Jones v Allianz Australia Insurance Limited

DETERMINATION OF REVIEW PANEL
CITATION:	Jones v Allianz Australia Insurance Limited [2025] NSWPICMP 755
CLAIMANT:	Eliza Jane Jones (by her authorised representative Cathy Fox)
INSURER:	Allianz Australia Insurance Limited
REVIEW PANEL
MEMBER:	Bianca Montgomery-Hribar
MEDICAL ASSESSOR:	Paul Friend
MEDICAL ASSESSOR:	Thomas Newlyn
DATE OF DECISION:	5 September 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury dispute; psychological injury; claimant passenger on bus; consideration of specific phobia, adjustment disorder, and post-traumatic stress disorder; significant medical history; claimant examined; Held – claimant meets the criteria for specific phobia, situation (bus travel) and adjustment disorder with anxiety; psychological injuries caused by the accident; specific phobia (bus travel) is not a threshold injury; MAC revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Christopher Rikard-Bell dated 28 November 2023. 2. The Review Panel issues a new certificate determining that the following injuries were caused by the motor accident: (a) specific phobia, situational (bus travel), which is a non-threshold injury for the purposes of the Motor Accident Injuries Act 2017, and (b) adjustment disorder with anxiety, which is a threshold injury for the purposes of the Motor Accident Injuries Act 2017.

STATEMENT OF REASONS

INTRODUCTION

On 5 December 2019, Eliza Jane Jones (claimant) fell off her seat when the bus she was travelling on “slammed on the brakes” (accident). This caused the claimant to hit her head on the glass pane in front of her seat and fall to the floor.
The claimant made a claim for statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act) on Allianz Australia Insurance Limited (insurer).
A dispute has arisen between the insurer and the claimant as to whether the claimant’s psychological injuries are “threshold injuries” within the meaning and for the purposes of the MAI Act.
Whether the claimant has suffered threshold injuries as a result of the accident affects her entitlement to both statutory benefits and damages: see ss 3.11, 3.28 and 4.4 of the MAI Act.
Pursuant to Schedule 2, cl 2(e) of the MAI Act, whether the injury caused by the accident is a threshold injury for the purposes of the Act is a medical assessment matter. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act, at first instance by a Medical Assessor,[1] and on review by a review panel.[2]
[1] Section 7.20, MAI Act.
[2] Section 7.26, MAI Act.
The dispute was referred to Medical Assessor Christopher Rikard-Bell. On 25 October 2023, the claimant was assessed by Medical Assessor Rikard-Bell, who issued a certificate on 28 November 2023. The Medical Assessor concluded that the claimant’s adjustment disorder, caused by the accident, was a threshold injury for the purposes of the MAI Act. The Medical Assessor concluded that “Specific phobia, other non-minor psychological injury”

was not caused by the accident.
The claimant lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Rikard-Bell’s assessment under s 7.26 of the MAI Act. On 7 February 2024, a delegate of the President determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect, on the basis that Medical Assessor Rikard-Bell failed to apply the correct test as to threshold injury. Accordingly, the delegate referred the application to a Review Panel.
This Review Panel (the Panel) has been constituted to conduct a review of Medical Assessor Rikard-Bell’s certificate dated 28 November 2023.

LEGISLATIVE FRAMEWORK

Appointed representative

The claimant is a person under a legal incapacity in accordance with s 7.47(2) of the MAI Act as she is a child under the age of 18 years old.
On 29 March 2023, the Commission issued an Appointed Representative Certificate in accordance with s 7.47 of the MAI Act, appointing Ms Cathy Fox to be the appointed representative for the claimant for the purposes of Division 7.7, until such time as the claimant turns 18 years of age.

Threshold injury (formerly minor injury) provisions

The Motor Accident Injuries Amendment Act 2022 (the MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From 1 April 2023, the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”. The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
The accident occurred and the original liability notices were issued by the insurer when the relevant term was “minor injury” which, because of the MAI Amendment Act, is now described as a “threshold injury”. Any reference in these reasons to “minor injury” is taken to be a reference to a “threshold injury”.
A threshold injury is defined in s 1.6 of the MAI Act and relevantly includes a “psychological or psychiatric injury that is not a recognised psychiatric illness”.
Section 1.6(4) of the MAI Act provides that the regulations may exclude or include a specified injury from being a threshold injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulations) further defines threshold injury as follows:
“4 Meaning of “threshold injury”, section 1.6(4) of the Act
…
(2) Each of the following injuries is included as a threshold injury for the purposes of the Act—
(a) acute stress disorder,
(b) adjustment disorder.
Note— See section 1.6 (5) of the Act in relation to the making of Motor Accident Guidelines for or with respect to the assessment of whether an injury is a threshold injury.
(3) In this clause acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013.”
Sub-section 1.6(5) provides that “[t]he Motor Accident Guidelines may may provision for or with respect to the assessment of whether an injury is a threshold injury for the purposes of this Act”.
Part 5 of the Motor Accident Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. Version 9.3 of the Guidelines is effective from 6 December 2024 and replaced version 9.2, except for claims arising from motor accidents before 1 April 2023.[3] For such accidents, such as the current accident, certain clauses do not apply, and specific clauses from version 9 of the Guidelines continue to apply.
[3] The current version of the Guidelines, v9.3, applies to policies that come into effect immediately after midnight 14 January 2025. For policies that come into effect from 15 January 2024 to 14 January 2025, Part 1 of the Motor Accident Guidelines v9.2 continues to apply: see clause 1.2. The Panel notes that version 10 of the Guidelines has been published, but does not commence until 15 September 2025.
The Guidelines contain the procedure for assessing whether an injury caused by the accident is a threshold injury for the purposes of the MAI Act, and provide the following general provisions for assessment:
“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    Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. 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.”
Further, cls 5.10-5.12 regard threshold psychological or psychiatric injury assessment and provide:
“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, Fifth Edition, Text Revision (DSM-5-TR), 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.”

Review procedure

Section 7.26(5A) of the MAI Act provides that the review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission.
The review of the medical assessment is not limited to a review of only that aspect that is alleged to be incorrect and is to be by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act. The function of the medical assessor is to form his or her own opinion on the medical question in dispute; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[4]
[4] Insurance Australia Group Ltd t/as NRMA Insurance v Keen [2021] NSWCA 287 and Insurance Australia Ltd v Marsh [2022] NSWCA 31.
As the High Court concluded, with respect to a medical panel:
“The function of a Medical Panel is neither arbitral nor adjudicative: it is neither to choose between competing arguments, nor to opine on the correctness of other opinions on that medical question. The function is in every case to form and to give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise”.[5]
[5] Wingfoot Australia Partners Pty Ltd v Kocak (2013) 252 CLR 480; [2012] HCA 43 at [47].
Part 5 of the Personal Injury Commission Act 2020 (PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a panel reviewing a decision of a Medical Assessor: s 41(2) PIC Act. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5. A review panel determines how it conducts and determines the proceedings.

PROCEDURAL HISTORY

On 10 December 2024, the Panel was convened in this matter. Also on 10 December 2024, the Panel made directions for a joint bundle from the parties and written submissions for the purposes of the Review.
Upon consideration of the joint bundle, the Panel identified that several potentially relevant documents had not been produced. These documents included community mental health clinic records and clinical records from the claimant’s general practitioner (GP) from 2 March 2022 to 26 February 2025.
On 26 February 2025, the Panel met to discuss the proceedings. On 26 February 2025, the Panel made directions for a supplementary bundle to be provided by the claimant by 25 March 2025 which contained those documents. Also on 26 February 2025, the Panel determined that an examination of the claimant was required. The Panel made directions for the claimant to be examined by Medical Assessor Newlyn and Medical Assessor Friend on behalf of the Panel on 31 March 2025.
On 31 March 2025, the medical examination with Medical Assessors Newlyn and Friend took place. The Panel then reconvened for a second teleconference on 14 April 2025.
The records of Ingleburn Community Health, being documents relevant for inclusion in the supplementary bundle, were not provided prior to the medical examination on 31 March 2025.
On 7 April 2025, the claimant informed the Panel that there had been a significant delay in obtaining the records of Ingleburn Community Health and that these were likely to be received by mid-April. The Panel informed the parties that these records were a relevant consideration, and it was possible that the claimant would need to be re-examined depending on the content of those documents.
On 17 April 2025, a sub-set of the records of Ingleburn Community Health were produced by the claimant.
On 23 April 2025, after considering the records of Ingleburn Community Health, the Panel determined that the claimant should be re-examined. The parties were informed accordingly.
On 12 May 2025, the claimant was re-examined by Medical Assessor Newlyn and Medical Assessor Friend. Given statements of the claimant’s mother regarding treatment that occurred through Ingleburn Community Health in 2020 and 2021, the Panel issued directions on 12 May 2025 for the outstanding records of Ingleburn Community Health to be provided.
On 19 May 2025, the claimant requested a four-week extension to provide the records. On 18 June 2025, the claimant requested a further four-week extension to provide the records. The Panel granted both extensions sought by the claimant given the potential relevance of the documents to the Review.
On 10 July 2025, the claimant requested that the Commission issue a direction for production on Ingleburn Community Health in respect of the records. The Member on the Panel issued the requested direction later that day.
On 8 August 2025, the claimant produced the further records of Ingleburn Community Health, under cover letter titled Macarthur Primary and Community Health, and a medical report of Dr David Sainsbury dated 21 July 2025.
The Panel reconvened for a third teleconference on 20 August 2025 to discuss the further records of Ingleburn Community Health and the medical report of Dr David Sainsbury. They also discussed their conclusions following a review of all documentation and the two medical examinations of the claimant.

ASSESSMENT UNDER REVIEW

On 25 October 2023, Medical Assessor Rikard-Bell examined the claimant and subsequently issued a certificate dated 28 November 2023. The threshold injury dispute to be assessed was noted by the Medical Assessor as “Psychiatric condition – specific phobia, other non-minor psychological injury”. The Medical Assessor concluded that the accident caused an adjustment disorder which is a threshold injury for the purposes of the MAI Act.

History

The Medical Assessor noted that the initial history was obtained from the claimant’s mother.
The claimant was noted to be a 9-year-old girl who is in Year 4 at primary school and resides with her older brother and older sister. The claimant was diagnosed with attention-defect/hyperactivity disorder (ADHD) at the age of 3 years old and commenced treatment with medication (Ritalin) in 2022. The claimant had her tonsils and adenoids removed in relation to obstructive sleep apnoea. The Medical Assessor noted that the claimant has missed a lot of school due to pain over the past two and a half years, and that her current medication is Ritalin 10 mg, Amitriptyline 10 mg and Clonidine 50 µg.
The Medical Assessor reported that he asked the claimant about the accident, and she said that when they got off the bus she felt quite scared. The Medical Assessor recorded that the claimant does not like buses, but she can get on a bus or a coach with seatbelts fitted as she feels safe. The Medical Assessor noted that it was unclear as to whether there is regular bus travel, however the claimant most likely avoids travelling on buses except for special circumstances.
The Medical Assessor noted that in 2022 the claimant was referred to the community mental health clinic for fortnightly sessions which were helpful. This treatment came to an end. There was continued treatment through the pain clinic at Westmead Children's Hospital from May 2023 on a three weekly basis which is also noted to have been helpful.
It was noted that the claimant continues to struggle with pain. On certain days there is no pain, however at other times, the claimant will have pain aggravated by movement or touching her neck. According to her mother (and Appointed Representative), this pain varies from between 4 out of 10 to 10 out of 10. The claimant refused to return to school until the pain settled.

Reasons of Medical Assessor

The Medical Assessor formed the view that, following the accident, there was most likely an adjustment disorder in relation to pain with sleep disturbance, pain avoidance behaviour, hypersensitivity to touch and fear of further injury or another motor vehicle accident. He found that the psychological condition is causally related to the accident and is a threshold injury.
The Medical Assessor recorded a subsequent minor motor vehicle accident in September 2023, which has not caused any ongoing issues but did scare the claimant a little.
The claimant’s mother reported that the claimant is currently sleeping well with medication, however without medication she suffers from interrupted sleep and difficulties with nightmares. The claimant was asked what her dreams were about, and she responded “the accident”. The Medical Assessor noted he was unable to get a clear description of the dreams and there seemed to be no distress in relation to dreams, despite the claimant’s mother emphasising that there were a lot of nightmares. The Medical Assessor noted that he did not place a great deal of weight upon the report of the nightmares and dreams of the accident as the claimant’s mother, who was also involved in the accident, appeared to be quite distressed about her own issues.
The claimant was reported to have a normal appetite, weight and growth. Her mood fluctuates and she can be irritable. There are no panic attacks, however she does not like to travel on a bus unless there are seatbelts.
The Medical Assessor recorded there was no impairment of self-care and personal hygiene, no impairment of social functioning, mild impairment of concentration, persistence and pace, and no impairment of social and recreational activities. The Medical Assessor opined a mild impairment of adaptation and a mild impairment of travel.
The Medical Assessor referred to the report of Dr Rastogi dated 16 February 2022. It was noted by the Medical Assessor that Dr Rastogi diagnosed specific phobia with pre-existing ADHD and some exacerbation of ADHD. Dr Rastogi found 6% whole person impairment with moderate impairment of travel.
The Medical Assessor formed the view that following the motor accident there was most likely an adjustment disorder in relation to pain with sleep disturbance, pain avoidance behaviour, hypersensitivity to touch and fear of further injury or another motor vehicle accident. It was noted that the claimant has been able to gradually overcome the anxiety in relation to buses and, although Dr Rastogi described a specific phobia of buses, “…to [the claimant’s] credit she has been able to join in on a number of school excursions travelling by bus, therefore the fear of buses has not significantly restricted her daily life”.

The Medical Assessor certified that the claimant’s psychological condition of adjustment disorder is causally related to the accident and a threshold injury for the purposes of the MAI Act. He certified that “specific phobia, other non-minor psychological injury” was not caused by the accident.

SUBMISSIONS

Both parties rely on their submissions lodged in relation to the application for review pursuant to s 7.26 of the MAI Act before the delegate of the President. The insurer also relies on its submissions in relation to the threshold injury dispute before Medical Assessor Rikard-Bell. The parties did not lodge any further submissions.
While the parties’ submissions are directed to the assessment of Medical Assessor Rikard-Bell, the Panel has considered them for the purposes of its Review.

Claimant’s submissions dated 22 December 2023

The claimant submits that Medical Assessor Rikard-Bell erred because he asked himself the wrong question, namely, whether the claimant suffered a specific phobia at the time of his examination, rather than at any time post-accident. The claimant submits that, where a decision maker asks the wrong question, a jurisdictional error arises.
The claimant submits that the Review Panel in David v Allianz Australia Insurance Ltd[6] enunciated the correct test for threshold injury.
[6] [2021] NSWPICMP 227 (David).
The claimant submits that Dr Rastogi provides a diagnosis of specific phobia, and that “if a specific phobia is decided to be accident related, then it follows that the claimant suffers or suffered a non-threshold injury.”
The claimant notes that Medical Assessor Rikard-Bell refers to the opinion of Dr Rastogi, but declined to find a panic[7] disorder because “to Eliza’s credit she has been able to join in a number of school excursions travelling by bus” and that she had been able to “gradually overcome” her fear of buses.
[7] The Panel assumes this should read “phobia” disorder instead of “panic” disorder.
The claimant submits that Dr Rastogi’s opinion was provided based on an assessment on 16 February 2022 and the Medical Assessor’s reasoning does not consider whether the claimant, at any time, had symptoms sufficient to warrant a diagnosis of a specific phobia which had improved or resolved. The claimant also refers to clinical records of the Children’s Hospital, which note that she was “initially avoidant of buses”. The claimant submits that, given the motor accident occurred in 2019 and Dr Rastogi’s assessment was in February 2022, it is conceivable that the phobia had been present for well in excess of the six months required under the DSM-5.

Insurer’s submissions dated 7 December 2022

The insurer submits that, in accordance with the MAI Act, for a psychological injury to be a non-minor injury, a suitably qualified person must diagnose a recognised psychiatric illness in accordance with DSM-5. The only reference to the claimant having sustained a psychological injury is contained in the claimant’s medico-legal report of Dr Richa Rastogi, psychiatrist, dated 16 February 2022. In her report, Dr Rastogi diagnosed the claimant with specific phobia disorder and attention deficit disorder with mild learning disability, pre-existing with exacerbation.
The diagnosis of specific phobia disorder is submitted by the insurer to have been made on the basis that the claimant reported she engages in fear avoidant behaviours related to travelling on a bus, refuses to get on a bus, and described irrational fears with worrying and catastrophic thoughts. The insurer submits that Dr Rastogi failed to identify the requisite criteria required to satisfy a diagnosis of specific phobia disorder under DSM-5, and that the claimant does not meet the diagnostic criteria to support the diagnosis. In particular, the insurer submits that Dr Rastogi did not address criterion D, E or F.
The insurer notes that Dr Rastogi does not comment on the absence of psychological complaint by claimant in her application for personal injury benefits, the WorkCover Certificate of Capacity dated 9 January 2020, or at any attendances upon Ingleburn Medical Centre between 6 December 2019 and 12 January 2022. The clinical notes of this practice do not include any reports of psychological injury and/or a phobia of buses following the accident.
The insurer records that, as at 7 December 2022, no referrals for treatment had been received with respect to the alleged psychological injury.

Insurer’s submissions dated 22 January 2024

The insurer submits that there is no material error in Medical Assessor Rikard-Bell’s certificate, and the assertion that he failed to apply the correct test as to threshold injury is simply a manifestation of the claimant’s disagreement with the Medical Assessor’s clinical findings.
The insurer notes that David involved consideration of whether radiculopathy needed to be present at the medical assessment or whether it was sufficient to have been found at any time following the accident. There, the review panel concluded that the latter was sufficient.
The insurer distinguishes the present matter from David. The insurer submits that the claimant relies on the opinion of Dr Rastogi who diagnosed a specific phobia, whereas the Medical Assessor diagnosed an adjustment disorder. It is evident from the certificate that the Medical Assessor did not consider the claimant satisfied the diagnostic criteria of a specific phobia or that she had recovered from same; rather, the Medical Assessor examined the claimant and medical evidence and, utilising the entire gamut of his clinical skills, diagnosed an adjustment disorder. An adjustment disorder is a threshold injury for the purpose of cl 4(2)(a) of the Regulations.
The insurer disputes the claimant’s submission that the Medical Assessor’s reasoning did not consider whether she had, at any time, symptoms to warrant a diagnosis of a specific phobia which had improved or resolved.
The DSM-5 diagnostic criteria for diagnosis of specific phobia requires the claimant to satisfy all diagnostic criterion ((a)-(g)). Even if it is conceivable that the phobia was present for more than six months, this is only one of the seven criterion for a diagnosis of specific phobia under the DSM-5 diagnostic criteria (being (e)), and the claimant must satisfy all of the diagnostic criterion for a diagnosis. The fact that the phobia has been present for six months does not in and of itself warrant a diagnosis of specific phobia.
The insurer disputes that the claimant satisfies criterion (c), as on the claimant’s self-report, it does not appear that she actively avoids buses but rather “likes to have an adult by” when she is near or on a bus.
The insurer submits that it is clear that the Medical Assessor considered whether the claimant’s fear of buses restricted her daily activities, as required by criterion (f), for a diagnosis of specific phobia. He concluded that her fear of buses has not significantly restricted her daily life and accordingly, she does not satisfy criterion (f).
Following his examination and review of the documentation, the Medical Assessor formed the view that the claimant satisfied the diagnostic criteria of adjustment disorder due to pain with sleep disturbance, pain avoidance behaviour, hypersensitivity to touch and fear of further injury or another motor vehicle accident.
The allegation that Medical Assessor Rikard-Bell’s conclusion differs to the claimant’s qualified medical doctor does not amount to error in the Medical Assessor’s assessment. The Medical Assessor is appropriately qualified and has utilised his gamut of clinical skills to arrive at the conclusion that the claimant sustained an adjustment disorder in the accident, albeit a different diagnosis to the claimant’s doctor. The Medical Assessor clearly referred to the entirety of the evidence before him at assessment and the history provided to him.
The insurer submits that, even if the Medical Assessor failed to consider whether the claimant satisfied a diagnosis of specific phobia, that error is not material, as the claimant does not satisfy all of the diagnostic criteria for specific phobia.

MATERIAL BEFORE THE REVIEW PANEL

On 11 February 2025, the claimant provided a joint bundle which consisted of all the material relied on by the parties for the purposes of the review.
On 27 March 2025, the claimant filed an additional bundle of documents pursuant to the directions of the Panel issued on 26 February 2025, and on 17 April 2025 provided a subset of the records of Ingleburn Community Health.
On 8 August 2025, pursuant to the Panel’s direction, the claimant provided further records of Ingleburn Community Health (Macarthur Primary and Community Health) and a report of Dr David Sainsbury dated 21 July 2025.
In conducting this medical review, the Panel has sought to follow and implement the words of Justice Basten in Rahman v Insurance Australia Ltd (t/as NRMA Insurance) [2022] NSWSC 1079 who stated, inter alia, that:
“[63] …. The [medical] assessor is not resolving a dispute between experts but forming his or her expert opinion. The application of expertise permits (and indeed requires) the assessor to be discriminating as to that material which he or she considers significant and that which may be disregarded or given little weight. There is no requirement to identify material falling into the latter category, nor to justify its exclusion from consideration.”
Accordingly, and in endeavouring to carry out its statutory function, and promote the objects and guiding principles of the legislation under which it operates, the Panel has not referenced or summarised all records relating to the claimant’s symptoms or injuries: see ss 3 and 42 of the PIC Act. If some of those medical records or reports are not referred to in the Panel’s review, it should not be assumed that the Panel was unaware of that medical material or that the Panel failed to take the material into account.

Claim documents

The claimant’s application for personal injury benefits dated 5 January 2020 records that, “[o]n entering bus [the claimant] approached her seat and bus exited after picking up speed he approached red lights and slammed his brakes on and [the claimant] fell off seat hitting her head as a result of the jolt”.
The claim form records that the claimant’s injuries resulting from the accident were “headaches and neck ache small bruise right eye”.
In a liability notice dated 1 April 2020, the insurer informed the claimant that it denied liability for statutory benefits beyond 26 weeks from the date of the accident as her injuries met the definition of “minor injury” under the MAI Act.
In a Certificate of Determination dated 19 May 2020, an internal reviewer determined that the claimant’s injuries resulting from the accident met the definition of “minor injury” as set out in the MAI Act. Relevantly, the Certificate of Determination stated “Whilst your solicitor has alleged you have sustained a psychological injury, I note no diagnosis in the WorkCover Certificate. Furthermore, no referrals for a psychological injury have been received by the Insurer”.

Clinical records

Ingleburn Medical & Dental Centre

The clinical records of Ingleburn Medical & Dental Centre titled “Complete Record as at 1 March 2022” and “Complete record as at 25 March 2025” have been considered, including the pathology results, imaging results and specialist referral letters. Relevantly, it is recorded:
(a)    on 17 February 2023, it is recorded “CTP. Was in MVA in 2019. Now gets neck pains off and on. Planned r/w in neurosurgery clinic, westmead. Last few consults noted. Advised fresh x-ray and MRI cervical spine?/ Examination: happy child, cooperative, well perfused, sitting comfortably, tender cervical paravertebral region c4/5. ROM good but child keeps complaining of pain. Nil radiculopathy”,
(b)    on 3 January 2024, it is recorded “Was in MVA in 2019. Occasional neck pain… normal alignment in the cervical spine. Child appears well and not in distress with pain…”, and
(c)    on 5 November 2024, the claimant attended Dr Satyajit Datta. It is noted “Came with mum. I have seen her in Feb 2023. By this time, she was under pain clinic. Seen the latter sometimes get neck pain. Mum wants physio referral. Referral done. … mum is concern re the ?? possible PTSD trait [sic]. Says she sometimes creams at night about the accident. [sic]. Going to school. Shegets [sic] counselling at school. Sleep ok. No selfharm. Chatty. Good eye contact. Mum is keen for Counselling referral. MH plan done referral done”. A referral to Real Therapy Solutions dated 5 November 2024 and a physiotherapist was prepared.
The GP Mental Health Treatment Plan prepared by Dr Datta dated 5 November 2024 has been considered. This lists “Possible PTSD train” under “Problem/Diagnosis”. The goal is listed as “for counselling”, actioned by a referral to a psychologist.
The records of Ingleburn Imaging Centre have been considered.
The referrals from Geoffrey Bent, Consultant Paediatrician, have been considered.
The Campbelltown Hospital Emergency Department discharge referrals have been considered. The discharge referral dated 11 December 2019 provides a diagnosis of “Neck injury (Discharge)” and records:
“HxPC. Pt was on a bus, on a seat high up near driver. Driver braked suddenly, pt hit head on glass screen just in front of her seat. Landed on floor – unsure exactly how she landed. Possibly going up to ?50km/h, height above 1 metre off floor.
Since then has had a headache & neck ache. Cried immediately after. Mum was on mobility scooter some way behind.
Denies headache now, has been constant, - controlled with panadol. Otherwise vomited x2 yeseterday, fever recordered 39.5* at home today. Says is less hyperactive than normal, although seems like normal 6y/o in ED. Small bruise Rt eye. Mum says more drowsy than normal
No loose stools, no cough, E&D less today normal prior. No coryzal symptoms, no ear ache or d/c, no other bruising.
No LOC, no confusion, no amnesia, no seizures. No pins & needles in arms.
PMHx. Tested for OSA.”
The Children’s Hospital at Westmead Discharge Summary dated 11 December 2019 has been considered.
The X-ray report of the cervical spine dated 8 December 2019, the I-Med Radiology report of the MRI of the cervical spine dated 27 February 2020, and the Medical Imaging notes printed 5 September 2023 have been considered.
The Operation Report dated 24 March 2021 has been considered.
The reports by Dr Geshani Jayasuriya, Paediatric Respiratory and Sleep Physician, electronically signed on 8 April 2019 and dated 30 April 2020 were considered.
The WorkCover NSW Certificate of Capacity dated 9 January 2020 was considered.
The Growing Healthy Kids Wight Management Service report has been considered.

Ingleburn Community Health Centre

The clinical records of Ingleburn Community Health Centre completed on 11 April 2025 and under cover letter dated 6 August 2025 have been considered.
The Community Health Psychology notes relevantly record:
(a)    a psychology intake was completed on 16 July 2018. This refers to the claimant having behavioural issues, having troubles sleep settling. Family trauma in the previous residence four years ago was reported;
(b)    an initial assessment on 1 July 2019 relevantly reports the claimant being avoidant of going to bed and experiencing nightmares about sharks;
(c)    a psychology intake completed on 24 December 2020 regards the claimant’s behaviour. It is noted that in December last year the claimant was on a bus which braked suddenly. The claimant’s mother reported that she and the claimant are still scared of buses and refuse to get on one anymore;
(d)    an assessment session on 23 February 2022 notes the claimant reported to be afraid of the dark. There was no reference to the accident;
(e)    on 2 March 2022, a progress call with the claimant’s teachers at Ingleburn Public School was held. The teachers reported no concerns socially and that the claimant performs within the low average range academically. They denied any current need for behavioural intervention at school. There is no reference to the accident;
(f)    notes of calls with the claimant’s parents on 2 March 2022, 8 March 2022 and 6 July 2022 are recorded. There are no references to the accident;
(g)    on 17 August 2022, the claimant attended a treatment session with her mother in attendance for part of the session. The session focused on feelings and anger management. The notes do not record any discussion of the accident;
(h)    on 7 September 2022, the claimant attended a treatment session. The session focused on feelings and anger management. The notes do not record any discussion of the accident;
(i)    on 16 November 2022, the claimant attended a treatment session with her mother. The session focused on emotion identification and psychoeducation on emotions in children with ADHD. The notes do not record any discussion of the accident;
(j)    on 7 December 2022, the claimant attended a treatment session with her mother. The session focused on the claimant’s school activities and the bullying being experienced by the claimant. The session discussed feelings and peer relationships. The notes do not record any discussion of the accident;
(k)    a handover note dated 8 December 2022 from the clinical psychologist notes the claimant’s presenting issues to be “ADHD, behaviour, emotion regulation”. In the summary of care provided there is no mention of the accident;
(l)    on 13 February 2023, the claimant attended a treatment session with her mother. The session focused on behaviour and inter-family relationships. The notes do not record any discussion of the accident;
(m)     on 3 March 2023, the claimant attended a treatment session with her mother. The session focused on behavioural concerns, communication at home, and bullying being experienced by the claimant. It was reported that the claimant’s behaviour had been worse since a school incident with her friend. The notes do not record any discussion of the accident;
(n)    on 31 March 2023, the claimant attended a treatment session with her mother. The session focused on anger issues and emotional control strategies. The notes do not record any discussion of the accident;
(o)    the Intake Form dated 26 April 2023 notes the reason for referral as “Behaviour”. Under “Summary of concerns” it states “Main concerns for Mo[ther] are Eliza’s behaviour (biting, swearing, hitting) and emotions. Mo would like for Eliza to learn more strategies to support Eliza with managing emotions and not “taking things to heart”;
(p)    on 26 April 2023, the claimant attended a treatment session with her mother. The presenting issue is noted as “behaviour”. The session focused on behavioural issues reported by the claimant’s mother and psychoeducation on the effects of ADHD, and friendship difficulties at school. The notes do not record any discussion of the accident. The claimant was discharged, however the claimant’s mother requested she be put back on the waitlist;
(q)    on 27 October 2023, the claimant’s mother participated in a phone conversation with Theodora Binasis, clinical psychologist. The claimant was not in attendance. Relevantly, it is recorded:
“PC made to Mo as per her request when seen in the ICHC waiting room on 26/10 where Mo reported that Eliza is being triggered by memories of past trauma and needs counselling. Asked Mo to elaborate on concerns for Eliza since last contact and Mo reported the following:
Eliza was recently assessed by 'government doctors' regarding a bus accident she was involved in approximately 4 years ago (Dec 2019). Mo reported being shocked about Eliza's reports of the impact of same on her. According to Mo, Eliza mentioned that she sees the bus accident in her head over and over, has nightmares that this is going to happen again, same happening every night, she is able to go back to sleep be of the medication she is on that makes her feel drowsy. Mo reported that her nightmares are of her going through the window in the bus and scared that this is going to happen again. Eliza reportedly copes better in coaches that have seatbelts but has panic attacks when she is on buses without seat belts. Mo worried about Eliza thinking of the worst. Mo reports believing that above explains some of the behaviours seen at home, when she gets angry she lashes out. Mo reports seeing a lot of anger in her and Mo thinks that this is also because of her troubled sleep because of the trauma. Mo believes that she is struggling with trauma. Eliza was described to be irritable and not know how she might react, can't play jokes on her because she might take it too seriously. Mo thinks that this has gotten worse over time and to have been exacerbated by a recent event. Mo reported that she became more shocked and it exacerbated trauma symptoms when she, her brothers and father got into a car accident on 14/9/23 where brother had to be hospitalised for whiplash from pain. Mo believes that nightmares have been more intense since then. She is able to get into cars but is very cautious. She is currently complaining of neck pain and doctors have prescribed her pain medication”;
(r)    a note dated 31 October 2023 on an “Non-inpatient Registration Form” dated 26 April 2024 records “Re-triaged urgent”;
(s)    the initial assessment dated 22 November 2023 record a discussion with the claimant’s mother and Ms Binasis. The claimant was not in attendance. This references the claimant’s behavioural issues as reported by her mother. It also notes “Mo reported that Eliza also has nightmares nightly that started when she was in a bus accident 4 years ago, reducing in frequency over time and then resuming to a nightly frequency following a car accident in September 2023”;
(t)    a “Child and Adolescent Trauma Screen-Caregiver” (CATS-C) form dated 22 November 2023 has marked “Yes” beside the list of events, being “Serious accident or injury like a car/bike crash, dog bite, sports injury”, “robbed by threat, force or weapon”, with a handwritten note “1 ½ yo”, and “someone close to the child dying suddenly or violently” with a handwritten note “mat uncle 2022”. In response to the question “what is bothering the child most now” it is noted “bus + car accident”. A score of 37 is noted in response to the questionnaire;
(u)    a “Parents’ Concerns Questionnaire” dated 22 November 2023 records the situation or behaviour the parent would most like to change by the service as “For Eliza to have less nightmares related to the accident and improve sleep quality”;
(v)    the progress notes of 6 February 2024 note the claimant’s mother has a report from the investigation of the bus accident and would like to send a copy to help understand what is going on in the claimant’s head.
(w)   the notes dated 6 February 2024 record a discussion with the claimant’s mother and Ms Binasis. The claimant was not in attendance. It is noted “Mo[ther] reported Eliza's nightmares come and go”;
(x)    the notes dated 21 February 2024 record a discussion with the claimant, her mother and Ms Binasis. It states:
“Review since last session: Eliza's case has progressed to the "higher panel" disputing the type of harm obtained from bus accident as being psychological. Mo reported there has been a recent death in the family. … Introduced the bus accident and enquired about Eliza's symptoms. Eliza completed the CATS questionnaire. Results from the questionnaire indicate probable PTSD (CATS Score of 25). She was asked if she could elaborate on some of her answers however she reported that she didn't want to. Introduced TF-CBT workbook and what it would entail/purpose of it. Eliza appeared willing to engage in same over the course of the therapy block”;
(y)    a “Child and Adolescent Trauma Screen” (CATS) form completed by the claimant dated 21 February 2024 has ticked “Yes” to “Serious accident or injury like a car/bike crash, dog bite, sports injury” and notes the “bus accident” is bothering her most now. An undated CATS Score is noted to be 25, with a handwritten note “indicative of probable PTSD”;
(z)    an undated page of the claimant’s “TF-CBT Workbook” describes the accident. This includes “[I] hoped back on the bus and then I fell asleep and then the driver sopped on the brakes hard while I was sleeping and I didn’t know what was happening I was scared so we hoped off the bus and went back to my room and went to bed calm…”. An addition of “and I hit the glass in front of me in the front [illegible]” has also been included;
(aa)    the notes dated 28 February 2024 record a discussion with the claimant, her mother and Ms Binasis. It is noted “Subjective: Eliza reported aspects of the bus and car accident. She reported feeling comfortable talking about same and reported not feeling anxious about talking about it.” A TF-CBT workbook was introduced. The bus accident was discussed and psychoeducation on these types of events was provided. It is noted “Eliza reported relating to some of these symptoms, including feeling anxious, hypervigilant and having trouble sleeping as well as remembering the events randomly”;
(bb)    the notes dated 6 March 2024 record a discussion with the claimant, her mother and Ms Binasis. TF-CBT was continued. The claimant is recorded to be engaged, attentive and respectful throughout the session;
(cc)     the notes dated 14 March 2024 record a discussion with the claimant, her mother and Ms Binasis. The claimant reported feeling “good”, “excited” and “doing good at school”. She reported nil nightmares or recurring thoughts about trauma. Activities in the TF-CBT workbook were continued;
(dd)    the notes dated 12 April 2024 record a discussion with the claimant, her mother and Ms Binasis. The claimant reported feeling mostly good between sessions. She reported nil nightmares, nil anxiety/sadness/re-remembering of accident. She reported practising her relaxation strategies before bed;
(ee)    the notes dated 1 May 2024 record a discussion with the claimant, her mother and Ms Binasis. The claimant reported not having any further nightmares;
(ff)    the notes dated 8 May 2024 record a discussion with the claimant, her mother and Ms Binasis. It is noted “Mo[ther] reported ongoing challenges with Eliza going to sleep on time, she reportedly may stay up till 3am. Mo[ther] queried whether it's nightmares keeping Eliza up however Eliza reported no longer getting nightmares and this not to be the reason for her not going to sleep.” It was also noted “Continued working on trauma story today, looking at Eliza's thought and feelings around the time of the accident and challenging these using evidence gathered since the accident. Eliza reported no longer feeling scared or worried about these thoughts, reflecting that out of all the times she ever went on the bus she only had one accident and it is unlikely to have another one in the future”;
(gg)    the notes dated 30 May 2024 record a discussion with the claimant and Ms Binasis. It is recorded “Eliza reported trauma story to be a neutral story, characterising it as just another story now”; and
(hh)    the discharge summary dated 5 June 2024 notes “Completed an initial assessment with Mo to ascertain Eliza's difficulties related to past motor vehicle accidents. Conducted a child assessment with Eliza where Eliza scored in the ‘probable PTSD’ (CATS Score of 25). Discussed treatment utilising a TF-CBT framework. Completed TF-CBT workbook, looking at psychoeducation on trauma, relaxation, affect, modulation, cognitive coping, and trauma narrating. Eliza worked through the workbook with minimal distress, showing a good understanding of strategies presented. She reported no longer feeling bothered by the event, or talking about the event...”

A referral dated 11 July 2018 notes the claimant attends Macquarie Fields pre-school one day a week. Her functioning was noted to be “Not listening, being a bully – reported by preschool teachers”. Concerns were focused on social / emotional / behaviour. Under “recommendations discussed” it is noted “consent to OT/psychology”. A progress note of the same date prepared by Fiona Tisdale has been considered.
On 15 April 2019, confirmation of a place in the Ingleburn Community Health group parenting program was provided.
On 2 July 2019, an email was sent from Ingleburn Community Health Centre to “FACS”. This notes that the claimant was initially referred to psychology services for behaviour support, and that it became clear at the initial assessment that FACS was already providing an intervention targeting behaviour support for the family. This was focused on sleep hygiene, diet and behaviour, as well as strategies to improve parental communication.
A Vineland Adaptive Behaviour Scales (Vinland-3) Report regarding an assessment on 20 March 2020 has no reference to the accident.
The progress notes of Ms Sheaves, Occupational Therapist, dated 20 March 2020 are noted. These record the claimant’s medical and developmental history. There is no reference to the accident.
The progress notes of Ms Sheaves dated 10 July 2020, 10 December 2020, 28 April 2021, 12 May 2021, 2 June 2021, 3 May 2022, 18 August 2022, 19 October 2022, 9 November 2022, 30 November 2022, 6 February 2023, 27 March 2023, 1 May 2023, 24 July 2023, 1 August 2023 and 12 September 2023 have been considered. The claimant attended occupational therapist intervention sessions with one of her parents and Ms Sheaves. She was consistently noted to present as active throughout the sessions but able to participate appropriately in the set tasks. In the 10 December 2020 and 27 March 2023 notes there are references to a psychologist referral due to the claimant’s behaviour and on 19 October 2022 and 30 November 2022 there are references to behavioural issues being reported by the claimant’s mother. There is no reference to the accident in any of these notes. On 2 April 2024, there is a reference to the claimant attending weekly psychologist sessions “for PTSD following a car accident”.
The claimant was discharged from occupational therapy on 2 April 2024. The claimant’s mother requested she be put back on the waitlist.
The discharge referral prepared by Ms Sheaves dated 29 April 2024 notes that a referral to the Primary and Community Health Psychology service was made with the consent of the claimant’s mother on 10 December 2020 for concerns regarding challenging behaviours. There is no reference to the accident.
A referral dated 10 December 2020 to “Community Health Psychology” lists presenting problems as “1. Difficulties managing behaviours; 2. Verbal and physical aggression”. There is no reference to the accident.
A Child and Family Health Client Multidiscipline Referral Form notes a referral on the mother’s request to see an occupational therapist due to handwriting concerns.
Notes of the occupational therapy intervention sessions dated 18 June 2025 and 2 July 2025 regard handwriting with no reference to the accident.
The notes of Growing Healthy Kids have been considered. Relevantly, it is recorded:
(a)    the initial assessment is dated 30 August 2023. Under “medical history” it is noted “bus accident – ongoing muscular neck pain”. Under “other services involved” it is noted “counselling at Ingleburn – since ceased, receiving counselling at pain clinic at Randwick Children’s Hospital (every 3-4 weeks appt)”. Under “Clinical” it is noted “Reported generally well, nil significant. Medications: Ritalin; pain medication for sleeping (from pain clinic)”;
(b)    on 12 September 2023 it is noted, under “Background” “Mental Health: ADHD, ODD”, “Other medical history: Nil relevant”;
(c)    on 29 February 2024 it is noted “Services involved: OT – community health now discharged, seeing psych at Ingleburn CHC weekly for trauma (bus accident)”;
(d)    on 13 June 2024, it is noted under “Clinical” “nil significant raised today. Completed therapy block with community psychology. Summary of care from EMR – conducted a child assessment with Eliza where Eliza scored in the ‘probable PTSD’ (CATS Score of 25). Discussed treatment utilising a TF-CBT framework”;
(e)    on 22 November 2024 it is noted under “Clinical History” “Mechanical: Neck pain almost everyday due to an accident 5 years ago – bus accident. Severe whiplash, bulged disk C5 seen surgeons for this, Mental Health: PTSD in context of an accident, takes amitriptyline (10mg 1 night), stopped taking melatonin”, and
(f)    on 12 September 2024 it is noted under “psychological: has history of bullying, wanting now to see counsellor for support” and “sleep disorders: … has nightmares about once every couple of weeks. This is reducing….”

Dr David Sainsbury

14 June 2023

On 14 June 2023, the claimant presented for an assessment before Dr David Sainsbury, paediatric specialist pain medicine physician, at the Sydney Children’s Hospital Pain Management Clinic. The claimant presented with her parents. A child life therapist, physiotherapist, occupational therapist and clinical psychologist were also present. Under the heading “Impact of Pain”, it is noted that the claimant has quite poor sleep. She experiences nightmares at least one to two times a week and can struggle to get back to sleep. Her nightmares are quite catastrophic in content, including people dying or having bad things happen to them.
It was noted that the claimant describes some post-traumatic stress traits. She thinks of the bus accident a couple of times a week and has some nightmares where she feels like she has gone through the glass pane. She has been able to go on a bus since and recently has used a bus for a school excursion although was initially avoidant.
She describes being relatively anxious, worrying about things a lot every day, especially about things happening to people and dying. Dr Sainsbury noted that this may be related to the fact that her uncle is currently dealing with cancer. She does not describe any disordered breathing and she does not really describe any significant sadness. Dr Sainsbury recorded that she doesn’t describe any significant anhedonia.
In terms of past medical history, it was noted that the claimant sees a paediatrician who is managing her oppositional-defiant disorder and her ADHD. She is currently prescribed ADHD medication although she refuses to take it. It was noted that “it sounds like some of her behavioural issues preceded her injury”.
Dr Sainsbury prescribed Amitriptyline 10 mg at night and discussed putting boundaries in place about mobile phone use at bedtime, as improving her sleep may improve her pain and contribute to an improvement in her behaviour. The possibility of central sensitisation with the pain was discussed.

16 October 2023

On 16 October 2023, the claimant presented for an assessment before Dr Sainsbury at the Sydney Children’s Hospital Pain Management Clinic via Telehealth. Dr Sainsbury issued a report to Dr Aung Kyaw dated 20 October 2023.
Dr Sainsbury noted that the claimant had initially made some good progress, taking her ADHD medication, putting some pain management strategies into place and spending more time at school. Her sleep disturbance was noted to have improved initially but has gotten worse in recent weeks. Dr Sainsbury notes it is not clear whether this was related to a further motor vehicle collision or having to go on a bus for a school trip, both of which are noted to be “quite triggering events for her”.
Dr Sainsbury noted the claimant seemed to have some significant ongoing post-traumatic stress disorder traits. He prescribed Clonidine 50µg in the evening and two x 25µg as required during the day to assist with the claimant’s nightmares, general level of arousal and hypervigilance.

30 April 2024

On 30 April 2024, the claimant presented for an assessment before Dr Sainsbury at the Sydney Children’s Hospital Pain Management Clinic via Telehealth. Dr Sainsbury recorded the claimant had been able to access some local psychological support, which she had found helpful and he considered good due to his concerns about her “possible PTSD traits”.
The claimant was recorded to be doing well, “pretty much pain-free”, and is attending school full time. Her medications are recorded to be Amitriptyline 10mg and Clonidine 50µg at night.

30 October 2024

On 30 October 2024, the claimant presented for an assessment before Dr Sainsbury at the Sydney Children’s Hospital Pain Management Clinic via Telehealth. Dr Sainsbury reported that the claimant’s pain symptoms are generally improved, with her headaches vastly improved and some neck pain managed with ibuprofen one to twice per week.
It was noted that the claimant’s major issue is management of her post-traumatic stress disorder. It was noted that her mother was trying to facilitate treatment via a charitable organisation or a school counsellor or school psychologist. Dr Sainsbury recommended trying to arrange formal psychology to address the post-traumatic stress issues, as he was informed that the claimant “still scores quite highly when assessed for PTSD”.
It was recommended that the claimant continue her medication to address her ongoing post-traumatic stress disorder and sleep disturbance, and it was recommended this be increased to clonidine 100µg at night.

21 July 2025

On 21 July 2025, the claimant attended Dr Sainsbury via telehealth. It was noted her symptoms seem very stable. She still experiences neck pain and headaches. She is awaiting assessment from “the insurance” in respect of her post-traumatic stress disorder and psychology input, but the medication changes have been “quite helpful in helping with her sleep. Her nightmares have now ceased and her sleep seems to be much better although apparently there are still some behavioural challenges at bedtime”.

Tracey Kenmuir

The claimant attended upon Tracey Kenmuir, occupational therapist, on 23 August 2023. The notes of Ms Kenmuir have been considered. The claimant reports an improvement in her quality of life and “FDI”, but remains very worried about people dying (her sick uncle) and has other worries. Ms Kenmuir noted that the claimant reports being angry and sad. The claimant’s mother reported worse quality of life and FDI since referral, but also highlighted issues related to anxiety.

Gabrielle Meredith

The claimant attended upon Gabrielle Meredith, physiotherapist, on 23 August 2023 with Kirsty-Leah Goymour, play / child life therapist and her mother as part of the claimant’s ongoing outpatient review for her chronic neck and head pain.
It was noted that the claimant gets into bed between 7.30pm and 8.30pm, but doesn’t fall asleep until midnight. The claimant reports that she considers her headaches are the reason she can’t fall asleep. She gets headaches once per day, 7/10, after recess when people are yelling in class.

Andrew Gorrie

The claimant attended upon Andrew Gorrie, physiotherapist, on 14 June 2023 and 25 July 2023 as part of her ongoing outpatient review for chronic neck and head pain.
14 June 2023
Mr Gorrie noted that this session was undertaken with Dr Sainsbury, Mr Farnsworth, and Ms Goymour, and that Dr Sainsbury and Mr Farnsworth recorded more comprehensive notes. It was recorded that the claimant runs around at recess and lunch, does cartwheels, swims socially, has played soccer and netball at school all with minimal concern. The claimant is said to avoid physical activity when she already has a headache.
25 July 2023
Mr Gorrie noted that the claimant’s mother was concerned that the claimant had a big bus trip upcoming and the claimant was likely to have a panic attack.
Mr Gorrie noted sleep was a concern and nightmares have recommenced for a week and a half. The claimant reports getting headaches one per day, 7/10, after recess when people are yelling in class. Her current pain coping strategy is fidgets and a bedtime book. Under “hobbies” it is recorded that she is “posting on TikTok about her dreams and fear around transport”. There were no signs of distress in the session.
In terms of treatment, Mr Gorrie recorded:
“Reinforced the consistency of pain management strategies for long term management, positive reinforcement about evening routine although hard to determine consistency – routine important. reframed concerns around all the progress she has made, pain impact much less than previous - not waking with pain, pain experienced only in middle of the school day in response to noise grounding with upper limbs through body breathing with ‘I'm safe’ modify exposure to triggers like noise in the middle of the day - e.g. headphones.” Under “Plan”, Mr Gorrie recorded “will discuss in meeting tomorrow mother's request re: meds allied health review F2F in August ?ePPOC at that appointment; pain seems to have less impact now and bigger concern is panic attacks [sic]”.

Dr Evelyn Goodison-Farnsworth

Dr Evelyn Goodison-Farnsworth, clinical psychologist, examined the claimant on 14 June 2023 and 20 June 2023 in person. The notes of Dr Goodison-Farnsworth have been considered.
14 June 2023
In relation to sleep it was noted that the claimant sometimes wakes up if she gets nightmares about people being mean to her, usually once to twice per week. She previously saw a psychologist and is now again on the waitlist.
In respect of mood, Dr Goodison-Farnsworth noted that the claimant experienced nightmares after the accident. The claimant’s mother reports that both she and the claimant continue to be very upset about the accident and that it is a very touchy subject. It was recorded that the claimant has a fear of movement and of her neck being touched, increasing pain. The claimant notices that she does not attend to her pain if she is enjoying herself. When she gets anxious, she thinks about her accident. She can get on the bus when it is sports day, but gets worried about it stopping quickly and “thought about that over and over”. She fears things will happen to people if they do something bad, and is worried when people get sick, like her uncle who has cancer.
Dr Goodison-Farnsworth also recorded:
“Also has fears about nothing. Gets low mood when friends get bullied. Has defiance and gets very angry. Hits people. On waitlist for a month to address the ODD. Can report clearly, gets furious and moody. The bus accident talked about continually in the household, and the compensation case also goes over the memories [the claimant] has about the accident.”
In respect of school, it is noted that she sometimes feels sick with her fears, reports no panic symptoms.
20 June 2023
Dr Goodison-Farnsworth recorded the claimant’s sleep had significantly improved and she has had no more nightmares.

Catherine Quinn

The claimant attended upon Catherine Quinn, play / child life therapist, on 20 June 2023. The notes of Ms Quinn have been considered.
Ms Quinn noted that the claimant’s mother indicated that medication is helping with pain and sleep, and the claimant was reported to have said the pain is going away faster. The claimant is noted to have been taking her medications. The claimant indicated she is not experiencing nightmares and not waking up throughout the night. Her pain is hurting less in the morning. It was recorded that she went on a school excursion on 19 June to Symbio wildlife park.
In terms of treatment, it was noted that Zones of Regulation were discussed, with strategies such as breathing, fidgets, colouring, trampoline, imagination walks, dancing and reading books. The claimant identified that getting worried about her uncle with cancer moves her into the “red zone”.

Kirsty-Leah Goymour

The claimant attended upon Kirsty-Leah Goymour, play / child life therapist, on 14 June 2023. The notes of Ms Goymour have been considered.

Medico-legal Reports

Dr Mohammed Asseem

Dr Mohammed Assem, rehabilitation and musculoskeletal medicine consultant, provided a report dated 29 September 2021. Dr Assem assessed the claimant via Zoom with her mother on 29 September 2021. Dr Asseem’s report has been considered by the Panel. In respect of her current status, Dr Assem noted:
“[The claimant] continues to experience constant neck discomfort associated with recurrent cervicogenic headache. She has been sent home from school early because of her headaches that interfere with her ability to focus and concentrate in class. Her mother stated that she had pre-existing learning difficulties and required support. Her mother has noticed some behavioural changes as Eliza appears to be angry and frightened to talk about the accident. She experiences nightmares and sometimes wets the bed. She consulted a paediatrician who has recommended nocturnal hypnotics. Otherwise, she takes Panadol when needed.”

Dr Richa Rastogi

Dr Richa Rastogi, psychiatrist, examined the claimant on 16 February 2022 via a face-to-face session with her mother.
Dr Rastogi diagnosed the claimant with specific phobia disorder and attention deficit disorder with mild learning disability, pre-existing with exacerbation. Dr Rastogi noted:
“[The claimant] was a passenger in the bus involved in an accident where she had headaches and fracture was queried but cleared on further investigation. She has headaches that were managed with Panadol . The nature of injury did result in bed wetting, mild increase in disruptive behaviours and intrusive nightmares for a short period of time as well as concentration difficulties with school absenteeism. She has overcome these and is attending school regularly . There is pre-existing learning difficulties and ADHD that have exacerbated with incidents of conflict and aggression as well as poor distress tolerance in school causing behavioural problems and disruption. There has bene [sic] mild behaviour escalation since the accident due to underlying anxiety, fears and poor stress tolerance.
She currently presents with phobia specifically related to bus and avoids travelling in a bus. The accident occurred three years ago and she is still debilitated by anxiety and avoidance behaviours. She refuses to get into a bus and gets easily triggered with avoidance behaviours. She gets agitated and anxious to stage of clinginess and crying when talking about a bus or even going for a ride. She describes irrational fears with worrying and catastrophic thoughts. She is able to travel in car and feels safe.”
Dr Rastogi considered the claimant would benefit from psychological counselling with exposure and working through anxiety and fears with a child psychologist on a monthly basis for six months.
Dr Rastogi opined that there is a direct connection between the accident and the claimant’s psychological injuries.
Dr Rastogi assessed a 7% whole person impairment as a result of the diagnosed psychological injury.

School and school counselling records

The claimant’s school records from Ingleburn Public School for Semesters 1 and 2 of 2022 and Semester 1 of 2023 were considered. In all records, the claimant’s overall achievement was a grade of “C” in all subjects. The reports note that a grade of “C” is a “Sound” achievement and is described as “The student has a sound knowledge and understanding of the main areas of content and has achieved an adequate level of competence in the processes and skills”.
The claimant’s school counselling records from Ingleburn Public School were also considered. A copy of a GP Management plan in the school record dated 4 March 2025 lists health issues of ADHD, neck pain, oppositional defiant disorder (ODD) and asthma.
Thai Tran, school counsellor and registered psychologist, assessed the claimant using the Wechsler Individual Achievement Test (WIAT-III). Ms Tran noted that, when compared to same age peers, the claimant’s overall oral language score was in the very low range, her total reading score was in the average range, and her mathematics score was in the average range.

A Vineland-3 functional assessment was completed by the claimant’s 2024 classroom teacher. This found her overall adaptive functioning to be in the moderately low range.
A Conners 4^th edition (Conners-4) Teacher Rating Scales was undertaken by the claimant’s teacher on 19 November 2024. According to the results, Symptom Counts were not met and the T-scores were average across all scales. The claimant did not appear to present with behavioural concerns or behaviours associated with ADHD or ODD in the school setting.
The Confidential School Psychologist Report dated 7 March 2022 has been considered. This notes the claimant had been reported to have symptoms of ADHD and was trialling Ritalin. It was opined that, based on the responses of the claimant’s teacher to the Conners-4, the claimant does not meet the DSM-5 criteria for a diagnosis of ADHD, conduct disorder or ODD. However, these responses were completed after knowing the claimant for one month and while the claimant was taking Ritalin. There is no reference to the accident.
The School Counsellor’s Brief Report dated 17 March 2025 notes that the claimant was referred for assessment by her mother to obtain updated information regarding her learning and academic abilities. The report was completed by Thai Tran, psychologist, on behalf of the school counsellor, Louise Asfoura, who was currently on leave. The claimant’s assessment using the WIAT-III was noted. There was no reference to the accident.

REPORT OF MEDICAL EXAMINATION ON 31 MARCH 2025

The claimant was examined by Medical Assessors Newlyn and Friend on 31 March 2025.

Who attended the assessment?

The claimant was 11 years old at the time of the appointment. She was at home in Macquarie Fields, accompanied by her mother, Ms Cathy Fox, who provided support and history. Her father and siblings, Emily and Isaac, were in a separate room. Isaac was absent from school due to a hand laceration. Emily no longer attends school.
The claimant was examined using MS Teams videoconferencing. The camera was focused on the claimant and Ms Fox occasionally entered the frame.

Reported medical history

The claimant was 149 cm. She weighed 54 kg. She is left-handed.
Active pain problems were reported from the accident.
Snoring occurred in preschool and tonsillectomy was recommended. The claimant had a tonsillectomy and adenoidectomy on 24 March 2021. Snoring has ended since surgery.
Due to her weight, the claimant began consulting a dietician in 2023. She has since lost about 10 kg.
She reported having no allergies to medicines.

History of education

The claimant began kindergarten at Ingleburn Public School in 2019. In kindergarten, she had learning problems, focusing problems, and processing problems. She has been in mainstream primary school and is now in year 6. Ms Fox says her problems have worsened since the accident.
The claimant’s mother reports that she is not eligible for the support unit because she is on the “borderline” for entry. Her mother said her daughter’s reading and writing were “not up to date”. She has missed school due to headaches, up to one or two days a week.

Family

The claimant said, “I get on with dad good”.
The claimant’s mother, Ms Cathy Fox, receives the disability support pension. Ms Fox said:
“I had two strokes as a child and lost strength on my right side. I use a four-wheel electric scooter as my balance is poor. When the bus stopped suddenly, I was sitting on the scooter. The scooter went up in the air. I had to push myself back down and injured the left side of my body”.
She said that she was now frightened to travel by bus and had not done so since the accident. Ms Fox has received a settlement for her personal injury claim.

Developmental history

Pregnancy: Ms Fox said that she had gestational diabetes, hypertension and pre-eclampsia in all pregnancies. The claimant’s pregnancy was the most dangerous of her pregnancies as Ms Fox had liver failure as well.
The claimant was born by emergency caesarean section at 37 weeks because of pre-eclampsia. She weighed 2.51 kg.
Infant Problems: None recalled.
Infant Feeding: No problems recalled.
Infant Sleep Cycle: No problems recalled.
Infant personality: Ms Fox described her daughter as a cheeky baby who remained cheeky.
Transitional Object: The claimant had a grey elephant that her father won. The claimant and mother then argued about what happened to the elephant with the claimant initially saying it was chucked out and then changing to saying it was donated. Her mother protested that the toy was not chucked out.
Milestones: Ms Fox said that her daughter’s motor, speech and toileting milestones were as expected.
Daycare History: She attended preschool three days a week from age four. ADHD was diagnosed by Dr. Manasee Bidarkar, a Consultant Paediatrician, in 2016 when the claimant was aged 3.
Preschool: No problems were reported with preschool behaviour by Ms Fox, who stated that her daughter performed well.
Trauma History: No childhood sexual or physical trauma reported.
Anger: Ms Fox said that her daughter did not have tantrums before the accident. There have been difficulties with anger since the accident.

Psychiatric history before the accident

Dr Bidarkar diagnosed ADHD and ODD. Ms Fox said that ODD was diagnosed because her daughter was not doing as she was told. Ritalin, the stimulant medication methylphenidate used for treating ADHD, was started when the claimant was 5½ years old, before the accident. Ms Fox said her daughter did not need counselling.

Pre-accident functioning

The only behavioural problem Ms Fox recalled before the accident was that the claimant sometimes had trouble getting along with her siblings. The ADHD and ODD diagnoses did not result in functional problems. Her daughter could travel on buses.

History of the accident

The claimant said: “We went to lunch and were coming back to the hospital in the bus to get my tonsils out. The driver stopped suddenly and I hit my head on the screen. I felt scared and hurt my nose. My neck was sore. My neck started hurting at 2.00am. My neck is better.”
Ms Fox said that her daughter had been booked for a sleep assessment at the Children’s Hospital at Westmead on the day of the accident and they proceeded to the assessment.

History of symptoms following the accident

The claimant said:
“My neck is trouble. The nightmares were three times a night and started a couple of weeks after the accident. They are about me going through the window. I dream of falling to the ground after getting out of the car. I started getting scared to go on buses. I needed talking and help about buses and it lasted for three and a half years.”
Ms Fox said her daughter used Panadol (the analgesic medication paracetamol) daily. It was reported that the insurer did not approve physiotherapy until late 2024. The claimant’s neck pain has improved since starting treatment. Ms Fox said that her daughter had a bulging disc that had since gone back to normal. She was aware of the disc because it had been discovered during an MRI scan. Ms Fox said that her daughter also had a black eye.
Ms Fox said that her daughter’s academic performance had declined over the past two or three years. She missed school on average one or two times a week. She had sleeping problems and nightmares that occurred three times a week. Sometimes when she woke, she would go to her mother’s room and might get back to sleep. Due to her sleep difficulties, she fell asleep in class.
Ms Fox said that her daughter had post-traumatic stress disorder with anger, depression and anxiety. Her daughter could not get on the school excursion bus until seatbelts were installed two years after the accident. However, a teacher needed to sit with her at first.

History of treatment following the accident

Ritalin has been prescribed since the claimant was aged 5½. The claimant’s current prescribed dose is 20 mg of Ritalin LA each morning. Ms Fox said she gives her daughter the medicine every day.
The claimant said, “I’ve chucked them in the bin for the last six months”.
Melatonin, a sleep-inducing neurohormone, was taken for two months and then discontinued.
Amitriptyline, a tricyclic antidepressant medicine, 10 mg nightly is prescribed. Ms Fox and her daughter agreed that she took this medicine, which was said to help with sleep and pain.
Catapres, the alpha-adrenergic blockading medicine clonidine, 100 µm each morning prescribed by the Sydney Children’s Pain Clinic. Ms Fox said the medicine had been prescribed to treat anxiety. The Panel notes that this medicine is usually prescribed to improve the sleep of children with ADHD.
Panadol is used as needed for pain relief.
No psychiatrist has been consulted since the accident.
Ms Fox said she had talked to her GP about her daughter’s need for counselling soon after the accident, but she felt she was not heard. She could not explain why there were no entries in the GP’s record about her daughter’s phobia. However, in late 2023, the insurer agreed to fund counselling at Real Therapy Solutions, which ceased in late September 2024. Ms Fox says that she has applied for further counselling and is aware there is a one-year waiting list.
The Panel noted the GP’s record also did not record ADHD or ODD symptoms.
The claimant sees Dr Manasee Bidarkar for review of her ADHD symptoms.
Physiotherapy was prescribed from the end of 2024. When the claimant was first referred to the Sydney Children’s Pain Clinic, the team had thought that medical treatment would help. Eventually, the clinic decided that a referral for physiotherapy was advised and treatment began in February 2025.

Details of any relevant injuries or conditions sustained since the accident

The claimant underwent a tonsillectomy and adenoidectomy on 24 March 2021 to reduce her snoring. The procedure was a success.

Current symptoms

The claimant said:
“I feel scared about the bus accident, but only on some days, like 2 days a week. I stay in my room then. When I went on the bus with my friend, I was sitting near her and I wasn’t scared. Her brother was also on the bus. After I was on the bus, I was picked up by a car. I can ride the school bus and the schoolteacher doesn’t have to sit with me anymore. I feel safe on the school excursion bus. I find art easy. I can concentrate when painting. They [her parents] take my phone, and that helps me get to sleep”.
Ms Fox said that her daughter had problems sleeping because of pain. Because of her neck pain it takes hours to go to sleep. She is traumatised and trying to cope with the accident. She still has problems travelling on the bus. Ms Fox said her daughter’s depression and pain is worse. She still has nightmares once or twice a week. The nightmares are about the bus or falling to the ground. When her daughter is anxious she does not want to go to school and wants to stay in her room. Ms Fox says her daughter shows depression by wanting to stay in her room or when she is snappy. She often does not want to go out and has missed a lot of school. In late 2024, she did go out with a friend on a bus. Ms Fox said that her daughter’s best subject in school was art.

Current and proposed treatment

The claimant receives GP care from doctors in Campbelltown Mall. The Medical Assessors were informed that the claimant has only seen these GPs since September 2024 and that they do not prescribe psychotropic medicines.
She is not currently receiving psychiatric or psychological treatment.
Physiotherapy is currently in progress.
Ms Fox did not expect a change in her daughter’s current treatment. Her daughter was on a waiting list for psychological treatment and expected notification within the year.

Mental state examination

Appearance: Appearance consistent with age. The claimant was a preteen dressed in ‘at-home’ clothes, sitting and holding a large teddy bear that she said she had bought for her mother three years ago.
Grooming: Neatly groomed. Her hair is cut every five to seven months.
Clothes: She wore a T-shirt top and shorts that she had chosen herself.
Activity: She was highly active throughout the two-hour assessment interview. She clutched a teddy bear that she had given her mother in 2023 for 110 minutes of the interview. Because she suddenly became non-responsive at the 110-minute mark, Medical Assessor Friend suggested she use one of her fidget toys. She went and got a plastic toothed alligator whose teeth were fidget toys. Earlier in the interview, she had fidgeted with her mother’s hair. She moved closer and further away from her mother depending on the emotional intensity of the moment. When her mother went to get a medicine box, the claimant left to go to the toilet.
No psychomotor retardation or agitation observed.
Movements: No tics or vocalisations reported.
Aggression: Her mother reported an increase in irritable behaviour since the accident.
Impulse control: Impulse control was poor with many impulsive behaviours observed.
Interaction: She was cooperative throughout the interview, willingly answering questions and engaging with the assessors. The claimant and her mother had a positive interaction, albeit with many differences of opinion. Her facial expression was appropriate to the verbal content.
Eye contact: Good.
Facial Expression: Serious.
Language: Her speech was rapid but of average volume. She focused on answering questions that were presented.
Coherence: Her focus was on answering questions presented. However, Ms Fox and her daughter often spoke over one another and there were frequent differences of opinion between them about the timing of events.
Affect: Euthymic.
Phobias: Phobic anxiety about bus travel reported.
Obsessions: She claimed obsessional symptoms, but her mother said there were none.
Dissociative: No behaviour observed or reported.
Preoccupations: None reported
Perceptions: No anomalies reported.
Sensorium: Clear.
Concentration: Developmentally poor with a diagnosis of ADHD from age 3. She could attend to the task of remaining in the assessment for two hours.
Piagetian developmental level lags chronological age.

Current functioning

The claimant lives with her parents and siblings in a house rented from the housing department in Macquarie Fields.
The family has two dogs, Nala and Storm (Stormy) and a bird, Hay Hay. Ms Fox said another bird, Moana, flew away in 2022. The claimant said, “Moana flew away last year. We all walk the dogs. We have a double leash. I always go with someone else”.
The claimant described her daily routine as:
“I get up at 7 if I went to bed early, between 7 and 8.30pm. I go to sleep at 9.30pm. Last night, I went to bed late because I watched Wonder Woman with Dad. I get up and play on my phone until 7.30am. Mum gives me tablets [Catapres and amitriptyline], but I don’t take them. Sometimes, if I don’t make lunch, I eat breakfast instead. I take fruit to school for lunch—an apple, grapes and a banana. I have made snacks and sandwiches this year. Dad drops me off after my brother. Dad picks me up at 3.10pm and he might have to drop someone off. We dropped my uncle off to pick up a car. After I get home, I play on my phone and have a shower. I draw or colour. After dinner, I play on the phone or watch TV before I go to bed.”
Ms Fox said her daughter mostly gets to sleep by 10.30pm. She has to wake her daughter at least five times in the morning. Her daughter’s phone is switched off at 6.30pm.
The claimant said:
“On Friday and Saturday I have the phone until 10pm. I go to the park on the weekend. Either I walk or dad drives me. I play on my phone. I go to see my friends in Minto, Ingleburn or Leumeah. I may stay a couple of days with my Ingleburn friend and we can walk to school together. My Minto and Leumeah friends don’t go to the same school as me. I can stay overnight with them. At home, I may play on the trampoline. I may visit my uncle and auntie in Leumeah and may stay overnight.”
Ms Fox says her daughter sneaks her phone when she can and that her iPad is not working.
Ms Fox says she tells her daughter to shower most of the time. This has been a problem since her daughter was aged 3 or 4. She has to be dragged into the shower and may need to be blackmailed.
Ms Fox and her father make dinner, with Ms Fox being the most frequent cook. The children eat in their rooms and rarely eat together as a family.
The claimant helps with washing up and cleans her room, which Ms Fox says is a struggle. She shares a bedroom with her sister, who likes the room to be perfect. The claimant said she had “OCD”, while her mother rejoined that she did not.
The claimant said, “I get on really good with people. Amelia hit me three times on the head and walked away. I passed out in the sick bay bed. It was in February, a week after school started.”
Ms Fox said her daughter struggled to make and keep friends. She hits back when people hit her head. Headaches are common.
She has a friend from kindergarten who lives in Ingleburn and they meet at school. She has two other friends from kindergarten at school. She does not get asked to parties because parents do not know her. She has been to two or three birthday parties in the last year.
The claimant's intrafamilial relationships are stressed with her siblings because she argues and fights with them. Ms Fox said Catapres was the only thing that calmed her daughter when she was arguing and fighting.
Ms Fox said they saved to go to the movies because it was so costly to go out.
The claimant was enrolled in Karate in 2024 and attended classes twice a week after school. She is not in Karate in 2025 because it is too expensive. School has flagged her neck as a problem and she does not play contact sports. At school, she plays netball, Newcomb ball, bin ball, red rover and red rush.
The claimant remains anxious when travelling by bus. Travelling by car is no problem. The family travelled by car to the Gold Coast for a holiday during the 2024-2025 school holiday.
Concentration problems predated the accident with no obvious effect on symptoms following the accident. The claimant said that she didn’t focus when she took Ritalin and so didn’t take it. Ms Fox said that her daughter was more focused when she took her prescribed Ritalin.
The claimant is not assigned homework. Ms Fox said her daughter sometimes did her homework when it was assigned but didn’t finish tasks at school.
The claimant works at recreational and scholastic activities at a rapid pace.
Ms Fox reports that her daughter's scholastic performance has suffered since the accident. The Medical Assessors consider that the school records and her WIAT-III score as evidenced in the documents do not support a change in academic achievement. Her attendance has worsened because of pain symptoms.
No regular religious attendance by the claimant’s family. She said the family was Catholic and Church of England.

REPORT OF MEDICAL EXAMINATION ON 12 MAY 2025

The claimant attended a further examination by Medical Assessors Newlyn and Friend on 12 May 2025.

Who attended the assessment

The claimant was at home in Macquarie Fields with her mother, Ms Cathy Fox, who provided support and history.
The claimant was reported to see Dr Manasee Bidarkar for review of her ADHD symptoms.

Details of any relevant injuries or conditions sustained since the accident

Her mother said the claimant had been in a motor vehicle accident on 14 September 2023 (the 2023 accident) which had increased the claimant’s nightmares. The claimant, her brother and father were in the 2023 accident. Her brother was hospitalised overnight with whiplash. The claimant’s mother said that after the 2023 accident, memories of the first accident came back because she was traumatised.
The family got a new car and the claimant continued to go to school in the car. She was scared but didn’t stop going in the car. The car accident was after the bus breakdown. When the bus broke down they had to take another bus which did not have seatbelts and that caused an increase in anxiety.
Her mother said that the claimant was seen by counsellors in 2018 because she was thought to have ADHD. She was seen again in 2019 because of ADHD symptoms. Her mother recalled the claimant seeing a counsellor six or seven times at Ingleburn Community Health in 2020 and 2021 because she wasn’t sleeping and had nightmares.

Reviewing the 2019 accident, the claimant’s mother said that her daughter’s neck pain had been their main concern. She was doing better in 2022 and symptoms started again in 2023. She did not go in a bus without a teacher until it was fitted with seat belts.
The claimant’s mother said that her daughter’s nightmares were bad at present and recently she had stayed awake until five in the morning.

Current and Proposed Treatment

The claimant has received GP care from Campbelltown Medical Centre since September 2024. She is also prescribed medicine by the Sydney Pain Clinic.
Amitriptyline was recently increased to 20 mg a day.
Catapres was now 100 µg twice a day.
The Sydney Pain Clinic now prescribes both medicines.
She was not currently receiving psychiatric or psychological treatment.
Physiotherapy is currently in progress.

Mental state examination

The claimant was again active throughout the 30-minute assessment interview but not as involved with her mother compared to the previous interview.

COMMENT ON CONSISTENCY

The history obtained was reliable and consistent with the psychiatric mental status examination. Review of the documentation found no inconsistencies. In the reports provided, when compared with the history and examination obtained from the claimant and her mother, it is the Panel’s view that the GP record is not a reliable informer of mental health symptoms.

COMMENTS ON DOCUMENTATION

In respect of the documentation, the Panel notes the academic records from 2022 and 2023 showed a sound overall achievement in both years. The claimant’s mother states that her daughter’s academic achievement has declined since the accident; however, her academic record does not support a change in achievement in years 3 and 4.
The counselling records contain assessment results of WIAT-III, a Vinland-3 and a Conners 4 Teacher administered to the claimant. The claimant’s mother initiated these assessments. The claimant was described as a mainstream student.
The Panel notes that the WIAT-III is often used when assessing children with ADHD diagnoses. The WIAT-III in the claimant’s bundle is undated but the Panel considers that it was likely calculated in either late 2024 or early 2025, based on the dating of the other reports. The WIAT-III showed the claimant’s oral language score was in the very low range, her total reading score was in the average range and her mathematics score was in the average range. This WIAT-III score does not support a significant deterioration in academic functioning since the accident.
The Vineland-3 is a measure of personal and social skills used to support a diagnosis of intellectual or developmental disabilities, as well as autism. The claimant’s overall estimate of personal and social sufficiency was moderately low. These results are congruent with the claimant’s reported history of ADHD but are not helpful in assessing the effects of the accident.
The Conners-4 Teacher score did not show behavioural concerns or behaviours associated with ADHD or ODD in November 2024. These results to not support the claimant’s report that she had not taken her ADHD medicine for six months.
A copy of a GP Management plan in the school record dated 4 March 2025 lists health issues of ADHD, neck pain, ODD and asthma, but no phobic, depressive or post-traumatic stress disorder problems.
In respect of the Ingleburn Medical and Dental Centre clinical notes printed on 25 March 2025, these begin on 8 March 2022 with the last clinical contact recorded on 5 November 2024. Until 5 November 2024 there is no mention of mental health issues related to the accident. Neck pain caused by the accident is not mentioned until January 2023 and there are no consultations between February 2023 and November 2024.
The 5 November 2024 consultation begins with a review of neck pain and a referral to physiotherapy. The claimant’s mother was concerned about “?? possible PTSD trait” and asked for a counselling referral. A GP mental health plan was written, and a referral to Real Therapy Solutions was made.
In respect of the Ingelburn Medical & Dental Centre clinical notes printed 1 March 2022, there is no reference to psychological referrals, post traumatic stress disorder, or any psychological issues arising from the accident.
The Panel notes that the Sydney Children’s Hospital pain clinic records note ‘PTSD trait’ in June of 2023, the first mention of any mental health symptoms attributed to the accident.
The Panel notes the insurer’s submission that the claimant’s did not meet the DSM-5-TR criteria for the diagnosis of a phobic disorder and that evidence of phobic symptoms was lacking in the documents. In the examination, the claimant’s mother claimed that she reported symptoms to her GP but could not explain why there were no entries in the notes. Ms Fox said that there was a greater focus on the pain symptoms. The GP consultations were few and after October 2020, neck pain was not recorded until early 2023 and then not again until early 2024. The Review Panel notes the GP records also did not mention ADHD except on a 2025 GP Mental Health Plan. There was one mention of a referral to a paediatrician.
Further, while a significant portion of the clinical notes before the Panel do not refer to the accident, the Panel finds this is not determinative, especially as the claimant has been attending numerous health providers for a variety of reasons including several unrelated to the accident.
The Panel finds that Ms Fox’s history was valid and that the GP records are not a reliable source of information about mental health problems.

DIAGNOSIS AND FINDINGS

The Panel is not required to choose between competing medical opinions and is required to form its own opinion.[8]
[8] Insurance Australia Group Ltd t/as NRMA Insurance v Keen (2021) 399 ALR 765; [2021] NSWCA 287; Insurance Australia Ltd v Marsh (2022) 99 MVR 1; [2022] NSWCA 31.
The Panel adopts the reasoning in Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6 (Lynch) at [70]-[71] that the psychological condition can be present at any time to establish that the injury is not a threshold injury for the purposes of the MAI Act.
The Panel also notes that the claimant bears the onus of establishing that any injury is not a threshold injury for the purposes of the MAI Act.[9]
[9] Lynch.
The Panel refers to the medical examination reports prepared by Medical Assessors’ Newlyn and Friend, set out above. These reports were provided to the Panel prior to the Panel meetings on 14 April 2025 and 20 August 2025, respectively. The Panel agrees with and adopts the findings made by the Medical Assessors as set out in the medical examination reports.
Based on the information before it, the Panel assessed whether the claimant met the DSM-5-TR criteria for:
(a)    specific phobia;
(b)    adjustment Disorder, and
(c)    post-traumatic stress disorder.
The Panel notes that it is reported by the claimant’s mother that the claimant had been diagnosed with ADHD and ODD prior to the accident. Behavioural disturbance is noted in the school reports well before the accident. The Panel notes that the claimant began treatment for her ADHD symptoms with Ritalin before the accident and has continued treatment. Her ODD symptoms are noted to be no longer present, although this condition is still listed by her GP. The Panel finds that any diagnosis of ADHD and ODD are pre-existing conditions and not caused by the accident.

Specific phobia

The Panel finds that the claimant meets the DSM-5-TR Diagnostic Criteria for specific phobia as follows:
(a)    the claimant has marked fear or anxiety about a specific object or situation (bus travel) (criterion A);
(b)    the phobic object or situation (bus travel) almost always provokes immediate fear or anxiety in the claimant (criterion B);
(c)    the phobic situation (bus travel) is actively avoided or endured by the claimant with anxiety (criterion C);
(d)    the claimant’s anxiety is out of proportion to the actual danger posed by the specific situation (bus travel) and to the sociocultural context (the everyday use of buses as a means of public transport and school transport) (criterion D);
(e)    the anxiety and avoidance is persistent and has lasted for more than five years (criterion E);
(f)    the anxiety causes clinically significant distress in the claimant (criterion F), and
(g)    the symptoms of another mental disorder do not better explain the claimant’s disturbance (criterion G).
Specify if: Situational (bus travel).
The claimant’s history and provided documents show a deterioration in functioning after the accident with specific phobia symptoms for bus travel. She did not travel by bus at school for two years because of her phobia symptoms.
The Panel notes that, after seatbelts were installed, the claimant reported that she could travel on the school excursion bus but still needed close support from her teachers until recently. She continues to report some anxiety about travel in buses but feels safe in the school excursion bus. With a friend’s support, she recently travelled a short distance in a public bus.
The claimant did not report any avoidance of bus travel prior to the accident and reports to have travelled on buses. There is no evidence before the Panel to the contrary.
Although her specific phobia symptoms are now mild, the Panel finds that the claimant continues to meet the DSM-5-TR criteria for the diagnosis of a specific phobia, situational (bus travel).

Adjustment disorder

The Panel finds that the claimant meets the DSM-5-TR Diagnostic Criteria for adjustment disorder as follows:
(a)    the development of emotional or behavioural symptoms in response to an identifiable stressor (neck pain and headache after the accident) occurring within three months of the accident (criterion A);
(b)    these symptoms or behaviours are clinically significant, as evidenced by one or both of the following:
(i)marked distress that is out of proportion to the severity or intensity of the stressor, considering the external context and the cultural factors that might influence symptom severity and presentation.
(i)significant impairment in social functioning show by her withdrawal to her bedroom and irritability with her family.
(criterion B);
(c)    the stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder (criterion C);
(d)    the symptoms do not represent normal bereavement (criterion D), and
(e)    once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional six months (criterion E).
Specify whether: With anxiety.
Specify if: Persistent:
With her persistent neck pain that causes poor sleep, the Panel finds that the claimant has developed a persistent adjustment disorder with anxiety that results in her missing school, retreating to her room and being irritable with her family.

Post-traumatic stress disorder

Given the claimant’s age at the time of the accident, the DSM-5-TR diagnostic criteria for post-traumatic stress disorder for children 6 years and younger apply. The Panel considered the diagnosis of post-traumatic stress disorder.
The Panel finds that the nature of the accident itself did not satisfy criterion A. The Panel finds that the claimant does not meet criterion C and does not meet criterion D, noting that her symptoms in respect of criterion D are from ADHD and pain. Accordingly, the Panel finds that the claimant does not meet the DSM-5-TR diagnostic criteria for post-traumatic stress disorder.

Causation of injury

Causation is not specifically addressed in Part 5 of the Guidelines. However, in Part 6, which deals with assessing the degree of permanent impairment arising from an injury caused by a motor accident, clauses 6.5 to 6.7 set out how causation of injury is to be assessed:
“…
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.' [emphasis in original]
This, therefore, involves a medical decision and a non-medical informed judgement.
6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
Justice Wright stated in Briggs v IAG Ltd (t/as NRMA Insurance)[10] at [35]:
“The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principles were intended to be applied when a medical assessment was being made in relation to causation of minor injuries.”
[10] [2022] NSWSC 372.
In Raiana v CIC Allianz Insurance Ltd, Campbell J noted[11]:
“One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002 (NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely.”
[11] [2021] NSWSC 13 at [65].
The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining the issues of negligence and causation.[12] It is therefore necessary for the Panel to consider whether the accident caused or contributed to the injuries. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[13]
[12] Sections 5D and 5E CL Act.
[13] Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50].
The Panel notes the claimant was 6 years of age at the time of the accident. The Panel finds that the accident, being the sudden breaking of a bus which caused the claimant to hit her head on the glass pane in front of her seat and fall off her seat to the floor, could have caused specific phobia, situation (bus travel), and adjustment disorder with anxiety.
As noted above, the Panel finds that the claimant’s history and documentation show a deterioration in functioning after the accident with specific phobia symptoms for bus travel. She did not travel by bus at school for two years because of her phobia symptoms. She continues to report some anxiety about travel in buses. The claimant did not report any avoidance of bus travel prior to the accident and reports to have travelled on buses. There is no evidence before the Panel to the contrary.
Accordingly, the Panel finds that the claimant’s specific phobia, situation (bus travel), was caused by the accident.
In respect of the claimant’s adjustment disorder with anxiety, the Panel notes the opinion of Dr Assem set out in his medico-legal report dated 29 September 2021 where he opined that the claimant appeared to have a sustained significant injury to her cervical spine that has continued to cause ongoing symptoms. This includes interfering with some of her school activities. Dr Assem opined that the claimant’s condition is consistent with injuries sustained in the accident. The Panel also notes the records of the Sydney Pain Clinic and the other medical records before it, summarised above, regarding the claimant’s physical injuries.
On balance, the Panel finds that the accident was capable of causing physical injuries which could lead to an adjustment disorder, and that the accident was a contributing cause to the claimant’s adjustment disorder with anxiety.
The Panel notes the subsequent 2023 accident. The Panel notes that this accident involved cars and the documentation indicates it did not cause or significantly contribute to the claimant’s psychological injuries. The Panel is not satisfied that there is any causal connection between the 2023 accident and the claimant’s specific phobia, situational (bus travel) or adjustment disorder with anxiety.

Conclusion

The Panel finds the accident was the cause of the following claimed psychiatric injuries:
(a) specific phobia, situational (bus travel), and
(b) adjustment disorder with anxiety.

THRESHOLD INJURY

The Panel revokes the certificate of Medical Assessor Christopher Rickard-Bell dated 28 November 2023 and issues a new certificate which certifies that the claimant meets the DSM-5-TR criteria for the diagnosis of two psychiatric injuries caused by the accident:
(a) specific phobia, situational (bus travel), which is a non-threshold injury for the purposes of the MAI Act, and
(b) adjustment disorder with anxiety, which is a threshold injury for the purposes of the MAI Act.

[2025] NSWPICMP 755

5 September 2025