to recovery included chronic pain,[7] that he was struggling with pain,[8] and that his sleep was affected by pain.[9]
[6] Report of Dr Rastogi dated 19 October 2022.
[7] Report of Dr Rastogi dated 30 October 2023.
[8] Dr Rastogi clinical notes dated 14 December 2022 and 16 February 2023.
[9] Dr Rastogi clinical notes dated 15 June 2023.
The Panel has evaluated and given weight to the recent report of Ms Khan,[10] the claimant’s treating psychologist. In addition to recording the claimant’s psychological symptoms and the impact of those symptoms on his functioning, Ms Khan reported that the claimant complained of worsening chronic pain in his low back, neck, shoulders and right leg over the past six months, and that the chronic pain results in several physical limitations affecting his capacity to drive, engage in household chores, interact with his children, perform daily routines and self-care and participate in family outings or social activities.
[10] Dated 4 July 2025.
The Panel also notes that the claimant told Medical Assessor Barrett that if his pain resolved he would return to normal work hours, complete normal household tasks and support his family.
The Panel is satisfied the claimant’s functioning in each of the PIRS domains has been diminished as a result of pain. As recorded earlier by the medical members of the Panel in their re-examination findings, the PIRS must not be used to measure impairment due to pain: cl 6.215 Guidelines. The classes allocated by the medical members of the Panel to each area of functioning in the PIRS reflect the impact of the claimant’s psychological injury and exclude the impact of pain.
The Panel is satisfied that the subsequent accident in August 2024 made a material contribution to the worsening of the claimant’s post-traumatic stress disorder. His symptoms increased and his functioning in the domain of adaptation reduced. Of particular significance, prior to the 2024 accident the claimant had returned to work driving a taxi, initially working 20 to 22 hours a week, subsequently reducing his hours to 10-12 hours a week. He was driving a taxi when the 2024 accident occurred.

Following the 2024 accident the claimant stopped taxi driving completely and has not returned to work as a taxi driver. The Panel has given weight to the account given by the claimant to its medical members that the 2024 accident affected him deeply and that he stopped working because he felt at risk to himself and others, was unable to handle his mental health, focus, and concentration, and was not generous or respectful to the customers.
Subsequent impairment is dealt with in cl 6.34. That clause states:
“Subsequent injuries
6.34The evaluation of permanent impairment may be complicated by the presence of an impairment in the same region that has occurred subsequent to the relevant motor accident. If there is objective evidence of a subsequent and unrelated injury or condition resulting in permanent impairment in the same region, its value should be calculated. The permanent impairment resulting from the relevant motor accident must be calculated. If there is no objective evidence of the subsequent impairment, its possible presence should be ignored.”
Because cl 6.34 of the Guidelines is in the same terms as cl 1.34 of the Permanent Impairment Guidelines decisions addressing the operation and application of cl 1.34 are relevant to cl 6.34. The common law principles set out in the judgment of Malcolm CJ in State Government Insurance Commission v Oakley (1990) Aust Torts Rep 81-003; 10 MVR 570 (Oakley) apply to the situation covered by cl 1.34 of the Permanent Impairment Guidelines: Slade v Insurance Australia Ltd t/as NRMA [2020] NSWSC 1031 (Slade) at [84] – [85].
In Slade at [90] Wright J explained the Oakley principles, with reference to cl 1.34, as follows:
“The injuries and damage or impairment covered by the Oakley principles are, like the impairment to be assessed under par 1.34, injuries and damage or impairment that result from a subsequent event. The first Oakley category concerns events or accidents that would not have occurred but for a previous relevant event in which the claimant had been injured. Thus, the first category applies to a “related” injury or condition. The second and third Oakley categories, however, concern injuries resulting from a subsequent event that “would have occurred had the plaintiff been in normal health”, which is, in other words, an “unrelated event” that leads to “subsequent and unrelated injury” within the meaning of par 1.34. The subsequent event and the associated injury or condition is “unrelated” because that event was not brought about by, or causally related to, the claimant’s condition as a result of the earlier accident.”
Wright J went on to say at [104] – [105]:
“[104]The principles in Oakley establish, relevantly for present purposes, in effect that:
(1)Where the further injury or impairment results from a subsequent incident, which would not have occurred had the claimant not been in the condition caused by the earlier motor accident, the added damage should be treated as caused by the earlier motor accident. In this situation, par 1.34 is not engaged because the “injury or condition” is not “unrelated”.
(2)Where the further injury or impairment results from a subsequent incident, which would have occurred even if the claimant had not been in the condition caused by the earlier motor accident, but impairment is sustained or is greater because of aggravation of the earlier injury, the additional impairment resulting from the aggravated injury should be treated as caused by the earlier motor accident.
(3)Where the further injury or impairment results from a subsequent incident, which would have occurred even if the claimant had not been in the condition caused by the earlier motor accident, but the impairment sustained includes no element of aggravation of the earlier injury, the subsequent incident and further impairment should be regarded as causally independent of the earlier motor accident.
[105]In the latter two situations, par 1.34 is engaged because the “subsequent … injury or condition” is “unrelated” to the first motor accident, as that expression is to be understood in that paragraph. The Oakley principles provide a structure of analysis which is of assistance when applying the approach referred to in pars 1.5 – 1.7 and 1.34 of the 2018 Guidelines and s 5D(1)(b) of the CL Act.”
When he was re-examined by the medical members of the Panel the claimant reported that the 2024 accident was “minor” and involved his vehicle colliding with the rear of another vehicle at low speed.
On the evidence before the Panel, the claimant’s injuries caused by the subject accident played no causative role in the 2024 accident. The Panel finds that the first Oakley category does not apply because it is probable the 2024 accident would have occurred had the claimant not been in the condition caused by the subject accident.
The Panel is satisfied, on balance, that the 2024 accident would not have caused a post-traumatic stress disorder; the accident involved a low speed rear-end collision and would not satisfy criterion A for post-traumatic stress disorder.
The Panel finds that, had the claimant not been suffering from post-traumatic stress disorder caused by the subject accident, it is unlikely the 2024 accident would have resulted in any impairment. The 2024 accident would have occurred even if the claimant had not been in the condition caused by the subject accident. It has resulted in impairment because it has aggravated the post-traumatic stress disorder caused by the subject accident.
The Panel finds that the impairment as a result of the 2024 accident has been sustained because the 2024 accident resulted in an aggravation of the post-traumatic stress disorder caused by the subject accident. The second Oakley category applies and the additional impairment resulting from the aggravated injury (post-traumatic stress disorder) is treated as caused by the subject accident.
The Panel finds that the third Oakley category does not apply because the impairment sustained by the claimant includes an aggravation of his earlier injury (post-traumatic stress disorder).
Clause 6.34 of the Guidelines requires a calculation of: (a) the value of the permanent impairment resulting from the subsequent unrelated injury; and (b) the value of the permanent impairment resulting from the relevant motor accident. In Slade, Wright J held at [92] that cl 1.34 “…does not require the assessor to subtract one value from the other in every case. Such a subtraction might[11] be appropriate if the situation fell within the third category in Oakley…”.
[11] Emphasis added.
Because we have found the second Oakley category applies, the Panel finds that the current impairment it has assessed is caused by the accident.
The Panel finds that the claimant has an 8% permanent impairment as a result of the accident caused post-traumatic stress disorder. It follows that the degree of permanent impairment of the claimant as a result of the injury caused by the accident is not greater than 10%.
The Panel revokes Medical Assessor Barrett’s certificate dated 2 June 2024 and issues a new certificate that reflects its findings.

[2025] NSWPICMP 609

14 August 2025