Leslie v Youi Pty Limited
[2025] NSWPICMP 575
•6 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Leslie v Youi Pty Limited [2025] NSWPICMP 575 |
CLAIMANT: | Paul Leslie |
INSURER: | Youi Pty Ltd |
REVIEW PANEL | |
SENIOR MEMBER: | Susan McTegg |
MEDICAL ASSESSOR: | Christopher Canaris |
MEDICAL ASSESSOR: | Himanshu Singh |
DATE OF DECISION: | 6 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); section 1.6(3); assessment of whole person impairment (WPI); claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) assessed 9% WPI as a result of post-traumatic stress disorder (PTSD) caused by accident; claimant sought review; significant pre-existing condition; Held – MAC revoked; claimant had sustained PTSD and substance use disorder caused by the accident; current WPI 22%; deduction for pre-existing WPI 13%; impairment caused by accident 9% WPI. |
DETERMINATIONS MADE: | MOTOR ACCIDENT INJURIES ACT 2017 Whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10% Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Alexey Sidorov dated 7 June 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a WPI of 9%: · post-traumatic stress disorder; and · substance use disorder (in remission). |
REVIEW PANEL REASONS FOR DECISION
INTRODUCTION
On 16 July 2021 Mr Paul Leslie (the claimant) whilst driving his vehicle when the at fault vehicle failed to give way and collided with the front of the claimant’s vehicle at an estimated speed of 50kph (the accident).
Mr Leslie has brought a claim for common law damages under the Motor Accident Injuries Act 2017 (the MAI Act).
Youi Pty Limited (the insurer) is the relevant insurer with liability to pay any damages to Mr Leslie under the MAI Act.
Section 4.11 of the MAI Act provides that there is no entitlement to damages for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%.
This dispute is in relation to whether the degree of permanent impairment sustained by Mr Leslie as a result of the injury caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1]
[1] Section 7.20 of the MAI Act.
The dispute as to permanent impairment in respect of the claimant’s psychological injury was referred to Medical Assessor Alexey Sidorov. He issued a certificate dated 7 June 2024.
DOCUMENTS CONSIDERED BY THE REVIEW PANEL
The Review Panel issued a Direction to the parties on 7 March 2025 (the Direction) requiring each party to file an indexed, paginated bundle of documents. In response to this Direction the solicitor for the claimant uploaded to the portal a bundle of documents paginated from pages 1 to 315 (claimant’s documents). The solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 8 (insurer’s documents).
RELEVANT LEGAL AUTHORITY
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.[2]
[2] Clause 1.2 of the Guidelines
Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:
“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.”
CERTIFICATE OF MEDICAL ASSESSOR SIDOROV
The injuries referred to Medical Assessor Sidorov for assessment was:
· Post-traumatic stress disorder
After making a deduction for a pre-existing condition Medical Assessor Sidorov issued a certificate dated 7 June 2024 in which he certified the following injuries caused by the accident gave rise to a whole person impairment (WPI) of 9%:
· Post-traumatic stress disorder.[3]
[3] Claimant’s documents p15
Medical Assessor Sidorov assessed a current 15% WPI in respect of a post-traumatic stress disorder as follows:
· Self-care and personal hygiene – Class 2
· Social and recreational activities – Class 3
· Travel – Class 2
· Social functioning – Class 3
· Concentration, persistence and pace – Class 2
· Adaption – Class 3.
Medical Assessor Sidorov noted the pre-existing diagnosis of post-traumatic stress disorder and despite the claimant’s assertion that he was symptom free and functioning well prior to the accident concluded there was evidence that he was experiencing active trauma and associated mood symptoms within one year prior to the accident. He found there was likely evidence of impairment in the categories of self-care and personal hygiene, social and recreational activities, social functioning, concentration, persistence and pace and adaption.
Medical Assessor Sidorov deducted 6% WPI for the claimant’s pre-existing condition assessed as follows:
· Self-care and personal hygiene – Class 2
· Social and recreational activities – Class 2
· Travel – Class 1
· Social functioning – Class 2
· Concentration, persistence and pace – Class 2
· Adaption – Class 3.
REVIEW PROCEDURE
The claimant has sought a review of the medical assessment of Medical Assessor Sidorov.
The application was lodged on 3 July 2024 within 28 days of the date on which the certificate of Medical Assessor Sidorov was made available to the parties.[4]
[4] Section 7.26(1)(b) of the MAI Act.
On 25 July 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Review Panel (the Panel).[5]
[5] Section 7.26 of the MAI Act; Claimant’s bundle p 9.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC 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.[6]
[6] Rule 128 of the PIC Rules.
The review is by way of a new assessment of all matters with which the medical assessment is concerned.
On 21 May 2025 the Panel agreed an examination was necessary.
EVIDENCE BEFORE THE PANEL
Police Report
The Police Report described the accident as a “major traffic crash”.
Application for personal injury benefits
In the Application for Personal Injury Benefits dated 2 July 2021 the claimant outlined the following injuries:
· Haemoptysis due to lung compression;
· Neck and back pain, and
· Worsening of mental health condition.[7]
[7] Claimant’s documents p 31
He reported the following pre-existing conditions:
· Post-traumatic stress disorder;
· Anxiety, and
· Depression.
Statement of claimant
Mr Leslie provided a statement dated 20 December 2022.[8] He reported sustaining a lower back injury in 2010 which progressively rendered him unfit for work until ultimately, he was placed on the Disability Pension.
[8] Claimant’s documents p 24
He stated he was diagnosed with post-traumatic stress disorder, depression and anxiety after witnessing a shooting in or about 2012. He stated he managed the conditions intermittently with medication and psychotherapy. He stated those treatments ceased over seven years earlier. He states
“After relocating to Newcastle in 2020 for a fresh start, I can confirm that any related symptoms were well managed and did not impact my ability to complete domestic duties. At this time, I no longer required ongoing support and ceased all forms of treatment. I maintained good social functioning with family and friends whilst regularly participating in hobbies.”
Mr Leslie states since the accident his self-care deteriorated, he struggles to sleep and experiences intrusive thoughts of the accident. He stated he is no longer motivated to prepare healthy meals. He no longer participates in recreational activities including fishing, going out for lunch or going to the beach. He is hypervigilant and stressed in public places and is apprehensive about leaving the house. He cannot drive independently and cannot use public transport due to his back condition. He described strain in his relationships, difficulty concentrating and loss of focus.
Pre-accident treating medical evidence
Sa-Cordeiro Medical Practice and Healthsure Medical Centre Jesmond
The following entries pre-date the accident:
2 April 2014
Dr Sa-Cordeiro[9]
“Chronic back ache – disc pathology with nerve irritation over the last 10 years. Problem with depression/anxiety.
Life has turned inside out lately with loss of a job.
Was made redundant.
Unable to handle happy situations with depression and tearfulness. …
Asocial and withdrawn. Housebound”
30 May 2014
Dr Sa-Cordeiro[10]
“Insomnia – depression related.
Paranoid personality
Anxiety disorder with panic disorder.
Counselling; psychoeducation & psychodynamic.
Cymbalta”
30 June 2014
Dr Sa-Cordeiro[11]
“Paranoia fears the bikies.
Persecution thoughts.
Cymbalta EC capsule 60mg 1 nocte”.
11 February 2015
Dr Sa-Cordeiro[12]
“Nervous breakdown … after being interviewed by CENTRELINK.
…
Very depressed. Hopelessness and despairing.
Suicidal ideation.”
29 March 2017
Dr Sa-Cordeiro[13]
Is going for custody of youngest child.
Still has back ache.
Relapsed into Pot use.
Paim
Dependent personality self-medicating with POT/alcohol for sleep”
22 December 2017
Dr Sa-Cordeiro[14]
“Homeless living in a motel < 2 weeks. Has been assaulted by one of the sons.”
19 January 2018
Dr Sa-Cordeiro[15]
“Mental Health Care Consultation
Paranoia. Bad dreams and delusions.
Multiple issues – social, mental and pain.
Antenex tablet 5mg 1 am and midday/ & 2 nocte 8pm.”
19 March 2018
Dr Sa-Cordeiro[16]
“… Major depressive disorder. Needs meds/psychological therapy. Easily distressed. Reduces to tears often…
Aurorix tablet 150mg”
2 May 2018
Dr Sa-Cordeiro[17]
“MH E: Feeling better since going on Aurorix Needs to continue on increased dose. But is feeling quite agitated and upset over the inappropriate semidetached house he has been offered….
Aurorix Tablet 300mg 1 b.d.”
16 January 2019
Dr Sa-Cordeiro[18]
Severe PTSD/Stress levels/Anxiety
Chronic sciatica - Disabling
23 August 2019
Dr Sa-Cordeiro[19]
“Going through some tough times. Having problems with housing and locat
Insomnia
Very agitated. Over thinking. Very agitated. Anxiety & panic in severe fear of everyone knowing that he witnessed a murder (shooting) Fear of reprisals.
Moving to Newcastle …
Olanzapine 5mg prescribed.”
26 August 2019
Dr Sa-Cordeiro[20]
“Mental Health Care Consultation …
Review of MSE affect better More controlled but is still very agitated over the revelation of having seen a murder.
Has improved somewhat with Zyprexia …
Prognosis – better. Is planning to move to N’Castle in 2 weeks.
Improvement rated at abot 10-15%
O/E affect even tempered, not so emotional More in control
Delusions; persecutory. Fear of bikies.”
30 August 2109
Dr Sa-Cordeiro[21]
“Distress still going thro severe fear of becoming discovered by the shooters. c/o severe back ache”
16 March 2020
Dr Sa-Cordeiro[22]
“Anxiety disorder, tearful”
2 September 2020
Dr Sa-Cordeiro[23]
“Very vulnerable. Labile moods.
Tearful feels displaced. Socially
Homeless
Still smoking POT.
Now drinking heavily Bourbon
DRUG INDUCED MENTAL HEALTH”.
26 November 2020[24]
Dr Soe
“suffered PTSD / depression
housing commission is in poor condition cockroach, blood stain, nicotine stain in the house exacerbated his mental condition cried and mental breakdown nausea +
using dulcolax sleeping 2 hours only
had valium early last week, got 2 tablets from afterhour GP never have valium in the past
son is 19, will be an eletrician soon
was homeless in Sydney
commission agreed to clean the house - but not sure when doesn't remember a lot these days
not on any medication at the moment
Dr. Nino Sacadiero in Campbell town
not using any recreational drugs”
9 December 2020
Dr Soe
condition is getting worse due to house condition
can't allow his son to his house because of his house condition will clean blood-stained or faeces stained carpet
still taking maxolon for nausea will get meeting tomorrow…
has PTSD and chronic depression PTSD since 2008 - sold motorbike, went to his home for rest of the money a man shot the man multiple times, no fatal injury children were in a car…
mood is not good, sad, angry
tried deptrin
no mental admission
no hallucination/delusion …
13 January 2021
Applying for NDIS
Has a big backyard at the back
Wants to get an assistance
…
Can continue mirtazapine
18 January 2021
…
Says he can’t do his normal day to day activities
Had a carer, son, for 4-5 years
Sometimes, couldn’t do toileting himself
Can’t cook, stand for long
When I saw him, he walked quite first without walking aid
20 February 2021
Came in with friend
Came in for more pain killer script
Palexia SR 100mg prn …
Known to have significant back issue
Back pain for disc prolapse x 5
Had surgery
Son has been looking after him
Now he got a job
Needs to have a new carer
Centrelink paperwork need to be filled
Needs help and prompt all the times
Poor mobility but does not use any aid …[25]
[9] Claimant’s documents p 177
[10] Claimant’s documents p 177
[11] Claimant’s documents p 176
[12] Claimant’s documents p 173
[13] Claimant’s documents p 171
[14] Claimant’s documents p 171
[15] Claimant’s documents p 171
[16] Claimant’s documents p 170
[17] Claimant’s documents p 169
[18] Claimant’s documents p 169
[19] Claimant’s documents p 169
[20] Claimant’s documents p 168
[21] Claimant’s documents p 168
[22] Claimant’s documents p 167
[23] Claimant’s documents p 167
[24] Claimant’s documents p 123
[25] Claimant’s documents p 128
NDIS Access Request
On 13 January 2021 the claimant completed an application for NDIS access.[26] He described his primary impairment as back pain and another significant impairment as “situational crises with recent situation, chronic depression, PTSD”. He reported he needed lawn mowing assistance and help with social interaction (has social anxiety).
[26] Claimant’s documents p 181
In an email to his General Practitioner dated 18 January 2021 Mr Leslie stated he also needed help with things such as cooking and cleaning. He stated he had had a carer for the last four years who had completed these tasks for him. He indicated he was seeking a new carer as his son was now working and no longer able to provide care.
On 20 February 2021 Dr Lwin completed a Carer Payment and/or Carer Allowance Medical Report in respect of chronic pain due to disc prolapse, post-traumatic stress disorder and depression. He noted the condition was permanent and unlikely to improve. Dr Lwin reported Mr Leslie needed minor help with transfers, help with mobility and dressing, help with stairs and sometimes help with bathing.[27]
[27] Claimant’s documents p 189
Post-accident treating medical evidence
On 19 July 2021 the claimant was transferred from Campbelltown Hospital to Liverpool Hospital with haemoptysis post-accident. He was discharged on 22 July 2021.[28]
[28] Claimant’s documents p 53
Liverpool Hospital reported a history of post-traumatic stress disorder/Depression, chronic lower back pain and GORD. The following social history was recorded:
Current smoker. 3 cig today
-16 pack year history
-Weekly binge ETOH 6-8 beers once a week
-Previous daily THC 10 years, quit 2 years ago
-Living with son currently, drives, independent Padls
-Does not work any more due to PTSD but previously in metal work, no relevant occupational exposures
-Has a dog, no other pets.
The Discharge Summary notes the claimants worsening mental health condition since the accident. On 22 July 2021 Mr Leslie was admitted to the Macarthur Aged & Mental Health Care (MHMAC). MHMAC reported Mr Leslie denied any current suicidality, was moving back to the Newcastle area and already had a psychology appointment arranged in August.[29]
[29] Claimant’s documents p 198
On 2 August 2021 Dr Lwin reported:
“recently involved in MVA on 16/07/2021
Whiplash injury
Haemoptysis due to lung contusion
Went to Campbelltown hospital for 2/7 and Liverpool hospital for 3/7
Reviewed by mental health team as well
Given pain killer and Valium to calm him down
…
Seeing Sharon McDermott for his mental health
Known to have PTSD + Depression + Anxiety
Can’t get appt till 23rd Aug 2021
…
Flash back memories about MVA
PTSD flare up
A bit of nightmares
Over thinking – can’t sleep
No suicidal thought”.[30]
[30] Claimant’s documents p 129
On 9 August 2021 Dr Lwin placed the claimant on a GP Mental Health Care Plan noting the accident had precipitated the claimant’s underlying post-traumatic stress disorder and depression /anxiety.[31] Dr Lwin reported:
“not coping well
Taking Mirtazapine 30mg + fluoxetine 40mg daily and Seroquel 25mg prn
Mood is not very low but angry and frustrated over minor things
No suicidal thought
Flash backs and nightmares
Social phobia
Feeling insecure
Can’t sleep well at night”.
[31] Claimant’s documents p 61
In an Allied Health Recovery Request No 1 dated 17 January 2022 Dr Stuart Edser of Newcastle Psychology and Health diagnosed post-traumatic stress disorder.[32] He reported textbook symptoms including revisiting the accident, avoidance (especially driving), numbing and negativity and hyperarousal.
[32] Claimant’s documents p 82
In a report dated 12 July 2022 Dr Edser reported a first diagnosis of post-traumatic stress disorder when a man was shot in front of him and a second diagnosis of post-traumatic stress disorder as a result of the accident.[33]He reported prior to the post-traumatic stress disorder the claimant was being treated for a recurring depression. Dr Edser reported the claimant was very angry and fixated on road rules and how people do not obey them. He reported the claimant had not followed a graded exposure strategy he proposed, he was very negative and intransigent and unable to allow himself to bring about change.
[33] Claimant’s documents p 87
The claimant was assessed by Dr Tahir Babur, psychiatrist on 26 February 2023.[34] Dr Babur reported in addition to the accident the claimant had another significant trauma in 2004 when he heard shooting and a lot of noises inside a house. He reported Mr Leslie did not require any treatment. Dr Babur noted no past discharge summaries or collateral information was available. His provisional diagnosis was post-traumatic stress disorder and major depressive disorder secondary to the accident and furthered by chronic pain.
[34] Claimant’s documents p 101
On 8 August 2023 Dr Edser noted attempts to manage the diagnosis of post-traumatic stress disorder had been intractable. He reported the claimant was a perfect candidate for a therapy dog.[35]
[35] Claimant’s documents p 105
In a report dated 27 February 2024 Dr Edser reported that the claimant had not been able to drive since the accident. He reported the claimant is withdrawn from society, he avoids people and is unable to be on the roads even as a passenger without serious anxiety, sometimes panic.
Dr Edser provided a report dated 24 April 2024.[36] He reported he had seen the claimant for 23 hourly sessions over a number of years. His treatment included the following modalities:
· Cognitive therapy;
· Behavioural adjustment;
· Relaxation strategies;
· Mindfulness techniques;
· Acceptance and commitment therapy, and
· Exposure therapy.
[36] Claimant’s documents p 308
Dr Edser reported he was aware of the earlier diagnosis of post-traumatic stress disorder after the claimant witnessed a shooting and that he understood his subsequent nervousness and anxiety were behind his move from Sydney to Newcastle. However, he stated the narrative of the shooting did not figure in his retelling of the accident or its aftermath. He diagnosed post-traumatic stress disorder caused by the accident. He reported little progress and in fact considered his symptoms had increased and broadened over time.
The claimant consulted Dr Lori Aranha, psychiatrist on 14 March 2024 on referral from Dr Mahroof.[37] She diagnosed post-traumatic stress disorder – chronic and noted the previous history of post-traumatic stress disorder. She concluded the claimant lived alone in Newcastle supported by his family and former partner. Dr Aranha reported:
“He has symptoms of PTSD since a car accident 3 years ago. He has prominent sleep difficulty (including nightmares) and problems with anger, and fear responses esp around cars/traffic/people. These problems have become chronic and are exacerbated by severe back pain. Psychotherapy unfortunately, has only been partially helpful. This is on a background of a previous episode of PTSD in the context of witnessing a shooting with his children in the car. He has had a history of previous diagnoses of depression, anxiety and cluster B personality traits.”
[37] Claimant’s documents p 302
Alexander Cameron, psychologist commenced treating the claimant on 23 April 2024.[38] He reported out of five sessions only the first was face to face due to the claimant’s anxiety about leaving his house. He reported:
“Current symptoms include heightened anxiety in public spaces, particularly around crowds, difficulty managing emotional reactions, and episodes of memory blanks when frustrated. He demonstrates avoidant behaviours to manage his symptoms, which has led to increased social isolation. His support network primarily consists of family members, with one support person (Claire) providing daily telephone contact.”
[38] Claimant’s documents p 312
Mr Cameron further noted:
“Treatment to date has involved Trauma-Focused Cognitive Behavioural Therapy, focusing on anger management strategies and cognitive restructuring. While Paul shows good insight into his triggers and limitations, his progress has been affected by various challenges, including severe symptoms of anxiety and anger related to his PTSD which prevent him from moving forward, recent adverse reactions to medication changes, and ongoing legal matters.”
Medico-legal evidence
Dr Frank (Kai Tai) Chow, psychiatrist
Dr Chow assessed the claimant and provided a report dated 20 March 2023.[39]
[39] Claimant’s documents p 90
Dr Chow reported Mr Leslie had a previous post-traumatic stress disorder after he witnessed a shooting. He reported he saw a psychologist for a few years and last had treatment 10 years earlier. Dr Chow reported he had been well since.
Dr Chow reported Mr Leslie has sleeping disturbance, flashbacks and nightmares. He was full of anger and rage and was easily irritated. He cannot manage to cook dinner and has poor memory and concentration. He no longer drove due to his fear of stupid people doing silly and dangerous things on the road. He did not go out much and was eating only one meal a day. He had no interest doing things or hobbies. He had poor energy and motivation and felt guilty, worthless and hopeless. He had aggression, emotional meltdown and disagreement with family in December 2022, and he was taken to hospital and again in February 2023, when he was charged by the police
Dr Chow assessed a 22% WPI in respect of a post-traumatic stress disorder caused by the accident as follows:
· Self-care and personal hygiene – Class 3
· Social and recreational activities – Class 3
· Travel – Class 3
· Social functioning and relationships – Class 2
· Concentration, persistence and pace – Class 3
· Employability – Class 4.
Dr Yajurveda Bisht, psychiatrist
Dr Bisht assessed the claimant at the request of the insurer on 18 October 2023. He provided a report dated 15 November 2023.[40]
[40] Claimant’s documents p 289
Dr Bisht reported Mr Leslie had experienced the following psychological symptoms since the day of the accident:
· frequent recollections of accident (nightmares and flashbacks);
· feeling anxious/sad while having these recollections/preoccupations;
· hypervigilance when he would be in a vehicle;
· lack of enjoyment in previously pleasurable activities;
· difficulty sustaining concentration;
· initial and middle insomnia;
· lack of motivation towards socialising and self-care, as well as hobbies;
· feeling anxious in day-to-day situations, and being easily startled;
· persistent flat mood;
· irritability;
· feeling distant from people, and
· lack of enjoyment.
Dr Bisht noted the pre-accident post-traumatic stress disorder arising out of the shooting and that the claimant was taking anti-depressant medication until the accident. He also noted the claimant used cannabis until 2020.
Dr Bisht diagnosed post-traumatic stress disorder and major depressive disorder which he concluded was partially related to the accident.
Dr Bisht assessed a current 19% WPI as follows:
· Self-care and personal hygiene – Class 2
· Social and recreational activities – Class 3
· Travel – Class 2
· Social functioning – Class 2
· Concentration, persistence and pace – Class 3
· Employability – Class 5.
He assessed WPI due to the pre-existing condition at 8% as follows:
· Self-care and personal hygiene – Class 2
· Social and recreational activities – Class 2
· Travel – Class 2
· Social functioning – Class 2
· Concentration, persistence and pace – Class 2
· Employability – Class 5.
Accordingly, Dr Bisht assessed a 11% WPI arising from the accident.
SUBMISSIONS
Claimant’s submissions
The claimant provided submissions dated 3 July 2024 in support of the application for review. It is noted that Medical Assessor Sidorov assessed a 15% WPI but subtracted 6% for the pre-existing impairment.
It is not disputed that the claimant sustained a pre-existing post-traumatic stress disorder. In or about 2007, the claimant witnessed a shooting and developed a psychiatric condition but it is submitted over the course of the next seven years, his condition improved.
The claimant was in receipt of a disability pension at the time of the accident in respect of a severe back injury sustained in 2010 rending him unfit for work.
The claimant submits there is no evidence he continued to suffer from any psychological symptoms or impairment in that six month period prior to the accident. It is submitted that lack of any evidence of psychological symptoms or impairment in the six months prior to the accident supports an inference that at the time of the accident, the claimant was functioning well and was not suffering from any impairment.
The claimant submits the Guidelines require that there be objective evidence of a
pre-existing symptomatic permanent impairment, that existed at the time of the accident before a deduction can be made and that without objective evidence its possible presence should be ignored.The claimant submits Medical Assessor made a deduction based on what he considers was “likely” to have been the claimant’s impairment at the time of the accident but in the absence of objective evidence. The claimant notes in Insurance Australia Limited t/as NRMA v Richards[41] Schmidt AJ said factual findings must be supported by logically probative evidence as per Australian Broadcasting Tribunal v Bond[42]; there must be a factual basis for findings, and that they cannot rest simply on a consideration of possibilities, for which there is no supporting evidence.
[41][41] Insurance Australia Limited t/as NRMA v Richards [2023] NSWSC 909
[42] Australian Broadcasting Tribunal v Bond (1990) 170 CLR 321; [1990] HCA 33 at 367
The claimant submits the pre-accident records do not provide any indication that the claimant had any impairment in relation to each of the classes at the time of the accident, and certainly not the actual impairment calculated by the Assessor.
The claimant also submits Medical Assessor Sidorov did not explain why he formed the view the claimant appeared to somewhat minimise his history and nor did he put to the claimant the alleged inconsistency in accordance with clause 6.41 of the Guidelines.
The claimant provided submissions dated 23 October 2023 in respect of the substantive dispute.[43] Those submissions rely upon the assessment of Dr Chow.
[43] Claimant’s documents p14
Insurer’s submissions
The insurer provided submissions dated 23 July 2024 in response to the application for review.[44]
[44] Insurer’s documents p 2
The insurer highlights the following in respect of the pre-existing complaints:
(a) the entry on 23 August 2019 makes it clear that the claimant's ongoing psychiatric symptoms stem from the shooting he witnessed over a decade earlier in 2007 / 2008. The entry refers to the claimant being "very agitated" and experiencing "anxiety and panic in severe fear of everyone knowing that he witnessed a murder (shooting)". He continued to experience "fear of reprisals".;
(b) the entry on 26 August 2019 indicates that the claimant was "still very agitated over the revelation of having seen a murder";
(c) the entry on 30 August 2019 reiterates that the claimant's psychiatric symptoms are linked to his fear of the "shooters";
(d) the entry on 26 November 2020 confirms a diagnosis of "PTSD / depression", and
(e) the entry on 9 December 2020 confirms that the claimant's post-traumatic stress disorder began in 2008, at the time of the shooting.
The insurer submits that when read wholistically, and in context, it is clear that the claimant did not suffer a transitory period of psychiatric complaints in late 2020 / early 2021, as apparently alleged. Rather, the claimant's clinical records reflect an entrenched chronic
post-traumatic stress disorder / depressive condition which began over a decade earlier when he witnessed the shooting in 2007 and continued to the time of the accident.The insurer refers to the Centrelink Form completed by Dr Phyu Hnin Lwin on 20 February 2021, four months before the motor accident, in support of a carer's allowance. Dr Lwin identified the following conditions of the claimant:
· chronic pain due to disc prolapse;
· post-traumatic stress disorder, and
· depression.
The insurer submits Medical Assessor Sidorov stated that:
(a) he did not accept the claimant's claims that he had recovered from his pre-accident post-traumatic stress disorder or that he was functioning well prior to the accident.
(b) he concluded, from his review of the claimant's clinical records, that the post-traumatic stress disorder which started with the shooting in 2007 was still active in the twelve months prior to the motor accident on 19 July 2021.
It is submitted Medical Assessor Sidorov correctly applied his clinical judgment in finding that the chronic post-traumatic stress disorder which started in 2007, and which was still active in January 2021, would not have spontaneously resolved by July 2021.
The insurer submits that there is clear objective evidence of a pre-existing symptomatic psychiatric impairment at the time of the accident and that Medical Assessor Sidorov correctly found that the claimant's assessment of his pre-accident psychiatric condition was not reliable because it conflicted with the contemporaneous medical evidence. Furthermore, it is submitted Medical Assessor Sidorov applied his clinical judgment in assessing the likely pre-existing impairment.
The insurer submits Medical Assessor Sidorov complied with clause 6.41 of the Guidelines when he put the content of the clinical notes to the claimant and recorded his responses.
MEDICAL EXAMINATION
Psychosocial history and pre-accident history
The claimant is a 52-year-old single disability support pensioner who was involved in a motor vehicle accident on 16 July 2021.
Before the accident, he “used to cook a lot – I did all the Christmas dinners – no problem”.
He maintains that his Housing Commission home was in a filthy condition when he moved in.
He was not working at the time of the accident. He had stopped working some 10 years back “because the medication I was taking – you can’t get a job if you're on morphine… the Palexia… for my back”. He had “a prolapsed disc, crushed nerves – a slow progression over the years” from “lifting, carrying, moving” at work. He then went onto the Disability Support Pension. He denied that anything other than his back pain and his medication had stopped him working.
He says he drinks alcohol very rarely. He does not use drugs. He smokes heavily.
He said he smoked dope when he was young, but had not used it in recent years, including in the time prior to the accident. He denied other drug use. He arced up when his attention was drawn to material in the records contradicting this assertion.
He admitted that he had witnessed a shooting some 30 years ago which gave rise to post-traumatic stress disorder. However, he had subsequently worked as a transport manager and had fitted out a number of buildings. However, he maintained, “my pain was managed – I could manage as a human – I could live my life – life as normal”. He maintained that he was socially outgoing denying any limitations in this regard.
He was asked to describe the incident involving the shooting. He was parked in his car and “saw people shooting”. He does not know if the shooters saw him. They did not come after him. The incident was “concerning – worrying – I had my children in the car with Claire… she had come up for the weekend – my son was affected…”. The Panel noted evidence in his documentation of prescriptions for various antidepressants, including Cymbalta (Duloxetine), Pristiq (Desvenlafaxine, and Aurorix (Moclobemide) for Endep (Amitriptyline – an antidepressant used in pain management), Quetiapine (a mood stabiliser/ antipsychotic/ anxiolytic) and Olanzapine (a mood stabiliser and antipsychotic).
He denied any other history of psychiatric illness before the shooting incident.
The Panel noted a reference in the documentation to a strong family history of schizophrenia.
He had broken up with his partner Claire some “30 odd years ago”. He was vague as to the reasons saying he had separated from her before the shooting. He has two adult sons. He had been in a relationship at the time of the accident and had broken up with her three and a half years ago (that is, subsequent to the accident).
He grew up in a single parent family – he had one brother and one sister. His father was not in the picture at all. He “got a couple of beltings as every kid did” but denied abuse – his stepfather was on the scene for about three years. He left home at the age of 17 years.
His brother had a serious stroke and is physically dependent.
He completed a diploma in engineering from TAFE while at work. He worked as a transport manager and supervisor. He also drove trucks and witnessed accidents more severe than this. He had no other claims history despite his back injury.
He completed year 10 studying at home in a Community Support Scheme.
History of the accident
On the day in question, he had driven his son to work. It was dark. He saw a car and slowed down. The car drove out of the street and T-boned him from the left. Airbags did not deploy. He “just sat in the car and people came up to the car to see if I was alright – everything was a blur”. He does not know if police or ambulance came – he “was in absolute shock”. He had to call his son to pick him up – neither car was drivable.
He went to the hospital about an hour later, “after I started coughing up blood,” and went to Campbelltown Hospital to be transferred to Liverpool Hospital, where he remained for two weeks. He had “whiplash” and “bruised lungs they said from blunt compression”.
History of symptoms and treatment following the accident
He has been “not very good physically” saying he cannot take his pain medication. He “used to take Palexia for my bad back” but cannot take it anymore because of “serotonin syndrome”. He is on Quetiapine, Venlafaxine, Prazosin, and Melatonin. He had previously been on Mirtazapine and Escitalopram which have been discontinued. According to the documentation on hand, he had also been on Fluoxetine and Sertraline.
He said, “It’s this feeling and it’s been ever since the accident – it’s my chest – it’s rage – it never goes away – this constant panic – anger that never goes away – not for one second… I’m forever yelling – I try to make my cereal, and I spill it and that makes me yell… I don’t know why I’m like that over every single thing”.
In short, he is very irritable; “I can’t deal with anything – I just freak out over everything”.
He complains of nightmares which are “constant all night every night… I take these tablets to get to sleep – I’m lucky to get two hours sleep before I wake up dripping with sweat… I sleep with a fan on me – the nightmares are absolutely crazy – I’m in a car accident and I can’t get help and then I crawl up the road and then I’m in hospital and the doctors are panicking because I’m dying – I stay awake maybe three or four hours and I get another hour of sleep – the doctor gave me stronger medication but then I sleep longer through the nightmares… I’d rather not be here, and my mind just goes blank.
He feels as though life was not worth living, saying, “I’m tortured every minute of the day when I’m awake” what with “the feelings – the panic – the anger – it’s like there’s a war in my head… I try to make sense of stupid things in my head…”.
He has been charged by police for “being angry and stupid” and “taken to hospital to see if I was crazy”.
The Panel noted that he had been seeing a psychologist and had also consulted psychiatrists in the past.
Details of any relevant injuries or conditions sustained since the accident
None in evidence.
Mental state examination
The claimant was interviewed by Microsoft Teams. He was at his home in Newcastle. Medical Assessors Canaris and Singh were in their respective offices. A good audiovisual connection was established.
He presented as a man who looked older than his stated age who wore a hoodie which he kept over his head much of the time but on removing this revealed unkempt and matted grey hair. He had a grey stubble on his chin. He provided the account documented above. He smoked cigarettes during some of the interview. He provided the account documented above and below. His narrative was rambling, repetitive, and disorganised. At times, he shuffled through notes and other times walked around his home and outside. He denied any ongoing fear relating to the perpetrators of the shooting he had witnessed or bikies, saying, “The only thing I’m worried about is cars – doctors – anything to do with any of that stuff”. His mood was dysphoric and his affect labile with an irritable edge. He denied suicidal ideation or thoughts of self-harm. Evidence of psychosis or cognitive impairment did not emerge.
Current functioning
He is currently much affected by his pain “which always gets worse – just to stand or move or walk – everything hurts – I can’t sit in the one position for very long”. He is presently on “some new tablets to try but they don’t do anything… Celecoxib – they don’t help… the only thing that helped was the really strong ones…”.
He was much dependent on the support of his ex-partner Claire, who came up for a week at a time, cooking and cleaning for him. When she is not there, he is on the phone to her every day. He does no cooking and cleaning. He showers and changes his clothes every four to six days “when I have to”. He had root canal treatment started on his teeth five years ago “and I couldn’t go back to get it finished… I got holes that are hurting”. He was vague as to who had been paying for his intended root canal. His appetite is poor (“I don’t eat a lot”), but he has been on tablets that made him gain weight, although these have been changed, and he is again losing weight. He would “sometimes not eat for two days”.
His ex-partner travels up by train to be with him. He occasionally travelled to see her – he says his youngest son would drive him down. He had been with a girlfriend up until three and a half years ago. He broke up with her “because of my head”. His relationship with his sons is not good – he got angry with one son because he bought a motorbike. He said, “I can’t be a father to my own children or grandfather…”. It seems one of his sons may have called police on him “because I was angry and yelling” resulting in his being charged; “I had to go to court on Valentine’s Day”.
He describes himself as “confined to this house – to this yard – since the accident”. He would “try to go to the shops here and there but that always goes bad…” Attributing this to “the people – the cars…”. He tries to go to the shops when Claire is there and has occasionally tried to go to the shops but only with Claire on the phone. He spoke of having “tried everything – all this exposure therapy – it just doesn’t work”. He is very apprehensive of other drivers. He says his doctor is “in the middle of trying to organise a support worker to organise all these things for me”.
He does not go out socially. “Not since the accident – I don’t even play darts – I didn’t have sports that I could do because of my back but darts was one of them” and he maintained that he played darts up to twice a week before the accident (“It was sort of seasonal”) and he last played darts “four and a bit years ago…back down in Sydney”.
He is now “a mess” and “stupid – my brain is spastic – I can’t remember anything – I can’t do anything – I put things in the wrong places – I put milk in the cupboard or tea in the fridge – I mess up everything I do – it doesn't make sense”. He “can’t watch the news – the television shows I like – the news are all about accidents and death – I try not to watch too much television or listen to the radio – that’s about it”. His memory “used to be perfect” but now he says he forgets things he is doing “or when I go to do something, I forget I was going to do it”.
Comments on consistency
The Panel noted the inconsistency between the history he provided in relation to recent substance use and evidence in the records. The Panel drew his attention to an entry in September 2020 which stated that he was still smoking pot and that he was drinking Bourbon heavily. He emphatically denied that he smoked pot or drank Bourbon at this time.
The Panel drew his attention to his GP’s records, indicative of active post-traumatic symptoms even in the time recently preceding his accident. The Panel also drew his attention to the history he provided in hospital in relation to his previous diagnosis of post-traumatic stress disorder noting he had stated this coupled with pain was the reason he was not working. He responded, “I could live my life – I was sleeping – I was working…”. It was pointed out to him that the records suggested he was quite unwell. He replied, “I didn’t think I was that bad – I could drive my car – I could do my shopping – I could live my life”. He was referred to entries that suggested he was at times housebound. He said, “It was a slow progression with the painkillers – when I could finally get the Palexia and that, I could manage the pain”.
In relation to his difficulties in 2020, he said he had accepted a Housing Commission home – he had been homeless. He found the house was “very neglected” attributing the neglect to the condition of his home.
The Panel asked how he came to be homeless. He said, “I was staying at Claire’s and my son assaulted me… he lived at Claire’s…”. He had lived there over “the last couple of months”. At the time, he was “living on a friend’s property – moved to Claire’s…”. He moved from his friend’s property for reasons that were not clear but “apparently people weren't supposed to stay there…”. He had been on that property “for a long time… years here and there – I lived at my mother’s…”.
Due to his agitation, disorganisation, and chaotic presentation, the Panel was unable to thoroughly examine each point of inconsistency in relation to his account of pre-accident functioning and the available documentation.
DETERMINATION
Diagnosis
The Panel considered a diagnosis of posttraumatic stress disorder and determined that the accident because of his physical injuries was in keeping with a Criterion A event as per the DSM-5-TR. It noted the presence of recurrent, intrusive, and involuntary recall of the accident manifested in nightmares and high anxiety in relation to motor vehicles (Criterion B) coupled with persistent avoidance of stimuli manifest in his avoidance of cars, his inability to watch news items involving motor vehicle accidents, and his difficulties going out of his house (Criterion C). There was evidence of negative alterations in cognitions and mood manifested in his perception that life was not worth living and his allusion to being “tortured” by “the war in my head” as well as his marked social withdrawal (Criterion D). There was clear evidence of marked alterations and arousal and reactivity marked by irritability and angry outbursts, hypervigilance, problems with concentration, and sleep disturbance (Criterion E). His disturbance caused clinically significant distress and psychosocial impairment as manifest in his presentation at interview and impairment in a range of aspects of his day-to-day life (Criterion G). Finally, there was no evidence that his disturbance was attributable to the physiological effects of a substance or to another medical condition (Criterion H).
The Panel noted evidence of a substance use disorder in apparent remission.
The Panel noted indications in the documentation and from aspects of the history of the presence of possible Cluster B personality traits but declined to make a diagnosis of personality disorder.
Causation
The Panel noted the presence of a prior post-traumatic stress disorder diagnosis and evidence of impairment associated with this in the documentation on hand. Nevertheless, given the nature of the accident and injuries sustained coupled with the presence of ongoing symptoms specific to that event, the Panel determined that the subject accident had given rise to an exacerbation of pre-existing posttraumatic stress disorder with the emergence of symptoms specific to the accident.
Permanent impairment
Given the passage of four years since the accident over which time he has had ongoing access to appropriate treatment, the Panel determined that the claimant’s condition had stabilised and that his current level of impairment was permanent in that it was unlikely to change substantially or by more than 3% over the next year.
Psychiatric Impairment Rating Scale
| Psychiatric diagnoses | 1. Post-traumatic stress disorder | 2. Substance use disorder in remission |
| Psychiatric treatment description | He is on Venlafaxine, Quetiapine, and Prazosin. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 3 | He was much dependent on the support of his ex-partner Claire who come up for a week at a time cooking and cleaning for him. When she is not there, he is on the phone to her every day. He does no cooking and cleaning. He would shower and change his clothes every four to six days “when I have to”. He had root canal treatment started on his teeth five years ago “and I couldn’t go back to get it finished… I got holes that are hurting”. He was vague as to who had been paying for his intended root canal. His appetite is poor (“I don’t eat a lot”) but he had been on tablets that made him gain weight, although these have been changed, and he is again losing weight. He would “sometimes not eat for two days”. Comment: The Panel noted his unkempt and dishevelled appearance as well as his dependence on the regular support of his ex-partner Claire. It noted that he had deteriorated in his functioning in this category since seeing Medical Assessor Sidorov. Using clinical judgement, all this equated to Class 3. |
| 2. Social and Recreational Activities | 3 | He does not go out socially (“Not since the accident – I don’t even play darts – I didn’t have sports that I could do because of my back but darts was one of them”) and he maintained that he played darts up to twice a week before the accident (“It was sort of seasonal”) and he last played darts “four and a bit years ago…back down in Sydney”. Comment: The Panel noted his agitation and lability of affect which it determined would be a major barrier to social engagement. |
| 3. Travel | 2 | He describes himself as “confined to this house – to this yard – since the accident”. He would “try to go to the shops here and there but that always goes bad…” Attributing this to “the people – the cars…”. He tries to go to the shops when Claire is there and has occasionally tried to go to the shops but only with Claire on the phone. He spoke of having “tried everything – all this exposure therapy – it just doesn’t work”. He is very apprehensive of other drivers. He says his doctor is “in the middle of trying to organise a support worker to organise all these things for me”. Comment: Using clinical judgement, the fact that is able occasionally to venture outside his home albeit with his ex-partner’s support places him in Class 2 in this category. |
| 4. Social Functioning | 3 | His ex-partner travels up by train to be with him. He occasionally travels to see her – he says his youngest son would drive him down. He had been with a girlfriend up until 3 1/2 years ago. He broke up with her “because of my head”. His relationship with his sons is not good – he got angry with one son because he bought a motorbike. He said, “I can’t be a father to my own children or grandfather…”. It seems one of his sons may have called police on him “because I was angry and yelling” resulting in his being charged because of which “I had to go to court on Valentine’s Day”. |
| 5. Concentration, Persistence and Pace | 3 | He is now “a mess” and “stupid – my brain is spastic – I can’t remember anything – I can’t do anything – I put things in the wrong places – I put milk in the cupboard or tea in the fridge – I mess up everything I do – it doesn't make sense”. He “can’t watch the news – the television shows I like – the news are all about accidents and death – I try not to watch too much television or listen to the radio – that’s about it”. His memory “used to be perfect” but now he says he forgets things he is doing “or when I go to do something, I forget I was going to do it”. Comment: The Panel noted his agitation and lability of affect and his overall chaotic and disorganised presentation. It noted that his presentation was considerably worse than when seen by Assessor Sidorov. Using clinical judgement, it determined he had Class 3 impairment in this category. |
| 6. Adaptation | 4 | While he had not worked for many years and was on the Disability Support Pension, he was manifestly not employable in any capacity whatsoever in his current condition and his levels of disorganisation and chaos as a historian. He was also not functioning in his role as homemaker, father, and grandparent. However, the Panel noted the contribution of pain which is not assessable for the purposes of whole person impairment. Using clinical judgement, it rated him as Class 4. |
| List classes in ascending order: 2, 3, 3, 3, 3, 4 | ||
| Median Class Value: 3 | ||
| Aggregate Score: 18 | ||
| % Whole Person Impairment: 22% | ||
*%WPI = Percentage Whole Person Impairment
Pre-existing/subsequent impairment
While the Panel noted the claimant’s assertions that he was functioning well before the accident and that he had not been working because of pain from his physical injury, it considered the medical documentation which indicated significant presentations with agitation, anxiety, and panic symptoms as well as presentations linked to his fear of shooters. It noted also his NDIS application dated 13 January 2021 which documented social anxiety. On 20 February 2021 Dr Lwin reported the claimant had come in with a friend. Dr Lwin reported the claimant’s son had been looking after him, but he had found a job and he needed a new carer. There was an application for a carer allowance dated 20 February 2021 which provided diagnoses of chronic pain due to disc prolapse, post-traumatic stress disorder, and depression and noted the presence of social anxiety. The latter paperwork confirms the presence of ongoing psychiatric symptoms and associated impairment although it is not clear from this how much is psychological and how much is physical in origin.
The Panel considered it significant that he had told hospital staff at the time of his accident that he was on the Disability Support Pension because of both his back injury and his post-traumatic stress disorder.
The Panel considered that the claimant was not a reliable reporter in relation to his
pre-accident levels of impairment. While it accepted that there had not been any mental health presentations documented between 20 February 2021 and the accident on 16 July 2021, it considered it improbable that symptoms and impairment that had been present for 30 years were no longer present as this was not in keeping with the natural history of chronic post-traumatic stress disorder. It considered it likely that symptoms and impairment evident over the 12 months preceding the accident would have been substantially present over that time.The Panel assessed the pre-existing impairment as follows:
| Psychiatric diagnoses | 1. Post-traumatic stress disorder | 2. Substance use disorder |
| 3. | 4. | |
| Psychiatric treatment description | Various psychotropics at various times. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 2 | He had stated that he was independent in relation to these activities before the accident. However, the Panel noted an email from the claimant to his GP dated 18 January 2021 clarifying that he had a carer to help him with cooking, cleaning, and general assistance. While it would appear from this email that some of his impairment related to his chronic pain, the email also refers to his chronic depression, post-traumatic stress disorder, and anxiety. Using clinical judgement, the Panel determined this to be consistent with Class 2 in this category. |
| 2. Social and Recreational Activities | 2 | While he maintained that he was socially outgoing, the panel noted his NDIS application dated 13 January 2021 which noted that he needed assistance with “social interaction” because he had “social anxiety”. The panel also noted the claimant’s email to his GP dated 18 January 2021 relating to his NDIS application in which he referred to among other things his “phobia of people”. In the absence of more specific information, using clinical judgement, the Panel determined this to be consistent with Class 2 impairment in this category. |
| 3. Travel | 1 | He denied impairment in this category and there was no evidence in the documentation to suggest otherwise. |
| 4. Social Functioning | 3 | The Panel asked how he came to be homeless. He said, “I was staying at Claire’s and my son assaulted me… he lived at Claire’s…”. He had lived there over “the last couple of months”. At the time, he was “living on a friend’s property – moved to Claire’s…”. He moved from his friend’s property for reasons that were not clear but “apparently people weren't supposed to stay there…”. He had been on that property “for a long time… years here and there – I lived at my mother’s…”. Comment: The Panel noted that he had been in a relationship at the time of the accident. However, the history he provided in relation to his homelessness was consistent with Class 3 impairment in this category given reported violence and the instability of his life situation. It noted also in this context documentation in his clinical file that his mood in the months preceding the accident was labile and that he was drinking large amounts of bourbon and smoking cannabis. While it noted that the claimant disputed this history, the Panel considered that he was an unreliable historian in this regard. |
| 5. Concentration, Persistence and Pace | 3 | While the claimant maintained that he functioned well in relation to this category, the Panel noted his chronic post-traumatic stress disorder with numerous presentations with labile mood and agitation as well as his heavy consumption of alcohol and cannabis coupled with substantial doses of opioid analgesics all of which was likely to cause substantial impairment in this category. The Panel considered the claimant to be an unreliable historian and using clinical judgement determined he had Class 3 impairment. |
| 6. Adaptation | 3 | He was not working at the time of the accident. He had stopped working some 10 years back “because the medication I was taking – you can’t get a job if you're on morphine… the Palexia… for my back”. He had “a prolapsed disc crushed nerves – a slow progression over the years” from “lifting – carrying – moving” at work. He then went onto the disability support pension. He denied that anything other than his back pain and his medication had stopped him working. Comment: The Panel noted documentation indicating that he had stopped work both because of pain and because of post-traumatic stress disorder. Using clinical judgement, it determined that he had Class 3 impairment in this category. |
| List classes in ascending order: 1, 2, 2, 3, 3, 3 | ||
| Median Class Value: 3 | ||
| Aggregate Score: 14 | ||
| Pre-existing % Whole Person Impairment: 13% | ||
*%WPI
Apportionment – pre-existing/subsequent impairment
He has 22% whole person impairment of which 13% is attributable to pre-existing psychiatric injuries.
Effects of treatment
The Panel made no adjustment for treatment effects.
CONCLUSION
The Panel revokes the certificate of Medical Assessor Sidorov dated 7 June 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a WPI of 9%:
· post-traumatic stress disorder
· substance use disorder (in remission).
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