Irani v Insurance Australia Limited t/as NRMA Insurance

DETERMINATION OF REVIEW PANEL
CITATION:	Irani v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 832
CLAIMANT:	Jim Irani
INSURER:	Insurance Australia Limited t/as NRMA Insurance
REVIEW PANEL
SENIOR MEMBER:	Brett Williams
MEDICAL ASSESSOR:	Melissa Barrett
MEDICAL ASSESSOR:	Steven Yeates
DATE OF DECISION:	29 October 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; medical dispute; scope of dispute; whether the claimant is entitled to statutory benefits under section 3.24 for the cost of dog walking and washing; Mandoukos v Allianz Australia Insurance Limited, and Geaghan v D'Aubert applied; Held – dog walking and washing was not “treatment and care”; the claimant’s psychological injury does not prevent him from walking or washing his dogs; the claimed expenses do not relate to the psychological injury resulting from the accident; statutory benefits under section 3.24 not payable.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Panel revokes the certificate of Medical Assessor Hong dated 7 December 2024 and certifies that for the purposes of s 3.24 of the Motor Accident Injuries Act 2017 the claimed dog washing and walking expenses are not “treatment and care” and do not relate to the psychological injury caused by the accident.

STATEMENT OF REASONS

BACKGROUND

Jim Irani (claimant) was injured in a motor vehicle accident at St Peters on 5 April 2022 (accident). He subsequently made a claim for statutory benefits on Insurance Australia Limited t/as NRMA Insurance (insurer) under the Motor Accident Injuries Act 2017 (MAI Act). Liability for the claim has been admitted.
A dispute has arisen between the parties about whether the claimant is entitled to statutory benefits under s 3.24 for the cost of dog walking and washing. The insurer initially paid those expenses “on compassionate grounds” for 12 months but subsequently denied liability to make further payments on the basis that “[p]et [c]are is not covered under the NSW CTP Scheme”.[1]
[1] Decisions dated 2 May 2023.
The claimant sought an internal review of the insurer’s decisions. On 24 May 2023 an internal reviewer found that “[dog minding and cleaning services] do not fall within the scope of [s]tatutory benefits payable in accordance with Section 3.26 of the Act.” Consequently, the internal reviewer found that the “subject request and associated decision does not fall within the Schedule of the Act that is internally reviewable.”
On 15 November 2023 the claimant filed in the Personal Injury Commission (Commission) an M01 application for medical assessment. It is recorded in the application that the dispute between the claimant and the insurer was about:
“Whether the provision of services for dog washing and dog walking are reasonable and necessary form of treatment for the Claimant's mental health.”
It was also stated in the application that the treatment in dispute was “services for dog walking and dog washing.”
The disputes referred by the claimant to the Commission are medical disputes that fall within the terms of Sch 2 cl 2(b) of the MAI Act.
In addition to the assessment under review, there have been two previous decisions of the Commission relating to the claimant’s dogs. The first decision was a merit review matter: Irani v Insurance Australia Limited t/as NRMA Insurance [2023] NSWPICMR 63 (Irani (No1)). The second was determined by a Member and is discussed further below: Irani v Insurance Australia Limited t/as NRMA Insurance [2024] NSWPIC 455 (Irani (No2)).
The medical disputes the subject of these proceedings were initially referred to a Member of the Commission. In Irani (No2) the Member certified that the provision of a therapy dog or dogs to an injured person is “rehabilitation” and therefore a form of “treatment and care” as defined in s 1.4 of the Act. In her reasons at [92], the Member recorded that the dispute “as framed” required decisions about:
(a)    whether therapy dogs can be treatment as a general proposition;
(b)    whether [the claimant] needs a therapy dog or dogs as a result of his injuries;
(c)    whether it is reasonable and necessary in his circumstances for Staunch and Chief to fulfil the needed role of therapy dog, and
(d)    what are the reasonable costs of the therapy dog or dogs.
At [93] of the decision it is recorded that “[t]he first matter must be determined first and is the subject of these reasons.” It follows that the Member was not determining whether the claimant’s dogs are “treatment and care” but whether, as a general proposition, therapy dogs can be “treatment”.
The Member was satisfied “emotional or therapy animals fall within the definition of rehabilitation and are therefore a form of treatment within the meaning of s 1.4 of the
MAI Act: Irani (No2) at [108]. The Member’s statement at [111] that:
“I have found that the provision of a service or assistance animal to a person injured in a motor accident is a form of rehabilitation and therefore treatment and care within s 1.4”
is to be qualified on the basis that the question she earlier identified as requiring determination was “whether therapy dogs can be treatment as a general proposition.”
The disputes were ultimately referred to Medical Assessor Hong for assessment. On

7 December 2024 the Medical Assessor certified that the following treatment and care does not relate to the psychological injury caused by the accident and is not reasonable and necessary for the claimant’s psychological injury “in the circumstances”:
“The provision of a therapy animal or animals relates to the claimant’s psychological or psychiatric injuries.
The provision of a therapy animal or animals.
The claimant’s dogs Staunch and Chief as therapy animals.”
While the certificate could have been more clearly worded, the following reasons given by the Medical Assessor provide context to his certification:
“[The claimant] described having physical difficulties looking after his dogs, which are not assessable by a psychiatrist. He is not using his dogs as therapy animals and they are not trained therapy dogs. I accept when his dogs are not properly looked after and not having sufficient exercise, they become unhealthy and have behavioural problems, and this has a flow-on effect on his psychological health, however, this is not the same as having a therapy dog.
Therefore, the provision is not reasonable and necessary for his psychological injury.”
The claimant subsequently applied to refer Medical Assessor Hong’s assessment to a Review Panel for review under s 7.26 of the MAI Act.
On 20 January 2025 a delegate of the President of the Commission found there was reasonable cause to suspect that the medical assessment was incorrect in a material respect, accepted the application, and referred the application to this Review Panel (Panel) to conduct the review of Medical Assessor Hong’s 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.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: rule 128.
Version 9.4 of the Motor Accident Guidelines (Guidelines), effective from
15 September 2025, apply to the Review.
If relevant, the question of whether the claimant’s dogs are or were “treatment and care”, including whether they were in fact “therapy dogs”, is a question of fact to be determined by the Medical Assessor (or Medical Panel) to whom the disputes were referred for assessment for the following reasons:
(a)    the Commission is a tribunal of limited jurisdiction;
(b)    the dispute between the parties relates to a “medical assessment matter”: Sch 2 cl 2(b);
(c)    a dispute about a “medical assessment matter” is a “medical dispute”;
(d)    only a Medical Assessor (s 7.20(2)) or a medical Review Panel constituted under
s 7.26 has the jurisdiction to decide a “medical dispute”, and
(e)    deciding whether the thing claimed is “treatment and care” is a matter necessary for the exercise of the Medical Assessor’s or a medical Review Panel’s jurisdiction: Cachia v Isaacs (1985) 3 NSWLR 366 McHugh JA at 387; Trustees for the Roman Catholic Church for the Diocese of Bathurst v Hine [2016] NSWCA 213 Meagher JA at [34] (Leeming and Simpson JJA agreeing).

CASE MANAGMENT

The proceedings were listed for case management on 9 July 2025 before Senior Member Williams on behalf of the Panel. At that time the parties confirmed the following matters were agreed:
(a)    the claimant suffered both physical and psychological injuries as a result of the accident;
(b)    the claimant owned two dogs, Staunch and Chief, before the accident;
(c)    before the accident the two dogs lived with the claimant and he cared for them, and
(d)    neither dog is a trained therapy or companion dog.
The insurer was not in a position to confirm whether it disputed the dogs were “treatment” as defined by the MAI Act. This was a matter to be addressed in the insurer’s written submissions.
Directions were made for the claimant to file a joint bundle that contained all material relied on by the parties for the purposes of the Review, together with the submissions he relied on for the purposes of the Review. The insurer was also directed to file the submissions it relied on for the purposes of the Review.
On 30 July 2025 the claimant filed a joint bundle that included the written submissions he relied on in the Review.
On 14 August 2025 the insurer filed two sets of written submissions, one dated 14 August 2025 and the second dated 1 November 2024. The 14 August 2025 submissions referred to and relied on the 1 November 2024 submissions. Many of the submissions made by the insurer in the 1 November 2024 submissions were repeated verbatim or re-phrased in the 14 August 2025 submissions. Other than those paragraphs, it was not clear to the Panel the extent to which the 1 November 2024 submissions were relied on by the insurer.
There were two further matters that arose from the submissions filed by the insurer. The first related to reference to and reliance by the insurer on “the opinion provided by Assessor Home.” The second was the reference made to Centrelink records. Medical Assessor Home’s certificate and reasons were not included in the joint bundle and there was no evidence from Centrelink before the Panel.
For these reasons, further directions were made by the Panel, including a direction that the insurer file a single set of consolidated written submissions.[2] The claimant was given an opportunity to file submissions in reply to the insurer’s submissions.
[2] See directions dated 19 August 2025 for full details of the directions made.
The Panel also directed that if either party sought to rely on records from Centrelink they were to file and serve those records, together with any written submissions they wished to rely on with respect to the records, on or before 1 September 2025. Any submissions in reply were to be filed on or before 8 September 2025.
It turned out that reference to Medical Assessor Home was a typographical error, and that the reference was intended to be to Medical Assessor Hong. No documents from Centrelink have been filed.
On 22 August 2025 the insurer filed submissions for the purposes of the Review. These are the only submissions from the insurer that have been considered by the Panel.
On 1 September 2025 the claimant, through his solicitors, confirmed that he did not propose to file further submissions.

PANEL DELIBERATIONS

The Panel convened on 11 August 2025 and 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

17 September 2025.

The Panel re-convened on 22 October 2025. The members of the Panel discussed the

re-examination findings and agreed on the outcome of the assessment as recorded in the certificate and these reasons.

STATUTORY FRAMEWORK

The entitlement to statutory benefits for treatment and care is dealt with in s 3.24. That provision states, relevantly:
“3.24   Entitlement to statutory benefits for treatment and care
(1)    An injured person is entitled to statutory benefits for the following expenses (treatment and care expenses) incurred in connection with providing treatment and care for the injured person—
(a)the reasonable cost of treatment and care,
(b) …
(c)…
(2)    No statutory benefits are payable for the cost of treatment and care to the extent that the treatment and care concerned was not reasonable and necessary in the circumstances or did not relate to the injury resulting from the motor accident concerned.
(3)    The Motor Accident Guidelines may provide for—
(a)circumstances in which the cost of treatment and care is taken to be reasonable for the purposes of this section, and
(b) circumstances in which treatment and care is taken to be reasonable and necessary for the purposes of subsection (2).
Note—
See Part 7 and Schedule 2 for provisions relating to disputes about whether treatment and care, or the cost or treatment and care, provided or to be provided to an injured person is reasonable and necessary.”
The definition of “treatment and care” is found in s 1.4 as follows:
“1.4   Definitions
treatment and care means the following—
(a)     medical treatment (including pharmaceuticals),
(b)    dental treatment,
(c)     rehabilitation,
(d)    ambulance transportation,
(e)     respite care,
(f)      attendant care services,
(g)    aids and appliances,
(h)    prostheses,
(i)     education and vocational training,
(j)     home and transport modification,
(k)    workplace and educational facility modifications,
(l)     such other kinds of treatment, care, support or services as may be prescribed by the regulations for the purposes of this definition, but does not include any treatment, care, support or services of a kind declared by the regulations to be excluded from this definition.”
Relevantly, “attendant care services” means services that aim to provide assistance to people with everyday tasks, and includes (for example) personal assistance, nursing, home maintenance and domestic services: s 1.4
“Rehabilitation” is defined as:
“rehabilitation of an injured person, means the process of enabling or attempting to enable the person to attain and maintain—
(a)     the maximum level of independent living, and
(b)     full physical, mental, social and vocational ability, and
(c)    full inclusion and participation in all aspects of life.”

ASSESSMENT UNDER REVIEW

As recorded earlier, Medical Assessor Hong issued a certificate and reasons dated
7 November 2024. Among other matters, the Medical Assessor recorded that the claimant had a pre-accident history of depression following the death of his mother seven years ago, and that he had been in receipt of a disability support pension for depression since that time.
The Medical Assessor recorded details of the accident and the claimant’s subsequent treatment, including the claimant’s psychological treatment. He recorded that the claimant continued to have chronic pain symptoms and disability, the worst problem being with his right foot and left knee. The claimant reported that due to his physical injuries he struggles to walk, cannot bend, and had stiffness and pain. He reported a walking tolerance of “around” five minutes and told the Medical Assessor that he uses a walking stick and right ankle brace for his foot drop.
The Medical Assessor recorded details of the claimant’s psychological symptoms, including reduced memory and concentration, disrupted sleep, nightmares, and flashbacks.
Medical Assessor Hong found that the claimant developed post-traumatic stress disorder as a result of the accident.
The claimant told the Medical Assessor that:
“…his 2 dogs are his family, everything he has, and they suffer because of the subject accident, and because of him and nothing to do with them, before the subject accident, he looked after them well and now, he struggles to care for himself and cannot look after them…He cannot wash them, they are not as clean and the house is dirtier. The dogs have been more destructive outside and inside the house, as they are not walked enough…Now, he and his dog[s] suffer, and seeing the dogs suffer makes him feel worse and it is unfair and financially, he cannot afford professional dog walkers…”
The claimant said that the dogs were “energetic” and that before the accident he walked them twice a day, usually 45 – 60 minutes each walk. The claimant reported that since the accident he cannot walk the dogs and that he struggles to walk for more than five minutes.
The claimant told the Medical Assessor that he had been paying a dog walker, initially five times a week then reduced to three due to “financial reasons.” Before the accident he showered and cleaned the dogs two or three times a week. Since the accident the dogs were washed professionally once a week because it was physically too difficult for him to perform that task. His friends and relatives sometimes help with the dogs.
Medical Assessor Hong found that from a psychological perspective the claimant can look after his dogs, and that his difficulties doing so related to his “physical difficulties”. The Medical Assessor stated that the claimant was not using the dogs as therapy animals, and the dogs are not trained therapy dogs.
The Medical Assessor accepted that when the dogs were not properly looked after and not having sufficient exercise, they become unhealthy and have behavioural problems and that this in turn had a flow-on effect on the claimant’s psychological health. This was not, in his opinion, the same as having a therapy dog.
The Medical Assessor determined that the provision of the dogs was not reasonable and necessary for the claimant’s psychological injury.

EVIDENCE

The documentary evidence before the Panel consists of the joint bundle filed on
29 July 2025.

Claim form

The claimant’s Application for personal injury benefits dated 19 April 2022 (claim form) contains a description of the accident. The claimant recorded that as a result of the accident he suffered physical injuries including back pain, right foot lacerations, hand lacerations, left palm pain and a “wobbly front tooth.” It is recorded that the claimant was in receipt of a disability support pension at the time of the accident.

Medico-legal reports

Dr Dias, occupational physician, reported on 2 May 2023. Among other matters, the doctor recorded that the claimant ceased working in 2015 “due to significant mental health issues.” He returned to work sporadically, was generally unemployed prior to the accident, and was in receipt of a disability support pension for his mental health conditions. The claimant reported that his mental health had stabilised “for some time” before the accident and he was looking to re-enter the workforce. He was due to start work as a cement renderer on a casual basis “around three days after [the accident].” He was not under the care of a treating psychologist or psychiatrist at the time of the accident and was not on any anti-depressant medications.
Dr Dias recorded a history of the accident, the claimant’s injuries, symptoms and treatment. He stated that the claimant’s involvement in the accident significantly aggravated his pre-existing depression and anxiety.

The doctor recorded details of the claimant’s functioning. He was independent with respect to self-care tasks. The claimant’s injuries had had a “significant negative impact” on his domestic functioning. He was not able to contribute to cooking, cleaning, gardening and grocery shopping duties. He lived alone and relied heavily on family members and friends to assist him. The claimant had been provided with commercial assistance, including daily walking and fortnightly washing of his two dogs.
In Dr Dias’ opinion the claimant suffered injuries to his low back, right forearm, middle finger, left wrist, left knee, right ankle/foot, and left hand as a result of the accident. These injuries had resulted in “debilitating symptomatology.” His prognosis was “relatively poor.”
The doctor’s recommendations for future treatment have been noted as has the doctor’s opinion about the claimant’s disabilities and the impact of these disabilities on his work capacity and capacity to perform domestic tasks. In the doctor’s opinion, the claimant has, and will, require assistance with domestic tasks, including the care of his two dogs.
In a separate report Dr Dias assessed a 32% whole person impairment.
Dr Bodel, orthopaedic surgeon, reported on 20 June 2023. The doctor recorded a history of the accident, the claimant’s symptoms and treatment. Under the heading “Social History” the doctor recorded:
“…He used to walk his dogs for two hours each day and in fact did part-time work as a dog walker in addition to walking his own dogs taking five dogs for 30 minutes each day. He has not returned to any of this.”
Dr Bodel diagnosed multiple fractures and ligamentous injuries involving the claimant’s left knee, right foot and ankle, back and hands. The claimant had ongoing pain and stiffness “in all the injured areas.” His prognosis was guarded because of the severity of his injuries. In the doctor’s opinion the claimant was unfit for work and his future earning capacity is “limited”. He required domestic assistance for heavy household activities and cleaning activities. In a separate report the doctor assessed a 31% whole person impairment.
Dr Bharadwaj, psychiatrist, reported on 19 June 2023. The doctor recorded that the claimant denied any difficulties with his physical and mental health prior to the accident. The doctor’s pre and post-accident history has been considered, as have the symptoms reported to him by the claimant.
The claimant reported that anxiety and depression started whilst he was in hospital in the context of “constant and severe pain”, not being able to walk, his multiple injuries, not being able to sleep, and constantly thinking about the accident.
The claimant reported that he was in constant pain, his left knee and right foot being “very bad.” He continued to use a walking stick to mobilise and had a brace on his left knee, right foot and left wrist. The pain made his anxiety and depression worse. In addition to the medication he was prescribed, the claimant was seeing a clinical psychologist, Ms Hayek.
In Dr Bharadwaj’s opinion, the claimant met the diagnostic criteria for post-traumatic stress disorder and major depressive disorder. These conditions had been caused by the accident, were severe, and had not stabilised. In the doctor’s opinion the claimant required ongoing treatment. His psychological injuries affected his ability to leave the house, socialise, and enjoy social activities.
Dr Vote, orthopaedic surgeon, reported on 8 June 2023. The doctor recorded that the claimant lives alone, has no dependants, and was very active before the accident. He went on to record:
“He is now very much handicapped and needs help which is provided in the areas of cleaning, lawn mowing, and also walking his two dogs. He gets some help from his sister…”
In Dr Vote’s opinion the claimant sustained multiple injuries “of a major nature” involving his right foot, right wrist, left wrist, and left knee. He had “serious” limitation of function in the right wrist, significant loss of use of the left wrist, weakness and loss of power in his right ankle, and “major disability” in his left knee. The claimant was not stable, and his recovery would be prolonged and uncertain. Further treatment was required. He was not fit for work.
In the doctor’s opinion the claimant’s injuries had a “major effect” on his abilities in activities of daily living. Walking his dogs for two hours a day, as he did pre-accident, “is quite beyond him.”
Dr Vote reported again on 17 October 2024. The doctor recorded that the claimant was seeking a psychologist. While his activities of daily living “seem satisfactory” he cannot walk his dog. The claimant reported weakness in his left wrist and right hand. He continued to have “major problems” with his left knee and right foot. Little had changed since the doctor last saw the claimant. Returning to employment was not considered to be realistic. The doctor assessed a 33% permanent impairment.

Vocational reports

The NRMA recovery plan in the bundle has been considered, including the care needs referred to.
A vocational report dated 11 February 2025 records that the claimant was certified as having no capacity for work. The report includes a history of the accident, the claimant’s injuries and his treatment. The claimant reported significant ongoing pain. He experienced symptoms such as anxiety, depressive symptoms, flashbacks, hypervigilance, poor memory and concentration, and disturbed sleep.
The claimant reported that most domestic tasks were completed by a cleaner. He could go to the shops to get small amounts of groceries but went with a friend to get heavy items. He usually only drives locally if he needs to go to the shops and was not able to walk his dogs.
The functional tolerances reported have been considered, as has the claimant’s vocational and employment history, and the “transferable skills analysis”. Having regard to the claimant’s reported functional tolerances, education, training, experience and “reasonably accessible labour market”, the vocational assessors were unable to identify any suitable employment at the time of the assessment. The various conclusions and recommendations contained in the report have been considered.

Material from treatment providers

A certificate from the Royal Prince Alfred Hospital (RPAH) dated 12 April 2022 records the claimant was an inpatient from 5 April 2022 and that he was unfit for “work/school/usual activities” from 5 April 2022 to 1 June 2022. It is stated in the certificate that the claimant was treated for “multiple and extensive soft tissue injuries of lower limbs.” It is also recorded that they were “[a]iming for surgical management next week” and the claimant was unfit for work.
A report from Dr Fritsch, orthopaedic surgeon, dated 3 May 2022 records that on
20 April 2022 the claimant was admitted to hospital “for a major surgical procedure” and that following the procedure he will be unfit for work duties from 20 April 2022 to 17 June 2022. The claimant would be reviewed at the conclusion of that period and “consideration made about a possible return to work date.”
A certificate of capacity completed by Dr Cooke on 13 April 2022 refers to a motorbike accident on 5 April 2022. The certificate is blurred and difficult to read. There is reference to injuries to the claimant’s left knee, “paraspinal pain”, right hand laceration and a “wobbly tooth.” The claimant was certified as having no “current” capacity for any work from
5 April 2022 to 15 May 2022.
Ms Carol Hayek, psychologist, reported on 12 October 2022. She diagnosed post-traumatic stress disorder. The report records that the claimant was not independent in self-care, pre-injury social and recreational activities, concentration and work capacity. He was anxious in motor vehicles and will not drive in the right lane. The claimant had been provided with appropriate psychological support and may benefit from regular attendance with a psychiatrist. In Ms Hayek’s opinion, the claimant had not reached maximum medical improvement.
Ms Hayek reported again on 23 June 2023. She recorded that the claimant had engaged in regular psychological treatment sessions to address the “high incidents of post-traumatic stress disorder symptoms and emotional dysregulation.” He was engaged in a
“trauma-focused CBT model.” The claimant’s capacity to manage emotional distress remained significantly impaired.
Ms Hayek recorded:
“[He] has two dogs, Staunch is an English Staffordshire Terrier and Chief is a rescue dog. He has cared for Staunch for 11 years and Chief for 3 years. [The claimant] described his companion pets as very significant to him. His dogs have offered him companionship, structure, and affection. [The claimant] reports that his dogs have mitigated some of the difficult effects of trauma exposure and psychological distress caused by the motor vehicle accident.”
The report records that the claimant stated that “the removal of services to his dogs will cause them distress due to a lack of exercise and hygiene”, that their pent-up energy and frustration will cause destruction to the yard, plants and furniture, and that due to lack of washing they will be prone to ticks, flies, and disease, and may become “seriously ill.” He reported that his inability to care for the dogs, together with the reduced care provided by the insurer, has caused significant distress and exacerbated his psychological disability.
Ms Hayek stated it is “well documented” that pets can offer a superior level of support to trauma survivors attempting to cope with the emotional aftermath of a traumatic event. She states:
“A pet can act as a lifeline when the individual they live with experiences PTSD and emotional distress. By simply playing with or cuddling pets, individuals can benefit from the calming, soothing effect of their company. Pets are able to soothe the emotional upsets of their owners who have experienced trauma by being present and offering support and connection through simple companionship. This connection and companionship offer a unique way to cope with emotional entanglement and other challenges throughout the process of addressing trauma related struggles. Also, dogs and other pets who provide emotional support can help increase mindfulness which is an essential contributor to psychological recovery.”
Ms Hayek also recorded that pets can provide emotional support by helping increase oxytocin levels which can help people feel calmer and at peace, and “battle the negative emotions and mental health effects often experienced following trauma.”
Ms Hayek stated that:
“…It is well documented that pets can facilitate and hasten the recovery process of PTSD and emotional distress. If [the claimant] was to lose his dogs due to lack of care resulting from the motor vehicle accident, his symptoms would become very exacerbated. He may become at risk and require more psychiatric acute care. His mental health would be extremely compromised as will his symptoms and capacity to function. [He] would be at risk of further psychological injury of his dogs were removed from his care, and as result, this may prolong his recovery.”
Ms Hayek recommended that the care of the claimant’s dogs be maintained to mitigate the risk of further psychological injury and aid towards his recovery.
The clinical notes from Dr Abraham’s practice are before the Panel. The notes were printed on 1 March 2025. The past medical history, prescriptions, and current medications recorded in the notes have been considered.
The first entry in the consultation notes is dated 4 January 2024. The last entry was made on 1 March 2025. Each of the entries in the notes has been considered. The consultation notes include reference to the claimant’s sleep being disturbed, the claimant being unable to work, pain and chronic pain, and medication reviews.
The records include a number of certificates of capacity. The first, completed by Dr Abraham, is dated 4 January 2024 contains details of the claimant’s injuries and treatment. It is recorded (among other things) that it is unlikely the claimant will ever be able to undertake “the level of preinjury duties, as a renderer.” Subsequent certificates are in similar terms. There is reference to significant pain, fatigue and reduced mobility. The most recent certificate is dated 14 February 2025.
There is a referral to Dr Ibrahim, sports physician, reports from that doctor, and GP management plans, all of which have been considered.

SUBMISSIONS

Claimant’s submissions

The claimant relies on undated written submissions contained in the joint bundle. The Panel is aware that the claimant has relied on written submissions in previous proceedings. In the Review proceedings the directions made by the Panel stated:
“[18] Each party should only provide the Panel with one set of submissions. To the extent that previous submissions are relied on, those submissions should be incorporated into the submissions filed in accordance with the directions made by the Panel.”
The claimant was directed to file the submissions he relied on for the purposes of the Review and was given an opportunity to file submissions in response to the insurer’s submissions filed in accordance with the Panel’s directions.
On this background, the Panel has proceeded on the basis that the only written submissions relied on by the claimant for the purposes of the Review are the submissions included in the joint bundle.
The claimant’s submissions at [2] state:
“The [i]nsurer has approved and arranged independent providers to walk and wash the [c]laimant’s dogs for 12 months after the subject motor vehicle accident. The insurer says it provided these services to the [c]laimant for one year on a compassionate basis but that the Legislation does not require for these services to be provided.”
The submissions record that he disagrees and:
(a) relies on s 3.24(1)(a);
(b) he is entitled to payments for the walking and washing of his dogs “as part of his treatment and care” pursuant to s 3.24(1)(a);
(c) relies on the report of Ms Hayek dated 23 June 2023 in support of his need for these services to be provided “as part of his treatment and care needs”, and
(d) claims “any out of pocket expenses he has had to outlay since the [i]nsurer ceased to pay for the walking and washing of his dogs.”
The claimant’s submissions make it clear the dispute is about the provision of “independent providers to walk and wash [his dogs].”
The claimant refers in general terms to the “medico-legal reports” obtained by the parties. The submissions state that those reports are “lodged to assist the [Panel] in understanding the type and severity of the injuries suffered [by him] in the subject accident.”
Other than Ms Hayek’s report and the medico-legal reports obtained by the parties, the claimant’s submissions do not refer with specificity to the other medical evidence in the joint bundle.
The claimant submits that Medical Assessor Hong failed to disclose his path of reasoning for “rejecting [his] claim that the care of the dogs is reasonable and necessary…”
In the claimant’s submission:
“…the reality is that whether the subject dogs are trained therapy dogs or not is that they have become therapy dogs and not just pets because of [his] mental health condition and need for that companionship. Whether they are trained ‘therapy dogs’ or not is immaterial to the question of whether they provide a reasonable and effective means of alleviating, controlling or prevention form [sic] deterioration of [his] emotional state.”
The claimant argues that the deterioration of the dogs due to an absence of care (walking and bathing) would “adversely affect that role of the dogs.” He submits Medical Assessor Hong has not considered the “other reality” that:
“…it is not just a case of the dogs’ condition deteriorating but the strong likelihood that [he] would have to give them up completely and thus have no dogs, as he is unable to look after them properly. As advised by Carol Hayek…this scenario would have disastrous adverse effects on [his] mental condition.”
The claimant submits that, having found that therapy dogs and their maintenance would be reasonable treatment, the Medical Assessor’s finding that his dogs “are not because they are not trained therapy dogs” leads to the “absurd situation” that he would have to “get rid of his pets” or find a means for them to be maintained by family and friends, but could then “call on the insurer” to provide two trained therapy dogs. In his submission, not only would this be a “much dearer” alternative, but there would be “no guarantee that [he] would bond with such dogs in a manner that helped his emotional state as much as his current non-trained dogs do.”
The claimant argues that if it is found training his dogs as therapy dogs would make a material difference to his recovery, the insurer should “arrange for the relevant training and pay for the same.”
The claimant does not submit the Panel is bound by any of the reasons, findings, or matters certified in Irani (No1) or Irani (No2). Nor does the claimant argue either decision creates an estoppel.

Insurers’ submissions

The insurer relies on written submissions dated 22 August 2025. The insurer agrees:
(a)    the claimant suffered injury as a result of the accident;
(b)    the claimant has two dogs, one of which he has cared for for 11 years and the other three years, and
(c)    neither dog is a trained therapy or companion dog.
The insurer argues the scope of the dispute, as originally framed by the claimant, ought to be confined to dog washing and dog walking services. In the insurer’s submission, the original application was not “centred around” the claimant’s dogs rendering him assistance and was concerned with services to be provided to the dogs, namely, dog walking and dog washing services.
The insurer submits the claimant has not, at any point in time, sought a therapy or assistance animal, or requested animals for treatment purposes and that the evidence relied upon by him is “fixated on the removal of services provided to his pet dogs based on an alleged inability to care for them as opposed to the need for support by them.”
The insurer submits that there is “no legislative requirement” to fund pet care services, such services not falling within the scope of “treatment and care” or domestic or attendant care services under the MAI Act.
The insurer does not agree animals can form part of an injured person’s treatment, recovery and rehabilitation plan, nor does it agree that an injured person’s pets, owned at the time of the accident, can form part of their treatment, recovery and rehabilitation plan.
In the insurer’s submission, evidence to support a causal need for the services that is reasonable and necessary is lacking. It argues the claimant’s psychiatric history will need to be considered, noting he had been on a disability support pension since 2015 for anxiety and depression. The insurer argues that consideration will need to be given to the claimant’s pre-accident condition and the role his pets played in his life prior to the accident.
The insurer submits the claimant carries the burden of establishing the accident is “causative of the present request.” In the insurer’s submission, in the absence of the Centrelink records, the claimant cannot be said to have discharged that onus.
The insurer’s submissions state that the medical questions posed by the Member in Irani (No2) and referred for assessment “assumed the claimant lacks the physical capacity to care for his dogs.” That, it argues, is a separate question that the insurer previously submitted requires determination.
The insurer disagreed with the order and wording of the questions proposed by the Member in Irani (No2) “as they appeared to redefine the scope of the dispute”. In the insurer’s submission, should (a) and (b) be answered in the affirmative and (c) in the negative, it would be bound to support the provision and maintenance of a service or therapy animal, a request that at no stage has been made by the claimant, a request that it hasn’t considered, and a request that has not been the subject of an internal review. Further, the insurer argues the medical referral as made is beyond the power of the Commission.

The insurer also argues that the questions posed by the Member, particularly question (c), required the Medical Assessor to have the relevant experience, competence and expertise to determine questions regarding the claimant’s pets, their capacity for training, learning, their temperament and character. In the insurer’s submission, “that is likely beyond the [Medical] Assessor’s expertise” and, in such circumstances, “the [Medical] Assessor cannot reasonably make a determination.”
The insurer submits that in the absence of a qualified expert opinion, following an assessment of the claimant’s dogs, factoring age and breed, the claimant has not discharged the onus of proving that his dogs are or could be therapy or service animals of a nature required by the alleged psychological or psychiatric injuries caused by the accident, whether they can be trained to qualify as a therapy or service animal, and whether such training will be effective in providing the functions and services expected of a therapy or service animal beyond “standard pet companionship”.
At [41] the insurer proposes a number of questions that should be answered. The submissions state that details regarding the claimant’s receipt of a disability pension and a copy of the Centrelink file remain outstanding and should be made available for consideration.
It is argued that, where the claimant’s pets provided a similar therapy or service function prior to the accident, the present need would not be one that was caused or contributed to by the accident.
The insurer submits the claimant’s dogs do not provide any therapy or service functions in relation to his psychological and psychiatric injuries sustained in the accident.
The insurer argues that the opinions expressed by Ms Hayek, are “largely based on” the claimant’s subjective reporting and the dogs offering “companionship, structure and affection”. In the insurer’s submission, Ms Hayek fails to consider the claimant’s pre-existing psychiatric symptoms and the role his dogs played during that period and prior to the accident”.
The insurer submits that Ms Hayek’s findings are not objective or well-reasoned and cannot be accepted. Further, Ms Hayek also failed to consider whether therapy or services animals are reasonable and necessary in the context of a person alleging that they cannot look after the maintenance requirements, “unlike a blind person with a guide dog.”
The insurer submits there is no evidence to support a finding the claimant’s dogs provide specific formal mental health services “other than standard companionship and affection provided by any pet.” In the insurer’s submission, “this is expressly distinguished from a scenario where for example, a guide dog assists a blind person which provides aid to a person with visual impairments to navigate.”
The insurer argues that consideration will need to given to whether the continued provision of pets for therapy or service functions is reasonable and necessary in the circumstances where the person cannot physically care for them.
The insurer submits treatment and care requests are required to follow the Clinical Framework for the Delivery of Health Services per cl 4.80 of the Guidelines. In its submission, pet care as treatment does not follow the following three principles:
(a)    Principle 1 - Measure and demonstrate the effectiveness of treatment;
(b)    Principle 3 - Empower the injured person to manage their injury, and
(c)    Principle 5 - Base treatment on best available research evidence.
In the insurer’s submission there is no objective evidence the claimant’s pets provide any measurable effectiveness in his recovery. Finally, the insurer relies on Medical Assessor Hong’s reasons.

RE-EXAMINATION FINDINGS

The claimant was re-examined by Medical Assessors Barrett and Yeates (Medical Assessors) by MS Teams on 17 September 2025. What follows are the findings and opinion of the Medical Assessors following the examination.

Psychosocial history and pre-accident history

The claimant was born in Sydney and raised with his mother, father, and younger sister. The claimant said that the family had enough money, food, and clothing and that he was not left wanting for life essentials. He denied any domestic violence in the family. As far as he knows he was born at full term and developed normally meeting his milestones during the expected periods. The claimant denied any exogenous physical, sexual, or emotional trauma. He reflected on his early life as “very good, I wouldn’t change a thing.” He was a physically healthy child and young person. The claimant is of Lebanese extraction and denies any family history of religious or ethnic persecution or exposure to war or war like conditions.
The claimant attended primary and high school. He had a circle of friends and denied any substantial disciplinary issues such as suspensions or expulsions. He completed year 12 with below average marks, commenting that he did not “pass his HSC.” Although he attended school regularly, he found himself wanting to work and took part-time jobs in a convenience store around 15 or 16 for around a year and a half. After high school the claimant completed two and half years of an apprenticeship but found the theory component of the training difficult. After leaving his apprenticeship he took labouring jobs in the construction industry intermittently for the balance of his working life.
The claimant said that he worked consistently, as determined by the availability of construction jobs, until 2002 when his mother died. The claimant said he was very bereaved, stopped work, and was ultimately referred to a psychologist due to low mood. The claimant stated that his low mood was ultimately improved through regular attendance at the gym, where he formed relationships and became physically strong. He resumed some occasional work in the construction industry around 2004 and continued to work until becoming a recipient of the disability support pension. The history of when the claimant became a recipient of the disability support pension is unclear, but it was most likely sometime in the 2010s due to depression and preceded the index accident by many years. He explained that his application for the pension was supported by a psychiatrist, Dr Berry, who he saw for a few sessions over about a year. The doctor also assisted him with an application for public housing. The claimant mentioned that he took antidepressants for about a year but could not recall the specific medication. He also had some contact with a psychologist around his mother’s death but could not remember who he saw, or the number of sessions attended. He denied having pervasive suicidal ideation. He has never had a psychiatric admission.
The claimant elaborated on the circumstances of his life between 2002 and 2012. He moved out of his family home around 2005, citing that his father remarried around 2006. He described this period as nomadic, saying he was “moving around,” and spent some time sleeping rough. During this period, the claimant said his depression worsened. The claimant explained that the loss of his mother was central to his mood disturbance because he was very emotionally dependent on her and was anticipating being helped to find a wife by her. The claimant said he rarely saw his father after his mother’s death.
The claimant stated that he owns two dogs, Staunch and Chief, who are relevant to the current dispute. The claimant became the owner of Staunch in 2013 and Chief in 2019. Before the accident, he “took them both everywhere,” including on boats, riding on his motorcycle, to the beach, and walked with them for an hour or two each day. The animals still remain in his possession but are mostly confined to the backyard.

There is no history consistent with a primary psychotic illness or bipolar disorder. There is no family history of major mental illness, addictions, or completed suicide. The claimant tried alcohol as a young man but has never been a regular drinker and does not currently consume alcohol. He has never used illicit drugs. During his time as a bodybuilder, the claimant used anabolic steroids and testosterone supplements to aid his physical conditioning and muscle growth. He does not gamble. There is no forensic history.

History of the motor accident

On 5 April 2022, the claimant was riding his motorcycle around 9.30 pm along Princes Highway at St Peters. He was in the far right-hand lane, stationary at the lights in a line with other cars. He began moving in parallel with other vehicles and saw a vehicle from the opposite side of the road cross the double lines into his lane, approaching him at high speed. He said he tried to avoid the vehicle but could not escape, resulting in a collision that sent him airborne, landing on the other side of the road. He recalled both vehicles were travelling around 60kmph. He described experiencing intense pain, feeling dissociated, and believing his leg might be permanently damaged. An ambulance attended the scene, removed his clothing to assess his injuries, and transported him to Royal Prince Alfred Hospital, where he underwent surgery on his fingers and sustained nerve damage to his right arm, as well as surgery on his right foot. He needed a brace for his left knee, had a fractured left wrist, and multiple torn tendons. He also suffered further dislocation and ligament rupture in his left knee. Overall, he was admitted to the Royal Prince Alfred Hospital for two weeks, followed by two to three weeks in the Mater Hospital for recovery. He later had additional surgery on his left knee.

History of symptoms and treatment following the motor accident

The claimant’s psychological symptoms began soon after the accident and included intrusive memories of the event, where he relives the moment in full emotional detail, including the sensation of being unable to escape the collision and crashing into the driver's side headlights of the vehicle. He experiences visual and auditory flashbacks that accompany these memories. He has not returned to motorcycle riding since the accident. He described nightmares and frequent awakenings with sleep disturbances that continue to the present. Currently, he experiences nightmares once or twice a week. He also described dissociative episodes in which he would observe himself from a distance during the accident. The claimant also described hypervigilance, social withdrawal, and a persistent negative emotional state.
The claimant could not precisely recall when he first started psychological treatment but remembers being referred by his general practitioner to Ms Hayek, whom he has seen weekly or fortnightly since the accident. He has not seen a psychiatrist. The claimant was also prescribed a range of analgesic and other medications by his GP. His current medications include Panadeine Forte, 1-2 tablets daily, Nurofen Plus, oxycodone (Endone)

5mg three times daily, melatonin for sleep, duloxetine 60mg daily, gabapentin 100mg, and rabeprazole.
In addition to his psychological symptoms, the claimant also has significant functional and mobility limitations related to his musculoskeletal injuries. This also includes a substantial component of chronic pain.

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

There are no relevant injuries or condition sustained since the motor accident.

CLINICAL EXAMINATION

Mental state examination

The mental state examination revealed a man presenting with polite and appropriate social manners. He was dressed in a green hoodie, had a full beard and shaved head, and spoke in complete sentences, with rapport developing to a moderate degree. His mood was low, and his affect was flat, with no moments of spontaneous levity. Thought content was

reality-oriented, with no features of psychosis or current suicidal ideation, it was filled with lamentations about his physical limitations and regrets regarding his ability to care for his dogs as he did before the accident. The thought form was normal. His speech was normal in grammar, structure, syntax, quantity, and spontaneous elaboration. Judgement was not acutely impaired, and there were no perceptual disturbances. Cognitive function appeared grossly normal, with no need for formal testing. Insight was reasonable.

Current functioning

The claimant currently lives independently in a public housing home with occupational therapy tools to support his physical disabilities, such as a shower seat, braces, and handles around the house. He showers every second day. He orders food for delivery and has a cleaner. He has no structured recreational or social activities, spending his days watching television or on social media. He rarely goes to the park, but he catches up with friends twice a week to eat out, lamenting that he cannot take his dogs on such outings. The claimant does not drive due to pain, concentration difficulties, and ongoing reminiscences of the accident. He does not use public transport but can ride as a passenger in an Uber when needed. He remains close with his sister but has lost other friendships. He regrets that he can no longer take his dogs on outings and feels this has strained his relationship with them. He cannot concentrate on a book, film, or sustain interest in a specific TV show and has not pursued further education or training. He last worked several months before the accident in construction.

Comments on Consistency

The interview was globally consistent.

Diagnosis

The claimant meets the DSM-5 criteria for post-traumatic stress disorder caused by the accident as outlined below:
“Posttraumatic stress disorder
A. 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).
This criterion is met as the claimant was the motorcyclist severely injured in the accident on 5 April 2022.
2. Witnessing, in person, the event(s) as it occurred to others.
3. 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.
4. 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.
B. Presence of one (or more) of the following intrusion symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
This criterion is met as the claimant experiences intrusive distressing memories of the other vehicle driving toward him where he is unable to escape and has auditory and olfactory intrusive memories.
2. Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
This criterion is met by the claimant’s report of distressing dreams about the motor accident that disrupt his sleep.
3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring.
4. Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
5. Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
This criterion is met by the claimant’s increased marked anxiety around motorcycling, including complete cessation of motorcycle riding and avoidance of other transport modalities except when required.
C. 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:
1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
2. 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).
This criterion is met by the claimant avoiding motorcycling completely and transport modalities unless absolutely needed.
D. 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)
2. 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”).
3. Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
This criterion is met, the claimant describing a persistent negative emotional state that includes fear and guilt, particularly pertaining to his capacity to care for his companion animals.
5. Markedly diminished interest or participation in significant activities.
This criterion is met by the claimant’s markedly diminished interest and participation in significant activities.
6. Feelings of detachment or estrangement from others.
This criterion is met by the claimant’s feelings of estrangement and general social isolation.
7. Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
This criterion is met by the claimant’s difficulty experiencing positive emotions including towards his companion animals.
E. 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:
1. Irritable behaviour and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
2. Reckless or self-destructive behaviour.
3. Hypervigilance.
4. Exaggerated startle response.
This criterion is met by the claimant’s history of easy startle.
5. Problems with concentration.
This criterion is met by the claimant’s history of diminished concentration, including the capacity to focus on recreational activities such as film or television.
6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
This criterion is met by the claimant’s history of ongoing sleep difficulties with middle awakening and unrefreshing sleep.
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
This criteria is met because the accident occurred on 5 April 2022 and symptoms have persisted since soon after the accident
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
This criterion is met by the claimant’s clinically significant distress and impairment in his general functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
This criteria is met because this does not apply as the claimant did not have a history of drug or alcohol misuse and there is no other medical condition that explains the symptoms better.”

The claimant’s dogs

The Medical Assessors gathered a detailed history of the claimant’s dogs, Staunch and Chief. He has owned Staunch since 2013 and Chief since 2019. Chief is an American Staffordshire Terrier and larger than Staunch, who is an English Staffordshire Terrier. Before the accident, he “took them both everywhere,” including on boats, riding a motorcycle, to the beach, and on daily walks of about one to two hours. The dogs are still in his care but are mostly kept in the backyard. The recurring themes regarding the dogs were the claimant’s lamentations that he could not care for the animals at the same standard as before the accident. For example, he is unable to wash the animals due to physical limitations that require him to pay a third-party dog washing service. Similarly, he is unable to walk the animals as frequently as before, so he employs a third-party dog walking service.

The claimant repeatedly discussed feelings of guilt regarding his care for his dogs, noting that they are now confined to his backyard and receive less care than before the accident. He did not provide a history indicating that his animals were providing medical treatment beyond the enjoyment and companionship of having dogs. The Medical Assessors concluded that the claimant was unhappy with his ability to care for his dogs and believed that, at least from his perspective, the animals were not being properly cared for without third-party assistance, which he found difficult to afford on a limited income.
The Medical Assessors determined that the claimant does not require dog walking and washing services as a result of his accident caused psychological injury. His psychological injury does not prevent him from either walking or washing his dogs. His psychological symptoms do not give rise to functional limitations that would prevent him from performing either task.
The Medical Assessors were not satisfied on the history given by the claimant and the evidence before the Panel that the dogs resulted in any improvement in the claimant’s physical or psychological state in a manner consistent with them being treatment. For instance, his dogs had not helped him increase social outings, to carry out needed domestic tasks, or to participate in other activities. In fact, the claimant openly expressed regret at not being able to take his dogs out socially as he used to or to walk them himself.
The Medical Assessors formed the view that the animals were pets that provided emotional support analogous to that of a family member. However, the Medical Assessors were not satisfied that the dogs served any therapeutic function.
Whilst the Medical Assessors acknowledge the claimant’s emotional attachment and bond with the dogs, and that they are much loved pets, the dogs have no role in assisting his ability to live independently or his inclusion in aspects of life.
The Medical Assessors agree with the treating psychologist that the dogs are a source of companionship. The Medical Assessors note and generally agree with the psychologist’s comments that, “[b]y simply playing with or cuddling pets, individuals can benefit from the calming, soothing effect of their company. Pets can soothe the emotional upsets of their owners who have experienced trauma by being present and offering support and connection through simple companionship.” However, the Medical Assessors consider that the treating psychologist is describing the usual role that all pets have in their owners’ lives, including owners who do not have a psychiatric condition. If the pet owner subsequently develops a psychiatric condition, the continuation of the previous role of the pet, unchanged, does not become redefined as a “therapy” on the basis of a change in the owner’s condition.
The Medical Assessors formed the view that within the definition and for the reasons elaborated above the claimant’s dogs do not constitute “treatment and care” as that term in defined.

DETERMINATION

Scope of the dispute before the Panel

The insurer has squarely raised an issue about the ambit of the medical disputes that are before the Panel. For the purposes of the MAI Act, “medical dispute” means a dispute between the claimant and the insurer about a “medical assessment matter.”
A medical dispute about a decision of an insurer may not be referred by a claimant for assessment under Division 7.3 until the decision has been the subject of an internal review by the insurer under Division 7.3: s 7.19(1). A medical dispute about a decision of an insurer may be referred for assessment under Division 7.5 without an internal review of the decision by the insurer if the insurer has failed to complete an internal review and notify the claimant of the decision on the internal review as and when required to do so or has declined to conduct a review: s 7.19. There are no matters prescribed by the regulations for the purposes of s 7.19(3).
In Mandoukos v Allianz Australia Insurance Limited [2024] NSWCA 71 it was held by Stern JA (Leeming and Kirk JJA agreeing) that:
“[72] … a dispute between a claimant and an insurer about a medical assessment matter, in s 7.17, is a reference to the dispute which has in fact arisen between a claimant and an insurer, albeit that, to fall within the definition of “medical dispute” in s 7.17, that dispute must relate to the subject matter of a medical assessment matter...”
Stern JA went on to hold:
“[77] …it is apparent that the medical dispute will not necessarily encompass the whole of the ‘decision’ or ‘claim’. Rather, the word ‘about’ denotes the subject matter in respect of which the medical dispute in fact arises.
[78] Thus, the medical dispute ‘about a medical assessment matter’ will, in each case, be a question of fact depending upon the ambit of the dispute between the parties at the relevant time having regard to the competing claims made. Whilst it is of course possible that a dispute about a medical assessment matter might comprise the whole of the relevant medical assessment matter, that is not necessarily so.”
The disputes before the Panel arise from the decisions made by the insurer on 2 May 2023 that it would “no longer be able to fund” dog walking services and dog washing services beyond 31 May 2023. The insurer’s decisions were predicated on the basis that “[p]et care is not covered under the NSW CTP Scheme.”
On 22 May 2023 the claimant made an application for internal review with respect to those decisions. By letter dated 24 May 2023 the insurer declined to conduct an internal review. The insurer’s reasons record:
“Following my review of your application, I understand you want me to review the decision to decline the following requests:
- Payment for dog walking assistance provided by Wagtail walkers of $175 dated 19 May 2023
- Payment for dog wash provided by Jim’s Dog Wash of $90 dated 19 May 2023.”
The internal reviewer declined to conduct a review of the insurer’s decisions because the claimed services did not fall within the scope of statutory benefits payable in accordance with s 3.26 of the MAI Act.
On 15 November 2023 the claimant filed in the Commission an application for medical assessment.[3] Under the heading “Matters in Dispute” the claimant has ticked the box indicating the dispute is about “[t]reatment and care reasonable and necessary”. Under the heading “Other Dispute Details” the following is recorded:
“What is the dispute?
Whether the provision of services for dog washing and dog walking are reasonable and necessary form of treatment for the Claimant's mental health
What outcome do you want?
The Insurer to continue payment for the provision of these services and reimburse payments made by the Claimant to date.”
[3] Form M01.
The submissions provided by the claimant in support of his application record he disagrees with the insurer’s decision not to pay for independent providers to walk and wash his dogs. The claimant submitted he is entitled to payments for the walking and washing of his dogs “as part of the reasonable costs of his treatment and care pursuant to section 3.24(1)(a) of the Act” and “claims any out of pocket expenses he has had to outlay since the [i]nsurer ceased to pay for the walking and washing of his dogs.” He relied on the report of Carol Hayek dated 23 June 2023 to support his need for these services to be provided “as part of his treatment and care”.
In its reply to the application, the insurer filed submissions that address, among other matters, the scope of the dispute. The submissions record that the dispute is about “[t]he [i]nsurer’s denial to fund the claimant’s request for dog washing and dog walking services.” The insurer argued that “these services do not fall within the scope of statutory benefits payable under the [MAI Act].” In the insurer’s submission, the issue to be determined is whether dog washing and dog walking services is “treatment and care” within the meaning of the MAI Act “for the purposes of statutory benefits payable under section 3.24.” The insurer referred to the definition of “treatment and care” in s 1.4 and argued that whilst the list of examples in the definition of “attendant care services” is not stated as being exhaustive, “dog washing and dog walking services cannot be categorised as personal assistance, nursing or home maintenance. Such services may be considered ‘domestic services,’ if at all.”
In the insurer’s submission, the “relevant authorities”[4] establish that services provided in relation to pet care such as dog washing and dog care are not domestic services of a kind in respect of which compensation or damages are payable.
[4] Geaghan v D’Aubert [2002] NSWCA 260, Schofield v Hopman & Anor [2017] QSC 297; Griffiths v Kerkemeyer (1977) 139 CLR 161; [1977] HCA 45.
On the evidence before the Panel the claimant has not made a claim for expenses relating to treatment in the form of his two dogs (or any other dogs) and the insurer has not made a decision about such treatment. That being the case, there is no relevant decision of the insurer that gives rise to a “medical dispute” capable of being referred to the Commission for assessment under Division 7.5. Further, a dispute about this subject matter has not been the subject of a request by the claimant for an internal review by the insurer. Section 7.19 has not been engaged and the dispute (if one existed) cannot be referred to the Commission for assessment.
A dispute about whether the dogs are treatment (or care) is materially different to the disputes prosecuted by the claimant about the payment of expenses for dog walking and washing. The disputes which have in fact arisen between the claimant and the insurer are about whether the claimed expenses for dog washing and dog walking are “treatment and care” as defined in s 1.4 and whether those expenses are reasonable and necessary in the circumstances and relate to the injury resulting from the motor accident. The “injury” concerned is the claimant’s psychological injury caused by the accident.

Does the claimant have a psychological injury as a result of the accident?

For the reasons given by its medical members, the Panel finds the claimant satisfies the diagnostic criteria for post-traumatic stress disorder.
The claimant was involved in a head on collision. He suffered significant physical injuries as a result. His psychological symptoms began soon after the accident and included intrusive memories of the accident. He experiences visual and auditory flashbacks that accompany these memories. He has not returned to motorcycle riding since the accident. He described nightmares and frequent awakenings with sleep disturbances. He also described dissociative episodes in which he would observe himself from a distance during the accident, together with hypervigilance, social withdrawal, and a persistent negative emotional state.
The Panel is satisfied that but for the accident the claimant would not have developed post-traumatic stress disorder. The Panel finds that the claimant suffered a psychological injury as a result of the accident.

Are the claimed dog walking and washing expenses related to the psychological injury resulting from accident?

An injured person is entitled to statutory benefits for the treatment and care expenses incurred in connection with providing treatment and care for the injured person: s 3.24(1). The expenses in dispute relate to walking and washing the claimant’s dogs.
No statutory benefits are payable for the cost of treatment and care to the extent that the treatment and care concerned did not relate to the injury resulting from the motor accident concerned: s 3.24(2).
The definition of “treatment and care” is set out earlier in these reasons. By reference to that definition, neither the claimed dog walking nor dog washing are: medical treatment (including pharmaceuticals), dental treatment, ambulance transportation, respite care, aids and appliances, prostheses, education and vocational training, home and transport modification, or workplace and educational facility modifications.
Neither the dog walking nor dog washing are part of a process of enabling or attempting to enable the claimant to attain and maintain the maximum level of independent living, and full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life. Accordingly, in this case, these services do not come within the definition of “rehabilitation”.
Dog walking and dog washing are not services that aim to provide assistance to the claimant with everyday tasks of the nature described in the definition of “attendant care services”. Those services are not personal assistance, nursing, or home maintenance. Nor are they analogous to those types of services.
The term “domestic services” is not defined in the MAI Act. Whether pet care, including dog walking and washing, constitutes “domestic services” for the purposes of the MAI Act has not been the subject of judicial consideration. The Panel considers that Geaghan v D'Aubert (2002) 36 MVR 542; [2002] NSWCA 260 (Geaghan); provides guidance with respect to whether pet care constitutes “domestic services”. In that case, Stein JA (Handley JA and Foster AJA agreeing) said this at [61]:
“I do not believe that Griffiths v Kerkemeyer, or any of its extensions, includes the provision of care to an injured persons’ pets or a hobby. The cases have accepted domestic care at home, in the garden and shopping. But counsel has found no case which extends domestic assistance to the care of domestic pets or the retention of a hobby.”
Geaghan has been followed in subsequent decisions including Makaroff v Nepean Blue Mountains Local Health District [2019] NSWSC 715 at [553] and Woods v Collins [2019] SASCFC 146 at [31].
The Panel has considered the reasons of Basten JA in Teuma v CP & PK Judd Pty Ltd [2007] NSWCA 166 at [98] (Teuma). However, the Panel notes that in the same case Ipp JA (Hodgson AJ agreeing) said this at [48]:
“Mr Harben relied on Geaghan v D’Aubert (2002) 36 MVR 542 where Stein JA (with whom Handley JA and Foster AJA agreed) held that Griffiths v Kerkemeyer (1977) 139 CLR 161 services did not include the provision of care to an injured person’s pets or a hobby: see at 549 to 550, [61] to [66]. Leave was not sought to argue that Geaghan was wrongly decided and the appellants did not contend that it was. Accordingly, I do not propose to consider that question. I shall assume the correctness of the proposition upheld in that case.”
The Panel has also assumed the correctness of what was said in Geaghan at [61]. While Geaghan was concerned with a claim for damages and involved different statutory provisions, as stated earlier it offers guidance to the Panel with respect to whether dog walking and washing services are “domestic services”. Because those services involve the provision of care to the claimant’s pet dogs, the Panel concludes they are not “domestic services” as defined in the MAI Act.
Dog walking and dog washing is not analogous to any of the tasks listed in the definition of “attendant care services”. It follows that neither walking nor washing the claimant’s dogs is “treatment and care” for the purposes of s 3.24.
The Panel has found that as a result of the accident the claimant has a psychological injury diagnosed as post-traumatic stress disorder. The Panel has considered the symptoms described by the claimant when he was assessed by the Panel’s medical members, and the impact those symptoms have on his functioning, including social withdrawal. The Panel has also considered the symptoms and functional limitations recorded by Medical Assessor Hong, Drs Dias, Bodel, Vote and Bharadwaj, together with Ms Hayek and the assessor who conducted the “transferable skills analysis assessment” at the request of the insurer.
The Panel notes that in neither of her reports does Ms Hayek record the claimant is unable to walk or wash his dogs (or undertake similar tasks) as a result of his psychological injury.
The Panel is not satisfied the psychological injury resulting from the accident prevents the claimant from washing his dogs. This is a task he could perform without leaving the grounds of his home.
Likewise, his accident caused psychological injury does not prevent him walking his dogs. He lives independently with occupational tools to support his physical disabilities. He catches up with friends twice a week to eat out. From a psychological perspective, he is able to leave his home to walk the dogs.
On the claimant’s history, his inability to walk or wash his dogs is the result of his physical injuries. The claimant reported to Medical Assessor Hong that due to his physical injuries he struggles to walk, that his walking tolerance is “around” 5 minutes and that he uses a walking stick. This is consistent with what the claimant reported to the medical members of the Panel when they re-examined him. The Panel agrees with Medical Assessor Hong that from a psychological perspective the claimant can look after his dogs, including washing and walking them.
The Panel is not satisfied that the impact the claimant’s psychological injury has on his motivation to perform household tasks would prevent him from walking or washing his dogs.
The Panel finds that the claimed dog walking and washing expenses do not relate to the psychological injury resulting from the accident.
Even if one or both of the claimed expenses came within the definition of “treatment and care”, the claimant would not be entitled to statutory benefits for those expenses because they do not relate to the psychological injury resulting from the accident: s 3.24(2).
If, contrary to the Panel’s view, the scope of the dispute includes the question of whether the claimant’s dogs are “treatment and care”, the Panel finds the dogs are not treatment and care provided or to be provided to him that relates to the psychological injury caused by the accident because:
(a)    the claimant did not provide a history indicating that his dogs were playing a role beyond the enjoyment and companionship he experienced as a result of having the dogs;
(b)    the Panel is not satisfied that the dogs resulted in any improvement in the claimant’s psychological state in a manner consistent with them being treatment;
(c)    the dogs do not serve any therapeutic function;
(d)    the dogs are not trained therapy dogs;
(e)    the dogs have no role in assisting the claimant’s ability to live independently or his inclusion in aspects of life, and
(f)    the role played by the claimant’s dogs is the same role that all pets have in their owners’ lives, and the same roll they played in the claimant’s life before the accident.
By reference to the definition of “treatment and care” in s 1.4, the dogs are not “attendant care services”; they do not constitute services that aim to provide assistance to the claimant with everyday tasks, and are not personal assistance, nursing, home maintenance and domestic services. Nor are they akin to any of these services. Further, the dogs are not “rehabilitation”; they do not enable the claimant (or attempt to enable him) to attain and maintain the maximum level of independent living, and full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life. The dogs do not fall within any of the other types of treatment and care in the definition.
Medical Assessor Hong’s certificate is not clearly worded and does not address the dispute that has arisen between the parties. For these reasons, the Panel revokes the certificate and certifies that for the purposes of s 3.24 the claimed dog washing and walking expenses are not “treatment and care” and do not relate to the psychological injury caused by the accident.

[2025] NSWPICMP 832

29 October 2025