Mahroei v QBE Insurance (Australia) Limited
[2024] NSWPICMP 339
•24 May 2024
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Mahroei v QBE Insurance (Australia) Limited [2024] NSWPICMP 339 |
| CLAIMANT: | Yashar Mahroei |
| INSURER: | QBE Insurance (Australia) Ltd |
| REVIEW PANEL | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Melissa Barrett |
| MEDICAL ASSESSOR: | John Baker |
| DATE OF DECISION: | 24 May 2024 |
| CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; threshold dispute for motor accident in June 2019; motor accident modest rear end collision; prior motor accident in September 2017 caused psychiatric injury; claimant re-examined by Medical Assessors; findings made that prior accident caused an adjustment disorder; inconsistent histories as to employment prior to motor accident; analysis of pre accident psychiatric symptoms; Panel satisfied that claimant suffered pre-existing adjustment disorder; Panel not satisfied that motor accident caused or aggravated psychiatric condition; reasons provided for rejecting medical opinions that claimant suffered psychiatric injury caused by motor accident; Held – assessment confirmed; no psychiatric injury caused by motor accident. |
| DETERMINATIONS MADE: | Medical Assessment – Threshold injury The Review Panel confirms the certificate dated 25 January 2023.1. |
REASONS
BACKGROUND
On 8 June 2019 Mr Yashar Mahroei (the claimant) alleges that he suffered injury in a motor vehicle accident. The claimant was a front-seat passenger in a vehicle which was rear ended by the insured vehicle (the motor accident).[1]
[1] Claimant’s bundle, p 20.
QBE Insurance Australia Ltd insured the owner and driver of the other motor vehicle for liability to pay Mr Mahroei any damages and/or statutory compensation entitlements under the Motor Accident Injuries Act 2017 (the MAI Act) for the motor accident.
The claimant was involved in a previous motor accident in September 2017 when he suffered injury and reported psychological symptoms. The medical evidence relating to the prior motor accident is summarised under the heading “Pre-accident medical records”.
The issue presently in dispute is whether Mr Mahroei sustained a psychological injury caused by the motor accident which is classified as a “threshold injury” within the meaning of the MAI Act.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be medical assessment matters including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor[2] and, pursuant to s 7.26 of the MAI Act, on review by a review panel.
[2] Section 7.20 of the MAI Act.
The disputes were referred to Medical Assessor Sidorov who issued a Medical Assessment Certificates dated 25 January 2023 (the medical assessment certificate). Medical Assessor Sidorov concluded that the motor accident did not cause post-traumatic stress disorder.
Whether a person has only suffered threshold injuries as a result of a motor vehicle accident affects the entitlement to both statutory benefits and damages.
Statutory benefits by way of loss of earnings and treatment and care expenses cease after 26 weeks if “the person’s only injuries resulting from the motor accident were threshold injuries”.[3] An injured person otherwise cannot recover damages under the MAI Act if the “only injuries resulting from the motor accident were threshold injuries”.[4]
[3] Sections 3.11 and 3.28 of the MAI Act.
[4] Section 4.4 of the MAI Act.
Statutory amendment
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From
1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
The original medical assessment was issued when the relevant term was “minor injury” which, because of the amendment, is now described as a threshold injury.
For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks.
Accordingly, an injury which does not fall within the definition of a threshold injury (a non-threshold injury) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26 week or 52 week limitation period.
REASONS OF MEDICAL ASSESSOR
The Medical Assessor concluded that the motor accident did not cause a psychiatric injury.
The Medical Assessor noted under the heading “consistency”:
“Mr Mahroei’s presentation appeared to be overdramatic, embellished and exaggerating of his symptoms and level of impairment. I note that in the factual investigation the accident was described as a low-speed impact. I had asked Mr Mahroei how a low-speed accident could have caused his physical and psychological injuries. He stated that, ‘If it wasn’t a heavy impact, then why was I taken to hospital for two days?’ I also note the report of Dr McMahon, suggesting evidence of malingering on testing. There is also a suggestion of malingering in the report by Dr George, dated 27 October 2020.”
Under “diagnosis” the Medical Assessor concluded:
“Based on the account presented by Mr Mahroei, his presentation and review of provided documentation, he has been diagnosed with a Posttraumatic Stress Disorder, secondary to a motor vehicle accident in 2017. Despite Mr Mahroei’s subjective account given, his embellished, overdramatic presentation, as well as evidence of embellishment or malingering on psychometric testing and the minor nature of the subject accident, there is no evidence that he has experienced an aggravation of his Posttraumatic Stress Disorder, secondary to the subject accident.
….
Mr Mahroei’s Posttraumatic Stress Disorder has been caused by the previous accident in 2017. There is no evidence of aggravation secondary to the subject accident.”
THE REVIEW
The application for referral of the medical assessment to a review panel was made by the claimant within 28 days after the parties were issued with the original certificate for the medical assessment for which the review is sought.
The President’s delegate referred the medical assessment to the Review Panel (the Panel) as they were satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application.[5]
[5] Section 7.26(5) of the MAI Act.
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the medical assessment the subject of the review was made on or after 1 March 2021, the new
review provisions apply.The review provisions provide[6] that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
[6] Section 7.26(5A) of the MAI Act.
Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor.[7]
[7] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[8]
[8] Rule 128 of the PIC Rules.
The parties filed bundles of documents for the Panel’s consideration.
The Panel subsequently requested further material that was provided by the parties.
STATUTORY PROVISIONS
A threshold injury is defined in s 1.6(1) of the MAI Act:[9]
“(1) For the purposes of this Act, a threshold injury is, subject to this section, one or more of the following—
(a) a soft tissue injury,
(b) a psychological or psychiatric injury that is not a recognised psychiatric illness.”
[9] This sub-section was amended by Amendment Act, Schedule 1[5].
Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a minor psychological or psychiatric injury. Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the Regulations) further defines a threshold injury to include an acute stress disorder and an adjustment disorder.
Part 1, cl 4(3) of the Regulations provide that any assessment must be made under The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the MAI Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a)a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b)a review of all relevant records available at the assessment
(c)a comprehensive description of the injured person’s current symptoms
(d)a careful and thorough physical and/or psychological examination
(e)diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the diagnosis of psychological injury. These clauses provide:
“Threshold psychological or psychiatric injury assessment
5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders (DSM-5), Fifth Edition, 2013, published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”
Sections 5D and 5E of the Civil Liability Act 2002 apply to the MAI Act.[10] In Raina v CIC Allianz Insurance Ltd[11] Campbell J stated:
“One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002 (NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely.”
SUBMISSIONS
Claimant’s submissions dated 26 July 2022[12]
[10] See s 3B(2) of the Civil Liability Act 2002.
[11] [2021] NSWSC 13 (Raina) at [65].
[12] Claimant’s bundle, p 1.
These submissions concern the minor injury decision made by the insurer. The claimant referred to the factual background including that an ambulance attended the scene of the accident, conveyed the claimant to hospital who was discharged the following day.
The claimant noted the certificate issued by Medical Assessor Paisley dated 23 April 2021 which determined that the claimant suffered post-traumatic stress disorder as a result of the motor accident and a further eight psychological sessions were reasonable and necessary.
The insurer does not accept that the claimant has a non-minor injury and relied upon the reports of Dr McMahon and Dr George.
The claimant noted that he was involved in a prior motor vehicle accident on 17 September 2017 and sustained a number of physical injuries and post-traumatic stress disorder.
The claimant submitted that he suffered a non-minor psychiatric injury as a result the motor accident and relied on the following medical evidence:
(a) report of Mr Neilsen, psychologist;
(b) report of Dr St George, psychiatrist;
(c) report of Dr Allen, psychiatrist;
(d) certificate issued by Medical Assessor Paisley, and
(e) clinical notes of workers doctors.
The claimant initially attended Dr Calvache-Rubio general practitioner (GP) on 25 July 2019 who recorded various psychological symptoms and referred the claimant to a psychologist.
The claimant first consulted the psychologist on 22 August 2019. Mr Neilsen subseqauently diagnosed the claimant with post-traumatic stress disorder which he opined had been aggravated by the motor accident.
In December 2019 Dr St George diagnosed the claimant with post-traumatic stress disorder and chronic pain disorder.
In April 2021 Medical Assessor Paisley diagnose the claimant with a significant exacerbation of his post-traumatic stress disorder caused by the motor accident.
In June 2022 Dr Allen diagnosed that the motor accident aggravated the post-traumatic stress disorder, and the claimant otherwise developed a major depressive disorder.
The claimant noted that the insurer relied on the reports of Dr McMahon and Dr George who opined that the claimant was malingering and suffered little or no injury as a result the motor accident. It was submitted that no issues of malingering had been raised by the treating specialist, Medical Assessor Paisley or Dr Allen.
The claimant submitted that the motor accident caused an exacerbation post-traumatic stress disorder and major depressive disorder which are not minor injuries.
Claimant’s submissions undated[13]
[13] Claimant's bundle, p 9.
These submissions sought leave to review the medical assessment.
The claimant submitted the Medical Assessor failed to provide sufficient reasons when he questioned the claimant’s credibility.
The claimant submitted that the Medical Assessor failed to engage with the various medical opinions (referenced in the previous submission) which supported the claimant.
The claimant submitted that the Medical Assessor relied on the psychometric testing of specialist qualified by the insurer and failed to perform a full medical assessment.
The claimant noted that the Medical Assessor relied on the report of the police officer who arrived at the motor accident scene after the accident and opined that this was a low-speed accident. This was contrary to the claimant’s version and there was no reasoning provided that the motor accident was of low impact.
Insurer’s submissions undated[14]
[14] Insurer’s bundle, p 5.
The insurer referred to the opinion of Dr George in a report dated 27 October 2020 which noted inconsistencies in history taking concerning whether the claimant had returned to work prior to the motor accident, commented upon the marriage breakdown, opined that the motor accident was extremely minor of low-impact collision and did not diagnose the claimant with a psychiatric disorder caused by the subject motor accident.
The insurer also reported referred to the opinion of Dr McMahon in a report dated 1 December 2020 who made various comments. They included:
(a) inconsistent history regarding certification for work after the motor accident;
(b) the description of the motor accident and the preoccupation of negative thoughts;
(c) the pattern of responding was inconsistent with genuine responding inconsistent with sub-optimal effort;
(d) reporting of alcohol consumption, smoking cannabis and purchasing Tramadol for pain relief off the black-market;
(e) reporting of seeing shadows and some paranoid type ideation;
(f) reporting of a marked trauma history;
(g) the reporting of visual hallucinations which either indicates severe liver dysfunction or feigning spectrum behaviour which cast doubt on the claimant’s symptomatic report;
(h) symptom validity testing which cast significant doubt on self-reporting, and
(i) improbable symptoms reporting including psychotic symptoms and substance misuse made it difficult to determine the relationship between the accident and the report symptoms.
The insurer relied on the opinions of Dr George and Dr McMahon which noted inconsistencies and vagueness of the claimant’s history and raised issues with the reliability of the claimant’s allegations. It submitted that the claimant had provided inconsistent histories to treatment providers and qualified doctors in the context of this claim which cast doubt on the claimant’s reliability as a historian.
The insurer referred to differences in histories regarding the circumstances of the accident. Dr Allan recorded that the vehicle was thrown several metres forward, Dr McMahon reported that the claimant was trapped in the vehicle and was cut out and Dr George recorded that the claimant was able to self-extricate.
The insurer also referred to the inconsistent histories regarding smoking and the consumption of alcohol. Dr Allen recorded that the claimant was not a drug user and only an occasional social drinker whilst Dr McMahon recorded history of cannabis use and significant drinking of scotch and use of cigarettes.
The insurer also noted that the claimant provided a different history such as work capacity prior to the motor accident, his driving ability and his medication regime.
The insurer also noted that Dr McMahon commented on the claimant’s presentation which included substance misuse and hallucinations which were not reported to the claimant’s qualified or treating doctors. It was noted that Dr Allen was not provided with this information and reports of Dr McMahon or Dr George. It submitted that Dr Allan was provided with a complete history and his opinion holds little weight.
The insurer submitted that the Medical Assessor Paisley did not have the benefit of the report of Dr McMahon or the supplementary report of Dr George and accordingly did not have the opportunity to comment on the various issues raised in these reports.
The insurer referred to the evidence provided by the police officer who concluded that the damage to the vehicle was “very minor”. It was submitted that the minor nature of the motor accident was not consistent with the claimant’s allegation that his vehicle was pushed metres forward.
The insurer otherwise submitted that the claimant received extensive treatment for a psychologist following the previous motor accident in 2017 with symptoms remaining up until the motor accident. It was noted that the last session recorded the clinical notes was approximately two months prior to the motor accident and that the claimant reported to Dr George that he continued receiving treatment up until the motor accident.
Insurer’s submissions undated[15]
[15] Insurer’s bundle, p 1.
These submissions were filed opposing the application to review the medical assessment certificate.
The insurer submitted that the Medical Assessor provided sufficient reasons, was required to assess the claimant as he found him, was entitled have regard to the observations of the attending police officer as to minimal car damage and was entitled to have regard to the opinions of symptom validity reported by Dr McMahon and Dr George.
The insurer submitted that the Medical Assessor had engaged with the evidence and the opinions of the other treating and qualified doctors.
The insurer submitted that the claimant had failed to identify how the assessment undertaken by the Medical Assessor was deficient and otherwise undertook a clinical examination of the claimant.
The insurer submitted that the Medical Assessor concluded that the accident was minor and did not give rise to a psychiatric injury which represented clinical findings.
MATERIAL BEFORE THE REVIEW PANEL
The parties filed bundles of documents for the Panel’s consideration. The insurer filed a subsequent bundle which included the reports of Dr George and Dr McMahon. The claimant filed a further bundle attaching the material from the prior motor vehicle accident.
Pre-accident medical records
The claimant was involved in a prior motor accident on 17 September 2017 in a T-bone collision.[16] Subsequent physiotherapy notes report pain in the neck, right shoulder and upper arm, right chest, lumbar spine and right thigh. On 12 December 2017 the physiotherapist noted that the clamant had returned to work on normal hours on light duties.[17]
[16] Claimant’s supplementary bundle, p 5. The supplementary bundle is not paginated – however it consists of 169 pages, and we have used the digital number appearing on the computer to identify the relevant page.
[17] Claimant’s supplementary bundle, p 24.
In a report dated 9 November 2017 Dr Abboosh noted the claimant presented to the clinic on 18 September 2017 following a motor accident with multiple aches and pains in various parts of the body and complaints of being stressed and anxious with the tax of accident flashback.[18]
[18] Claimant’s supplementary bundle, p 107.
On 12 December 2017 Dr Eric Lim (GP) noted pain in various body parts, trouble sleeping, flashbacks, anxious and cautious to drive.[19]
[19] Claimant’s supplementary bundle, p 22.
On 8 May 2018 the physiotherapist noted that the neck was improving and the claimant “sleeps better when not prone”.[20]
[20] Claimant’s supplementary bundle, p 17.
On 8 May 2018 the psychologist noted that the claimant was not able to sleep, was cautious in the car, had lost his job and income and was “feeling very sad depressed, mood is quite low”.[21]
[21] Claimant’s supplementary bundle, p 15.
On 22 May 2018 the psychologist noted symptoms of flashback when the claimant was driving the previous day.[22]
[22] Claimant’s supplementary bundle, p 13.
On 26 July 2018 the psychologist noted that the claimant was blunted and depressed and diagnosed somatic symptom disorder with predominant pain and adjustment disorder with depressed and anxious mood.[23]
[23] Claimant’s supplementary bundle, p 7.
Dr John Davis was qualified by the claimant and provided a report dated 22 October 2018.[24] The doctor obtained a history that the claimant had not worked since the motor accident with ongoing symptoms in the cervical and lumbar spine with radiation into the right trapezius and right lower extremity.
[24] Claimant’s supplementary bundle, p 114.
Dr Davis diagnosed multiple disc injuries in the cervical region and disc protrusion in the lumbar spine with multilevel annular tears and an adjustment disorder. The doctor opined that the claimant was unfit to return to his preinjury duties as a painter as a combination of the physical and psychological sequelae caused by the motor accident.
Dr Davis assessed whole person impairment caused by these physical injuries to the cervical and lumbar spines at 15%.
On 25 October 2018 the psychologist noted symptoms of confusion, fearful and diagnosed an anxiety disorder.[25]
[25] Claimant's bundle, p 120.
Dr John Bentivoglio, orthopaedic surgeon, was qualified by Suncorp Queensland and provided a report dated 28 December 2018.[26] The doctor noted a history that the claimant was off work initially for about six or seven months, return to work on limited hours and ceased working about five to six months ago.
[26] Claimant’s supplementary bundle, p 127.
Dr Bentivoglio noted that the investigations indicated discal damage with annular tears at three levels of the lumbar spine with ongoing pain and peripheral radiation down the right lower leg with ongoing pain in the neck with radiation towards the right shoulder.
Dr Bentivoglio assessed impairment at 5% due to the cervical spine and 5% for the lumbar spine made a deduction of three quarters in respect of the assessment of the lumbar spine noting there was back pain for more than three months in the early part of 2017.
On 28 November 2018 Dr Singh provided a quote for surgery by way of a L4/S1 decompression and fusion.
On 10 January 2019 the psychologist diagnosed a somatic symptom disorder with predominant pain and an adjustment disorder with depressed and anxious mood.[27]
[27] Claimant's bundle, p 116.
On 21 February 2019 the GP noted that the claimant may need further surgery and was becoming depressed.[28]
[28] Claimant’s bundle, p 109.
On 7 March 2019 the claimant presented to his GP with severe lower back pain and right sided S1 radiculopathy. A further MRI scan was organised.[29]
[29] Claimant’s bundle, p 110.
On 8 March 2019 Dr Khong noted the lower back pain with right S1 radiculopathy and recommended a repeat MRI scan.[30]
[30] Claimant’s supplementary bundle, p 40.
On 21 March 2019 the GP certified the claimant had capacity for some type of work for four hours a day, two days per week.[31] This certification was repeated in a certificate dated 5 April 2019.[32]
[31] Claimant’s supplementary bundle, p 165.
[32] Claimant’s supplementary bundle, p 168.
On 5 April 2019 the psychologist noted depressed mood, disturbed sleep, low mood and hypervigilant.[33]
[33] Claimant’s bundle, p 105.
Medical evidence
The first post-accident consultation with the GP was on 26 July 2019.[34] The GP noted the pre-existing injuries to the neck and back from the motor accident in 2017 and that the claimant was working full-time as a painter.
[34] Claimant’s bundle, p 102.
The claimant reported various physical injuries and “trouble sleeping, flashbacks, anxious and cautious to drive”.
A claim form dated 26 July 2019 concerning the motor accident referred to a variety of physical symptoms and “flashbacks, trouble sleeping”.[35]
[35] Claimant’s bundle, p 21.
Mr Carl Neilsen, psychologist, provided a report dated 1 November 2021.[36] The psychologist noted a history of a prior motor accident causing post-traumatic stress disorder which had stabilised prior to the subject motor accident.
[36] Claimant's bundle, p 44.
Mr Neilsen noted a history of a deterioration in mental state following the motor accident with a variety of symptoms and diagnosed post-traumatic stress disorder. The psychologist opined that the motor accident aggravated a post-traumatic stress disorder.
Dr Nirenjen St George, psychiatrist, provided a report dated 3 December 2019.[37] The doctor noted the prior motor accident in 2017 and the subject motor accident with the development of chronic pain as well as limitations with functionality and mobility and a deterioration in his mental state. This appeared to be contradicted by the initial self-assessment report following the motor accident which stated the claimant was working full-time.
[37] Claimant's bundle, p 42.
Dr St George opined that the claimant suffered from post-traumatic stress disorder and chronic pain disorder and recommended that the claimant recommence Valdoxan.
Qualified opinions
Dr McMahon, psychologist, was qualified by the insurer and provided a report dated 1 December 2020.[38] Dr McMahon noted the progress notes of Dr Lim who diagnosed the claimant with an adjustment disorder with depressed and anxious mood and the restrictions of certification of capacity in the initial assessment report of Dr Calvache-Rubio dated 26 July 2019 which stated the applicant was working full-time.
[38] Insurer’s supplementary bundle, p 43.
Dr McMahon undertook a Test of Memory Malingering (TOMM) and opined that the pattern of responding was inconsistent with genuine responding and was consistent with sub optimal effort. A further test of malingering was consistent with sub optimal effort and efforts to appear overly symptomatic.
Dr McMahon opined:[39]
“Mr. Mahroei’s performance on the Symptom Validity Testing casts significant doubt on his self-report. If his report is taken at face value, the first accident caused anxiety and pain such that he did not return to driving and had reduced work capacity and this was aggravated by the second accident. However, the improbable symptoms reported, including psychotic symptoms, and the medication and substance misuse make it difficult to accurately determine the relationship between the subject accident and the reported symptoms.”
[39] Insurer’s supplementary bundle, p 51.
Dr Graham George, psychiatrist, was qualified by the insurer and provided a report dated 27 October 2020.[40] The doctor noted a history that the claimant suffered a significant physical injury after the 2017 accident, was placed on light duties and could not remember when or if he resumed full-time work.
[40] Insurer’s supplementary bundle, p 53.
Dr George did not believe that the claimant suffered a psychiatric injury from the subject motor vehicle accident. He diagnosed the claimant with adjustment disorder with depressed mood on the breakdown of his marriage some four to six months ago. The doctor otherwise opined that this was an extremely minor, low impact collision and, in his opinion, was not sufficient to have caused any psychiatric disorder.
Dr George suggested that the claimant undergo forensic psychological testing using a multiple test approach.
Dr George provided a further report dated 9 February 2021 which commented upon the psychometric evaluation carried out by Dr McMahon.[41]
[41] Insurer’s supplementary bundle, p 64.
Dr George noted that Dr McMahon has drawn a conclusion that malingering is highly likely in this case and that tended to confirm his opinion.
Dr Allan was qualified by the claimant and provided a report dated 22 June 2022.[42] The doctor noted the history of the prior motor accident in 2017, the claimant had a considerable period of time off but then returned to work some two months prior to the motor accident working up to six, eight-hour days per week if work was available.
[42] Claimant's bundle, p 25.
Dr Allan noted a history that the motor accident caused a marked exacerbation of the previous psychological symptoms. The doctor opined that the motor accident caused an aggravation of the post-traumatic stress disorder and the development of an enduring major depressive disorder.
Other medical assessment
Medical Assessor Paisley issued a medical assessment certificate dated 20 April 2021 relating to whether a further eight psychological sessions were reasonable and necessary and related to the motor accident.[43] The Medical Assessor obtained a history of the prior motor accident and that the claimant “was slowly building his life up again and had just returned to work in a restricted capacity” prior to the subject motor accident.
[43] Claimant's bundle, p 189.
Medical Assessor Paisley concluded:[44]
“There was a significant exacerbation of the of his pre-existing PTSD as a result of the second motor vehicle accident on 8 June 2019. This exacerbation persists and continues to impede his functioning. His PTSD symptoms from the first accident had improved significantly prior to the second accident. His PTSD is worse following the second accident.
Other factors, such as the breakdown of his marriage and the Covid-19 pandemic may also have contributed to his distress but were not the cause of his PTSD.
Therefore, the accident 8 June 2019 caused a substantial and persistent exacerbation to his PTSD. The proposed psychological treatment is for his PTSD and so does relate to the accident 8 June 2019.”
[44] Claimant’s bundle, p 193.
Police reports
The police officer who attended the motor accident provided an electronic record of interview on 29 January 2020.[45] The police officer stated that he spoke to the claimant who said that he could not come out of the car because of his injuries.
[45] Insurer’s bundle, p 24.
The police officer identified minor damage on the claimant’s vehicle on the rear bumper bar and more significant damage to the vehicle in the rear with a detached front bumper bar and damage to the headlights and numberplate. The officer opined that it was fairly minor damage, did not recall any skid marks and describe the impact as low speed.
EXAMINATION
Mr Mahroei was examined by both Medical Assessors on 15 May 2024 who provided the following report.
“The claimant was assessed by both Doctors Barrett and Baker by video conference using Microsoft Teams. The claimant was located at his lawyer’s office, Michael Petricevic Lawyers, Norwest.
A competent interpreter engaged by the Personal Injury Commission was present for the assessment. The assessors clarified whether with both Mr Mahroei and the interpreter, that neither had any difficulties understanding the other.
Mr Mahroei is a 34-year-old man. He incorrectly provided his age as 33-years-old. For the last year he has been living in a home in Epping, sleeping on a mattress on the floor of his friend’s room in shared accommodation. He has no income. His last bridging visa expired in about 2021. As a result of having no valid visa he is unable to work and has no entitlement to Centrelink or Medicare.
Mr Mahroei has a son, who was born in November 2019, and is thus 4-years-old, who lives with Mr Mahroei’s ex-wife in Carlingford. Mr Mahroei reports he last saw his son for his son’s birthday in November 2023. He feels reluctant to see his son because he, ‘can’t get things for him’, meaning that he cannot provide for his son.
He is currently single and has not had a relationship since the break-up of his marriage. He could not recall whether this occurred in 2020 or 2021, although the records appear to indicate it occurred in 2020. The reason for his marriage broke up was that his wife told him he was, ‘not mentally stable’. For a period she apparently restricted Mr Mahroei’s access to their son but there are no current restrictions to his access.
Mr Mahroei was born in Tehran, Iran. He described his birth as healthy and of his childhood stated, ‘everything was perfect’. He has a sister who is three or four years older, and both his parents and sister remain in Iran. He initially stated he had no other family in Australia. He later revealed he had an aunt in Australia, who had not made him feel welcome when he arrived and had no contact with her10. His childhood was ‘very good’ and denied any childhood trauma. He acknowledged he was exposed to witnessing people assaulted or killed in front of him by police during demonstrations. He was fearful of persecution and brutality by the police for minimal transgressions. He acknowledged he was once arrested by police for playing cards with friends and detained for a period of about a week but denied any torture.
He completed high school and then entered two years of military service. He described military service as, ‘very hard’ physically, and reported harsh punishment for refusing to pray, such as time added to military service. He denied any exposure to fighting during his service. After completing military service, he had decided he wished to save money so that he could leave Iran. He worked as a shop assistant in retail and then in a jewellery factory.
At 24 or 25-years-old, he travelled from Iran to Indonesia and then by boat from Indonesia to Australia. He was motivated to come to Australia as his aunt was here and he had grown up watching Australian TV shows and perceived Australia to be a safe place. He described the boat journey from Indonesia as lasting six days through treacherous waters. They were unable to sleep because of the waves and he had to hold his friend’s hand to avoid them falling off the boat. He stated people were screaming and no one was fitted with life jackets. Upon arrival to Australia, he was in Christmas Island Detention Centre for a month, then in Darwin Detention Centre for one and a half months. He stated this was, ‘good, felt safe’.
He denied any known family psychiatric history.
He is a former smoker who states he quit because he has been unable to afford to smoke for a number of years. He uses alcohol occasionally when offered to him, averaging about one standard drink every three or four months. He tried marijuana but has never used regularly. He stated, ‘I want to be a good role model for my son’. He denied any other drug use history.
In the period before the 2017 accident, he was well and had no prior physical illness. He denied any prior psychiatric illness and specifically denied any features of post-traumatic stress disorder arising as a consequence of his experiences in Iran, the journey by boat to Australia or experience in immigration detention.
He had been released to the community on a temporary visa. He reported that a previous girlfriend had made-up false charges about him. The police were involved but did not lay any charges. However, the police identified that he was on an expired visa and he returned to immigration detention for a period.
He subsequently met his wife and married in 2015. He was living with her in Brisbane, Queensland. He would help with some of the chores. He states they had a loving happy relationship. He was working full time as a painter and in his free time enjoyed gardening, running and exercising.
He was involved in previous accident in 2017 but could not recall the month it occurred. He was driving a Hyundai I30 and he and his friend were on their way to the shops to buy supplies for a planned social barbeque. He reports he was T boned by another car, colliding with the driver’s side at high speed and causing his car to spin. The airbags deployed and the car was written off. The at-fault driver left the scene. Police were called but no ambulance was called. He travelled by taxi home.
The next day he experienced pain and attended his previous GP in Brisbane. He described physical injuries sustained in 2017 accident, a back injury, right shoulder injury and right knee injury. He was treated with an injection in his back which he states helped a little.
In the period prior to the 2019 accident, he acknowledged, he still had pain but it was, ‘a little bit better’. He was having physiotherapy and doing exercises. He estimated his pain in the pre-2019 accident period was about 8/10, on a scale of 1 to 10 where 10 is most severe. He reports the pain preventing him from sitting for long hours.
When asked about any psychiatric symptomatology arising from the 2017 accident, he initially denied psychiatric symptomatology, responding, ‘Not really, it was more physical’. The panel raised with him that this appeared inconsistent with the contemporaneous records which indicated a diagnosis of post-traumatic stress disorder had been made. He responded, ‘Yes, of course’. He explained that he could not go to work, had pain, had no income, and this was causing arguments with his wife. He was in a lot of pain and was unable to sleep due to pain and as a result was, ‘nervous, stressed’. He was worrying that he was so impacted at his age and worrying about what the future would hold. When asked specifically if he feared having another accident, he responded that his concerns were primarily related to his pain and his inability to work. When asked specifically if he had symptoms such as nightmares, he responded, ‘Of course, because of speed car hit’, ‘a little bit concerned and scared’. When asked if he was avoiding driving, he responded, ‘mixed’, ‘pain mostly’ and then he was worried that he, ‘couldn't drive because of pain’.
He had seen a psychiatrist but he had ceased seeing the psychiatrist by the time of the 2019 accident. He stated he was using psychotropic medication, the antidepressant agomelatine. He took it for about six months but ceased because he had side effects, ‘made me weak’ and he therefore ceased by 2019. When asked if he was still seeing the psychologist, he responded that he was not. It was raised with him that the contemporaneous records indicated that he had seen the psychologist two months prior to the subject accident, in April 2019. He responded that he could not recall but accepted this as accurate if it was in the records.
In the period prior to the 2019 accident, he was living with his wife in Sydney. The relationship was happy and he was particularly attentive to her as she was pregnant with their son. He had returned to work because he, ‘had to work – no other choice’. He could not recall when he returned to work but stated it was gradually. He had started working three days a week. He acknowledged his employer would not give him ‘proper jobs’ because of his unreliable attendance.
The subject accident occurred on the 8 June 2019. He was a front seat passenger in his friend’s Ute, on their way home from work. He said they were stationary at a traffic light and he heard a sound and looked in the rear view mirror and saw a car coming fast behind them. He states the car then hit them from behind. The panel raised with him that the circumstances he described are inconsistent with the descriptions of accident by the driver and the police officer who attended the scene. The police officer and driver instead provided a narrative that the car Mr Mahroei was travelling in, a blue Ford Ranger Ute, was stationary at red light with the indicator to turn left and when the light turned green began to travel around the corner before suddenly came to a stop. The at-fault driver stated she could not stop in time and there was a rear end collision. When this inconsistency was raised with him, he maintained that the driver’s narrative was incorrect. He was wearing a seat belt and was pushed forward but no airbags deployed. He was, ‘so scared’, ‘very very nervous’, ‘felt like I was going to die’. He was asked why he interpreted the accident as one in which he was at risk of dying, he responded, that it was due to the noise he heard of ‘breaking of glass’. It was raised with him that there were no windows broken in the accident and he responded, ‘could have been any sound’. He states he thought it was ‘third unlucky’. It was raised with him that this was apparently only his second accident and he did not respond.
An ambulance was called and he was taken to hospital. He had no new physical injuries but the 2017 accident related injuries were worsened because they were only healing. He stated, ‘all the pain’ came back. He later described worsening of back pain and new onset neck pain, impacting sleep.
He reported that after the accident, his doctors certified him fit to work eight hours a week, but his employer would not give him work which he reports was due to his inability to work full time. Further, he states employers were reluctant to employ him as they were fearful of becoming liable for his physical injuries.
Currently, he states his pain is at a severity of about 5/10, on a scale of 1 to 10 where 10 is most severe. He described it as, ‘a little better, comes and goes.’ He is using gabapentin 2 tablets daily. He states he would not be able to work full time but if work was available he ‘would do best to do it’, stating it would be difficult, ‘but much better than feeling this way’. He has worked rarely, on an off, last for a few days about five months ago.
In regard to the psychiatric symptomatology following the 2019 accident, he stated it had ‘affected me very badly’. He states his ‘manhood damaged’. He described feeling hopeless and useless because he cannot do anything for his son, meaning providing financial support. He reports that he cannot make decisions or think properly and has had difficulties with his memory for the last two or three years. He described his appetite as increased, with craving for simple carbohydrates, sugary drinks and that his weight has increased. He reports his sleep is impacted, ‘mentally and emotionally’ due to his thoughts about his son, ‘feel like I can’t see him’. He denied anhedonia and acknowledged he can enjoy seeing his son. He previously experienced some suicidal thoughts but had dismissed them due to the impact upon his son.
After the 2019 accident, he had been ‘forced to drive’ on a few occasions. His driver’s license expired in 2021, which he attributes to having no money to renew the licence.
He had been receiving treatment through Workers’ Doctor’s practice. However, since his visa expired in 2021, he has no Medicare entitlement. Further, he states the insurer stopped funding treatment. Therefore, he has not received any further prescriptions for medication. He has tried to remember the strategies suggested by the psychologist, including pleasant event scheduling and distracting activities.
Currently, he acknowledged significant difficulties related to his invalid visa. He states that without the visa he cannot work but that he cannot afford the $2500 required to apply for a permanent residency visa. He acknowledged these circumstances were, ‘much more difficult than you can even imagine’. He is not entitled to Centrelink and thus states he has had no income for a few years. He has had periods of homelessness. He used to have a tent which he would sleep in at times but states his tent became mouldy.
Over the last year, he has been staying on a friend’s floor in a shared home. He states he eats, ‘whatever I can get’. He has never begged for food but has asked for help, stating he has been, ‘never disappointed by the universe’ and has always been able to access food. His friend does his laundry for him. He does not perform any cooking or chores. When asked why this was so, he stated that because of his reliance on his friend, ‘I feel like I’m useless’. When asked why he was not contributing to any chores, he responded, ‘I don’t know’ and described lack of motivation. He reports that he showers once a week. He sits in the garden and looks at the trees. His relationship with his wife broke-up in 2020 or 2021. She told him he was, ‘useless’, ‘not working’ and, ‘mental’, because he was, ‘sitting at home doing nothing’. He had argued with his wife and she then prevented him from having access to their son as she was angry with him. He denied that there was ever any suggestion that he was any risk to their child. He states his contact with his son had been restored for the last few months. He loves his son but does not see his son regularly as he is ashamed that he does not provide financial support to his son. He is single. He has maintained friends, who he lives with. He last spoke with his mother two or three months ago. He has not seen his aunt since 2012 when he arrived in Australia, stating he had not felt welcomed by her.
Mental State Examination
Mr Mahroei was assessed by video conference. He presented wearing a beanie and hoodie but his clothing appeared clean. He had a long beard but a neatly trimmed moustache. He displayed some pain movements throughout the assessment. He displayed a full range of facial expressions and a warm smile at times. There were no psychomotor features. His speech was normal in rate, volume and rhythm. He provided very detailed responses to questions at times and needed to be asked to pause so that the interpreter could convey the content.
His affect was warm, bright and animated. His affect was reactive to the content, particularly when talking about his son. His mood was described as low.
He describes feeling useless and hopeless. He attributes this predominantly to his inability to work and provide financial support to his son. He stated that working might be difficult but that he would prefer to do so as it would be ‘much better than feeling this way’. He was not hopeless or negative, stating he had been, ‘never disappointed by the universe’. There were no delusions. There was no formal thought disorder. There were no perceptual abnormalities.
He denied any current suicidal ideations. He denied any risk to others.
He was able to concentrate well for the duration of the assessment. He could provide detailed responses to questions. Although he reported an ability to recall certain details, including his work hours in the period immediately prior to the 2019 accident, this appeared inconsistent with his capacity to provide a detailed history regarding other issues in the same period.
Consistency of Presentation
There were a number of inconsistencies at assessment. Mr Mahroei’s description of the subject accident in 2019 was inconsistent with that recorded by the police. When this was raised with him, he maintained the accuracy of his description. Further the panel considered Mr Mahroei’s assertion that he felt he was going to die was inconsistent with the nature of the subject accident and when asked to explain his reasons, hearing breaking glass, was inconsistent with the police records of the accident.
5. Conclusion
On issues raised by the parties, the panel considers that based on a comprehensive history of the pre-existing condition, as well as a review of all relevant pre-accident contemporaneous records, that Mr Mahroei had a pre-accident diagnosis of an adjustment disorder.
There is no evidence either from history or the screening medical assessments by the International Health and Medical Services who assessed him when he was in the detention centre, of any post-traumatic stress disorder due to military service or other experiences in Iran.
At this assessment, he reported the predominant impact of the 2017 accident was physical rather than psychological and that the psychological symptoms were due to the impact of pain and his concerns about the impact of pain upon his capacity to work and earn an income. The panel conducted a thorough exploration of PTSD symptoms. In response, he did not report sufficient symptoms to fulfill DSM-5TR criteria for PTSD, noting his account of minimal psychiatric symptomatology, and the absence of PTSD related fear or avoidance symptoms, or significant re-experiencing symptoms. Instead, the Panel considered that his symptoms after the 2017 accident were more consistent with a diagnosis of an Adjustment Disorder.
The Panel notes the diagnosis provided by the pre-accident treating psychologist, Carl Nielsen, was adjustment disorder with depressed and anxious mood and somatic symptom disorder, predominant pain, as of entries of 26 July 2018 having previously diagnosed post-traumatic stress disorder in the 14 July 2018. Mr Nielsen acknowledges the diagnosis of adjustment disorder secondary to pain in his letter of 18 November 2019, which is consistent with his contemporaneous entries of 10 January 2019 and subsequent entries where he recorded ‘anxiety disorder’ which is not a DSM-5TR condition. It is, therefore, unclear why Mr Nielsen’s letter of 1 November 2021 indicated a history of post-traumatic stress disorder arising from the 2017 accident.
Mr Mahroei’s account that the psychiatric symptoms had resolved by the time of the 2019 accident were inconsistent with the persistence of psychological symptoms recorded in the psychologist’s entry of 5 April 2019, just two months prior to the accident.
Mr Mahroei provided a vague account of his employment history in the period between 2017 and 2019, acknowledging there was a period he was unable to work, but that he had gradually returned to work, albeit with intermittent attendance in the period before the accident. The panel noted that Mr Mahroei has provided differing accounts of his employment history prior to the 2019 accident. The contemporaneous records indicate that the certificate of capacity/certificate of fitness completed by Dr Lim on 22 November 2018 which indicated he had no work capacity and the certificate of capacity/certificate of fitness by Dr Lim on 6 December 2018 indicated he had no work capacity. The certificate of capacity/certificate of fitness 21 March 2019 completed by Dr Sebastian Calvache-Rubio indicated he had the capacity for part-time work from the 21 March 2019 to the 11 April 2019, eight hours a week and the certificate of capacity/certificate of fitness on 5 April 2019 by Dr Lim indicated he had capacity for part-time work, 5 April 2019 to 2 May 2019 eight hours a week, that is within one month of the subject accident. Thus, the panel finds that Mr Mahroei was not working full time in the period prior to the accident.
His post 2019 accident work capacity, for part time work, thus appears consistent with the pre-accident work capacity. Mr Mahroei’s assertion that employers refused to give him work because he could not work full time, and because of the past history of physical injury, does not seem plausible given he was apparently attaining part time work after the 2017 accident.
FINDINGS
The review is a new assessment of all matters with which the medical assessment is concerned. The original medical assessment related to the injuries sustained in the motor accident were minor or non-minor as defined under the MAI Act.
The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[46] and Insurance Australia Ltd v Marsh.[47]
[46] [2021] NSWCA 287 at [40], [41] and [45].
[47] [2022] NSWCA 31 at [11], [21] and [64].
The Panel adopts the reasoning in Lynch v AAI Ltd[48] that the psychological condition can be present at any time to establish that the injury is not threshold for the purposes of the MAI Act.
[48] [2022] NSWPICMP 6 at [70]-[73] (Lynch).
We also adopt the reasoning in Lynch[49] that the claimant bears the onus of proof in establishing that any injury is not a threshold injury for the purposes of the MAI Act.
[49] at [44]-[62].
The Panel adopts the joint examination report of the Medical Assessors and adds the following further reasons.
We adopt the reasoning in AAI Ltd v Hoblos[50] that the psychological condition is evaluated in determining whether the motor accident caused or materially contributed to a psychiatric condition, albeit by way of aggravation.
[50] [2023] NSWPICMP 210 at [141]-[181] (Hoblos).
Since the reasons were published in Hoblos, the Supreme Court has held that a psychological injury was established if the motor accident aggravated, accelerated or exacerbated a psychological condition.[51]
[51] Todev v AAI Limited t/as GIO [2023] NSWSC 836 (Todev) at [50]-[53].
We note the differing accounts regarding the circumstances of the subject accident. In the context of these inconsistencies, we prefer the account of the police officer who was in attendance shortly after the impact and provided observations of the perceived severity of the impact. Contrary to the claimant’s submission, the police officer was appropriately qualified to provide an assessment of the severity of the impact.
Based on the police officer’s account of the subject accident, the clinical opinion of the medical expertise on the Panel is that the subject accident was objectively not of the nature that could directly cause a primary psychiatric injury that would impact work capacity, being a minor accident at low speed and not of an emotionally traumatic nature. Further the panel finds the subject accident did not cause a secondary psychiatric injury, noting his functioning, reflected in his work capacity, after the accident was unchanged compared to prior to the accident.
Instead, there are alternate plausible reasons for the claimant’s inability to work. At assessment, and consistent with the documentation, including the certificate of Dr Sidorov, Mr Mahroei has not had a valid visa for a period of about three years and stated that he could not work in Australia.
In addition, the absence of visa raises a number of other significant stressors, including the inability to access health services via public hospitals or Medicare and inability to access Centrelink or other social services. There have been very significant social problems, related to the absence of income and stable accommodation, noting intermittent homelessness and reliance upon people in his social network for help with food and accommodation, as well as support for personal hygiene and laundry.
The panel considered whether the stressor of loss of marriage could be attributed to the subject accident. The panel notes Mr Mahroei’s account was that the inability to work contributed to the loss of his relationship. Considering the inability to work was unrelated to the subject accident, the panel thus considers the loss of his relationship was unrelated to the subject accident.
It was noted there was an entry by Dr Lim, the treating GP on 21 February 2019, prior to the subject accident, ‘discussed relationship – becoming depressed’. The first entry in regard to the breakup of his marriage was by the Psychologist, Carl Nielsen on 30 September 2020. Further, the claimant’s parents-in-law intervened, and this was the reason for the separation from his wife.
Accordingly we find that the relevant psychological stressors are first, an inability to work, which was present prior to the subject accident and is unrelated to the subject accident, secondly, loss of his marriage, due to the 2017 accident work restrictions and the actions of his parents-in-law, and thirdly, not having a valid visa since 2021 resulting in very significant stressors impacting his ability to work or access financial and other social supports. We conclude that there is no psychiatric condition caused by the subject accident.
We note the report of Dr Martin Allen 22 June 2022. There are a number of inconsistences, including that at the time of Dr Allen’s assessment, Mr Mahroei had apparently described having a protection visa, when Mr Mahroei had reported to the Panel he had not had a valid visa since 2021, which was also noted by Dr Sidorov in his certificate and which explains Mr Mahroei’s circumstances at the time of Dr George’s report, ‘Mr Mahroei does not receive any Centrelink payments’.
Dr Allen’s account that in the one or two months prior to the subject accident, Mr Mahroei was working six, 8-hour days per week, if work was available, was not consistent with the contemporaneous records of the treating GP including the certificates of capacity/certificates of fitness or the report of Mr Mahroei’s treating psychiatrist, Dr St George dated 3 December 2019 in which Dr St George reports that in the period prior to the subject accident in 2019, Mr Mahroei had been able to return to work ‘in a limited capacity’.
We consider that Dr Allen’s assessment of Mr Mahroei’s 2017 accident and current functioning was impacted by an inaccurate understanding of Mr Mahroei’s actual 2017 accident and current circumstances. Based on information from assessment, mental state examination and the contemporaneous records of Mr Mahroei’s treating doctors, the Panel has formed an alternate view to that of Dr Allen in regard to the cause of Mr Mahroei’s current circumstances that were independent of the subject motor accident.”
We note the opinion of the treating psychiatrist, Dr St George, that Mr Mahroei had a diagnosis of PTSD after the 2017 accident. The Medical Assessors conducted a thorough history of the impact of the 2017 accident at assessment and the symptoms reported were insufficient to meet the DSM-5TR diagnostic threshold for PTSD. Accordingly, we do not accept the opinion that there was an aggravation of a post-traumatic stress disorder.
We also note the medical assessment certificate of Dr Shannon Paisley. Medical Assessor Paisley did not record Mr Mahroei’s post-2017 accident psychiatric symptoms or functioning. We do not accept that the Medical Assessor established an independent diagnosis of PTSD after the 2017 accident and which his ultimate diagnosis was partly based.
The Panel is reliant on the clinical expertise of the Medical Assessors who undertook the recent examination process. We have considered the parties’ submissions concerning various diagnosis and the material which we have summarised earlier in these Reasons which include some doubt as to a particular diagnosis. As we noted, we are not bound by these opinions.
In rejecting that the claimant has established causation of psychiatric injury, we have considered the contemporaneity of onset of psychological symptoms, the significance of the motor accident and the various clinical records. We conclude that the motor accident did not cause or aggravate a psychiatric injury, assessed in accordance with DSM-5TR.
CONCLUSION
The medical assessment certificate is confirmed.
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