Khan v AAI Limited t/as GIO

DETERMINATION OF REVIEW PANEL
CITATION:	Khan v AAI Limited t/as GIO [2025] NSWPICMP 73
CLAIMANT:	Mohammed Khan
INSURER:	AAI Limited t/as GIO
REVIEW PANEL
MEMBER:	Elizabeth Medland
MEDICAL ASSESSOR:	Christopher Canaris
MEDICAL ASSESSOR:	Michael Hong
DATE OF DECISION:	10 February 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of medical assessment of single Medical Assessor (MA); whether injuries are threshold injuries; psychiatric injury suffered following motor accident of 19 March 2021; rear-end collision; allegation of post-traumatic stress disorder; insurer submit that the diagnosis did not set out necessary diagnostic criteria; original MA found psychological injury of adjustment disorder is a threshold injury; after clinical examination Review Panel diagnosed a specific phobia (driving), and persistent depressive disorder; Held – Certificate revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION ASSESSMENT OF THRESHOLD INJURY Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Matthew Jones dated 18 January 2023 and certifies that the following injuries caused by the accident are NOT threshold injuries: · specific phobia (driving), and · persistent depressive disorder.

STATEMENT OF REASONS

Mr Mohammed Khan (the claimant) alleges injury from a motor accident occurring on

18 March 2021. The claimant was the driver of a vehicle that was rear ended by another vehicle.
He subsequently lodged a claim upon AAI Limited trading as GIO (the insurer), the insurer of the vehicle considered at fault. The claimant seeks payments of statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act).
A dispute has arisen between the parties as to whether the claimant has suffered a psychological injury caused by the motor accident and whether any such injury is a “threshold” injury for the purposes of the MAI Act.
A threshold injury determination is an important one in terms of an injured person’s entitlements under the MAI Act. If a determination finds that the motor accident has caused a non-threshold injury then the gateway to ongoing statutory benefits and an entitlement to claim damages is opened.
An application was lodged with the Personal Injury Commission (Commission) seeking a determination of the dispute.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor.
The dispute about whether the injury caused by the motor accident is a threshold injury, is a medical dispute, as defined by s 7.17 of the MAI Act, and a medical assessment matter: Schedule 2, cl 2(e) of the MAI Act.
Medical Assessor Matthew Jones issued a certificate and reasons dated 18 January 2023, which certified that the motor accident caused the claimant to suffer a chronic adjustment disorder with depressed mood and mixed anxiety, which is a threshold injury for the purposes of the MAI Act.

THE REVIEW

The claimant sought a review of the medical assessment in accordance with s 7.26 of the MAI Act. On 11 April 2023 the President’s delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel).
Section 7.26(5A) of the MAI Act provides that a 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 of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act.
Rules 127 and 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the Rules.
The Panel met via video conference on 19 March 2024 and determined that a re-examination of the claimant was required. A medical examination was arranged to take place on

18 June 2024 with Medical Assessor Canaris and Medical Assessor Hong via Microsoft Teams. The claimant failed to attend that examination. A further examination was arranged to take place on 24 October 2024 at 11.00am via Microsoft Teams. The examination took place as scheduled with both Medical Assessor Canaris and Medical Assessor Hong.
The Panel reconvened via videolink for a second teleconference on 4 November 2024.

RELEVANT STATUTORY PROVISIONS

The term “threshold injury” is defined in s 1.6 of the MAI Act. It provides that a threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness: s 1.6(1)(b).
Section 1.6 also provides that the regulations may exclude or include a specified injury from being a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (Regulation) further defines threshold psychological or psychiatric injury to include acute stress disorder and adjustment disorder. For the purposes of cl 4 ‘acute stress disorder’ and ‘adjustment disorder’ have the same meanings as in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013: cl 4(3) of the Regulation.
Part 5 of the Motor Accidents Guidelines (Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by a motor accident is a threshold injury for the purposes of the MAI Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“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.”
Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the assessment of threshold psychological or psychiatric injury. These clauses provide:
“Threshold psychological or psychiatric injury assessment
5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, 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.”

ASSESSMENT UNDER REVIEW

Medical Assessor Jones took a history of the accident, noted physical symptoms, and that the claimant “lost all motivation to move forward”. The claimant had resigned from his job as a sales coordinator for a chemical company some months after the accident having done so because he and his wife were separated, had too much going on in his personal life, and was making silly mistakes at work.
He had subsequently attempted to do some work in security but was unable to stand for one or two hours at a time or carry things. He was trying very hard to find work but with no success and was in financial difficulties. He was noted to wake in the middle of the night ruminating that had he not had the accident his life would be different. He was noted to be leading an unstructured life. He would eat only when he was very hungry and had lost a lot of weight. His energy levels were “not that great”.
He admitted to re-experiencing phenomena for example flinching if he saw a car coming from the opposite direction when he drove. He had occasional nightmares. He now drove very rarely restricting himself to local shops and avoiding driving on the M5.
His friendship circles had contracted significantly partly it seems because he felt ashamed after his wife took out an AVO on him. He had tried to quit smoking marijuana but with limited success as he did not have much to do. He was noted to be self-reliant in relation to self-care and personal hygiene cooking for himself. He was noted to have been referred to a psychologist and psychiatrist but had not done so because he could not afford it.
Medical Assessor Jones considered that his presentation was more consistent with an adjustment disorder with mixed anxiety and depressed mood which was noted to be highly reactive to his circumstances which he determined was a threshold injury.

SUBMISSIONS

Claimant’s submissions dated 20 February 2023

It is submitted that Medical Assessor Jones did not ascribe sufficient weight to the report of Dr Naidoo as contained within an Allied Health Recovery Request (AHHR) dated

27 April 2021, and as such had not reviewed and evaluated all the available evidence.
The claimant submits that the Medical Assessor failed to adequately disclose his path of reasoning by failing to provide reasons for discounting the “pathology identified” by

Dr Naidoo.

Insurer’s submissions dated 7 June 2022

These submissions were lodged in support of the insurer’s original reply to the medical dispute. Insofar as they are relevant to the psychological injury, the insurer submits that the diagnosis of post-traumatic stress disorder as set out in the AHHR by Dr Naidoo is not adequately supported by specific reasoning to conform with the diagnosis.
The insurer acknowledges the claimant is suffering psychological symptoms, however the evidence was then inconclusive and insufficient for the purposes of assessing a minor (threshold) injury.

Insurer’s submissions dated 28 March 2023

The insurer submits that Medical Assessor Jones provided clear reasoning for his diagnosis and that he was not under an obligation to deal with every single document presented to him.
The insurer submits that the claimant has misconceived the role of the Medical Assessor, and the Medical Assessor in fact sufficiently conducted his independent role and provided clear and adequate reasons for his decision.

DOCUMENTATION

The Panel has considered all documents provided by the parties in their bundles lodged in compliance with the directions of the Panel.
Dr Robert Gertler provided a report dated 15 December 2021 to the claimant’s representatives. The doctor noted the claimant’s recent marital separation and that he had not worked that year due to back pain and concentration difficulties. He noted the subject accident, that he lost 10kg and had poor appetite, was hypervigilant when driving and having mood swings and irritability. He had a referral to a psychologist and was not on psychotropic medications.
Dr Gertler diagnosed post-traumatic stress disorder and noted 10 years marriage with some strains previously, but with deterioration in the marital relationship after the subject accident resulting in separation. He has occasional contact with two children. Prognosis was uncertain. The doctor opined that maximal medical improvement had not been reached.
The reports of Dr Herald, orthopaedic surgeon dated 1 December 2021 and

27 December 2021 were noted. Dr Herald assessed a 15% whole person impairment owing to a soft tissue injury to the cervical spine with non-verifiable radicular complaints that seemed to have resolved. Ongoing symptoms related to an L4/5 disc prolapse were noted.
His subsequent report is a brief supplementary document the principal relevance of which was that he had been depressed in 2018 and offered some counselling.
The Panel noted sundry certificates of capacity/fitness certifying the claimant as having neck pain with radiculopathy, back pain and chest pain with anxiety, stress, and post-traumatic stress disorder.
The Panel noted the complete record of Mac-Field Medical Practice as printed on

10 December 2021. He had a history of psoriasis. On 17 December 2018, he had presented with depressed mood, low self-esteem, and insomnia with early morning wakening. His wife had left him. He was described as having a gambling addiction which he wanted to deal with. A K10 yielded a score of 24 which would be consistent with a “mild mental disorder” (a score of 25 would have been consistent with a “moderate mental disorder”). An entry on 31 December 2018 noted that he was still not feeling good, still had family issues, had not been able to go to work. He needed a medical certificate and had made an appointment with a psychologist. Subsequent entries deal with physical issues until 15 March 2021 when he presented with pain in his neck and shoulder as well as headache following a motor vehicle accident on the previous night. An entry on 30 March 2021 notes that he had neck pain with radiculopathy and back pain following his motor vehicle accident. He was noted to have “anxiety, stress and PTSD”. On 9 May 2021, he was noted to have seen a psychologist for these conditions and was apparently advised not to work. On 27-28 May 2021, he was referred to a psychiatrist. An entry on 2 June 2021 refers to what appears to be a WorkCover certificate, and he is said to be improving. An entry on 7 July 2021, again refers to a WorkCover certificate for anxiety and depression. He is said to be “stable” but needing a referral to a psychiatrist. An entry on 29 November 2021, again refers to anxiety, depression, and post-traumatic stress disorder and he said to be under the care of a psychologist. On

3 December 2021, a mental health care plan for his psychologist, Dr P Naidoo for anxiety, stress, and post-traumatic stress disorder was prepared. He was not in any psychotropic medication apart from a prescription for zopiclone (a sleeping tablet) on 23 April 2021.
The Panel noted the AHHR of psychologist Dr Naidoo dated 27 April 2021. Dr Naidoo gave a diagnosis of “PTSD” and major depression. He had administered the Beck Depression Inventory, the DASS, the Clinician Administered PTSD Scale for DSM-5, and of the PTSD’s Checklist – Civilian Version which “indicated severe symptoms of depression, stress and anxiety” noting that the patient had experienced “intrusion symptoms; avoidance; negative alterations and cognitions and mood; impact on arousal and reactivity”. It noted the claimant to be “Struggling to return to premorbid functioning levels and experiencing severe back pain which makes returning to work not possible at this time” with “Reduced capacity for all household tasks – can still complete activities of daily living but with difficulty and discomfort” adding that he “Does not engage in usual sporting activities so has lost the social connections that come along with this. Reluctant to go out in the community due to pain and tiredness”. The psychologist’s action plan was duly noted.
The post-traumatic stress disorder checklist (PCL-5) results were not provided to the Panel.
The Panel noted the certificate of Medical Assessor Alexander Woo dated 9 August 2022 which determined that his soft tissue injury to his lumbar spine was a minor (threshold) injury for the purposes of the act. Medical Assessor Woo noted that he “presented with a depressive mood”.
“RS”, a colleague’s statement, indicated that had worked with Mr Khan since the end of 2022 as security officer and he no longer works with them, that he was mentally unfit for work in his opinion adding that he often complained of back pain, was unable to drive due to anxiety and that he had to drive Mr Khan.
The claimant’s statement has been noted.
A handwritten application for personal injury benefits form noted the nature of the accident, the presence of serious anxiety since the accident, and that he could not drive.
Certificates of capacity state anxiety, stress and post-traumatic stress disorder while the existing factor section indicated there were no relevant pre-existing factors. Certified as having work capacity for eight hours, five days per week from March 2021 by Dr Zaman.
Dr Abul Mamun, neurologist, 6 August 2021, noted symptoms suggestive of post-traumatic stress disorder, chronic pain symptoms, and that he argued with wife who now lived separately.
A letter from the same neurologist, dated 30 April 2021 to his general practitioner (GP) noted physical symptoms secondary to the accident. The accident was said to have “caused psychological impact of worsening his anxiety and causing some PTSD symptoms”. With “reports of mild forgetfulness as noted by his wife” although “this could be related to his anxiety rather than concussion as he did not have a head injury”. He was noted to have had a motor vehicle accident as a passenger in 2009 with a major injury because of which he apparently did not drive on highways. A further letter dated 6 August 2021 talks of persisting pain and “PTSD symptoms”. Note was made of “personal issues” including an argument with his wife who is now living separately from him, and he was said to be awaiting referral to a psychiatrist.
Dr Zaman, GP completed records:
·     the top entry was on 10 December 2021, mental health care plan for anxiety, stress, post-traumatic stress disorder, from motor vehicle accident, no hallucination, delusion, suicidal ideation and has neck pain;
·     treatment focussed on Mr Khan's physical injuries;
·     23 April 2021, Zopiclone for sleep, after the subject accident;
·     4 November 2020, sleep well;
·     21 September 2020, 85kg;
·     17 December 2018, sleep problems, early morning wakening, depressed mood, low self-esteem, no hallucination. No suicidal ideation reported. Wife left him. Gambling on sports, affected relationship, sleep problems, mood depend on if wins happy. K10 score, Mental health care plan. Gambling addiction, wants to stop. Comment: this was discussed with him during the assessment and he confirmed having anxiety and depressive symptoms associated with gambling, which then resolved, and
·     K10 score 17 December 2018, most symptoms were some of the time, or little of the time, score 24/50.

RE-EXAMINATION

Psychosocial history and pre-accident history

Mr Khan was born in Bangladesh and came to Australia in 1999. He grew up with his grandmother in Australia, he was living with his father and stepmother, but he has never been particularly close to them. After Year 12, he lived by himself. He was an only child. There was no developmental trauma identified.
He was a student in Bangladesh and in Australia, he completed Year 12 at Randwick Boys High School. He attempted university and attempted an advanced diploma in accounting, but did not finish either.
Mr Khan said he always worked. When he was 15, he started working at McDonald's family restaurant, and later did a lot of retail work, for example, at Woolworths supermarket. He worked at St John's Ambulance head office in a sales coordinator role for about four and a half years.
In terms of general medical history, he does not have cardiac, thyroid or liver disease.
He is not aware of a family history of mental illness.
Mr Khan has not had a previous motor vehicle accident.
He does not drink much alcohol, only socially. He said that after the accident, he tried cannabis, but has not used it since he went overseas a few months ago. He said he gambles a little, usually betting $10 on Sportsbet when games are on at the TAB.
In terms of his forensic history, he reported that when he was in Year 10, he was caught shoplifting with a friend and was given a warning and was not charged.

Past psychiatric history

With prompting, he recalled having gambling issues in 2018 but it did not involve much money involved, as he gave his pay to his wife to manage. He confirmed he saw the GP and had a mental health care plan, but did not see a psychologist. He said he took medicines for anxiety, for a couple of weeks only.
He denied other episodes of psychological/psychiatric treatment before the subject accident.
He said after 2018, his marital relationship was better and they had another child together and thought the marriage was getting better. He could afford two family cars and was financially going well. His wife did not work and he could support the family well. He did not think he had any psychological issues immediately before the subject accident, as his family life was good.

History of the motor accident

Mr Khan had an accident on 15 March 2021 and stated he was driving in Moorebank on his way home after work, being the sole occupant in his car. He said that it had been a while since the subject accident, and recalled he had worked over the weekend following a night shift as a security officer. He stopped at the lights and was rear-ended while stationary. There were two vehicles involved in the accident. It was almost midnight, and not many cars were around.
He said he was hurt from the collision, and the other driver came to check on him. He was in shock and then called his friend, who took him home, and his friend drove the damaged car to a nearby mechanic. Neither the ambulance nor the police attended the scene. The airbags in his car did not deploy. His car was repaired four weeks later.
He provided a statement to the police before visiting his GP with his friend the next day. He said he experienced nightmares and severe distress and saw his GP. He stated that he followed all instructions from the GP.
Mr Khan sustained physical injuries from the subject accident and reported ongoing problems with standing due to a back injury. Physically he has improved. He said each time he attempted security work, he could not manage prolonged standing and had to stop. He has no other physical injuries from the accident now. He has not had surgery since the accident.

History of symptoms and treatment following the motor accident

Psychologically, Mr Khan said since the accident, he has had anxiety driving and anxiety as a passenger and later became depressed, because he thought how he changed since the accident needing to ask friends to take him places but often people were not available. He struggles to work and support himself financially. Depression became overt after 6-7 months, as things were not going well and he had chronic pain symptoms and struggled with work. He said depression became worse over time as physically he still struggles to work.
He stated that he had been unable to manage the driving anxiety that had developed since the accident, and even sitting in a car with his friend made him feel jumpy and anxious. After the accident, he stopped driving and sold his car in late 2021, citing his inability to drive due to anxiety as well as financial reasons.
Mr Khan had limited psychological treatment and continues to struggle with driving, though he can manage quiet back streets now. However, he cannot cope with main roads or highways. He stated that he is always afraid when on the road and worries that his friends might laugh at his overreaction when he is a passenger.

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

Mr Khan has not had further car accidents or sustained other psychological injuries.
In terms of his marriage, Mr Khan reported that he was married for nine years. He has two children, a four-year-old son and an eight-year-old daughter. However, the relationship ended within two or three weeks after the accident. He said there had been pre-existing marital problems, but he eventually discovered that his wife had not been faithful. She took out an Apprehended Violence Order against him, which he believes was an attempt to manipulate the system and said it was never proven, and all charges were dropped, which is why he retained his security licence. He said he struggles to have regular contact with his children and only saw them once in the past four months, and his limited finances are part of the problem.
The Panel discussed with Mr Khan the marital breakup and its close proximity to the accident. He said that overall, the accident had a bigger impact on his psychological health, but that the marital stress had also affected him.

Current symptoms

Mr Khan described having depressed moods constantly as he feels alone. He said he worked hard to achieve in life but everything went down since the accident, and he does not have much support in Australia. He cheers up in mood when he can see his children. He said his depression has worsened over time.
He said after the subject accident, he lost 15-20kg and his friends commented about his weight changes. He said he felt stressed and was not eating. Recently, he gained a bit as he went overseas and his family was around him. His depression was better and he felt supported and ate more. He reported his energy levels are poor and he is always tired.
He said he was outgoing and friendly, he liked to communicate in the past, but after the accident, he does not want to talk. He does not get angry anymore. He reported having major problems with his concentration and memory. He said his sleep is his biggest problem, with initial insomnia and he would wake up and struggle to fall asleep again. He said he has dreams related to his children generally, and not really bad dreams.

Current and proposed treatment

Mr Khan does not take any medication now. He took an antidepressant after the subject accident for one week and did not continue. He consulted Dr Naidoo, psychologist from around one month after the subject accident, and had treatment for a couple of months and has not had other psychological/psychiatric treatment. He said he cannot afford treatment.
There are no proposed treatments.

Clinical examination – Mental state examination

Mr Khan had short greying hair and was unshaven. He engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. He was not restricted in his affect range and reactivity. He smiled and laughed intermittently. He spoke spontaneously and fluently. He was not thought disordered and the provided history was easy to follow. There was no overt cognitive impairment.

Current functioning

Mr Khan is 42 and lives in a shared house with two other people.
In terms of daily activities, Mr Khan said he does not work and so “time does not go”. He has been looking for work and has been applying online. He watches TV.
He attends to the household chores and struggles with cooking and food preparation as he is not a good cook and said he generally eats noodles. He said he is not close to shops and cannot drive, so he tries to buy groceries when his friends are available to drive him.
In terms of recreational activities, he played indoor soccer and cricket previously but not now.
He said he is embarrassed to see his friends. He has friends but they are not as close now, and he thinks others are "successful" and he is not. He calls some friends and thinks they are avoiding him.
He said he has never been close with his stepmother or other family in Australia.
He previously played under 17 state cricket and was on the Australian school team for soccer.
Mr Khan went to the Mosque but said he has not been good with going, and now he prays at home.
In terms of Employment history after the subject accident, at the time of the accident,
Mr Khan worked as a state sales coordinator at Vesuvius, and he was processing orders and doing invoicing full-time for two years. After the accident, he said he started making silly mistakes. His employer was supportive and arranged for him to work from home, but even then, he could not manage. Mr Khan recalled that, due to anxiety about driving, he had to take the bus and train to get to work. He eventually resigned in September 2021.
Mr Khan said he has done security work for a long time and was doing it on the weekends before the accident. However, since the accident, he has struggled to maintain any work. He probably worked for one or two months, but nothing ever lasted long due to his poor concentration and difficulties standing. He said that in 2024, he has probably worked for two or three weeks in security roles at pubs, offices, and for Alarm Security. Currently, he is receiving JobSeeker payments from Centrelink.
He stated that he has been struggling with work since the accident due to concentration problems, which have led to him making mistakes. When he worked in alarm security, he made invoicing mistakes, and his boss spoke to him about it, after which he resigned. He said that before the accident, he had been told he was good at his job.

Comments of consistency

There was no inconsistency identified.

Comments

DETERMINATIONS

Diagnosis and reasons

Mr Khan has a past psychiatric history and did not proceed with psychological treatment recommended by his GP. He reported good psychological health two years before the subject accident, as he was working two jobs and making good money.
He reported being in shock during the accident and developed severe anxiety and a phobia of driving, and six months after the subject accident, depression became more severe. His depressive symptoms have persisted more than two years now and he still has a specific phobia of driving.
The Panel noted the relative minor nature of the accident and his described response which was not consistent with the post-traumatic stress disorder criterion A description and therefore, he does not have post-traumatic stress disorder.
Mr Khan fulfils the DSM-5-TR diagnostic criteria for a specific phobia (driving);
(a)    Mr Khan has a marked fear about driving;
(b)    driving always provokes immediate fear or anxiety and he has not been able to drive on highways even to the present day;
(c)    driving and being a passenger, is endured with significant anxiety;
(d)    his anxiety is out of proportion to the situation;
(e)    his anxious-avoidance has persisted since the subject accident, and lasted longer than six months;
(f)    his anxious-avoidance causes clinically significant distress and impairment as he relies on alternate transportation, trains or buses, and his friends to take him to work and appointments, and
(g)    his behavioural disturbance is not better explained by the symptoms of another mental disorder. Specifically, his anxiety is not better explained by panic attacks, panic disorder, agoraphobia, obsessive-compulsive disorder or another psychological condition.
Mr Khan fulfils the DSM-5-TR criteria for a persistent depressive disorder:
(a)    Mr Khan has depressed mood for most of the day, for more days than not, for at least two years.
(b)    He described being depressed and also having the following symptoms:
(i)poor appetite and significant weight loss 15-20kg;
(ii)insomnia;
(iii)chronically low energy;
(iv)low self-esteem, and
(v)poor concentration.
(c)    During the two-year period, he has never been without the depressive symptoms above for more than two months at a time.
(d)    The Panel noted Mr Khan has not fulfilled the DSM-5-TR criteria for a concurrent persistent major depressive episode as his depressive symptoms have never been pervasive.
(e)    There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder.
(f)    His psychological symptoms are not better explained by Schizophrenia or a related psychotic disorder.
(g)    His symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hypothyroidism).
(h)    His symptoms cause clinically significant distress and impairment in social functioning, and he has been withdrawn from people as a result of depression.

Causation and reasons

Mr Khan has a past psychiatric history but did not proceed with psychological treatment recommended by his GP recommended. He reported good psychological health two years before the subject accident, as he was working two jobs and making good money.
He reported being in shock during the accident and developed severe anxieties and a phobia of driving, and six months after the subject accident, depression became more severe. His depressive symptoms have persisted more than two years now and he still has a specific phobia of driving.
The Panel noted previous marital problems and his marriage ended shortly after the subject accident, with an AVO against him.
Overall, following clinical examination, the Panel has concluded that the subject accident has caused his driving phobia and contributed to his depressive symptoms, and there is more than a negligible contribution from the subject accident to Mr Khan's current psychological injury.

CONCLUSION

The Panel find the claimant has suffered the following psychological injuries caused by the motor accident:
· specific phobia (driving), and
· persistent depressive disorder.
Accordingly, the injury is not a threshold injury for the purposes of the MAI Act.
The Panel revokes the certificate of Medical Assessor Jones and issues a new certificate at the beginning of these reasons.

[2025] NSWPICMP 73

10 February 2025