Issa v AAI Limited t/as AAMI

DETERMINATION OF REVIEW PANEL
CITATION:	Issa v AAI Limited t/as AAMI [2025] NSWPICMP 541
CLAIMANT:	Charly Issa
INSURER:	AAI Limited t/as AAMI
REVIEW PANEL
MEMBER:	Terence O'Riain
MEDICAL ASSESSOR:	Wayne Mason
MEDICAL ASSESSOR:	Steven Yeates
DATE OF DECISION:	25 July 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury; claimant applied for review of MAC; Medical Assessor certified claimant suffered an adjustment disorder which is a threshold injury under the Act; Held – Review Panel was satisfied that the accident caused an adjustment disorder which is a threshold injury as defined by section 1.6; MAC confirmed.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Review panel assessment of minor injury Replacement certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 (the MAI Act) 1. The Review Panel confirms Medical Assessor Chew’s certificate dated 5 October 2023. 2. The accident caused the following injury: • an adjustment disorder, which is a THRESHOLD INJURY for the purposes of the MAI Act

STATEMENT OF REASONS

BACKGROUND

The claimant was injured in an accident on 17 November 2022.
The insurer is responsible for loss arising from the claimant’s injuries from the subject accident under the Motor Accident Injuries Act 2017 (MAI Act).
The insurer and the claimant are in a dispute about whether the claimant’s injuries caused by the accident are threshold injuries as defined in s 1.6 of the MAI Act.
The claimant applied to the Personal Injury Commission (Commission) to resolve this dispute.
On 5 October 2023 Medical Assessor Gerard Chew assessed the claimant’s psychological injury as a threshold injury, an adjustment disorder.
The President of the Commission constituted the Review Panel (the Panel) to conduct the Review of the Medical Assessor’s certificate dated 5 October 2023.
Pursuant to cl 128(1) of the Personal Injury Commission Rules, 2021 (the PIC Rules) the Panel ‘is to conduct and determine the proceedings in accordance with procedures determined by the panel’.
The Panel met on 22 January 2025 to discuss the material lodged in the portal and whether to conduct a re-examination. It was agreed that it was necessary to re-examine the claimant.
The Panel agreed that due to the insurer putting weight on the claimant’s psychological history before the accident and the importance of the trajectory of his psychological condition after the accident it would assist the Panel if the claimant provided his PBS, Medicare, and Centrelink records since 2020.
Further, the Panel noted that the claimant’s general practitioner (GP) recorded on
24 June 2024 that the claimant had recently spent a year in Lebanon. It would also assist the Panel if the claimant provided a brief statement about how often he has returned to Lebanon since 2014 and how long he had spent on each visit.
The Medical Assessors agreed to examine the claimant together via MS Teams on 28 March 2025 on the Panel’s behalf.

Statutory provisions

Dispute resolution

Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Chew’s, further medical assessments and the review of medical assessments by this Panel.
Applications for review of a medical assessment are made to the President of the Commission on grounds that the assessment “was incorrect in a material respect” (s 7.26(1)). If the President, or his delegate is satisfied “there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect” then the President arranges to the application to be referred to a review panel consisting of a Member of the Commission and two Medical Assessors (s 7.26(2) and (2B)).
The review is not an appeal looking for error and is not confined to the issues raised in the application (or the reply) but is “a new assessment of all the matters with which the medical assessment is concerned” (s 7.263A).
Rule 128 of the Personal Injury Commission Rules (the Rules) 2021 permits the Panel to determine its own proceedings and the Panel is not bound by the rules of evidence and may inquire into relevant matters as it thinks fit.
Part 5 of the Personal Injury Commission Act 2020 (the 2020 Act) enables the Commission to make rules about the practice and procedure before the Commission including proceedings before a panel that will review a decision of a Merit Reviewer or a Medical Assessor.[1]
[1] Section 41(2) of the 2020 Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made under Part 5 of the 2020 Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[2]
[2] Rule 128 of the PIC Rules.

Threshold injury

The term “threshold injury” is defined in s 1.6 of the MAI Act and includes a “threshold psychological or psychiatric injury.” A threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness: s 1.6(3).
Section 1.6 provides the regulations may exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulation) further define threshold psychological or psychiatric injury to include acute stress disorder and adjustment disorder.
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by a motor accident is a threshold injury for the purposes of the MAI Act. Version 9.3 of the Guidelines commenced in December 2024 and applies to motor accidents occurring on or after 1 December 2017. In respect of assessing whether an injury is a threshold injury, the Guidelines provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the assessment of threshold psychological or psychiatric injury. These clauses provide:
“Minor psychological or psychiatric injury assessment
5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders (DSM-5), Fifth Edition, 2013, published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”

Causation

The Guidelines state as follows with respect to causation of injury in respect to assessing permanent impairment:
“Causation of injury
6.5    An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.
6.6    Causation is defined in the Glossary at page 316 of the 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 accident. The accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
Despite the Guidelines referring specifically to permanent impairment in respect of causation, the principles are applicable to assessing causation in respect of the threshold injury question.
The Panel must consider whether the accident caused or contributed to the diagnosed condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

Assessment under Review

Medical Assessor Chew interviewed the claimant on MS Teams on 5 October 2023. The claimant provided a statement dated 25 October 2023 that the interview was brief, being no more than five minutes. This will be further discussed below.
Medical Assessor Chew questioned the claimant about his psychological history before the accident. The claimant denied having any, but the Medical Assessor put the history in the clinical notes to him, which indicated he has experienced psychological difficulties before the accident.
The Medical Assessor diagnosed adjustment disorder stating that the claimant's condition did not match any other DSM – 5 criteria. The reasons did not include a comprehensive history, or a comprehensive description of the claimant symptoms.
The claimant's statement confirmed that during this examination the Medical Assessor asked less than a handful of questions, which could lead to a conclusion this examination did not comply with cl 5.6 of the Guidelines.

Disputes and issues the parties identified

Submissions

Claimant’s submissions

The submissions referred to cls 5.10 – 5.12 of the Guidelines on assessing a psychological condition.
The claimant referred to the Medkare Medical Centre clinical notes as of 21 April 2023, recording that the claimant has been suffering from anxiety symptoms since the accident. The medical records provide that the claimant has been very ‘anxious’, ‘stressed’ and ‘irritable’ since the accident. Accordingly, the claimant submits that his psychological injury is not a ‘threshold injury’ under the MAI Act.
Medical Assessor Chew failed to consider the entirety of the claimant’s treating medical evidence, in particular the records provided in the claimant’s application to admit late documents dated 3 October 2023. It appears that these records were not provided to Medical Assessor Chew because he does not refer to the documents which provide a history of the claimant’s psychological treatment since the date of the accident.
There are several discrepancies between Medical Assessor Chew’s opinion, and the claimant’s treating medical records which shows that there was sufficient evidence that there were psychological complaints made by the claimant immediately after the accident, and a psychological condition was diagnosable, which satisfies the requirement of non-threshold injuries for the purposes of the MAI Act.
The claimant submits that the records provide contemporaneous evidence which shows the claimant sustained a non-threshold psychiatric injury as a result of the accident.

Insurer’s submissions

The insurer submits that there was no error in Medical Assessor Chew’s certificate and reasons.
It was open for the Medical Assessor to make his findings based on the available evidence and his examination of the claimant. The path of reasoning was clearly evident upon a fair reading of the certificate.

Documentation

Summary of relevant documentation

Application for personal injury benefits dated 13 December 2022 includes a description of the accident, which occurred at 8.22am on 17 November 2022 in a roundabout at the intersection of Buist and Cann Streets Bass Hill.
As the claimant was exiting the roundabout another vehicle collided with the left side of his car. Injuries were listed as a “discal” injury to neck, radiculopathy of the upper left limb, injury to left shoulder and psychiatric disorder consisting of anxiety/depression/post-traumatic stress disorder.
The claimant had been employed as a Didi driver and was off work until 9 December 2022.
Complete record of Medkare Medical Centre Dulwich Hill is dated 21 April 2023; the record commences with his general practitioner (GP) Dr Wagdy Latif on 2 January 2009 and as follows:
·        16 November 2009 severe major anxiety. Venlafaxine 75 mg and referral to psychologist Dr Mahmoud Abu Arab. Anxiety was continuing in December 2009 and there were further prescriptions for the antianxiety medication alprazolam on
1 December 2010. Cigarette smoking and asthma were long-term problems. Chronic obstructive pulmonary disease (COPD diagnosed 20 July 2012).
·        10 December 2012 venlafaxine 75 mg prescribed and there was a referral to
Dr Morgan regarding drug health services.
·        12 January 2013 presents with depression and requests housing assistance.
·        15 August 2013 deteriorating COPD, continue rehab.
·        11 October 2014 deteriorating anxiety plus COPD.
·        17 March 2015 diazepam 5 mg as needed for anxiety. Anxiety and depression continuing in April 2015. Exacerbations of asthma in 2016.
·        17 August 2016 COPD, poor compliance, anorexia, underweight, continues smoking. BMI 17.6.
·        1 September 2016 form completed for taxi driver's licence.
·        8 June2017 major stress and anxiety. Diazepam 5 mg prescribed.
·        19 July 2017 exacerbation of asthma and COPD, still smoking, homeless, anxiety and depression with psychomotor retardation, dyspnoea on minor exertion, letter to housing assistance. Still living in car on 24 July 2017.
·        30 August 2018 chronic anxiety and depression, underweight, poor nutrition, excessive marijuana user.
·        21 September 2018 chronic anxiety and depression with insomnia. Chronic neck and lower back pain.
·        5 February 2019 major stress and anxiety, insomnia +++, still smoking marijuana daily.
·        15 November 2019 malnutrition, underweight, marijuana abuse.
·        8 September 2020 deteriorating depression, house in Lebanon damaged with recent blast, lost multiple relatives.
·        9 November 2020 mild manic depression/bipolar, severe irritability, anxiety and restlessness, escitalopram 20 mg and Seroquel 25 mg at night.
·        23 February 2021 escitalopram 20 mg ceased; quetiapine 50 mg at night.
·        18 June 2021 chronic neck pain, bilateral shoulder pain, chronic depression and anxiety, underweight, anorexia, excess marijuana plus COPD plus heavy smoking.
·        9 December 2022 reports subject motor vehicle accident. MRI cervical spine.
·        16 December 2022 pain worse on left side of neck radiating to left shoulder interrupting sleep. Panadeine Forte prescribed.
·        14 March 2023 not commenced physiotherapy.
·        23 March 2023 Norgesic 35/450 mg 2 tablets 3 times daily.
·        13 April 2023 had only 1 session of physiotherapy, anxious and irritable, diazepam 5 mg as needed.
Centrelink medical certificates dated 16 November 2009 indicates severe anxiety and panic; unable to work or study. Referred for counselling and SSRI commenced. Similar certificate dated 10 September 2012. On 15 November 2013 certificate listed anxiety and major depression plus severe asthma. On 15 April 2015, the condition was anxiety and panic. On 15 March 2016, 8 September 2016, 20 March 2017, 30 August 2018 and 9 September 2019, the conditions were anxiety and major depression plus severe asthma and left shoulder pain.
Physiotherapist Ms Tracey Wu on 5 May 2023 noted the claimant had returned to work and was driving for six hours.
AHRR 1 referral by Dr Wagdy Latif to social worker Ms Jamille Abou Raad is dated
14 August 2023. Diagnosis is depression and anxiety plus chronic pain. Symptoms were described as frustration, irritability, low self-esteem, flashbacks related to accident, lack of motivation, symptoms getting worse, heightened anxiety around driving resulting in jerking, fear, low mood, impacting on caring for self, high levels of stress and depression, linked to constant pain daily, financial stress due to less work hours and low income resulting in alcohol drinking at home. The document states there was no history of depression or anxiety before this accident and no history of counselling intervention before the accident. Plan was to continue with cognitive behavioural therapy (CBT) and liaise with referring doctor. It records the claimant stated he was driving 40 hours/week as a taxi driver over 14 years.
First session with Ms Raad on 14 August 2023:
·        claimant is currently driving five days/week for five to six hours/day.
·        12 September 2023 second session. Commenced new employment in a glass factory 2 weeks ago, doing 20 hours over two and half days. Constant pain on the left side.
·        17 October 2023 third session. Working in a glass factory
·        20 November 2023 fourth session. Left work. Stress due to work and health issues.
·        9 January 2024 fifth session. Receiving Centrelink payments: Managing pain and seeking employment.
·        13 February 2024 sixth session. Not in employment. Struggling without car. Criminal check to drive taxi. Pain increasing and causing depression.
·        12 March 2024 seventh session. Not attending physio because no benefit, constant pain, considering construction work.
·        23 April 2024 eighth session. Medical certificate reviewed. Court attendance x 2, second appeal. On Jobseeker.
·        28 May 2024 physical health worsening. Court case first time loss and second time appeal. COVID-19 infection. Needs glasses.
·        24 June 2024 pain increasing and referred to new physio. Previously was in Lebanon Army for 1 year.
·        29 July 2024 unable to lift arm due to dog attack. Pain worsening.
·        2 September 2024 needs Valium to go out. Taxi driving two days/week.
·        23 September 2024 hand less functional, unable to hold cigarette.
·        21 October 2024 hand worse, unable to hold phone.

AHRR 2 by Dr Wagdy Latif to social worker Ms Jamille Abou Raad is dated 29 April 2024.
Dr Wagdy Latif’s report to insurer AAMI indicates there was no psychological diagnosis until 16 December 2022 and the claimant had not been referred for psychological treatment. Medications consisted only of Mobic and Panadeine Forte. On 3 March 2023 he indicated there were no reported psychological injuries.
Services Australia information indicates medical certificates for fractures and crush injuries from 3 December 2024 until 6 April 2025 with no fitness for work.
Medicare history statement indicates no consultations with a psychologist or psychiatrist.
Employment Services Assessment reports on 27 October 2020, 28 November 2022 and
11 July 2023 indicated baseline work capacity of between 8 and 14 hours with potential to improve to 15 to 22 hours. Conditions listed were asthma and COPD, anxiety and depression, and left neck and shoulder pain.
Plaintiff's statement indicates he is an Australian citizen. He was born in Beirut, Lebanon, which made him now 52 years of age. He migrated to Australia in 2007. He returned to Lebanon to visit his family between 10 December 2017 and 11 January 2018. He stated his family paid for his trip.

REVIEW PANEL FINDINGS

Who attended the assessment

On the date fixed Medical Assessor Mason and Medical Assessor Yeates examined Mr Issa via video assessment.
The Panel identified the claimant from his photograph on his NSW driver license. He was located alone in the room at his lawyer's office.
He was interviewed using the Microsoft Teams application with a good internet connection. The interview commenced at 9.00am and concluded at 10.10am. He was assisted by a NAATI certified Arabic interpreter. Mr Issa demonstrated a good command of the English language and required interpreter assistance on only a few occasions.

Personal history

Mr Issa is a single man who lives alone in Department of Housing accommodation in a Western Sydney suburb. He is not in a relationship and does not have children. He said he has not worked for one year. He currently receives sickness benefits because of a 10 m fall from his balcony three months ago in which he sustained two fractures of his right humerus. He said he last worked one year ago as a Didi driver.
Mr Issa described a normal birth and development. His 90-year-old father was in hospital in Lebanon and was expected to die within 48 hours of this examination. His mother died of breast cancer two years ago at the age of 78 years. Mr Issa is the eighth of nine children; his siblings are now all living in Lebanon. He said his sister travels between Lebanon and Australia.
He described a happy early family life in which he suffered no form of abuse. When questioned about exposure to civil unrest in Beirut he said there were many wars, it was crazy and it was scary growing up. He said he was frequently fearful for his life but denied any long-term post-traumatic effects. He specifically denied nightmares, intrusive recollections and disturbed sleep related to the civil unrest.
He attended school until year 11 but left before completion. He then worked in import/export for four or five years and subsequently in "night life hospitality" for five or six years. He completed the compulsory one year service in the Lebanese Army between 1993 and 1994. He said he experienced only military training and was not involved in military conflict.
Mr Issa said his brother and sister were living in Australia and he briefly visited here in 2003 and 2005. He married in Lebanon in 2007 and then migrated to Australia. He was married for four years and said the marriage did not work out. When asked what the problem was, he said after coming to Australia "everything about the marriage was wrong". He said it caused him to become depressed and they separated in 2011. He has not been in a relationship since then.
After he separated from his wife Mr Issa stated he lived in boarding houses but acknowledged he had a bad real estate rental record for failure to pay rent. He consequently was moving from boarding house to boarding house. In 2017 he spent approximately eight months homeless and was living in his car.
Work history in Australia consisted of taxi driving between 2009 and 2016; he said he continues to hold a taxi driver's licence. He commenced Uber driving for one year and then Didi driving for two years because it was more flexible. He also drove limousines for one year in 2018. He returned to Didi driving in 2020 and said he was driving six or seven hours/day.
When asked about leisure activities prior to the accident Mr Issa said he would come home and cook and he did not go out very much. He said in the past he enjoyed swimming, snow skiing and music. He also enjoyed watching movies on YouTube and looking at Instagram.
Mr Issa initially denied any past insurance claims for motor accident or workers compensation matters. Later in the interview he acknowledged he had been involved in multiple small motor accidents in his work as a driver; he said these were not serious, did not involve injuries and did not result in claims for treatment or compensation.
Mr Issa initially denied any history of problems with the law. He then added in 2015 he had an argument with a lady in a boarding house in Balmain over access to a washing machine. He then stated this occurred in a boarding house in Tempe. She apparently laid charges against him which were dropped. He said they later became friends. There was a second incident where he experienced road rage after another Uber driver changed lanes on him and forced him onto the kerb. He said he reported the matter to the police and he was then later required to attend the police station for follow-up but did not do so. He was subsequently charged but said the matter was dismissed when it went to court.
With regard to medical history Mr Issa was asthmatic from birth. His GP reported exacerbation of COPD due to smoking which he acknowledged. He described recurrent pulmonary infection requiring treatment with antibiotics. His GP had noted concern about his low body weight; he also acknowledged this has been and continues to be a problem. He said he has not undergone any surgery.
When asked about past psychiatric history he said, "not really". He was then reminded that he had been depressed in 2009 following the ending of his marriage. He was also reminded of multiple entries in the GP medical record regarding anxiety and depression. He reluctantly agreed there had been anxiety and stress since 2009 but insisted it had never been severe. When specifically questioned he agreed he had required the use of both antidepressant and anxiolytic agents between 2009 and 2021. Mr Issa denied any family history of psychiatric illness.
Drug and alcohol history consists of the continuing use of 15 cigarettes/day despite difficulties with asthma. Alcohol consumption consists of half a bottle of white wine on three or four days/week. He commenced marijuana use in 2016 and continued to use it regularly on the weekend. Until February 2019 he was using 1.5 g/day but insisted he had reduced the amount over the last three years. He also reluctantly acknowledged purchasing an unregulated substance called “scrubba” intermittently from tobacconists. It was not possible to determine from him if this was a psychoactive substance or a form of vape. He said he continues to use marijuana on weekends. He then added he had stopped all drugs one or two years ago. He denied ever using illicit opioids, amphetamine, or other substances such as cocaine or hallucinogens. With regard to caffeine, he consumes one coffee and several bottles of Coca-Cola per day. In general terms the history he provided regarding substance use was internally inconsistent.
Current medications consist of agents for control of asthma including Ventolin and Symbicort. He said he needed antibiotics every two months to control recurrent pulmonary infections. With regard to anxiety, he said he was using diazepam 5 mg but insisted this was stopped three months ago. He denied the use of an antidepressant but later acknowledged using escitalopram 10 mg for four or five months during 2024.

History of the accident

On 17 November 2022 Mr Issa stated he was using a rental car and was on his way to pick up a Didi passenger. He was passing through a roundabout when he was T-boned by another vehicle on the passenger side. He said the impact was with both the front and rear passenger doors. He was wearing a seatbelt but airbags did not deploy. He said he did not see the vehicle before it hit him because it was coming fast. He experienced immediate pain on the left side of his neck but was able to exit the vehicle while holding his neck. Neither police nor ambulance attended. He exchanged details with the other driver. He was able to drive the vehicle back to the base and repairs were arranged.

History of symptoms and treatment following the accident

Mr Issa said he went back to work as a Didi driver for 10 to 15 days but was in increasing pain so he attended his GP Dr Latif after 15 or 20 days. He in fact attended four weeks later on 9 December 2022. Dr Latif provided Mobic and Panadeine Forte and referred him for X-rays of his neck. He was also referred for physiotherapy which did not help much. He said eventually the insurer refused to fund ongoing physiotherapy.
After another 15 days he said he became stressed and he started to get angry. He said if people upset him on the road he would "give them the finger" or "flip them", by which he meant driving in front and cutting them off. He said he attempted to continue working by using heat packs and Tiger Balm to manage the pain but it caused him to slow down.
He then described the development of depression and anxiety. He would make himself go to work but after 5 or 10 minutes would become stressed and was unable to do it. He said he became fearful and could no longer force himself to do it. He said if another vehicle came close to him, he would have a reaction. He said he pressured himself to continue working. He was determined to force himself to work through the pain and through the worry but in the end, he said he got lost in the process. He would experience anger and frustration in the streets while driving. The more upset he got, the worse the pain became in his left neck and shoulder. He said the pain would affect his fingers and make them numb. He said this happened while he was driving and also if he was a passenger in a taxi, a train, or a bus. He said he started to slow down
Mr Issa said at that point he developed mental problems and became depressed because he was not making any money. At that time, he was in boarding house accommodation at Hurlstone Park and he was evicted by the police for failure to pay rent and again became homeless. Eventually with the assistance of Dr Latif he obtained Department of Housing accommodation.
Mr Issa was asked on four occasions to outline any other psychological symptoms he has experienced since the accident. These have been described above and he confirmed there were no further symptoms to add.
When asked about treatment, he said he was provided with diazepam by Dr Latif to assist with his anxiety. In August 2023 he was referred to social worker/counsellor Ms Jamille Abou Raad and had attended approximately 10 counselling sessions before the insurer withdrew funding three months ago. He described the sessions as helpful because she was "someone to talk to". He was prescribed the antidepressant escitalopram 10 mg which he used for a few months but that ceased five months ago. He did not believe it was helpful. He continues to use diazepam 5 mg intermittently.

Injuries or conditions since the accident

As noted above Mr Issa described a period of homelessness when he was forced to live in his car.
In November 2024 Mr Issa fell 10 m from the balcony of his home and sustained two fractures of his right humerus. He is receiving treatment at Bankstown Hospital. The fractures were managed conservatively with a sling. He describes significantly reduced function of his right arm which has exacerbated claimed difficulties with his left arm arising from the accident.
He did not indicate any degree of distress at his father’s imminent death.

Current symptoms

Mr Issa described ongoing anxiety about being hit by another vehicle while driving. However, until injuring his right arm he was able to drive a taxi on two or three days/week with the assistance of diazepam. He continues to complain of symptoms arising from his left neck and shoulder which impact the function of his left hand. He described some degree of depression because of his inability to earn money. Currently, this is exacerbated by the fractures of his right humerus. He said he remains frustrated and easily irritated.

Current and proposed treatment

There is no current or proposed psychological or psychiatric treatment. He continues to use intermittent diazepam 5 mg.

Mental state examination

Mr Issa is a right-hand-dominant man whose appearance is consistent with his stated age.
Mr Issa was neatly dressed and well presented. Throughout the interview he displayed no evidence of anxiety or depression. He denied suicidal ideation. His range of affective expression was full and appropriate. He complained of pain in his left neck and shoulder along with hand pain and numbness arising from the accident. He also complained of pain and restricted movement of his right arm and shoulder following a fall from his balcony in November 2024. No specific pain behaviour was evident throughout the interview.
He was cooperative with the interview but the Panel found it very difficult to obtain accurate details with regard to his past history, particularly in relation to the use of substances and pre-accident difficulties. He tended to provide vague summaries of events and despite repeated questioning it was not possible to obtain a clear history.
Mr Issa was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.

Current functioning

Mr Issa is a tall thin man who was well presented for the interview. He related well to the Panel members. There appeared to be no difficulty with his self-care and personal hygiene. He described reduced social activity because of his physical injuries and noted he tended to stick to himself. He is able to use all forms of transport. He is not in a relationship and has not been for many years. There were no problems with his concentration, persistence, and pace throughout the interview. He is capable of working three days/week as a driver but is currently restricted from doing so because he injured his right arm.

Consistency of presentation

There were number of inconsistencies in Mr Issa’s presentation which have been described above throughout the report.

Formulation

Mr Charly Issa was involved in a T-bone collision in a roundabout on 17 November 2022,
two years and five months before the re-examination.
He first attended his GP with physical pain four weeks later and was first noted to be anxious and irritable four months later. During the interview with the Panel, he described symptoms of frustration and irritability related to his physical injuries and increasing pain and difficulty with driving. He subsequently became anxious while driving and depressed at his inability to earn a living.
At no time during the interview did he describe trauma related symptoms such as fear of serious injury in the accident. Nor did he describe nightmares, flashbacks, or intrusion symptoms subsequent to the accident. In addition, he did not describe anhedonia and ongoing suicidal ideation.

Causation and reasons

Mr Issa was involved in an accident on 17 November 2022 which was capable of causing physical and psychological symptoms.
While there is some evidence that Mr Issa experienced chronic anxiety and depression before the accident until June 2021, there was no evidence that it was present at the beginning of 2022. The Panel therefore concluded his symptoms of anxiety and depression were caused both directly and indirectly by the accident.

Diagnosis and reasons

Psychiatric members of the Panel reached the conclusion that Mr Issa meets DSM-5-TR diagnostic criteria for persistent adjustment disorder with mixed anxiety and depressed mood as follows:[TO1]
Criterion A. He developed emotional and behavioural symptoms within 3 months of the accident.
Criterion B. He developed clinically significant symptoms which were out of proportion to the severity of the stressor and they resulted in impairment in social and occupational functioning.
Criterion C. The symptoms do not meet criteria for another mental disorder and are not merely the exacerbation of a pre-existing mental disorder.
Criterion D. Because the symptoms have persisted for more than 6 months the condition is present in persistent form.
The psychiatric members of the Panel were satisfied that the accident did not satisfy criterion A for a diagnosis of DSM-5-TR post-traumatic stress disorder [TO2] because it was not life-threatening.
Similarly, psychiatric members of the Panel were satisfied that Mr Issa did not satisfy DSM-5-TR criteria for major depressive disorder because he does not have depressed mood most of the day nearly every day and does not experience recurrent thoughts of death or suicidal ideation. He also does not satisfy DSM-5-TR criteria for persistent depressive disorder because he has not had depressed mood most of the day for more days than not for at least two years.
Mr Issa does not meet DSM-5-TR Criterion A for specific phobia of driving simply because he is able to drive.
Finally, Mr Issa does not meet DSM-5-TR Criterion A for generalised anxiety disorder because he does not describe excessive anxiety and worry occurring more days than not for at least six months about a number of events or activities such as work or school performance.

Panel’s deliberations

The Panel met on 17 April 2025 and adopted the re-examination report as evidence in this case.
This was a dispute about whether the claimant suffered a non-threshold psychological injury in the motor accident; the claimant was re-examined by both Medical Assessors of the Panel who found that the diagnosis meets DSM-5-TR diagnostic criteria for persistent adjustment disorder with mixed anxiety and depressed mood.
The Panel considered whether the accident had caused the claimant to have ever suffered from a psychological injury that would fall outside the definition of a threshold injury, which would satisfy DSM-5 criteria, but was currently in remission.
The Panel observed that if that was the case then the Panel would have to revoke Medical Assessor Chew’s certificate dated 5 October 2023.[3]
[3] Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6.
The Panel decided Mr Issa had not ever met DSM-5-TR criteria for a non-threshold injury since the motor accident. The Panel noted the presence of an adjustment disorder in the past following the ending of his marriage in 2009. There had also been intermittent recurrences to this condition from time to time prior to the motor accident. The Panel specifically did not agree with the psychiatric diagnostic conclusions of his GP Dr Wagdy Latif because his conclusions did not meet DSM-5-TR criteria.

Threshold injury

Persistent adjustment disorder with mixed anxiety and depressed mood is a threshold injury for the purposes of the MAI Act.

Conclusion

The Review Panel’s findings in relation to the threshold injury confirm the findings as stated in the Medical Assessor Chew’s certificate dated 5 October 2023. The Review Panel has determined this certificate is to be confirmed.

[TO1]Is this a threshold injury?

[TO2]Were there other times when the DSM 5 TR was satisfied?

[2025] NSWPICMP 541

25 July 2025