Khaled v AAI Ltd t/as AAMI - [2025] NSWPICMP 526

DETERMINATION OF REVIEW PANEL
CITATION:	Khaled v AAI Ltd t/as AAMI [2025] NSWPICMP 526
CLAIMANT:	Mostapha Khaled
INSURER:	AAI Limited trading as AAMI
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Melissa Barrett
MEDICAL ASSESSOR:	Surabhi Verma
DATE OF DECISION:	18 July 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury considerations; claimant injured on 20 August 2022 but had previously suffered a work injury in 2016 for which he had a generalised anxiety disorder, adjustment disorder and severe depression; the Medical Assessor (MA) concluded that the claimant did not satisfy diagnostic criteria for a psychiatric disorder and that his level of functioning was similar to his pre-accident level of functioning; claimant had ongoing disabilities relating to right arm following 2016 work injury; Review Panel satisfied that the claimant had a pre-existing Somatic Symptom Disorder all that additional pain and physical restrictions arising from the accident exacerbated this condition; Review Panel adopts the reasoning in Lynch v AAI Ltd that the psychological condition can be present at any time to establish that the injury is not threshold; an accident can cause a non-threshold psychiatric condition if the evidence establishes that the accident caused or materially contributed to the psychiatric condition even if only by way of aggravating a pre-existing conditionsee Todev v AAI Limited t/as GIO and AAI Limited t/as GIO v Hoblos; Held – Review Panel was satisfied that the accident has caused such an aggravation; MAC revoked.
DETERMINATIONS MADE:	1. The claimant was injured in a motor vehicle accident on 17 December 2023. 2. Certificate and reasons of Medical Assessor Jones dated 1 December 2023 is revoked. 3. The claimant suffered physical injuries in the accident which in turn led to an aggravation of his pre-existing somatic symptom disorder. 4. The claimant has suffered a non-threshold injury.

STATEMENT OF REASONS

INTRODUCTION

This is an application by the claimant for review of a certificate and reasons of Medical Assessor Jones (the Medical Assessor) dated 1 December 2023.
For determination was whether the claimant had suffered a threshold psychiatric injury.
The following injuries were referred by the Personal Injury Commission (Commission) for assessment:
· psychiatric injury.
The Medical Assessor concluded that the claimant had not suffered a psychiatric injury caused by the accident.
Following on from this assessment the Medical Assessor said that consequent on that outcome, a decision about whether the injury was a threshold injury for the purposes of the Motor Accident Injuries Act 2017 (the Act) was not required.

Amendment to legislation

The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2023 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.
For motor accidents occurring…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Continue reading Khaled v AAI Ltd t/as AAMI

Details

AGLC: Khaled v AAI Ltd t/as AAMI [2025] NSWPICMP 526
Case: [2025] NSWPICMP 526
Decision Date: 18 July 2025

CaseChat Overview and Summary

The case of Khaled v AAI Ltd t/as AAMI involved a dispute over the revocation of a Medical Assessment Certificate (MAC) issued under the Motor Accident Injuries Act 2017. The claimant, Khaled, sought to overturn a decision by the Medical Assessor who had concluded that his psychiatric condition did not meet the diagnostic criteria for a psychiatric disorder and that his level of functioning post-accident was comparable to his pre-accident status. Khaled argued that his mental health condition, exacerbated by the accident, did not meet the threshold for a compensable injury.

The legal issues before the court centred on whether Khaled's psychiatric condition, which had been present prior to the accident, could be considered as a result of the motor accident, thus making it compensable. The court had to determine whether the accident materially contributed to Khaled's condition, even if it merely aggravated a pre-existing disorder. The Review Panel considered the precedent set in Lynch v AAI Ltd, which held that a psychiatric condition can be established at any time if it results from the accident or is materially contributed to by it. The court also referenced Todev v AAI Limited t/as GIO and AAI Limited t/as GIO v Hoblos, which further clarified that an aggravation of a pre-existing condition by an accident can lead to a compensable psychiatric injury.

The Review Panel found that the evidence presented demonstrated that the accident had indeed caused a material aggravation of Khaled's pre-existing Somatic Symptom Disorder. They concluded that the psychological condition could be present at any time and that the accident had contributed to it. As such, the Review Panel revoked the MAC, ruling that the accident had caused an aggravation of Khaled's pre-existing condition, thus satisfying the threshold for compensation. This decision was grounded in the precedent that a psychiatric condition can be established if the accident contributed to its manifestation or exacerbation.

The court ordered that the MAC be revoked, allowing Khaled to pursue compensation for the injuries sustained in the motor accident. This outcome recognised the impact of the accident on Khaled's existing condition and validated his claim for compensation under the Motor Accident Injuries Act 2017.

Orders