Loudaros v AAI Limited t/as GIO

DETERMINATION OF REVIEW PANEL
CITATION:	Loudaros v AAI Limited t/as GIO [2024] NSWPICMP 391
CLAIMANT:	Alexandros Loudaros
INSURER:	AAI Limited t/as GIO
REVIEW PANEL
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Paul Friend
MEDICAL ASSESSOR:	Christopher Rikard-Bell
DATE OF DECISION:	20 June 2024
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; claimant’s application for review under section 63; claimant sustained physical injuries in accident on 21 October 2017 and developed psychological condition; Medical Assessor (MA) Samuell found a Major Depressive Disorder but certified that it was not caused by the accident and the claimant had no permanent impairment caused by the accident; claimant’s physical impairments certified as not greater than 10% and there were issues of excessive weight gain (due to the claimant’s physical injuries), the development of eczema, and a gambling problem; Held – claimant had developed a Major Depressive Disorder caused by the accident due to his physical injuries, ongoing pain, diminished ability to exercise, and weight gain; whole person impairment assessed at 7%; Medical Assessment Certificate of MA Samuell revoked; no matter of principle.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Issued under Part 3.4 of the Motor Accidents Compensation Act 1999 The Review Panel: 1. Revokes the certificate of Medical Assessor Samuel dated 27 October 2022. 2. Certifies that the degree of Alexandros Loudaros’ permanent impairment resulting from the injuries caused by the motor accident on 21 October 2017 is not greater than 10%.

STATEMENT OF REASONS

INTRODUCTION

Alexandros Loudaros was involved in a motor accident on 21 October 2017. He was a passenger in a car that was hit on the side and which then spun out of control hitting a barrier or wall.
Mr Loudaros says he injured his neck, lower back, right knee and right ankle in the accident and developed a psychiatric injury. He made a claim for damages against GIO, the third-party insurer of the vehicle that he says caused his accident.
A medical dispute about the degree of the claimant’s whole person impairment (WPI) has arisen in connection with that claim and GIO referred that dispute to the Personal Injury Commission (the Commission) for assessment.
On 27 October 2022, Medical Assessor Samuel determined Mr Loudaros did not have a psychological injury caused by the accident and that therefore no assessment of WPI was required.
The claimant then lodged an application with the Commission seeking a review of the Medical Assessor’s decision. On 5 May 2023, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and has allowed the Review and on 6 February 2024, the President’s delegate convened this Panel to conduct the Review.

LEGISLATIVE FRAMEWORK

Mr Loudaros’ claim and entitlements to compensation are governed by the provisions of the Motor Accidents Compensation Act 1999 (the MAC Act).
Compensatory damages under the MAC Act are awarded for economic as well as non-economic losses resulting from the injuries, disabilities and impairments caused by the motor accident.
Damages for non-economic loss are provided for in Part 5.3 of the MAC Act with some limitations and restrictions. For example, non-economic loss damages are limited to a maximum amount in accordance with s 134[1] and entitlement to those damages is restricted by s 131 to persons who have a greater than 10% WPI as a result of the injuries sustained in the accident.
[1] The current maximum as of October 2023 is $620,000.

Permanent impairment assessment

Permanent impairment is to be assessed in accordance with the Motor Accident Permanent Impairment Guidelines (the Guidelines)[2] which are largely based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides).
[2] Section 133. The current version of the Guidelines is Version 1 which is effective from 30 November 2017.

Dispute resolution

If there is a dispute about the degree of the claimant’s permanent impairment, damages for non-economic loss cannot be awarded and disputes must be referred to a Medical Assessor for determination.[3]
[3] See s 132 and s 44(1)(c) of the MAC Act.
Part 3.4 of the MAC Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Samuell’s, further medical assessments and the review of medical assessments by this Panel.[4]
[4] Sections 61, 62 and 63 of the MAC Act.

ASSESSMENT UNDER REVIEW

Medical Assessor Samuel says at paragraph [2] he was asked to assess the claimant’s psychological injury and at [3] that the claimant says he has a major depressive disorder and gambling use disorder caused by the accident. The Medical Assessor noted at [4] the insurer conceded the claimant has a major depressive disorder but that there was a dispute about WPI (22% vs 7%).
The claimant denied any previous history, lived with his mother at the time of the accident, he was 27 never married and with no children. The claimant said he attended school to year 12 but had no tertiary qualification and worked in security for three years at a Leagues club.
The claimant says he was a passenger in his own car. As he had a drink, he let his friend drive and his friend lost control and the car spun. The claimant was taken to St George Hospital by his brother.
The claimant reported feeling neck pain at the time, that he was discharged from hospital the next day. Psychological conditions developed but he could not recall when. He saw a psychologist (Rita) about 15 times, saw a psychiatrist (Dr Verma) twice and was prescribed Effexor.
The claimant reported gaining 85kg due to stress and depression. He feels helpless and hopeless.
He said he still takes Effexor and Mitrazapine along with pain medication.
Mr Loudaros says his general practitioner (GP) has stopped bulk billing him and he cannot afford to get Centrelink certificates. He was reported to have not worked since March 2019.
The claimant acknowledged a gambling problem before the accident but that he has not gambled for six months.
The claimant says his physical injuries have stopped him going to the gym or his other hobby of fixing building and racing cars.
Medical Assessor Samuell says at [20]:
“The nexus between the subject accident and the Major Depressive Disorder is complicated. There is considerable physical medical evidence that the subject accident does not explain the extent of Mr Loudaros’ reported physical symptoms. Mr Loudaros appears to rely on his reported physical symptoms to assert a deterioration in his mental health. Physical medicine experts suggest that the physical symptoms may be explained by psychological factors and Dr Cocks says that his psychological symptoms are caused by physical factors. If it is accepted that the subject accident does not explain the extent of the physical symptoms, there is no clear causal nexus between the subject accident and the reported Major Depressive Disorder beyond that of a temporal association. I accept part of Dr Cocks’ argument that Mr Loudaros has engaged in maladaptive coping mechanisms, including resorting to his previous history of gambling, as well as over-eating and inactivity that has massively increased Mr Loudaros’ weight and, as such, negatively impacted on his self-esteem. While it is accepted that the Major Depressive Disorder followed the subject accident, the argument that the subject accident caused the Major Depression is not compelling. The diagnosis of Major Depression does not require external causality. I determined that the Major Depression was idiopathic and not caused by the subject accident.”

ISSUES FOR DETERMINATION

Claimant’s submissions

After setting out the law and the relevant cases, the claimant says there are two reasons why the Review should be allowed:
(a) failing to apply the lawful test of causation, and
(b) failing to provide lawful reasons.
The claimant notes the Medical Assessor found the claimant had a major depressive disorder but that it was not caused by the accident. The claimant notes the test of causation is whether the accident could have caused the claimant’s condition and did cause the condition and that the accident need not be the sole cause but a contribution more than negligible. The claimant says if any of his physical symptoms caused or contributed to the psychological condition, that would be sufficient.
The claimant asserts that the Medical Assessor’s reasons are “opaque” and that the Medical Assessor notes the physical examiners have suggested the claimant’s physical symptoms are caused by psychological factors but that the psychological examiners suggest the claimant’s psychological factors are caused by the physical symptoms.
The claimant notes Medical Assessor Assem has certifies the claimant does have physical symptoms caused by the accident and an impairment of 9%.
In the submissions lodged with the claimant’s reply to the original assessment[5] the claimant relied on the diagnosis by Dr Verma of a major depressive disorder as well as the medico legal reports of Dr Cocks. The claimant also alleged he had a gambling use disorder causally related to the accident.
[5] Page 4 of the claimant’s bundle.

Insurer’s submissions

The insurer submitted that in respect of the test of causation, Medical Assessor Samuell had taken a history from the claimant of gambling, over-eating and inactivity which contributed to his weight gain and negatively impacted his self esteem. The Medical Assessor had found the claimant depressive disorder was not caused by the accident but was idiopathic. The insurer says this conclusion was open to the Medical Assessor.
The insurer notes that the Medical Assessor found that the claimant’s major depression arose after the accident but not because of it.
The insurer notes that the decision of Medical Assessor Assem is not binding on Medical Assessor Samuell.
The insurer’s submissions in the original medical assessment matter[6] disputed all physical and psychiatric injury.
[6] Page 6 of the insurer’s bundle.
In terms of the psychiatric injury, the insurer relied on the report of Dr Jones who assessed WPI at 7% on the basis of an accident-related chronic major depressive episode. The insurer said at [41] that it conceded the claimant suffered a psychiatric injury in the accident.

Procedural matters

The Panel issued directions to the parties on 8 February 2024. The claimant was to provide a bundle of documents by 29 February 2024 and the insurer was to provide its bundle of documents by 22 March 2024.
The Panel met on 15 April 2024 and reported to the parties.
The Panel noted that the claimant alleged physical injuries in the accident which has led to the development of psychological injuries. The Panel also noted that Medical Assessor Samuell had found no causal link between the accident and the claimant’s current physical complaints.
The Panel then noted that after Medical Assessor Samuell’s decision was issued to the parties, Medical Assessor Assem determined the claimant had a degree of WPI in relation to a number of physical injuries caused by the accident. That decision has not been challenged by either party. The Panel noted it was undertaking a de novo assessment of the claimant’s psychological injuries and that Medical Assessor Assem’s decision was in evidence before the Panel.
The Panel then said:
“[8] In a WPI assessment of psychiatric injuries there are usually the following issues to consider:
(a) the diagnosis of the current injury;
(b) the causation of that injury;
(c) the PIRS assessment of impairment resulting from that psychiatric injury.
[9] The Panel notes in the submissions lodged with the original assessment, the insurer “concedes the claimant suffered a psychiatric injury in the subject accident.” The Panel notes the insurer’s expert diagnosed a major depressive episode as did Dr Verma and Dr Cocks.
[10] The Panel asks the insurer to confirm it maintains the concession about causation and continues to rely on its expert and his diagnosis of a Major Depressive Disorder.”
The Panel requested additional documents and advised the parties of the medical re-examination.
Responses were due from the insurer by 26 April 2024 and from the claimant on

17 May 2024.

The further submissions of the parties

On 26 April 2024 the Panel received short submissions from the insurer. The insurer advised it withdrew its concession that the claimant sustained a psychiatric injury on the basis of the findings of Medical Assessor Samuell.
The insurer also advised that while is accepts Medical Assessor Assem’s certificate as to the degree of WPI not being greater than 10%, it relies upon its previous submissions in particular [10] – [37].
The claimant provided additional documents in particular correspondence that confirmed the claimant has not sought treatment from Dr Strokon since 16 April 2019.

REVIEW OF THE EVIDENCE

Claim form and claim documents

The Personal Injury Claim Form dated 21 April 2018 lists the claimant’s injuries as:
(a)    shock;
(b)    cervical spine soft tissue sprain “which is resolving”;
(c)    thoracic spine ligamentous injury – “ongoing”;
(d)    right knee ligamentous strain – “resolving”, and
(e)    right ankle “unknown - muscular ligaments”.
The claimant denied previous claims, previous relevant injuries and conditions and said he was seeing Dr Penna and having acupuncture.
A medical certificate completed by Dr Penna and dated 13 November 2017 says the claimant had been a patient for 14 years. He lists the claimant’s injuries as
(a)    soft tissue injury of neck now resolved;
(b)    talofibular ligament injury right ankle, and
(c)    pain and tenderness in the right talofibular ligament.
The medical certificate by Dr Penna dated 23 April 2018 notes the claimant had been a patient for of his practice for 13 years and was first seen after the accident on 31 October 2017. He diagnoses the claimant’s injuries as, “on going pain”.
The police report documents the motor accident occurred in a 70 kmph zone and that the claimant’s vehicle was in lane 1 of Southern Cross Drive attempting to “undertake” another vehicle which was in lane 2 which indicated and merged left and that a collision between the two vehicles occurred. The claimant was identified as a passenger in his own vehicle.
On 19 November 2021 the claimant gave a statement in support of his claim. In it he says:
(a)    he was born in Greece where he completed his secondary education and nine months of compulsory military service;
(b)    he emigrated to Australia in August 2014 to live with his mother two older siblings and a niece in the family home in Sydney. His father continued to live in Greece, and
(c)    he started working in November 2014 as a security officer at a rugby league club.
He initially worked as a waiter for six months and subsequently in a security role for three years but left the job to work with his brother who was opening a bistro. He worked in the bistro six days each week from 11am to 9pm. There were difficulties working with his brother who has since returned to Greece.
He completed a trial for a head guard security position for the Intel group at Auburn, from 3 to 19 October 2017 five days each week, 40 hours each week. He had intended to continue and wanted to run his own company,
He had minor eye surgery in Greece in 2006 or 2007.
He was overweight as a teenager whilst living Greece but got his weight under control when he joined a gym from 2012. He enjoyed swimming. He continued this activity in Australia training 5 to 6 times each week for 60 to 90 minutes, rode a stationary bike at home and did other cardio exercises.
The claimant said after the accident, the police asked him to move his vehicle and he did not go to hospital in the ambulance that arrived at the scene of motor accident because he to arrange for his vehicle to be towed. His brother took him to St George Hospital.
He documents his physical symptoms and treatment and said he has gained 70 kg in weight since the accident.
He was referred to Ms Rita Azzi psychologist and had 15 sessions of treatment to date.
He has consulted Dr Naresh Verma at St John of God Hospital clinic in Burwood. He was prescribed Efexor and mirtazapine.
He says:
(a)    he has depression, anxiety, shortness of breath, difficulty with sleeping, suicidal thoughts and a fear that when he falls asleep he will not wake up. The depression has affected his relationships and strained the relationship with his girlfriend;
(b)    he has difficulty with his personal care. He cannot prepare his own meals and does not have the motivation to shower daily or wear clean clothes;
(c)    he has become socially withdrawn and rarely attends social events which he previously did frequently;
(d)    he usually avoids travelling without a support person;
(e)    he is unable to function within society and avoids social contact;
(f)    his concentration is affected. He no longer has the ability pursue things to completion or engage in conversation, and
(g)    he has not been able to contemplate returning to work and feels that he does not have the coping skills to deal with work on a day-to-day basis.
He attempted to return to work, as a truck driver from 26 February to 13 March 2019. This job required him to do heavy lifting and he could not continue with it.
His original goal was to open in his own security company but he says this is now not possible. He cannot do security or restaurant work because of his physical and psychological symptoms.

Treating medical records and reports

The records from St George Hospital record a presentation on 21 October 2017. The claimant complained of neck pain and right knee pain. The upper and lower limbs were normal with no loss of power, reflexes, sensation or co-ordination recorded. The claimant was able to flex and extend his right knee and there was no effusion.
A CT scan of the cervical spine showed no obvious fractures and normal alignment.
The clinical notes from the Five Dock Medical Centre from 27 May 2003 to

13 November 2017 include the following entries and reports of relevance:
(a)    11 February 2016 - he had lost a considerable amount of weight in the last few years and has an abdominal apron. He was referred for a possible abdominoplasty;
(b)    30 October 2017 - he was a front seat passenger hit from behind causing the vehicle to spin and hit a side wall. Since then, he has had neck pain and right leg pain. CT scan of the neck at the hospital was normal. He had tenderness just lateral to the patella with a spongy feel to the patella and acute tenderness of the talonavicular area of the right foot;
(c)    13 November 2017 - the neck pain had resolved but the ankle pain persists. He has tenderness over the talofibular ligament;
(d)
a report by Dr Phillip Kolos, paediatrician, dated 1 September 2005, states

Mr Loudaros has been previously seen about his weight two years ago. He has gained excessive amounts of weight for which he is teased and is reluctant to go swimming. The claimant was said to eat breakfast, snacks at morning tea and eats throughout the day. He has two adult sized serves for dinner. He dislikes fruit and vegetables and the food he eats is high in carbohydrates and fats such as chips. He was said to exercise regularly including playing rugby and water polo but he also watches TV or video games for four hours per day and six hours on weekends, and
(e)
the report by Dr Darrell Perkins, surgeon, dated 20 March 2016 states that

Mr Loudaros’ weight has dropped from 160 to 107kg and he had reached 96kg at one stage. The claimant had excess skin on his abdomen. He gets sweats and rashes underneath the rolls which inhibit him from exercise. It states he has advised him of the risks of an abdominal lipectomy. The claimant was also advised to cease smoking.

A further set of clinical notes from the Five Dock Medical Centre have been provided from

13 November 2017 to 24 September 2020 and include the following entries:
(a)    6 November 2019 states - the right ankle pain persists. He has right neck pain with radiculopathy. He has weight gain;
(b)    4 February 2020 states - his weight is 155kg and a height of 188cm, giving him a body mass index of 43.85;
(c)    27 April 2020 states - he has pain in his upper back and left ankle. He was prescribed Efexor XR 37.5mg and Panadeine Forte. He is waiting to see a psychiatrist. His weight is 142kg, and
(d)    24 September 2020 - he has back pain. He is consulting a dietician and a psychologist and says he is feeling better. He is doing exercise with an exercise physiologist. He is having hydrotherapy for his back and ankle. He was prescribed Efexor XR 150mg capsules and Panadeine Forte.
Dr Strokon, orthopaedic surgeon, wrote to Dr Penna on 18 April 2019, stating that

Mr Loudaros continues to have lumbosacral pain and pain in the right ankle.
The bone scan showed a hotspot on each ankle in the same area of the posterior process of the talus. Closer examination of the MRI showed the posterior process of the talus is in fact an os trigonum which is linked to the main body of the talus via a scar or chondral junction. It appeared this connection was causing the activity on the bone scan.
It was felt that his symptoms could have been coming from this false joint of os trigonum. This anatomical arrangement is congenital and he was quite asymptomatic prior to the motor accident. Dr Strokon expresses the view that the motor accident has aggravated an underlying anatomical arrangement and made it clinically obvious.
The claimant also complained of chronic low back pain. The bone scan seemed to indicate increased activity in both sacroiliac joints which raises a suspicion there may be pain arising from these joints that have somehow been destabilised by the motor accident.
Mr Loudaros was referred to the physiotherapist Dr Saunders.
Dr Verma, psychiatrist, has treated the claimant. In his letter to Dr Penna dated 6 June 2020 Dr Verma says that Mr Lousaros’ mental symptoms commenced soon after the motor accident. The claimant had nightmares but this had improved. His sleep was disrupted every few hours by pain. He has chest pain and dizziness and ruminates frequently. There is some hypervigilance when he is a passenger in a car. He feels he has lost his previous life.
He had thoughts of jumping to end his life. He was worried about his weight which has increased to 156kg.
His diagnosis was of a major depressive disorder in the context of chronic pain and functional impairment. He has some symptoms of post-traumatic stress disorder such as anxiety and hypervigilance.
Dr Verma recommended Melatonin 2mg for insomnia, Efexor to increase from 75mg and gradually to 150mg, Quetiapine 12.5mg at night for sleep which could increase later.
Dr Verma, reported to the claimant’s GP again on 3 August 2020 stating that Mr Loudaros is now taking Efexor 112.5mg and Quetiapine 25mg daily. He has not used melatonin.
The claimant’s mood was said to be poor, sleep was broken, and he felt hopeless. He had suicidal ideation but no active intent or plan.
He reported that his pain was ongoing. He had not yet seen a pain specialist or psychologist. He tries to get out of the house, but this is limited by his pain and mood. He attends the exercise physiologist each week.
The diagnosis was again major depressive disorder in the context of chronic pain and functional impairment. Dr Verma considered there were some symptoms of post-traumatic stress disorder such as anxiety and hypervigilance.
He recommended increasing the Efexor gradually to 187.5mg and then up to 300mg. He also recommended adding Mirtazapine 7.5mg increasing to 15mg and later to 30mg.
He was permitted to reduce or cease the Quetiapine if the sleep improves.
Ms Azzi, psychologist treated the claimant and has produced records including the following entries.
On 21 August 2020 the claimant’s scores on the Depression Anxiety Stress Scale were in the extremely severe range for depression and anxiety and in the severe range for stress but it did not provide the actual scores. His presenting issue was depression.
The claimant weighed 140 kg, wore eyeglasses, squinted in pain when he moved on the couch and needed to keep changing seating positions.
He was a passenger in his own vehicle which was involved in a motor accident on

21 October 2017. A friend was driving. The vehicle suffered a rear end collision. Mr Loudaros lost money because he was not insured for his friend to drive the vehicle.
The claimant reported chronic right sided lower back pain radiating down the leg and ankle. He has pain in the shoulder blade and neck.
On 8 September 2020 the claimant said that every time he goes to sleep he worries that he might die in his sleep. He was scared that he will not wake up from sleep. He stops breathing and his mum or girlfriend wake him.
On 17 September 2020 Ms Azzi reports that the claimant says he has lost his head, nothing goes right and he cannot change his negative thoughts because it has become a part of him.
Her records of 30 September 2020 say that he is different since the accident. It is all in his head. He cannot work on a car, (presumably a vehicle that he owns) and he was in bed for a week when he tried to work on the car.
The Allied Health Recovery Request by Rita Azzi, psychologist, dated 21 August 2020 states that Mr Loudaros has a diagnosis of depression. His symptoms are low mood, lethargy, low motivation, anxious and depressed ideation, social withdrawal, difficulty sleeping, anger outbursts. He also has feelings of helplessness and hopelessness due to physical restrictions, weight gain, chronic pain and change of life.
The records from the C-Life Health Club indicated that Mr Loudaros joined on

30 August 2014. He subsequently either rejoined or reactivated his membership on

27 May 2017.

Radiology

The report by Dr L Ha, radiologist, of an X-ray of the right foot and the right knee dated

3 November 2017 reports as follows:
(a)    right knee – the margins in the knee are intact, no fracture, no effusions, no loose bodies;
(b)    right ankle foot – ankle mortise is intact as is the distal tibiofibular syndesmosis, and
(c)    a small accessory ossicle is seen at the dorsal aspect of the cuneonavicular joint. No acute fracture. The tarsal joints are intact.

Medico-legal reports – physical injuries

Dr Mitchell, occupational physician provided a report to GIO dated 15 September 2019.

Mr Loudaros reported ongoing pain in the right side of the neck and lower back together with radiation to the right ankle. The claimant denied any right knee pain. Dr Mitchell has a record of the lower back pain commencing four months earlier (May 2019).
The claimant was reported as weighing 137kg. Dr Mitchell states there were no abnormalities found on physical examination. Doctor reports the ongoing pain is of a severe level and is not consistent with the nature of the described accident and the absence of any significant clinical or radiological findings to indicate an underlying injury. The report states the injury is soft tissue injury to neck and lower back as well as the right ankle.
Dr Patrick provided a report dated 11 March 2020 to the claimant’s solicitors. He suggests the claimant had been doing or attempting some work since the accident. The claimant reported gaining 52kg since the accident. Dr Patrick considered all of the claimant’s physical injuries were caused by the accident, that the claimant was not fit for work and that his prognosis was poor. In a separate report he assessed the claimant’s WPI at 15%.
A further report from Dr Mitchell is dated 15 June 2021. At that time the claimant weighted 147kg. Dr Mitchell documents inconsistency in movement. The doctor states that

Mr Loudaros has a congenital condition of the os trigonum on each side of his ankle which is asymptomatic on the left side compared to the right.
It was said there was no radiological evidence of any underlying injury in the neck or the right-side of the lower back. Dr Mitchell found no clear underlying evidence of injury relating to the right ankle.
Dr Dalton, consultant in rehabilitation examined the claimant at the request of the insurer and provided a report dated 3 March 2021. Dr Dalton states that Mr Loudaros suffered a mild soft tissue cervical strain injury which appears to have fully resolved by the time he consulted

Dr Strokon. The claimant reported he weighed about 95kg at the time of the accident.
Dr Dalton found no evidence the claimant sustained an injury to his lumbar spine or either shoulder and no evidence to support the claim that he sustained an injury to his right ankle.
The insurer obtained a report from Dr Jones, psychiatrist, dated 15 June 2021. Dr Jones documents that following the motor accident, Mr Loudaros has problems with his right leg and neck pain. He has not undergone any surgery or had any injections.

Medico-legal reports – psychiatric injury

Dr Cocks, psychiatrist, provided a report dated 27 August 2019 to the claimant’s solicitors.
Dr Cocks states Mr Loudaros described his mood as depressed and that he cannot support his partner, mother or himself and feels like nothing. He described a loss of hope for the future and pervasive feelings of worthlessness.
He has lost faith in the medical profession as there is no solution to his problems.
He has marked anhedonia with loss of interest in activities he once enjoyed.
He has problems with intimacy due to his weight gain. His weight has increased from 95 to 152k and he feels ashamed and disgusting. He comfort-eats. He states that he eats three times that of an individual of his age. Food briefly numbs his feelings of distress.
He has no patience and is easily angered which is out of character for him. He has a general sense of feeling uncomfortable in himself. His sleep pattern is adequate but of poor quality. He wakes in the morning feeling fatigued and has a general loss of energy, drive and motivation.
The claimant did not report any symptoms of mania or hypomania.
Mr Loudaros noted his pattern of gambling has increased since the injury, estimating he has lost over $80,0000 through using poker machines. He goes to the local hotel and uses poker machines. He says his gambling is now restricted and he does not have access to financial means to continue this behaviour. He reported no history of pre-accident gambling related problems.
Dr Cocks diagnoses a major depressive disorder and a gambling use disorder.
Dr Cocks states there is a strong causal link between both these conditions and the motor accident on the basis that the claimant had no previous history of mental health problems and no previous history of problematic gambling behaviour.
Dr Cocks declined to assess WPI.
A second report by Dr Cocks is dated 1 February 2021 and notes that the claimant has had treatment from Ms Azzi, psychologist and Dr Verma, psychiatrist. He has been prescribed Venlafaxine (375mg) in the morning and Quetiapine (150mg) at night. Mr Loudaros had also seen a physiotherapist, exercise physiologist and a nutritionist.
Dr Cocks states that the claimant meets the criteria for major depressive disorder. In a separate report, he assessed the claimant’s WPI at 22% assigning Class 2 to Travel and Social Functioning, Class 3 to Self Care and Personal Hygiene, Social and Recreational Activities, Concentration Persistence and Pace and Class 5 to Employability.
Dr Jones obtained the history from the claimant that his weight increased from 94 to 160kg.
Mr Loudaros complained of a sharp pain in his lower back which goes down to his leg and goes numb. It is difficult to walk and sometimes it affects his routine by putting him in a bad mood.
He was prescribed venlafaxine which makes him feel lightheaded but otherwise does not improve his mood. He is also taking quetiapine.
The claimant said he had trouble walking and with everything. He cannot train, work or be happy.
The claimant said he had consulted Dr Verma at St John of God Hospital and was referred to a psychologist. They think that he needs motivation, but he says it is nothing about motivation. He is in pain which restricts him, and he feels demotivated because of the pain is not getting better.
Mr Loudaros said he avoids being a passenger and tends to drive because he is more comfortable. His sleep is always broken because of pain, numbness and bad dreams. This is mostly pain. He is always in pain and always thinking the worst possible. He feels that he won’t wake up and said he stops breathing and he feels like choking and is short of breath. He feels like going back to sleep when he wakes up and he feels like giving up. He does not remember things and what people have told him which worries him. He has difficulties concentrating.
Dr Jones diagnoses a major depressive disorder.
He states that there is significant pain focus, and this appears to be his major limiting factor and the perpetuating factor of his mood disorder.
Dr Jones assigns a WPI of 5%, assigning Class 1 to Self Care and Personal Hygiene and Travel, Class 2 to Social and Recreational Activities and Social Functioning, Concentration Persistence and Pace, and Class 3 to Adaptation.
Dr Jones added 2% for the moderate effect of his antidepressant medication.

Other assessments

Medical Assessor Assem examined the claimant on 21 February 2023 and issued his certificate with reasons on 22 February 2023.
He confirms at [2] that he was asked to assess the cervical and lumbar spine as well as the right knee and right ankle.
Medical Assessor Assem records a history at [8] that the claimant was 27 who worked as a security officer at the time of the accident and attempted to work after the accident as a truck driver but has not been able to work. The Medical Assessor has at [9] a history of a several pre-accident medical matters none of which are relevant to the injuries sustained in the accident.
The claimant gave a history recorded at [9] of being a front seat passenger in a vehicle being driven by a friend which was clipped by another car, spun several times and collided with a wall and guardrail. The claimant says he was wearing a seat belt and that the airbags did not deploy. The claimant reported no head injury or loss of consciousness and while he was thrown around inside the car, there was no impact to his body with any part of the vehicle. The claimant was taken to hospital.
The claimant is said at [10] to have told Medical Assessor Assem that he had difficulty recalling events from five years ago. He said he was taken to hospital, saw his GP, had investigations of neck, right knee and ankle pain. Medical Assessor Assem put to him that lower back pain did not develop until September 2018 and he did not respond.
The claimant reported at [12] right scapula and neck discomfort, a numb right arm, intermittent lower back discomfort and numbness down the lateral aspect of the right thigh. He said his right knee symptoms have resolved. His main concern was said to be constant pain in his right heel.
The claimant is reported at [13] to be taking Panadeine Forte, Panadeine Osteo or Voltaren, Effexor, Mirtazapine and Quetiapine.
All the affected body parts were examined and the Medical Assessor summarised the various records before him.
At [21], Medical Assessor Assem found on the basis of contemporaneous medical evidence that the claimant had soft tissue injuries to his neck, right knee and right ankle. Medical Assessor Assem noted the right knee injury had resolved and that the cervical spine injury may be contributing to the claimant’s current symptoms. Medical Assessor Assem diagnosed an aggravation of a pre-existing constitutional abnormality in the os trigone. He was not satisfied that the claimant sustained any lumbar injury in the accident.
Whole person impairment was assessed 9% on the basis of a 5% cervical spine injury and 4% right ankle injury.
Medical Assessor Cameron determined a number of disputes about treatment in a certificate issued on 21 October 2023. The treatment includes domestic assistance in the past and future, further GP reviews, specialist consultations for the ankle and cervical spine, medication for life and surgery to the ankle to remove the os trigonum and the false joint that connects it to the main body of the talus.
Medical Assessor Cameron found that the claimant sustained soft tissue injuries to his right ankle and cervical spine and that he has continuing disability associated with morbid obesity. He found the treatment sought was not causally related to the accident due to the minor nature of the insurer. He specifically found the proposed surgery not causally related before the ossicle trigonum was pre-existing and not related to the accident.

RE-EXAMINATION FINDINGS

Mr Loudaros was examined by video teleconference by Medical Assessors Friend and Rickard- Bell. Mr Loudaros attended unaccompanied.

Psychosocial history and pre-accident history

Mr Loudaros was born in Greece and lived on an island with a population of about 30,000 people. He spent most of his life up to age 18 years in Greece. He lived for two periods of time in Australia during that time.
He completed secondary school in Greece in 2012. He completed his compulsory military service in the Special Forces for six or nine months in 2013.
He immigrated permanently to Australia in 2014.
He initially worked as a gaming attendant at Canterbury Leagues Club. He later obtained his security licence and worked doing security work at the leagues club until about 2016.
He also worked for other companies doing security work.
He was training six times each week and was very fit.
He was very interested in high performance motor vehicles. He went to race meetings at Eastern Creek and drove his own high performance motor vehicle.
He lived with his mother and older brothers in Australia. His father operates a Greek restaurant in Greece. His parents are not separated.
He assisted one of his brothers in his restaurant which was at a Club and from time to time, his other brother who owned a coffee shop. He worked “on and off” with his brothers.
He was working full time in security 38 to 48 hours each week in the month prior to the motor accident. He assisted his brothers in their various businesses when required.
Mr Loudaros has been in a relationship with his girlfriend since 2015, but they have never lived together.
Mr Loudaros has not been involved in any previous motor accidents and has not had any serious health problems.
He had surgery on one of his eyes in 2006 or 2007 for a “lazy eye” in Greece.
He was overweight as a teenager but started attending a gym while he lived in Greece, was able to lose weight and complete his compulsory military service, in the Special Forces.
He believes his weight was 92-94kg prior to leaving Greece for Australia in 2014.
Mr Loudaros smokes 15-20 cigarettes each day which he did prior to the motor accident.
He is abstinent of alcohol and illegal substances.
He drinks tea 4-5 times each week, coffee 2-3 times each day and consumes a cola drink every 1-2 days.

History of the motor accident

The motor accident occurred when Mr Loudaros was travelling as a passenger in his own vehicle which was being driven by a friend.
The vehicle was “clipped” on the right-hand rear side causing it to spin. They were at that stage on the Southern Cross Drive Bridge near the airport. The vehicle hit the side wall more than once but did not roll over.
Passers by assisted him out of the vehicle. He remembers leaning on the concrete barrier beside the road covered with blankets.
Police and ambulance arrived.
His vehicle was later written off.
The police told him that he had to move his vehicle off the bridge. He arranged for it to be towed and this was why he did not go to hospital in the ambulance.
The motor accident occurred in the early hours of the morning. He was driven to St George Hospital by his brother and was discharged about 15 hours later on the same day.

History of symptoms and treatment following the motor accident

Mr Loudaros was examined at the hospital and underwent various investigations including scans and other tests at St George Hospital.
He was in a wheelchair and wearing a neck brace when he was discharged from hospital.
He subsequently consulted his general practitioner but cannot remember exactly when. The clinical notes from the Five Dock Medical Centre state that he attended on

30 October 2017. He was described as having neck pain and right leg pain, tenderness on the lateral side of the patella, a spongy feel to the patella and tenderness in the talonavicular area of the right foot.
His doctor prescribed analgesic medication and referred him for X-rays and MRI scans. He subsequently had physiotherapy, acupuncture, hydrotherapy and was referred to an occupational therapist.
Mr Loudaros had pain in the right side of his neck which radiated down to his scapula. He had pain on the right side of his lower back which radiated down his right leg to the right ankle. He said he felt “shocked” and “shaken up”. He cannot remember more about his mental state, immediately following the motor accident because it occurred in 2017.
The claimant said he ceased working in security. He tried to return to work, in 2020 as a truck driver, doing deliveries for a carpentry business but because the job required heavy lifting, he was deemed unfit for the job.
He commenced ride share driving in October 2023 and has done it on and off a few days at a time. He described staying in bed feeling disorientated and not wanting to do anything after a few days of ride share driving. He feels uncomfortable because of his weight gain.
He appears to have mostly gained weight in the 12 months, following the motor accident and currently weighs over 160kg. Mr Loudaros said that the weight gain occurred because he was eating too much, following a poor diet, was unable to train or exercise, or in his words, unable “to stay on track”. He has tried to return to the gym but cannot do it consistently because of his physical injuries and pain.
Mr Loudaros was referred to Ms Azzi because he was depressed. He remembers not being able to focus or concentrate and that his mental state was “not the best”. He felt unworthy, useless, was losing friends because he was short-tempered and there were difficulties in the relationship with his girlfriend.
He was also referred to Dr Verma, psychiatrist, who prescribed Venlafaxine and Quetiapine, the doses of which were increased at least to 150mg and 12.5 or 15mg daily, respectively.
He ceased the treatment with Ms Azzi when the insurance company declined to pay for more treatment. He has ceased the antidepressant medications but cannot recall when.
He reported that part of the problem with maintaining treatment, especially medication was because one of his longstanding GPs, Dr Penna retired, and a subsequent general practitioner he consulted at the same medical practice also retired, about one year ago. He has recently found a new GP at the Belmore Medical Centre who is trying to find a psychologist to whom he can be referred.

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

Mr Loudaros has not been involved in any subsequent motor accidents or sustained any work injuries.
He has gained over 60kg of weight since the motor accident, primarily in the 12 months following the accident.
He has had eczema “all over my body”, for the past 6-8 months. He previously had rashes because of his excessive weight which were worse in summer but not as severe as the current situation.
He easily becomes short of breath because of the weight gain.

Current symptoms

Mr Loudaros says he continues to have pain on the right side of his neck down to his right scapulae and back pain from the lower right side of his back, down his right leg to his right ankle.
He describes feeling mentally disorientated by which he means he has poor concentration and cannot get himself on the “right path”. Getting on the right path means getting up, shaving, having a haircut, trying to better himself on a day-to-day basis and going for a walk.
He is inclined to stay at home, feels depressed, anxious, and does not feel like undertaking any activities.

Current and proposed treatment

As mentioned previously, his current GP is trying to find a psychologist to whom he can refer him.
Mr Loudaros takes paracetamol 665mg each day and over the counter analgesic medication. He uses muscle creams on his muscles and has been prescribed several creams to treat the eczema. He has been referred to have skin scrapings and a fundal culture of the dead skin.
He attends physiotherapy once each week.
He has only recently been able to find a GP and it is taking time for the GP to get his files and to come to terms with his condition.

Mental state examination

Mr Loudaros was on time, alert, orientated, and understood the purpose of the examination.
He described ongoing pain from soon after the motor accident affecting the right side of his neck and radiating down to the right scapula and again back pain from the lower right back all the way down to his ankle.
He says he has gained in excess of 60kg of weight due to overeating, not being able to maintain his gym routine and having a poor diet.
Mr Loudaros says he is depressed, anxious, socially withdrawn, and has a loss of interest in previous activities.
He says his concentration is impaired, he cannot get himself into a daily routine or even regularly get out of the house each day.

Current functioning

Mr Loudaros says he showers every couple of days when his mother reminds him to do so.
He is now using what he refers to as the “outdoor bathroom” which is a shower installation in the laundry. This was installed after the motor accident, because he could not fit into the shower cubicle in the bathroom inside the house.
He does not shower every day because he is mostly at home, does not look forward to doing anything and there is nothing for him to do.
He gets dressed most days, more than he showers and wears clean clothes which his mother washes.
It is difficult to get dressed because of his weight. He feels uncomfortable even to lift his arms.
He says he no longer can do the gardening or lawnmowing. He previously cooked all his own food, ate a high protein diet and had a disciplined approach to diet and exercise.
He does not eat breakfast. He eats whatever food that he can find at home and what his mother prepares.
He does not undertake any activities at home, including doing laundry, gardening or cleaning, in part because he is so uncomfortable with his weight. He has pain generally and he is not interested in doing any activities. He admits that he eats for comfort.
He occasionally goes out for a coffee but does not buy any groceries or food and does not want to go to the shops.
Mr Loudaros occasionally goes out to meet friends, to go to their houses or to go for a drive with friends. He has gone out to Eastern Creek to watch the car racing but has not driven his high performance motor vehicle which has been sitting in the garage for a long time.
He says, this is in part because he feels depressed, but also because he has pain and has developed eczema. He is not motivated to leave home and feels embarrassed about his appearance.
Mr Loudaros can drive locally to the physiotherapist, to his doctors’ appointments and to see friends who live locally. He needs to drive because he feels scared travelling as a passenger. Friends have said that he is “a wuss” for not being able to travel as a passenger and this has caused him some loss of friendships.
He works as a ride share driver, but does not drive every week. He says he will drive at most for six hours in two-hour blocks, during the course of a day. He needs to repeatedly stop, get out and stretch.
He says he can choose the ride share jobs that he accepts. He has only driven a maximum of 20 minutes when doing ride share driving. He feels that it would be wrong for him to suddenly tell the customer that he has to get out and stretch. He does not know how he would react if he had to drive further afield.
Mr Loudaros, before the motor accident, was very interested in high performance motor racing. He drove his own high performance motor vehicle at race days as Eastern Creek and work on his own motor vehicle. He has not been trained as a motor mechanic, but he had lots of friends who are mechanically minded who assist him. He watched online videos or looked websites to obtain more information about how to repair/maintain his vehicle.
Part of his problem with not resuming high performance racing is that it requires money to do so. He is no longer interested in working on his high-performance vehicle. His weight is also a factor.
Mr Loudaros lives with his mother. His older brothers are married, have children and live separately. He mostly has a good relationship with his mother. He has a somewhat difficult relationship with his brothers. They have arguments at a variable frequency which he described as “a different type of argument”. He now tends to not answer their telephone calls, is more short-tempered and does not help them when they ask for assistance.
He described the relationship with his girlfriend as “complicated”. It is “not the same”, they have more arguments and he stated that “other things coming into play”. They are no longer intimate and there was nothing positive about the relationship. There is no intimacy because of his weight gain and how he feels about his physical appearance. He has been in a relationship with her since 2015.
Mr Loudaros describes his memory as bad, that he does not recall “a lot of things” and can no longer remember the good things in his life.
He does not watch television, but he does look at social media and YouTube videos on his mobile telephone. He does these activities for a variable period of time, sometimes for as short as one minute. He could not explain his problems with concentration any “better”. He does not play games on his mobile telephone.
Mr Loudaros returned to work as a ride share driver in October 2023. He works at variable intervals. He has worked up to four hours each over 6-7 hours. He will not work for periods of up to a month and/or work or lesser periods of time when he does work. He does not work regularly each week even for two consecutive days.
He needs to take regular breaks to stretch because of the physical pain. He, at times, cannot keep driving, turns off the ride share app and goes home.
The Review Panel asked Mr Loudaros at this stage about his earlier life. He replied that he lived on an island with a population of 30,000 people and that there were no problems. He was the president of his secondary school. He had a good childhood. He was overweight but still played sports. There was no bullying about his weight or for any other reason.
Mr Loudaros was asked about the gambling which he had not mentioned. He replied that before the motor accident he gambled occasionally commencing 8-10 years ago when he first went to the casino. Gambling became “a big problem” since late 2018 or early 2019 he was not sure exactly when but he was clear it was after the accident.
The report of Dr Cocks dated 27 August 2019 states that he gambled in a local hotel and had lost over $80,000 on poker machines. Mr Loudaros agreed that he had probably lost this amount of money. He did not go to the hotel or gamble each day. He last gambled 6-8 months ago. He has self-excluded himself once. He reported that his mother helped him to stop gambling. It appears the main way he stopped gambling is by staying home, which his mother has encouraged him to do.
Mr Loudaros reported that pain is a significant factor in limiting his activities. He rated his pain as 7 to 8 out of 10 and sometimes up to 9 out of 10. He stated, for example, that the previous day he could not move his ankle for at least an hour after he got up. He reiterated he has pain in his right scapula up into his neck and he has a loss of flexibility. He agreed he would feel significantly improved if he did not have the pain.
At the end of the examination Mr Loudaros showed the Medical Assessors a photograph before the motor accident when he weighed 94-98kg which indicated that he was a muscular man.

Comments on consistency

Mr Loudaros’ history and symptoms were generally consistent throughout the examination.
He struggled to describe his psychiatric/psychological symptoms. He mostly stated that his reduced function was attributable to both his physical and mental symptoms. He was very embarrassed about his weight gain which he attributed to his physical injuries and pain and the associated difficulty with exercising.
The Panel notes that the claimant’s level of daily functioning was more consistent with the report of Dr Matthew Jones in his report dated 15 November 2021 than the earlier in time report of Dr Christopher Cocks dated 1 February 2021.

CONDSIDERATION OF THE ISSUES

Diagnosis and causation

Mr Loudaros has been diagnosed by Dr Verma, Ms Azzi, Dr Cocks, Dr Jones, and Medical Assessor Samuell as having a major depressive disorder.
Medical Assessor Samuell noted that Mr Loudaros was unable to say when his psychological difficulties began and there was not a clear causative link between the motor accident and the major depressive disorder. The others who diagnosed major depressive disorder attributed it to the injuries sustained in the motor accident on 21 October 2017.
The medical members of the Review Panel have considered all of the pre and post-accident documentation in evidence and Mr Loudaros’ description, noting his difficulties with describing how he felt. It is the clinical judgment of these Medical Assessors that the claimant is experiencing a psychiatric injury and that a diagnosis of major depressive disorder is appropriate. Mr Loudaros has symptoms of social withdrawal, depressed mood, anxiety, a loss of motivation, being unable to establish a regular routine, generally feeling depressed and sad.
This condition appears to have developed gradually after the motor accident as the claimant’s ongoing pain from his physical injuries persisted, his ability to exercise diminished and his weight increased.

Causation and reasons

The Review Panel determined that the condition of major depressive disorder did arise from the injuries sustained in the motor accident.
Mr Loudaros described himself as shocked and shaken up soon after the motor accident. He was unable to say when he started to become depressed but it does appear that this started to develop as his weight increased, which the consequence of overeating, not being able to maintain his exercise routine and eating in an irregular and unhealthy pattern.
It is also exacerbated by increasing pains that he has suffered as he has gained weight.
The Review Panel determined Mr Loudaros was involved in a significant motor accident. The vehicle in which he was travelling spun and bounced off concrete barriers on a bridge.
Mr Loudaros had no impairment of his functioning prior to the motor accident and was working full time in security and assisting his brothers in their businesses.
He has not been involved in any subsequent motor accident or developed any new medical conditions other than eczema which would explain his current psychiatric symptomatology.
The Review Panel concluded that the condition of major depressive disorder arises from the injuries sustained in the motor accident.

IMPAIRMENT ASSESSMENT

Permanent impairment is defined in the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) (page 315) as follows:
“Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment. A permanent impairment is considered to be unlikely to change substantially by not more than three percent in the next year with or without medical treatment.”
The Panel considered that Mr Loudaros’ condition has stabilised. It is over six years since the motor accident. He has had treatment by a psychologist and psychiatrist but currently is not having any treatment or taking any psychiatric medication.
The Panel felt his condition was not improving or deteriorating and therefore was stabilised and his impairment permanent. Mr Loudaros’ condition is considered to be unlikely to change substantially and by not more than three percent in the next year, with or without treatment.

Degree of permanent impairment psychiatric impairment rating scale

The determination as to permanent impairment is made in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Motor Accident Guidelines.
Impairment is assessed due to the effect of the psychological injury only and the Panel has taken care to distinguish impairments related to the claimant’s physical injuries.

Psychiatric diagnosis

Major Depressive Disorder

Psychiatric treatment description

Treatment by a psychiatrist and psychologist

Treatment with Mirtazapine, Efexor and Quetiapine

Category	Class	Reason for Decision
1. Self Care and Personal Hygiene	2	Mild impairment. Mr Loudaros does not shower every day but does get up every day and mostly gets dressed in his clothes each day. He showers when his mother reminds him to do so. His ability to undertake personal care is impaired by his physical injuries, resultant pain and his obesity. Part of the problem relates to his physical condition in that he does not fit into the shower in the indoor bathroom. He is now showering in an outdoor bathroom (which is larger) in the laundry. He relies on his mother to do cooking, but it appears he eats whatever food is available. He described eating when he feels anxious or wants to forget about his current situation. He has ceased doing any chores or activities at home because of the pain from his physical injuries and his associated weight gain.
2. Social and Recreational Activities	2	Mild impairment. Mr Loudaros goes out unaccompanied. He sees his girlfriend. He has gone to race days at Eastern Creek. He still has an interest in high performance vehicles but is no longer racing in part because of a lack of money, in part because he cannot work on his motor vehicle and in part because of his physical symptoms and weight gain. He does go out for coffee and to meet friends from time to time.
3. Travel	2	Mild impairment. Mr Loudaros is working as a ride share driver but does not do this consistently. He works in short blocks of no more than two hours in part because of the pain from his physical injuries. He generally drives locally and states that the ride share trips have been no more than 20 minutes at a time. His ability to drive is limited by his physical state but appears also to be limited by his mental state in that he does not have much motivation or interest in driving further afield.
4. Social Functioning	2	Mild impairment. Mr Loudaros’ relationship with his girlfriend has been maintained over the more than six years since the accident but it is strained and there are more arguments. He is having more arguments with his two older brothers, but he has a good relationship with his mother.
5. Concentration, Persistence and Pace	2	Mild impairment. Mr Loudaros struggled to describe his psychiatric/psychological symptoms, but this appeared in significant part because of his difficulty finding the right words to describe how he felt. He described the events in his life and particularly his physical symptoms as well as the decline in his daily functioning without difficulty. He watched YouTube videos and looked social media although sometimes for short periods of time. He sat through an examination which lasted 1½ hours, although as mentioned he struggled to describe his psychiatric/psychological symptoms.
6. Adaptation	3	Moderate impairment. Mr Loudaros has not worked regularly since the motor accident. He has changed jobs to a lesser demanding job and does not work regularly even one day each week as a ride share driver. He does not drive regularly because of the lack of motivation and also because of his weight and pain from his physical injuries and in particular the need to get out and stretch.
List classes in ascending order: 2, 2, 2, 2, 2, 3
Median Class Value: 2
Aggregate Score: 13
% Whole Person Impairment: 7 %

Apportionment

Pre-existing/subsequent impairment

Mr Loudaros had no impairment of his functioning prior to the motor accident.
He has not developed any medical conditions or been involved in any subsequent motor accidents which have significantly impacted on his day to day functioning.
There is no reason therefore for any adjustment of his WPI in accordance with cl 1.34 of the Guidelines.

Effects of treatment

Mr Loudaros is currently not receiving any treatment and there is no evidence that the previous treatment by the psychologist or the psychiatrist led to any significant benefit.
There is therefore no reason for any adjustment of his WPI in accordance with cl 1.222 or

cl 1.223 of the Guidelines.

CONCLUSION – PERMANENT IMPAIRMENT

The Panel is satisfied that the degree of permanent impairment caused by the motor accident is assessed at 7%.
As Medical Assessor Samuell found no psychiatric injury caused by the accident and therefore did not assess impairment, his certificate must be quashed.

[2024] NSWPICMP 391

20 June 2024