Kim v Youi Pty Limited

DETERMINATION OF REVIEW PANEL
CITATION:	Kim v Youi Pty Limited [2025] NSWPICMP 628
CLAIMANT:	Heasuk Kim
INSURER:	Youi Pty Ltd
REVIEW PANEL
MEMBER:	Terence Stern OAM
MEDICAL ASSESSOR:	Matthew Jones
MEDICAL ASSESSOR:	Ronald Gill
DATE OF DECISION:	21 August 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; medical assessment of whole person impairment (WPI) by Medical Assessor (MA); claimant injured in motor vehicle accident; MA determined the claimant’s permanent impairment at 10%; the claimant sought a review of the assessment under section 7.26; the Review Panel re-examined the claimant; Review Panel revoked certificate of MA; substituted determination of 12% whole person impairment.
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 Paul Friend dated 7 July 2024 and substitutes the determination that the following injuries caused by the accident gave rise to a permanent impairment of 12% and is greater than 10%: · Post-Traumatic Stress Disorder, and · Major Depressive Disorder.

STATEMENT OF REASONS

INTRODUCTION

The claimant, Heasuk Kim (Ms Kim) was injured in a motor vehicle accident at Lidcombe on 6 December 2021 (the accident). Following the accident, Ms Kim made a claim for damages under the Motor Accident Injuries Act 2017 (MAI Act) on the insurer, Youi Pty Ltd (the Insurer).
A dispute has arisen between Ms Kim and the insurer about whether the degree of permanent impairment that has resulted from psychological injury caused by the accident is greater than 10%. The dispute is a medical dispute, as defined by s 7.17 of the MAI Act, and a medical assessment matter: Schedule 2 cl 2(a) of the MAI Act.
The medical dispute was referred to Medical Assessor Paul Friend for assessment. Medical Assessor Friend examined Ms Kim on 27 June 2024 and on 7 July 2024, he certified that the following injuries caused by the accident had given rise to a permanent impairment of 10% as a result of:
· Post-Traumatic Stress Disorder, and
· Exacerbation of pre-existing Major Depressive Disorder
Ms Kim sought a review of the assessment. The President’s Delegate subsequently determined that there was reasonable cause to suspect that the assessment was incorrect in a material respect. The review application was accepted and referred to this Review Panel (the Panel).

THE REVIEW

The Panel is to conduct the Review in accordance with s 7.26 of the MAI Act. Section 7.26(5A) provides that the panel is to be constituted by two medical assessors and a member assigned to the Motor Accidents Division of the Commission.
The Review is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) MAI Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128.
Version 9.2 of the Motor Accident Guidelines (Guidelines), effective from 10 November 2023.

Directions

On 1 April 2025, the Panel made directions for provision of documents and written submissions.
Further Directions issued on 5 June 2025 noted that the re-examination of Ms Kim by the Review Panel was necessary and that she was to be examined by Medical Assessor Jones and Medical Assessor Gill on behalf of the Panel via Microsoft Teams on 3 July 2025

STATUTORY PROVISIONS

Permanent impairment

If there is a dispute about whether the degree of permanent impairment of an injured person is sufficient for an award of damages for non-economic loss, damages may not be awarded unless the degree of permanent impairment has been assessed by a medical assessor under Division 7.5: s 4.12(1) MAI Act.
The method of assessing the degree of impairment is dealt with in s 7.21, which is in the following terms:
“7.21 Assessment of degree of permanent impairment
(1)    The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.
(2)    Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.
(3)    In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.
(4)    A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent.”
Clause 6.35 of the Guidelines states that psychiatric impairment is assessed in accordance with ‘Mental and behavioural disorders’, found in clauses [6.201]-[6.228] of the Guidelines.

Pre-existing impairment

Pre-existing impairment is addressed in clauses 6.31-6.33 as follows:
“Pre-existing impairment
6.31 The evaluation of the permanent impairment may be complicated by the presence of an impairment in the same region that existed before the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value. If there is no objective evidence of the pre-existing symptomatic permanent impairment, then its possible presence should be ignored.
6.32 The capacity of a medical assessor to determine a change in physical impairment will depend upon the reliability of clinical information on the pre-existing condition. To quote the AMA4 Guides (page 10): 'For example, in apportioning a spine impairment, first the current spine impairment would be estimated, and then impairment from any pre-existing spine problem would be estimated. The estimate for the pre-existing impairment would be subtracted from that for the present impairment to account for the effects of the former. Using this approach to apportionment would require accurate information and data on both impairments.' Refer to clause 6.218 for the approach to a pre-existing psychiatric impairment.
6.33 Pre-existing impairments should not be assessed if they are unrelated or not relevant to the impairment arising from the motor accident.”
Clause 6.35 of the Guidelines states that psychiatric impairment is assessed in accordance with “Mental and behavioural disorders” within the Guidelines, namely clauses [6.201]-[6.228] of the Guidelines.
In order to measure impairment caused by a specific event, a medical assessor must, in the case of an injured person with a pre-existing psychiatric diagnosis or diagnosable condition, estimate the overall pre-existing impairment using precisely the method set out in the Guidelines, and subtract this value from the current impairment rating: cl 6.218.

Causation

The Guidelines state as follows with respect to causation of injury:
“Causation of injury
6.5    An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.
6.6    Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1.The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2.The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.’
6.7    There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the 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.”
It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychiatric condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The motor accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

ASSESSMENT UNDER REVIEW

Medical Assessor Friend examined Ms Kim on 27 June 2024 and issued his certificate on 7 July 2025.
At [2], he lists the injuries referred for review:
· Post-Traumatic Stress Disorder; and
· Major Depressive Disorder
At [3]-[4], he briefly discussed the submissions of the parties.
The documents reviewed by Medical Assessor Friend at [5] were limited to those with the Application and Reply, and the late documents referred to at [6].

History

Medical Assessor Friend took an extensive history at [8].
He refers to the consistency with the entry in the clinical notes of Dr Jung Sook Kim with respect to her thyroid cancer and surgery. Dr Kim also refers to Ms Kim’s depression following her husband’s death and that it was difficult to determine when it commenced.
He continues by referring to Ms Kim’s depression and admission to Liverpool Hospital in 2013 and to her treatment with antidepressant medication.
He refers to the continued consults with Dr Kim from 2013 until about two years prior to the accident.
He refers to what Ms Kim told him about when she ceased taking antidepressants prior to the accident and reported that she was feeling better.
He discusses the timing of that cessation and that it was inconsistent with the clinical entries in the notes of Dr Mark Yim (20 September 2017 until 12 December 2023).
He refers to the entry of 3 September 2021 of Dr Yim, that her mood remained low and that she had escalating anxiety and difficulty sleeping.
Medical Assessor Friend comments that there did not appear to have been a cessation of medication or complete resolution of psychiatric symptoms before the accident.
He refers to the last report of Dr Jung Sook Kim, prior to the accident, of 14 October 2020 which stated that Ms Kim continues to report a severe level of depression and anxiety, worsened by two cancer operations.
He refers to the scores on the DASS-21 and DASS-42 and their implications for complete resolution of depressive symptoms.
He notes that Dr Kim had stated that Ms Kim required ongoing treatment and assessment.
Medical Assessor Friend then set out the history of the accident at [9], noting that Ms Kim stated that she ‘feels scared’ when she thinks about it [the accident]. She stated that someone had driven through a stop sign and collided with her vehicle which was later written off. A passerby took her out of the vehicle. Ambulance, police and a Korean interpreter attended the accident. She was conveyed to Westmead Hospital by ambulance where she remained for the rest of that day, if not into the next day.
Medical Assessor Friend then set out the history of symptoms and treatment following the accident at [10], including an undated report of Dr Jung Sook Kim which stated that Ms Kim had diagnoses of Major Depressive Disorder and Post-traumatic Stress Disorder, and that her condition had been aggravated by the accident.
Medical Assessor Friend referred to the reported scores on the DASS-21 of
25 January 2022 with 42 for Depression, Anxiety, and Stress, and he commented that those scores were in the extremely severe range.
Medical Assessor Friend at [12] referred to Ms Kim’s current symptoms, noting that she had scary thoughts, dreams about vehicles running over her, would wake up from sleep crying, and had difficulties getting back to sleep.
Medical Assessor Friend set out current and proposed treatment at [13], noting that Ms Kim was receiving physiotherapy and hydrotherapy both about once each week. She consulted Dr Mark Yim once every two weeks and Dr Jung Sook Kim about once each week. Her current medications were Pristiq 50mg tablets, Avanza 30mg tablets, Duloxetine, Temazepam for sleep, Panadeine Forte, Panadol, Aspirin 100mg, Celebrex 100mg and Amoxil. Ms Kim could not name these medications but instead showed Medical Assessor Friend the boxes of these medications. She could not tell him the dose of each tablet. The only proposed treatment is the scheduled corticosteroid injection into her back.
Medical Assessor Friend conducted a clinical examination at [14] and set out her current functioning at [15] including that she showered about once every 10 days and stayed in bed most of the time. She told him about her social and recreational functioning before the accident as compared with at the time of the examination.
He pointed out to her the similarity between Dr Yim’s notes between 29 October 2021 and 14 January 2022 and 6 May 2022 appeared to be very similar in stating that her anxiety was stable. She said that the examiner should look at the dates and that the medication was increased after the accident.
Medical Assessor Friend then set out his review of the relevant documents, including the clinical notes of Dr Yim, and the undated report and clinical notes of Dr Kim.
He then reviewed the documentation at [17], including reports of Dr Jung Sook Kim, Dr Mark Yim, Dr Ki Tai (Frank) Chow, and Dr Yajuvendra Bisht.
Medical Assessor Friend reviewed the medications that Ms Kim had been taking over the period covered by the clinical notes.
At [18] under diagnosis and reasons, Medical Assessor Friend commented that Dr Mark Yim’s clinical notes did not record many new symptoms following the accident but the account of Ms Kim which is supported by the contemporaneous account in the clinical entries of Dr Kim described many symptoms following the accident, particularly trauma-related symptoms.
Medical Assessor Friend notes that Dr Kim, Dr Bisht, and Dr Chow made diagnoses of Post-Traumatic Stress Disorder and Major Depressive Disorder.
Dr Yim made a diagnosis of Post-Traumatic Stress Disorder.
Medical Assessor Friend concluded at [18] that Ms Kim reached the criteria for a diagnosis of Post-Traumatic Stress Disorder: -
Category A - She was involved in a very frightening accident and described being scared;
Category B – She had recurrent and distressing nightmares about the accident which occurred every night of the first year following the accident, but are now less frequent; she had recurrent thoughts about the accident, present most of the time causing her to panic with her heart beating, being scared, and having tearfulness;
Category C – She avoids driving and travelling by motor vehicle;
Category D – She continues to have a negative emotional state;
Category E – She is hypervigilant when travelling in a motor vehicle. She has problems with concentration and sleep;
Category F – The disturbance has been present for more than a month;
Category G – The disturbance causes clinically significant distress and impairment in social, occupational, and other important areas of functioning;
Category H – For disturbances not attributable to the physiological effects of substance or other medical condition.
Medical Assessor Friend continued at [19] that Ms Kim did have a pre-existing Major Depressive Disorder, but her condition was stable before the accident.
Medical Assessor Friend determined at [20] that the following injuries were caused by the accident:
· Post-Traumatic Stress Disorder, and
· Exacerbation of pre-existing Major Depressive Order
Applying the PIRS scale at [22], Medical Assessor Friend determined a median class value of 3 and an aggregate score of 17, and a whole person impairment percentage of 19%.
Medical Assessor Friend then went on to assess the pre-existing impairment and arrived at a 10% WPI for the reasons he set out for each category with a median class value of 2 and a pre-existing WPI of 7%.
At [25], he added 2% pre-existing WPI for the effect of medication prior to the accident leaving an aggregate pre-existing WPI of 9% and a final WPI as a result of the accident of 10%.

THE EVIDENCE REFERRED TO BY THE REVIEW PANEL

Statement of Heasuk Kim – 29 April 2025

The Panel briefly summarises relevant sections of Ms Kim’s Statement below:
[8]     The impact of the collision caused my vehicle to slide, resulting in a secondary collision with a Ford Falcon, with registration number CZ0 9VU, which was parked facing north along Auburn Rd.
[9]     I hit my mouth on the handle, resulting in tooth pain.
[10] Soon after the accident, I was experiencing pain in my chest and jaw, along with a headache and nausea.
[11] I lost consciousness for a short period following the collision. I was unable to get out of my vehicle, which had to be cut open. I was later assisted by a police officer.
[12] Ambulance, police and a Korean interpreter attended.
[13]    I was conveyed to Westmead Hospital by ambulance and was discharged the following day, 7 December 2021.
[19] On 14 January 2022, I had my initial consultation with Dr Mark Yim, a psychiatrist. I have been under his care since 20 September 2017.
[20] On 25 January 2022, I had my initial consultation with Dr Jung Sook Kim, a psychologist. I have consulted Dr Jung Sook Kim since 2013, although there was a break between 14 October 2020 and 25 January 2022
[22] Until 30 January 2023, I had attended several psychological sessions with Dr Jung Sook Kim. The treatments included psycho-education, coping and stress management skills, pain adaption skills, problem-solving skills, and Cognitive Behaviour Therapy (CBT). I was taking antidepressants, sleeping tablets and pain killers. My medications were being reviewed by my psychiatrist once every two (2) weeks since 30 January 2023.
[25] Until 12 December 2023, I had attended several psychiatric sessions with Dr Mark Yim. I received repeated education on medication dependence, particularly benzodiazepines and regular reviews approximately every ten (10) weeks, with prescription adjustments as needed.
[29]    Since the accident, I have been prescribed and consumed the following medication:-
(a)Avanza (Mirtazapine) – antidepressant.
(b)Oxazepam – for insomnia.
(c)Pristiq (Desvenlafaxine) – antidepressant.
(d)Oroxine – for thyroid hormone replacement.
(e)Seroquel (Quetiapine) – for sleep and anxiety.
[31] As a result of the accident, I have sustained the following continuing disabilities:-
(nn) Fear of driving.
(oo) Feelings of guilt, shame, worthlessness and hopelessness.
(pp) Feelings of sadness and emptiness.
(qq) Avoidance behaviour.
(rr) Nightmares.
(ss) Flashbacks.
(tt) Fluctuating depressed mood.
(uu) Anxiety attacks.
(vv) Aggravated anxiety when in the car and on the street.
(ww) Hypervigilance.
(xx) Tiredness and fatigue.
(yy) Lack of interest to do things and see people, other than family.
(zz) Poor concentration, motivation and confidence.
(aaa) Difficulty recalling.
(bbb) Occasional suicidal ideation.
(ccc) Easily angered, irritated and frustrated.
(ddd) Easily triggered with cars nearby.
(eee) Difficulty forming and maintaining relationships.
(fff) Anxiety.
(ggg) Stress.
[32] In around 2003, I suffered from depression following the passing of my husband. I was prescribed antidepressant medication, which I continued to take until 2012.
[33] In around 2010, I again experienced symptoms of depression and anxiety. I had my last session with a psychologist on 14 October 2020, prior to the accident. I received conservative treatment focused on stress management, including acupuncture therapy. With the support of medication, my symptoms resolved, and I no longer required ongoing psychological treatment
[35] In around 2019, I was diagnosed with thyroid cancer and underwent multiple cycles of chemotherapy.
[36] On 3 June 2019, I underwent a right hemithyroidectomy, which involved the surgical removal of the right lobe of my thyroid gland.
[37] On 23 September 2019, I underwent a total thyroidectomy, resulting in the complete removal of my thyroid gland.

Application for Personal Injury Benefits Form – 12 December 2021

The Panel briefly summarises the description of the accident:
“Stole car coming from Auburn Road hit the side of main traffic car. despite its stop sign at the intersection.”
The reported injuries included: -
“Whiplash, Multiple soft tissue contusion (Face, RY shoulder, Both Arms, RT leg, Chest Wall), Neck sprain, Back strain, Jaw strain, Philtrum, PTSD”

Ambulance Report – 6 December 2021

The Panel briefly summarises the Ambulance Report below:
“CT MVA ?unconscious pt. OA: As per bystanders Pt was driving her white Lexus along the road, when another vehicle had proceeded through a stop sign without slowing down and approx 80kph and bystanders state T bone the car hitting the front right of the pt's vehicle. This vehicle was then pushed into a parked vehicle. Police on scene. Fire arriving on scene with paramedics. Pt had been extricated. It was alleged the pt was removed from the vehicle by police and bystanders. All airbags deployed. Pt states she wore seatbelt. Major frontal deformity to pt vehicle. Pt NESB, Korean. A bystander happened to speak Korean and assisted with translation. OE: Primary survey: Nil major haemorrhage found. A: Patent and clear, pt crying. B: C+E lungs. Nil decreased breath sound on auscultation. 98% sats RR28. C: Nil bleeding, 140sys BP. D: GCS14 initially as could not answer the day or year but pt became GCS15 over time. SS: Pt reporting pain to front of head, moderate C spine pain. Chest pain, Right shin abrasion. Pt stated SOB but pt panicking and pt breathing resumed to normal levels over time. PEARL size4. Abdo soft and tender. Nil hip deformity. Pt could mobilise both legs. Nil active bleeding. Pt states LOC, unsure how long, as pt was conscious upon paramedic arrival. Normotensive. 12 lead sinus rhythm. Nil punctured lungs. Some minor left sided lower back pain. Pt tearful and highly distressed for majority of treatment. Mx: Spinal precautions, spine board, C-spine hard collar, sandbags. IV access, Morphine, ondansetron. Monitored. DOM requested to scene. ICP DOM attended scene. ICP did not need to attend with 335. Code 3 passed to Westmead hospital.”

Police Report – 11 February 2022

The Panel provides the crash summary details from the Police Report below:
“At 2145 hours on 06 December 2021 driver 1, 43-year-old male was driving a Ford Territory SUV south along Auburn Rd, Auburn. Driver 1 has failed to stop at the intersection of Auburn Rd x Vaughan St, which is clearly marked with a line and stop sign. Driver 1 has subsequently collided into the offside of driver 2, who was driving a Lexus SUV west along Vaughan St. The collision has caused both motor vehicle to slide and collided into a Ford Falcon parked facing north along Auburn Rd.”

Medicolegal Report of Dr Frank Chow – 16 August 2024

The Panel summarises the report of Dr Frank Chow below:

History

On 6 December 2021, she was involved in a motor vehicle accident when another car failed to stop and collided with the right side of her vehicle. She was taken to Westmead Hospital and stayed overnight. She sustained a whiplash injury, soft tissue contusions, and injuries to her neck, back, and teeth. She received pain medication and physiotherapy.
She continues with physiotherapy, remedial massage, and psychological treatment. She reports ongoing headaches, chest and back pain, poor sleep (requiring medication), and fluctuating depressed mood. She has lost three to four kilograms, eats less, and feels unmotivated, guilty, and hopeless. She experiences occasional suicidal ideation (no active plans), and family remains a protective factor.
She remains anxious, particularly in or near vehicles, and has not returned to driving. She continues to see a psychologist weekly and her psychiatrist monthly, with increased medication. Prior to the accident, she was independent and socially active. Though on DSP for thyroid and depression, she had plans to study cookery and work as a cook.

Lifestyle and Medications

Ms Kim is skipping showers. She showers every three to four days. She is wearing the same clothes many days in a row and she is in pyjamas most days. She is not doing house chores. Her daughter comes to do house chores and grocery shopping one to two times a week for her. She does not attend grocery shopping.
She travels out by herself at times to the park. She travels by bus and train. She does not drive. Her daughter drops her to the train station when she goes to see her physiotherapist, psychologist and psychiatrist.
She used to love cooking. She is not engaging in hobbies and activities now. She is not engaging socially. She is not seeing friends. She has lost friendships.
She denied drug and alcohol habits.
Ms Kim takes Pristiq 50 mg, Avanza 60 mg, Seroquel 50-100 mg and Oxazepam 15-30 mg.

Past Medical/Psychiatric History

Ms Kim has a past history of depression in 2003 when her husband passed away. She took antidepressant for seven to eight years. She was psychologically stable and came off antidepressant for two years. She had seen psychologist on and off over the years. She had thyroid cancer and surgery in 2019. She has been seeing a psychiatrist for four years on a monthly basis. She had a psychiatric admission in 2013 for depression. She said she has rheumatism in both hands.

Personal/Social History

Ms Kim was born and grew up in Korea. Her childhood was good with no childhood trauma. Her relationship with parents was good when young. She has four brothers and a sister. She finished Year 12. She did cleaning work for three to four years previously, then has not worked for more than ten years as she was a homestay mother. Her husband passed away 20 years ago. She came to Australia around 2003. She has two children, one daughter in Australia and one son in Korea. She has regular contact and support from daughter locally. She has some contact with her son and siblings overseas.

Mental State Examination

Ms Kim was a 63-year-old female, who appeared of stated age. Assessment was conducted by video conference. Assessment was interpreted by Korean interpreter as well. She had dark hair and was in pyjamas. She appeared slightly dishevelled. She was cooperative, but distressed when talking about her difficulties. There was some eye contact. Rapport was superficially established. Speech was soft spoken.

Summary and Opinion

Ms Kim is a 63-year-old woman living alone with a pre-existing history of depression. She has been on the Disability Support Pension since 2019 due to thyroid cancer and depression.
On 6 December 2021, she was involved in a motor vehicle accident, sustaining physical and psychological injuries. Despite physiotherapy and pain medication, she continues to experience physical pain and restrictions.
The trauma from the accident has prevented her from returning to driving and has aggravated her pre-existing depression. She continues to suffer significant psychological symptoms despite ongoing treatment, warranting diagnoses of
post-traumatic stress disorder and major depressive disorder.
She will require continued psychological and psychiatric care. Her condition is expected to remain ongoing and chronic.

Diagnosis

“Posttraumatic stress disorder and major depressive disorder. Diagnoses based on history provided by Ms Kim, clinical examinations, but also the documentation provided. I do consider her psychiatric injury has been the result of the subject accident on 6 December 2021. She suffers posttraumatic stress disorder as a result of trauma from the motor vehicle accident and there is aggravation of pre-existing major depressive disorder due to the trauma of the accident but also the ongoing physical injuries and pain as a result of the motor vehicle accident on 6 December 2021.”

Prognosis

“Her conditions have remained significant despite ongoing psychological and psychiatric treatment over the last 1½ years. Prognosis of her psychiatric injury as a result of the motor vehicle accident is likely to remain ongoing and chronic.”

Capacity

“She said she was on disability support pension prior to the motor vehicle accident. With stability of her thyroid cancer condition and depression, she had a plan to do a cookery course and work as a cook prior to the motor vehicle accident. She now would not have the capacity to do so due to the psychiatric injury as a result of the motor vehicle accident on 6 December 2021.
She is likely to remain having no capacity for work into the future.”

Report of Dr Yajuvendra Bisht – 1 September 2022

The Panel summarises the report of Dr Yajuvendra Bisht:
History of Injury
“Ms Kim described that she was involved in a motor vehicle accident on 7 December 2021. She said that she was driving her car when big car hit the front of the car she was in, head on. She said that she became unconscious and then was taken by the ambulance to the hospital. Ms Kim described that after the accident she realised that she could have died. She sustained multiple injuries in the accident, and described that she continues to have pain in her lower back, despite having undertaken treatment. She said that she still has constant pain in her lower back. She said that she is not able to go to church anymore, or meet her friends, as she is not able to walk more than a few meters. She described that the pain has also impeded her ability to do housework as well as self-care activities, and tasks like reading and driving. Her elder sister has been living with her for the last 3 months and helps her with some of those tasks. Ms Kim described that after the accident she started to experience persistent decreased interest in previously pleasurable activities. She was also feeling increasingly disconnected from her family members and friends. She would have almost daily recollections of the accident (in the form of flashbacks and nightmares), as well as the preoccupations with the physical injuries. Whenever she would have the recollections or preoccupations, she would feel very anxious. She also started to become more hypervigilant about her own safety and the safety of her family. She also started to have sleep disturbances middle and initial insomnia. These would occur on most nights. Her concentration was affected (she would not be able to sustain concentration for the same lengths of time as before) and her memory was impaired. She started to get anxious in day-to-day situations, such as being in crowded places. She would also get irritable on a frequent basis. She described that as a result of her symptoms she also became quite neglectful of her self-care, such as grooming and diet/exercise, as well as becoming socially reclusive. Ms Kim described that there has been little improvement in her condition so far.”
Diagnosis
“The diagnosis is major depressive disorder and post-traumatic stress disorder, as per DSM 5.”
Prognosis
“The prognosis of further recovery is unfavourable, considering the duration of symptoms, despite treatment.”
PIRS Rating Form

Psychiatric diagnoses	1.Post-traumatic stress disorder	2.Major depressive disorder
Psychiatric treatment	Psychotherapy & Medications
Is impairment permanent?	Yes

PIRS Category	Class	Reason for decision
Self-care and personal hygiene	2	The client is able to live independently. Her sister has only been living with her for the last 3 months. She told me- “I wake up at 9 or 10 o'clock. I drink milk and I make cereal.” Then she takes her medications and then goes for a 10- minute walk. She watches Korean TV for part of the day. In the afternoon, she sometimes takes a nap. If she has appointments, then her daughter takes her to her appointments. She eats fruits in the afternoon and evening, she told me she makes sandwiches. She would be able to walk to nearby shops and buy from there.
Social and recreational activities	3	She does not ever attend social gatherings now. She used to go to church every Sunday, she told me. She had friends through the church, and they would spend time at the coffee shop after the church service. She said that she is not able to go to church anymore, or meet her friends, but that is partly because she is not able to walk more than a few meters.
Travel	2	The client can travel without support person, when travelling to unfamiliar areas. She travelled to South Korea on her own, last year.
Social functioning	2	The client has a distant relationship with the family but there have not been any periods of separation.
Concentration, persistence and pace	2	The client described being unable to read more than a few lines before losing concentration. However, the client was able to sustain concentration throughout the course of the interview with me. In addition, part of the reason that the client gets distracted is the pain condition. Hence, excluding the contribution from the physical condition, the client would be able to do a course, although slower than peers. Also, time, she was able to undertake overseas travel on her own.
Adaptability	2	There would be mild impact from the accident-related psychiatric condition on her adaptability. Prior to the accident, she was however able to be more meticulous with self-care and housework. She is still able to live independently and has regular meals, medication intake, but she eats simpler meals now. She has been able to travel independently to South Korea last years, which indicate a mild impairment in concentration, although she stated that she is now unable to read a few lines before losing concentration.

“Aggregate Score = 13 Impairment (% WPI) from PIRS table = 7%. Deductions for pre-existing impairment (%WPI) = 0 (as there is not enough information to calculate the WPI due to pre-existing condition). Final impairment = 7%. No additions are to be for treatment effect as the treatment has not brought about substantial improvement.”

Reports/Clinical Notes of Dr Jung Sook Kim, Psychologist -

The Panel summarises the report of Dr Jung Sook Kim dated 14 October 2020:
“Ms Kim completed 6 sessions of treatment from 02/03/2020 to 14/10/2020. She continued to report severe level of depression and anxiety which has worsened after her 2 cancer operations. The treatment continued to focus on assisting Ms Kim to better deal with her negative emotions and to perform daily functioning more effectively. Ms Kim learnt coping and stress management skills. She had psychoeducation in relation to her reality and limitations. She was encouraged to have a balanced lifestyle through healthy diet and regular exercise. She was also encouraged to practise mindfulness. She learnt problem solving skills to overcome feelings of hopelessness and helplessness. Ms Kim's response to treatment has been slow. I found there are barriers to recovery including ongoing health problems and financial difficulties. She is unfit to work but has not been approved for Disability Support Pension on multiple occasions which put her in a vulnerable position. She is having an isolated lifestyle. These factors are barrier to recovery. Ms Kim has been taking multiple medications with side effects which make her drowsy and unclear mind, which adversely impacts her day-to-day activities. Ms Kim was administered DASS 21 on 14/10/2020 and she scored 30/42 for depression, 32/42 for anxiety, 34/42 for stress. In my opinion, Ms Kim requires ongoing treatment and assessment to improve her condition and prevent further deterioration.”
The Panel summarises the clinical notes of Dr Kim dated from 25 January 2022 to 2 May 2023 below:
The entry by Dr Kim dated 25 January 2022 refers to the accident and also to an Allied Health Recovery Plan.
The entry dated 16 February 2022 states she is taking antidepressants and sleeping tablets and sees the psychiatrist every two months. She is unable to drive and fearful of another motor accident, she has problems with her digestion, poor appetite and sleeping difficulties.
The entry dated 5 April 2022 states she is unable to drive and remains fearful and anxious in the car and on the street. She did visit Korea to attend her son’s wedding on 29 March 2022 and had physiotherapy in Korea. She was unable to get involved in any activities other than attending the wedding. She has recurrent thoughts of the accident and flashbacks of the accident and sleeping problems combined with a lack of energy and low mood. Ms Kim confirmed that she went to the wedding but was unable to undertake any other activities.
The entry dated 4 May 2022 states she is still unable to drive and relies on her daughter, has sleeping difficulties and is unable to do things effectively. She has difficulties relaxing due to intrusive thoughts, has a low level of energy and low mood. She remains fearful travelling in a motor vehicle but it was not too stressful on the aircraft because it was bigger. She is largely depressed, has a low level of energy. She has a car phobia and PTSD following the accident in 2022 (presumably December 2021). It states she feels a little more positive after going to Korea and she was happy that her son was married and settled.
The entry dated 18 May 2022 states she has recurrent thoughts and flashbacks of the accident, has feelings of hopelessness and helplessness and is depressed. She is hypervigilant in the car and on the street and is sensitive over little things such as car sounds.
The entry dated 1 June 2022 states she has a low level of energy, low mood, feels hopeless and helpless and feels fearful outside. She is socially withdrawn, unable to drive due to fear and has recurrent thoughts and flashbacks of the accident.
There are multiple entries from 1 June 2022 to 2 May 2023 which report similar symptoms and minimal, if any, improvement.
The entry dated 2 May 2023 notes that Ms Kim has difficulty eating, has lost weight, relies on her daughter and is unable to drive.

Report of Dr Mark Yim – 4 May 2023

The Panel read the report of Dr Mark Yim:
“I am writing to provide a clinical summary and treatment update for my patient, Ms Heasuk Kim, a 63-year old lady of Korean background. Ms Kim has been under my care since September 20, 2017. She has a long history of Major Depressive Disorder with chronic insomnia, as well as multiple chronic physical health conditions which have perpetuated her depressive symptoms. Despite ongoing treatment efforts over the years, her depressive symptoms have remained treatment-resistant.
On 7 December 2021, Ms Kim was involved in a serious motor vehicle accident as the driver, The accident was the fault of the other driver, who crossed the midline from the opposite direction. Since the accident, she has developed severe Post-Traumatic Stress Disorder symptoms which include:
-      Flashbacks
-      Nightmares
-      Dissociative experiences
-      Persistent avoidance of both internal and external trauma reminders
-      Inability to drive or travel in a motor vehicle
-      Hypervigilance
-      Exaggerated startle response
-      Difficulty concentrating
-      Furthermore, her sleep has worsened, necessitating increased medication for sleep assistance, and her depression has also significantly worsened.
Ms Kim is currently on the following medications:
-Pristiq 50mg
-Avanza 60mg
-Seroquel 50-100mg
-Oxazepam 15-30mg
In my professional opinion, Ms Kim would likely benefit from a course of transcranial magnetic stimulation (TMS)
However. due to her inability to attend the clinic for the duration of the proposed treatment course, she is unable to access TMS therapy.
I kindly request that you take these factors into consideration when evaluating Ms Kim's claim and provide her with the necessary support and coverage for her treatment.”

SUBMISSIONS

Submissions of the claimant of 2 August 2024

The Panel summarises the submissions of Ms Kim of 2 August 2024 by reference to paragraph numbers:
[2]     Ms Kim respectfully submits that Dr Friend applied the wrong test and failed to consider the Motor Accident Guidelines (MAG) and the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA4). By failing to consider the MAG and AMA4 and applying an incorrect test, his assessment is incorrect in a material respect.
[3]     Ms Kim submits that two PIRS categories were incorrectly applied to her pre-existing impairment: Social and Recreational Activities and Adaptation.
Social and Recreational Activities
[4]     Dr Friend assessed Ms Kim’s pre-existing Social and Recreational Activities as Class 2. The MAG describes Class 2 impairment as:
“Mild impairment. Able to occasionally go out to social events without needing a support person, but does not become actively involved; for example, in dancing, cheering favourite team.”
[5]     However, Ms Kim submits that her own history, as noted by Dr Friend, supports a Class 1 classification. The MAG examples for Class 1 include:
“No deficit or minor deficit attributable to normal variation in the general population. Able to go out regularly to cinemas, restaurants or other recreational venues. Belongs to clubs or associations and is actively involved with these.”
[6]     Ms Kim submits that she satisfied the Class 1 criteria, as prior to the accident she had no or only minor deficit. She regularly attended church, went bushwalking, visited a local pub, played lawn bowls, and sang with friends. This history is recorded by Dr Friend on pages 8 and 25–26 of the Certificate, including:
“Ms Kim, prior to the motor accident she attended church every Sunday and also worked as a volunteer. She had attended a prayer meeting or Bible study and would see friends. She went to a local club and played lawn bowls and went singing and dancing with her friends. She went bushwalking about once each week near Taronga Zoo. She caught the train from Lidcombe to Circular Quay and then the ferry to Taronga Zoo.”
“Ms Kim was living alone and did report she went to church and attended Bible study and other groups at church each week.”
[7]     The Independent Medico-legal report by Dr Frank Chow dated 16 August 2024 also assessed Ms Kim’s pre-existing Social and Recreational Activities as Class 1. Dr Chow noted she enjoyed going to church and meeting friends. Ms Kim submits that this supports a Class 1 finding.
[8]     Ms Kim submits that there is no evidence to the contrary. Dr Friend noted that the clinical notes of Dr Jung Sook Kim do not describe the activities Ms Kim undertook or was unable to undertake. Therefore, in the absence of contrary evidence, Ms Kim submits that her history at the Medical Assessment must be accepted.
[9]     In summary, Ms Kim submits: -
(a)She attended church weekly prior to the accident.
(b)She attended Bible study weekly.
(c)She attended other social groups weekly.
(d)She regularly and independently socialised and enjoyed the company of others.
(e)By attending church and Bible study, she was actively involved in her church community.
[10] As submitted at [4], Class 1 includes examples such as “able to go out regularly” and “belongs to clubs or associations.”
[11] As submitted at [3], Class 2 includes “able to occasionally go out” and “does not become actively involved.”
[12]   Ms Kim submits that, based on the history obtained by Dr Friend, her pre-existing impairment under Social and Recreational Activities should be assessed at Class 1.
[13] Ms Kim further submits that there were no issues raised about her consistency or presentation during the examination with Dr Friend, as confirmed on page 11 of the MAC. Accordingly, it must be accepted that Dr Friend accepted her history.
Adaptation
[14] Dr Friend assessed Ms Kim’s pre-existing Adaptation as Class 5, based solely on her inability to work due to her pre-existing condition.
[15] Ms Kim refers to clause 6.210 of the MAG, which defines Adaptation (or deterioration or decompensation) as referring to repeated failure to adapt to stressful circumstances.
[16] Clause 6.221 of the MAG requires that where adaptation cannot be assessed by reference to work or work-like settings, consideration must be given to usual pre-injury roles such as caring, housekeeping, managing finances, volunteering, study, or other responsibilities.
[17] Clause 6.220 provides that class descriptors are illustrative, not literal, and that the assessor must obtain a history of the pre-accident lifestyle and assess how it changed.
[18] Ms Kim submits that both the MAG and AMA4 must be considered in assessing Adaptation, pursuant to clause 6.205 of the MAG.
[19]   Page 294 of AMA4 defines “deterioration or decompensation” in terms of difficulty with daily living, social relationships, and task completion. It states the reviewer may assess “residual functional capacity” based on understanding, persistence, social interaction, and adaptation.
[20] Ms Kim submits that, pursuant to clauses 6.220, 6.221, and AMA4, Dr Friend should have assessed her Adaptation based on her pre-injury roles and functioning. Dr Friend noted that she had not worked since 2013 or shortly after, but Ms Kim submits he erred by limiting the assessment solely to work ability (noted on page 27 of the PIRS table).
[21] Ms Kim submits that the following pre-accident history noted by Dr Friend on page 8 should have been considered in assessing her functioning:
(a)Lived independently and had no difficulties with day-to-day activities and personal care.
(b)Drove unaccompanied.
(c)Left home unaccompanied.
(d)Attended church and volunteered weekly.
(e)Attended prayer meetings and Bible study.
(f)Had no impairment in ability to travel.
(g)Had no social functioning impairment; had good relationships with daughter, son-in-law, and friends.
(h)Only mild impairment in concentration, persistence, and pace.
(i)Intended to study cookery and return to work as a chef.
[22]   Given the above, Ms Kim submits that she was independent and functioned normally in the general population prior to the accident, with only mild impairment in concentration.
[23] Ms Kim further submits that Dr Friend failed to consider that her Disability Support Pension was due to both thyroid cancer and depression. Therefore, he should have apportioned the impairment accordingly but failed to do so or provide reasons.
[24] Considering her pre-injury roles and apportionment due to thyroid cancer, Ms Kim submits that her Adaptation should be assessed at Class 3 for her pre-existing psychiatric condition, representing moderate impairment.
Conclusion
[25] Ms Kim submits that Dr Friend applied the wrong test and failed to consider the MAG and AMA4, and therefore erred in his assessment. The matter should be referred to a Review Panel.
[26]-[31] If Ms Kim’s submissions are accepted, her pre-existing class ratings would be: 1, 1, 1, 2, 2, 3. The median score is 1.5, which rounds up to 2. The aggregated score is 10. Table 17 of the MAG converts this to 5% WPI. Adding 2% for treatment effect, the final deductible for pre-existing WPI is 7%. The final WPI is therefore 19% – 7% = 12% WPI.
[32] Ms Kim submits that this result would materially affect her claim, as she would meet the 11% WPI threshold and be entitled to Non-Economic Loss damages.

Submissions of the Insurer of 22 August 2024

The Panel summarises the submissions of the Insurer of 22 August 2024 by reference to paragraph numbers:
[2] The Insurer submits that there is no reasonable cause to suspect material error in Assessor Friend’s Certificate, as required by s 7.26(2) of the MAIA.
[3] The Insurer submits that Ms Kim’s arguments focus only on Medical Assessor Friend’s assessment of two PIRS categories in relation to her pre-existing impairment:
(a)Social and Recreational Activities.
(b)Adaptation.
Pre-Existing Psychiatric Injury
[4]-[5] The Insurer highlights that Medical Assessor Friend diagnosed a Pre-existing Major Depressive Disorder. The Insurer submits this is a significant psychiatric condition.
[6] The Insurer refers to page 5 of the Certificate, where Medical Assessor Friend recorded Dr Yim’s 14 October 2020 report, stating Ms Kim’s DASS scores were 30/42 (depression), 32/42 (anxiety), and 34/42 (stress), all in the "extremely severe" range.
[7] The Insurer submits that it is unsurprising Assessor Friend assessed Ms Kim’s pre-existing impairment on the PIRS at 7% WPI plus a 2% treatment effect, totalling 9% WPI.
Pre-existing impairment – social and recreational activities
[8] The Insurer highlights paragraph 6.220 of the Motor Accident Guidelines (MAGs), which states that PIRS descriptors should not be applied literally.
[9] Paragraph 6.220 provides:
"The classes in each area of function are described though the use of examples. These are intended to be illustrative rather than literal criteria."
[10] The Insurer submits that Ms Kim’s submissions ignore paragraph 6.220 and improperly criticise Medical Assessor Friend for not applying PIRS examples literally.
[11]Ms Kim disputes a mild impairment to her pre-accident "Social and Recreational Activities" by making a literal comparison between the Class 2 PIRS example and the history recorded by Assessor Friend.
Claimant’s History Not Reliable
[12] The Insurer notes Ms Kim bases her argument primarily on the history recorded on page 8 of Medical Assessor Friend’s Certificate.
[13] The Insurer highlights that Medical Assessor Friend found that history to not be reliable.
[14]The Insurer refers to Medical Assessor Friend’s statement regarding “Social and Recreational Activities”:
"The account in the clinical notes of Dr Jung Sook Kim indicate that [she] was not as functional as she described in this examination. It indicates she was struggling with depression, was feeling hopeless and helpless."
[15]The Insurer submits that Medical Assessor Friend did not fully accept Ms Kim’s self-report of her pre-accident functioning and instead concluded that it was affected by hopelessness and helplessness linked to her pre-existing Major Depressive Disorder.
Application of Clinical Judgment
[16] Ms Kim argues that Medical Assessor Friend should have assessed her pre-accident "Social and Recreational Activities" at Class 1 rather than Class 2.
[17] The Insurer highlights paragraph 6.217 of the MAGs which provides:
"The scale must be used by a properly trained medical assessor. The psychiatrist’s clinical judgment is the most important tool in the application of the scale. The impairment rating must be consistent with a recognised psychiatric diagnosis and based on the psychiatrist’s clinical experience."
[18]The Insurer submits that Medical Assessor Friend correctly applied his clinical judgment when assessing Ms Kim’s pre-existing psychiatric impairment.
[19] Medical Assessor Friend stated:
"Unfortunately, the clinical notes of Dr Jung Sook Kim do not describe what activities she undertook or was unable to undertake although it referred repeatedly to increased levels of anxiety and from time to time periods of feeling hopeless prior to the motor accident."
[20]The Insurer submits that Medical Assessor Friend applied his clinical judgment in accordance with clause 6.217 of the MAGs to determine an impairment rating consistent with Ms Kim’s pre-existing Major Depressive Disorder.
[21]-[22] The Insurer submits that Medical Assessor Friend rightly relied on his clinical expertise rather than rigidly applying the PIRS examples. The Insurer submits that no error is disclosed.
Pre-existing Impairment – Adaptation
[23] The Insurer repeats its submissions concerning “Social and Recreational Activities.”
[24] In particular:
(a)The Insurer highlights that Ms Kim relies heavily on the history recorded on page 8 of Medical Assessor Friend’s Certificate, although Medical Assessor Friend found this history not fully reliable when weighed against her pre-accident psychiatric records.
(b)The Insurer submits that Medical Assessor Friend correctly applied his clinical judgment in assessing Ms Kim’s pre-existing impairment in “Adaptation” at Class 5.
[25] The Insurer notes that Ms Kim argues her inability to work is due to both her pre-existing Major Depressive Disorder and thyroid cancer.
[26] The Insurer submits that Assessor Friend was not required to apportion the cause of Ms Kim’s inability to work because her psychiatric condition and thyroid cancer are intertwined and symbiotic, not independent.

RE-EXAMINATION BY THE PANEL

Medical Assessors Matthew Jones and Ronald Gill, assisted by a Korean interpreter, assessed Ms Kim via audio-visual link on 3 July 2025.

Background and history of the presenting complaint

Ms Heasuk Kim is 65 years old, born on 28 April 1960. She lives alone in Guildford, NSW, and has resided there for roughly seven years. This is public housing accommodation. She is on the Disability Support Pension because of previous thyroid cancer and depression. Her daughter visits regularly and provides care support. Her daughter is not receiving a Centrelink Carer’s benefit.
On 6 December 2021, Ms Kim was involved in a motor vehicle accident at Lidcombe, NSW. While driving her vehicle, another car ran through a stop sign and collided heavily with her car, leading to the vehicle being written off.
She was initially trapped and needed assistance from bystanders to be removed from the car. Emergency services, including ambulance and police, attended the scene. She said the last thing she remembered was the car hitting her and regaining consciousness with police, an interpreter and emergency services being there.
She was transported by ambulance to Westmead Hospital, where she underwent various investigations and received initial treatment. She said that the car air bags did go off.
She said that she almost died in the accident. The travel route was familiar to her. She was driving a one-year-old Lexus 350.
Following the accident, she experienced significant physical symptoms including persistent pain in her lower back, difficulty walking, and chest pain, necessitating ongoing medical interventions such as physiotherapy, hydrotherapy, MRI scans, and spinal injections.
Her self-esteem and confidence levels have been impacted, directly attributed to the impact of the accident. She has stopped smiling because of loss of teeth, and lack of confidence. She does not attend her church nowadays. She feels generally anxious being outside.
At home she watches Korean TV.
She had intrusive thoughts related to the accident. She said that she since the accident she had gotten worse. She had social anxiety.
Her mood was described as “stuffy inside [her]self”.
She spends most of the time at home, when the weather is nice, she goes to the park and attends physiotherapy

Physiological symptoms

Ms Kim’s sleep is described as suboptimal. She needs sleeping pills to assist with sleep. She can sleep for eight to nine hours when taking two tablets.
She had no dreams. She wakes up feeling tired and with a headache.
Ms Kim’s memory was described as not optimal. She tended to struggle with organising herself and relied heavily on her daughter to assist with organisation. Her concentration and attention are subjectively impaired.
Ms Kim’s motivation and energy levels are described as low. During the day she was limited in her ability to do things because of the headaches. She described her headaches as her mind is not clear. These are described as different from the preinjury headaches. She attributed this to head pain and fainting at the time of the accident.
Her self-care and hygiene have been impacted. She showers every few days, and showers slowly. She can dress herself.
She no longer drives due to severe anxiety related to car travel, relying on her daughter to assist with transportation. She had not driven since the accident. She was scared even when in the passenger seat. She can catch a train, but not a taxi.
Her appetite was decreased and has lost three kg in weight. She was weighing 57 kg at the time of the examination. Her height is 160cm (Body Mass Index of about 22, which is in the normal range).
She had trouble eating. She said that her teeth were wobbling after the accident and had three teeth missing (the front three). If she could cook now, she would like to make Korean BBQ.

Psychiatry history

Ms Kim has been diagnosed with Major Depressive Disorder and Post-Traumatic Stress Disorder. She engages with psychiatrist Dr Mark Yim for psychiatric management. She sees him monthly.
Pre-injury depression started after the death of her husband in Korea, and she started to take medications and saw a psychiatrist and a psychologist. She could not give a clear timeline on when she started to see the psychiatrist and psychologist, nor when she was taking medication. For example, she initially stated she had ceased approximately two years before the accident, however the psychiatrist notes indicated that they had been taken continuously.
When she was seeing the psychologist prior to the accident for about five years, it was related to the concerns about her husband’s death, and she was “depressed”. She stopped for a period of two years and then restarted to see Dr J S Kim, prior to the motor accident. She said that she got better, she started work as a cleaner and was attending church.
She said that she started to see a psychiatrist prior to the accident and was referred by a general practitioner and was prescribed an antidepressant.
On describing the depressive symptoms post her husband’s death, she said that she felt lonely, depressed and kept crying. Her drive to do things decreased. She historically was seeing psychiatrist, Dr Yim, every two weeks.
There is no reported family history of mental illness.
There is a history of hospital admissions for psychiatric reasons, notably in 2013.

Medical History

Ms Kim has medical issues including thyroid cancer, for which she had two surgical treatments in 2019 and 2021, and chronic back pain post-accident.
The back pain limits her ability to walk for long periods, and she cannot lift heavy things.
She has no history of head trauma or seizures. She has no known allergies.

Medication History

As per the documentation provided, Ms Kim was taking Desvenlafaxine 50mg, Mirtazapine 30-60mg, Duloxetine, Oxazepam 15-30mg as needed, Temazepam, Panadeine Forte, Panadol, Aspirin 100mg, Celebrex 100mg, and Amoxil.
She said that she could not recall the name of the medications, stating that there are too many. She takes mirtazapine, an antidepressant. Later when two antidepressants were brought to her attention, she agreed that she was taking both of these.
She started to take the medications two years before the accident. Initially she said that she had stopped medication, but when challenged on this there were inconsistent responses. On one occasion stating that she stopped medication for two years, and that she was studying English and cooking.
Historically, she had tried Temazepam, Stilnox, for sleep, and various antidepressant medications.
The contradictions in the medication history were evident and were elicited by both the assessors separately. Ms Kim was unable to reconcile these inconsistencies with either assessor.

Salient Features of Psychosocial and Developmental History

Ms Kim’s primary emotional support comes from her daughter, and she reported she feels lonely. The social supports in Australia are limited. The familial supports are in South Korea, and she FaceTime’s them. She said that the family in Australia worries about her.
She has a son in South Korea, and has one grandchild from him, who is three years old. Her daughter has two children, and they are eight and five years old. Her daughter is not working.
She has made friends in church, however, since she has stopped attending her church after the accident, her social connectedness has decreased. She said that she needs someone to pick her up and drop her to the church. She said that she when she is at church, she feels anxious. She cannot sit for an hour to listen to the sermon. If she were picked up, she would want to attend her Korean language church, but said that she cannot stay there for long due to social anxiety. She said, “People think I am angry as I do not smile”. For the first year after the accident, she had visitors, but this stopped, and they said that she does not talk to them and she does not feel happy or interested.
Ms Kim was born in South Korea and migrated to Australia around 2003. She completed secondary education.
She worked as a chef in South Korea and as a cleaner in Australia. She started cleaning work two years after she came to Australia and stopped when she had thyroid issues and was started on the Disability Support Pension. Historically, she has applied for DSP, and it appears from the documentation that this was on more than one occasion. Ms Kim, however, said that she had only applied once prior, before she became an Australian citizen, and this was rejected. Once she became a citizen she was accepted.

Mental status examination

On mental state examination, Ms Kim was a female who appeared her stated age. She was appropriately dressed and groomed. She was ultimately able to be engaged, and we were able to establish a good rapport with her. There was no psychomotor agitation or retardation. Her body demeanour was reserved. Initially, she was reserved and displayed reluctance to engage in a prolonged interview. Her speech was of slowed rate, and normal volume and tone. The thought form was goal-directed. An impression of amplification of symptomatology was noted. Slowed cognitive processing was noted. The timelines had to be brought to her attention, and there were inconsistencies noted in the history provided and the documentation. The inconsistencies were at times self-contradictory, stating, for example, that after starting the medication, she had pulled herself together. The content reverted to conversation related to the subject accident. The thought content revolved around her perceived difficulties and the questions asked. There was no evidence of any psychosis or perceptual disturbances. Her affect (expressed emotion) was showing minimal reactivity and at times she appeared dazed. Her mood was sad and lonely. She was oriented to person, place, and time. Her insight was best described as partial. Her judgement at the time of this review was reasonable.

Clinical summary

Ms Kim presented with Post-Traumatic Stress Disorder (PTSD) and (an exacerbation of pre-existing) Major Depressive Disorder (MDD), these diagnoses are not in dispute. There was also an impression of some abnormal illness behaviour, with some degree of symptom amplification and the adoption of a sick role. This does not invalidate the diagnoses, or that Ms Kim has experienced an impact from the accident.
Given the lack of clarity about some of the history, and the apparent inconsistencies which were not able to be resolved when brought to Ms Kim’s attention, the medical assessors needed to rely more on the available, and contemporaneous, documentation.
Ms Kim has stabilised in her recovery, and has a permanent psychiatric impairment related to the accident. She is unlikely to change in her level of psychiatric impairment, to any significant degree in the upcoming twelve months.

Psychiatric Impairment Rating Scale – Pre-existing impairment

Psychiatric diagnoses	1. Major Depressive Disorder	2.
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	Ms Kim was seeing a psychiatrist and taking psychiatric medications in the period leading up to the accident. She had seen a psychologist previous to the motor accident.

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	1	Minor deficit attributable to normal variation in the general population. Ms Kim was living alone and was independent with respect to her self-care and personal hygiene. There is no evidence available to indicate a higher level of impairment.
2. Social and Recreational Activities	2	Mild impairment. Although Ms Kim had pre-existing mental health problems, she was reportedly attending church on a regular basis. She would drive herself there. There is little, if any, evidence of more extensive or involved social or recreational activity (for example consistent with Class 1 descriptors). There was ongoing anxiety and depressed mood (for example recorded in Dr Yim’s notes, prior to and after the accident) which would have been consistent with some mild impairment.
3. Travel	1	Minor deficit attributable to normal variation in the general population. Ms Kim was driving, alone, at the time of the accident. She was able to travel independently.
4. Social Functioning	1	Minor deficit attributable to normal variation in the general population. Ms Kim had no strain in her close family relationships. She had some friends through Church. Utilising clinical judgement, she had a Class 1, minor deficit.
5. Concentration, Persistence and Pace	2	Mild impairment. Ms Kim had ongoing psychiatric symptoms, including problems with mood and anxiety in the period leading up to the accident. Ms Kim was also having problems with chronic headaches. She was receiving the DSP, and was travelling to English classes (not for TAFE or University, in the assessor’s understanding) at the time of the accident. There is no evidence of functioning at a demanding cognitive level around that time. Utilising clinical judgement, Ms Kim had a mild impairment at that stage.
6. Adaptation	4	Severe impairment - Ms Kim was receiving the DSP for mental health and medical (thyroid) problems. She had reduced capacity for employment, and with respect to her other adaptive roles. Any capacity in this category would have been low stress and demand, and part-time and infrequent, consistent with a Class 4, severe impairment.
List classes in ascending order: 1, 1, 1, 2, 2, 4
Median Class Value: 2
Aggregate Score: 11
% Whole Person Impairment: 5%

With respect to pre-existing treatment effect, it appears Ms Kim was taking multiple psychiatric medications and seeing a psychiatrist, prior to the accident. (She had seen a psychologist also prior to the accident; however this treatment had stopped several months prior). Ms Kim reported that she had been improving in her mental state prior to the accident, and that treatment was assisting. A moderate treatment effect (reported improvement, but only a moderate reduction in symptoms) adjustment of 2% is appropriate to apply to Ms Kim’s pre-existing impairment. Therefore, total pre-existing WPI is 7%

Psychiatric Impairment Rating Scale – Current impairment

Psychiatric diagnoses	1. Post-Traumatic Stress Disorder (PTSD)	2. (an exacerbation of pre-existing) Major Depressive Disorder (MDD)
Psychiatric diagnoses	3.	4.
Psychiatric treatment description	This was hard to fully clarify. There is some psychiatric medication being taken, and Ms Kim reported seeing a psychiatrist monthly. Regardless, Ms Kim indicated there was no noticeable current treatment effect (no adjustment for effects of treatment).

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	2	Mild impairment. Ms Kim lives alone. She reported she showers approximately only every 3 days due to restrictions from pain. She reported she can undertake this activity, and dress herself, by herself, however she is slow. Her daughter visits twice a week to assist with shopping and cleaning, and assist in Ms Kim going out, in part because she is afraid of falling. Her daughter brings food for her, such as bread and milk, and she has eating difficulties due to loose (and lost) teeth, which she attributes to the accident. She will prepare simple meals for herself, but has lost interest in more complex cooking, such as Korean barbecue, something she would previously enjoy.
2. Social and Recreational Activities	3	Moderate impairment. Ms Kim reported she spends a lot of her day sleeping or walking short distances. If the weather is fine, she will go to a park nearby by herself. Her poor dentition interferes with her social confidence, for example she is reluctant to attend church as she fears people think that she is antisocial as she smiles less. She has reduced confidence socially. She recounted that her daughter took her out to Circular Quay one day, however she was uncomfortable around the crowds. Ms Kim reported she no longer attends her own church, although she would like to, as she needs someone to pick her up and take her. She was attending a Korean church. Her daughter attends another, local, church and when she goes there with her daughter, she finds it difficult to partake in bible studies or listen to the whole sermon.
3. Travel	2	Mild impairment. Ms Kim has a driver’s licence but no longer drives since the accident. Her daughter uses her car. She can travel as a passenger, but she is nervous. She reported she can travel by train by herself, since the accident, but not travel by taxi. There is nowhere she regularly goes by herself, apart from a walk to the local park. Ms Kim is anxious when she is out. She reported that her feelings of anxiety and panic have become worse since the accident.
4. Social Functioning	2	Mild impairment. Ms Kim has maintained a close relationship with her daughter. She maintains a close relationship with her son, however he is overseas. She had made numerous friends in Australia through her church; however, these friendships have dropped off. The reason she gave was that others have said she does not talk to them as much, and that she has lost interest, and she feels unhappy. Part of this social withdrawal is her loss of confidence and self-consciousness due to her poor dentition.
5. Concentration, Persistence and Pace	3	Moderate impairment. Ms Kim has problems with chronic back pain which interfere with her general persistence and pace, and limit her ability to lift things, or walk long distances. She describes herself as “very sore”. These are physical problems and are not taken into account in this assessment. Ms Kim also commented that she is limited in her ability to persist at activities because she develops headaches (a symptom she experienced before the accident). Ms Kim reported she will watch Korean TV, more so after the accident, as she was not well, and stayed at home more. When Ms Kim does attend church, she finds it hard to listen to the whole sermon, although she would like to. Ms Kim concentrated quite well for the 90-minute assessment.
6. Adaptation	5	Total impairment - Ms Kim is receiving the DSP (as she was prior to the accident). She would be unable to sustain gainful employment and has very limited capacity in any other adaptive role.
List classes in ascending order: 2, 2, 2, 3, 3, 5
Median Class Value: 3
Aggregate Score: 17
% Whole Person Impairment: 19 %

Apportionment

Pre-existing impairment is assessed as 7% (see above table). There is no adjustment for subsequent impairment.

Effects of treatment

There was a 2% adjustment for effects of treatment for Ms Kim’s pre-existing impairment, but no adjustment for effects of treatment for her current impairment.

HOW THE PANEL DEALT WITH THE SUBMISSIONS

The Panel met for a second time on 17 July 2025 and discussed all of the issues, including the views expressed by the medical members of the Panel on history, diagnosis, medical causation, and the psychiatric impairment rating scale (PIRS). After this discussion, the Panel concluded that there would be a determination of a final WPI of 12% after taking into account the current impairment as per the PIRS of 19% and the pre-existing impairment of 7%, leaving a final WPI of 12%.
The Medical Assessors conducted their own mental state and clinical examinations and made an independent assessment of permanent impairment.
The Panel addressed the submissions of the parties made in respect of Medical Assessor Friend’s assessment, particularly, without limiting the generality, regarding the categories of Social and Recreational Activities and Adaptation.
The Panel comprehensively considered all Psychiatric Impairment Rating Scale (PIRS) categories. It agreed with the following class ratings:
·        Self-Care and Personal Hygiene: Class 2 (mild impairment)
·        Social and Recreational Activities: Class 3 (moderate impairment)
·        Travel: Class 2 (mild impairment)
·        Concentration, Persistence and Pace: Class 3 (moderate impairment), excluding physical impairment
·        Adaptation: Class 5 (total impairment), due to inability to sustain gainful employment
The Panel agreed with its assessment of the pre-existing impairment at 7% WPI, including a 2% adjustment for treatment effects. It noted deterioration post-accident, resulting in a current 19% WPI.
After adjusting for the pre-existing 7% WPI, the Panel unanimously determined a final WPI of 12% attributable to the accident.

CONCLUSIONS

The Review Panel revokes the certificate of Medical Assessor Paul Friend dated 7 July 2024 and substitutes the determination that the following injuries caused by the accident gave rise to a permanent impairment of 12% and is greater than 10%:
· Post-Traumatic Stress Disorder, and
· Major Depressive Disorder.

[2025] NSWPICMP 628

21 August 2025