Meiselbach v Transport Accident Commission
[2024] VCC 1501
•8 October 2024
| IN THE COUNTY COURT OF VICTORIA AT MELBOURNE COMMON LAW DIVISION | Revised Not Restricted Suitable for Publication |
SERIOUS INJURY LIST
Case No. CI-24-00921
| KRISTY MEISELBACH | Plaintiff |
| v | |
| TRANSPORT ACCIDENT COMMISSION | Defendant |
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JUDGE: | HIS HONOUR JUDGE PILLAY | |
WHERE HELD: | Melbourne | |
DATE OF HEARING: | 9 September 2024 | |
DATE OF JUDGMENT: | 8 October 2024 | |
CASE MAY BE CITED AS: | Meiselbach v Transport Accident Commission | |
MEDIUM NEUTRAL CITATION: | [2024] VCC 1501 | |
REASONS FOR JUDGMENT
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Subject:TRANSPORT ACCIDENT
Catchwords: Serious injury application – two transport accidents – psychiatric injury – whether psychiatric injury severe – whether the impairment consequences can be separated - permanency
Legislation Cited: Transport Accident Act 1986 (Vic)
Cases Cited:Petkvoski v Galletti [1994] 1 VR 436; Transport Accident Commission v Katanas (2017) 262 CLR 550; Juma v Kone Elevators Pty Ltd [2024] VSCA 217
Judgment: Leave granted to the plaintiff to commence proceeding
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APPEARANCES: | Counsel | Solicitors |
| For the Plaintiff | Ms M Pilipasidis SC with | Slater and Gordon |
| Mr C Sidebottom | ||
| For the Defendant | Ms A Hartley KC with Ms J Frederico | Transport Accident Commission |
HIS HONOUR:
1Kristy Meiselbach claims that she has sustained a severe psychiatric injury arising from the death of her father in a motor vehicle accident on 21 January 2020. To succeed, she must separate that injury and its impairment consequences from those she previously sustained on 17 September 2019 when she was struck while walking on a pedestrian crossing in Carlton. Even if she is able to demonstrate such separate injury and consequences, the defendant argues that they are not permanent and, further, they do not rise to the level which could be considered a severe long-term mental or behavioural disturbance or disorder in accordance with s93 of the Transport Accident Act. In determining this matter, the following central questions must be answered:
(a) What injury and impairment consequences flowed from the first incident on 17 September 2019 and were extant at the date of the second accident on 21 January 2020?
(b) After the second accident, did the plaintiff suffer injury and did it result in impairment consequences?
(c) If yes to the preceding question, can the injury and impairment consequences which arose as a result of the second accident be separately identified and isolated from the injury and impairment consequences flowing from the first incident?
(d) If the injury and impairment consequences flowing from the second accident can be isolated, can they be regarded as permanent?
(e) Are any permanent injury and impairment consequences flowing from the second accident sufficient to satisfy the definition of being a severe long-term mental or severe long-term behavioural disturbance or disorder?
2For the reasons which follow, I have determined that the plaintiff can separately identify injury and permanent impairment consequences flowing from the second accident. When isolated, those impairment consequences satisfy the definition of being a severe long-term mental or behavioural disturbance sufficient to warrant a determination that the plaintiff has a serious injury.
Brief relevant factual background
3The plaintiff was born in May 1994. She completed Year 12 and then completed a Bachelor of Biomedical Science at RMIT. She did one year’s Honours study at the University of Melbourne and commenced the initial qualifying degree of Bachelor of Medicine and Science (MBBS) at Deakin University. She completed two years of the MBBS degree, but deferred after her son was born. In the year 2019, though there was some contest about this, she was working as a research assistant and intending to commence a position as a PhD candidate at the University of Melbourne at the beginning of 2020. At that time, she was working as a research assistant at the University of Melbourne for two professors. In particular, her work involved cervical screening and treatment for First Nations women.
4The plaintiff gave evidence that it was her intention to complete her PhD, then return to finish her MBBS and ultimately work as a public health physician in the area in which she was conducting her research.
5The plaintiff was, as of 2019, an extremely fit, young person. She boxed regularly and had a particular passion for bodybuilding. She had entered bodybuilding competitions and had been quite successful. Vigorous exercise was part of her regular life.
6Before coming to the first accident, it is relevant to give some background to the plaintiff’s domestic circumstances. As at 2019, she was with her long-term partner, Patrick Brouet. She had one son and also had taken custody of her seven-year-old niece, Sophie. They lived together in Melton South. The plaintiff’s past medical history was reasonably unremarkable, save for some anxiety surrounding custody issues with her niece for which she was prescribed a short course of Sertraline. She had a further short course of medication in relation to depression and anxiety at the beginning of 2019, but it does not appear that this treatment was ongoing at the date of the first accident.
7On 17 September 2019 she was walking on a pedestrian crossing in Carlton when she was hit by a car on her right-hand side. She was taken to the Royal Melbourne Hospital and scanned, which cleared her of structural damage. She was diagnosed with soft tissue injuries and discharged from the hospital the next day. However, shortly afterwards, she attended at her treating doctor, Dr Elmahadi, at Q1 Medical, reporting right hip pain with flashbacks and anxiety.[1] She was prescribed Panadeine Forte and Diazepam. She was also given a referral to psychological counselling with Ms McColl. Prior to going to see Ms McColl, she reattended Dr Elmahadi who diagnosed acute stress disorder, prescribed Lexapro and increased her dosage of Diazepam.[2] It is worth detailing some of the notes from Dr Elmahadi because it was the defendant’s argument that the plaintiff had suffered from a very significant psychiatric reaction from the first accident. For example, Dr Elmahadi noted on 20 September 2019, that is, some 10 days after the first accident, that the plaintiff suffered from daily vivid dreams, flashbacks, lack of sleep, was depressed, anxious and irritable. Ms McColl, the psychologist, first saw her on 8 October. At that first session, she was noted to be suffering from severe and vivid flashbacks both during the day and particularly at night. Ms McColl recorded that she was unable to perform all but the most basic activities due to her physical incapacities.
[1]Plaintiff’s Court Book (“PCB”) 43
[2]PCB 43-45
8She attended Ms McColl shortly afterwards and, was noted to be slightly more positive.[3] She was particularly encouraged by attempts her employer was making to have her return to work by arranging a taxi so that she would not have to walk across the same crossing where she was struck. Ms McColl noted that the plaintiff was “very invested in recovery and being at work again”.[4] She recorded that the daytime flashbacks were decreasing, but they remained at night.[5] The plaintiff, however, continued to complain of pain in the right hip.
[3]PCB 54
[4]PCB 54
[5]PCB 54
9On 28 October 2020, Ms McColl saw the plaintiff again. At that stage, she had had an increase in her antidepressant medication and was still needing Valium daily. She considered that there were clear symptoms of ongoing traumatic stress, being intrusive thoughts and re-experiencing avoidance and hyperarousal in relation to the scene of the accident.
10On 15 November 2019, the plaintiff had an MRI of the lumbar spine which revealed an L4/5 disc bulge.[6] She attended a neurosurgeon who recommended conservative treatment and referred her on to Mr Kiran Tippur, a pain specalist. Due to continuing complaints however about her right hip, she had an MRI of the right hip on 2 December 2019.[7] This was significant as it revealed a labral tear with trochanteric bursitis. She was referred to an orthopaedic specialist. At that stage, the plaintiff had attempted a return to work, but it proved exhausting and it was agreed that she should not work at that stage.[8] The plaintiff gave evidence that having the MRI reveal the structural problems in her right hip was in some ways a setback, but also in some ways a relief as she now knew that her pain had an anatomical cause. In her words, she now knew what she was dealing with.
[6]PCB 15
[7]PCB 16
[8]PCB 54
11Ms McColl reported that there had been progress in terms of anxiety and that the plaintiff was now able to cross roads locally with her partner. Nighttime flashbacks continued, though it appears that the daytime flashbacks had decreased. However, Ms McColl did note, at her 7 January 2020 appointment, that the flashbacks now contained an extra element, being the car and the driver’s face. When taken to Ms McColl’s notes that at this stage she was increasingly socially isolated, the plaintiff confirmed that this was by reason of her physical injuries which made walking difficult.
12The plaintiff consulted Dr Chandrasekaran, surgeon, in mid-January 2020 and, shortly thereafter, saw Dr Tippur. She was using a walking stick to get around at this stage and she was considered a candidate for steroid and local injections.[9] Dr Elmahadi ceased her Lexapro at this stage and began her on Cymbalta. On 21 January 2020, the second motor vehicle accident occurred. The plaintiff then deposed in the following terms:
“20.My dad was involved in a transport accident on 21 January 2020 in Tooboorac where he lived. I understand he was a passenger in a car which was stationery waiting for oncoming traffic to clear before making a right hand turn. My dad’s car was hit from behind and pushed into the path of the oncoming traffic.
21.I was at home when I received a call from someone in the town telling me that there had been a really bad accident involving my dad’s car and that there were helicopters at the scene. The owner of the local pub who also worked for the SES, was at the scene. My dad apparently lost consciousness in his arms. The owner of the local pub contacted my brother and told him dad had been air-lifted to the Royal Melbourne Hospital. We drove to the Royal Melbourne Hospital and got there at the same time the helicopter landed. They put us in a tiny room, we knew it was really bad. A doctor came into the room and said they needed a family member. Because of my medical studies it was me. I remember walking down the hallway past paramedics. It was like a blur. The doctor told me that my dad was in the passenger seat and had been hit head on and had suffered a severe brain injury. The doctor also told me that they needed to operate. If they didn’t he would die within four hours. If they did operate he may never be the same, he might not even wake up. The doctor asked me what I wanted to do. I had to explain this to my family. I signed the consent form for the operation.
22.Before the hospital operated on my dad we were told we better come and say goodbye to him because he might not survive. Dad was covered in blood. We waited at the hospital all night. Dad survived the operation. We were told that he had suffered a diffuse axonal injury. Dad was placed in an induced coma. When they subsequently lifted him out of the induced coma, dad continued in a persistent coma. Sadly he never woke up. Initially he was on a respirator. When they took dad off the respirator we waited outside his room wondering whether he was going to die. I stayed at the hospital for days, I didn’t want dad to be on his own. I kept talking to him, just hoping and wishing for a miracle. After dad was showing no signs of improvement, someone from the hospital pulled us into a little room and asked what my dad would have wanted to do. We had to make the decision for dad to go into palliative care. We were sitting there for a week watching him deteriorate and lose weight before seeing him pass away. As I was a medical student the doctors would come to me and then I would have to tell my family what the doctors said. They would ask what did the doctors mean and I would have to explain it to them. I did not handle it well my mental state went downhill and I was heavily medicated.”[10]
[9]PCB 16
[10]PCB 16-17
13The plaintiff’s father died on 8 February 2020.[11] She was recorded by Dr Elmahadi as feeling grief and having PTSD symptoms. Panic attacks were noted to have increased. Her grief reaction was described as abnormal. Her Cymbalta doses increased over the course of February from 30 milligrams to 120 milligrams and by March she was referred to a psychiatrist, Dr Lekan Ogunleye. It is relevant to note that in the referral letter, Dr Elmahadi considered the plaintiff now had severe PTSD, whereas previously she had been considered to have PTSD only.[12]
[11]PCB 118
[12]Defendant’s Court Book (“DCB”) 29
14The plaintiff also recommenced seeing Ms McColl in March 2020 . On her first visit to Ms McColl, it was recorded that her flashbacks had changed in quality and that the plaintiff was at times feeling suicidal.[13] Dr Ogunleye commenced the plaintiff on Quetiapine. The plaintiff was also trialled with medial branch blocks in her low back. These did not appear to have a great effect and she was commenced with osteopathic rehabilitation.[14] She continued to see Dr Ogunleye, who continued to increase her dosage of Quetiapine.[15] She came for review with Dr Chandrasekaran in May 2020 and he recommended arthroscopy of the right hip.[16] On 31 July 2020, she had surgery to her right hip and then physiotherapy.[17]
[13] PCB 222
[14]PCB 18
[15]PCB 106-108
[16]PCB 18
[17]PCB 18
15The plaintiff continued seeing Dr Ogunleye throughout the latter part of 2020. I will come to detail the findings in respect of that treatment in due course, but dealing with it briefly, she continued to have increasing doses of medication and trials of various medications. She had further median branch blocks into the facet joints in her low back during the beginning of 2021. In April 2021, she was referred to a psychologist, Dr Arran Rose.[18] In mid-2021, she began epidural injections and bilateral radiofrequency neurotomy about her low back under the care of Dr Tippur.[19]
[18]PCB 62
[19]PCB 119
16In August 2021, the plaintiff began eye movement desensitisation and reprocessing therapy (“EMDR”) to help with her mental state. From that time on she has had some 68 sessions until about May this year.[20]
[20]PCB 62 and 68
17In August 2021, returned to work on a graduated return to work plan and has gradually built up her hours to about 20 per week. Since about late 2021, she has regularly had the epidural injections and the radio-frequency neurotomy of the facet joints on about a six-monthly basis. She has continued seeing Dr Ogunleye and Dr Rose. In November 2023, she began work as an editorial assistant at the University of Melbourne as well, and as at the date of trial, she was working four days per week with one day off to have her EMDR treatment.
What injury and impairment consequences flowed from the first incident on 17 September 2019 and were extant at the date of the second accident on 21 January 2020?
18In conforming with the principles in Petkovski v Galletti,[21] it is necessary to first identify the injury and then the impairment consequences which flowed from the first accident. For the reasons which follow, I find that, as a result of the first accident, the plaintiff sustained an injury to the right hip and lower back. The injury to the lower back can be described as a disc bulge at the L4-5 level. The injury to the right hip can be defined as a labral tear with trochanteric bursitis. In respect of psychiatric injury, that can be described firstly as an acute stress disorder which ultimately came to be described as a PTSD. The reason for this is that the first reporting of Dr Elmahadi on 24 September 2019 referring the plaintiff for psychological treatment to Ms McColl, was with a history of an acute distress disorder[22] and at that point Dr Elmahadi had noted the plaintiff was getting flashbacks and had anxiety.[23] A week later, however, he noted daily vivid dreams, flashbacks, lack of sleep, depression, anxiety and irritability. In Ms McColl’s notes for the 28 October 2019 counselling session, she noted clear symptoms of traumatic stress, being intrusive thoughts, re-experiencing, avoidance and hyperarousal. This was similar to the recordings of Dr Elmahadi in November 2019.[24] By this stage he was diagnosing her with a PTSD. All that seems to me to be a suggestion that the plaintiff’s condition worsened from initial onset in September until at least mid-January, when it was properly described by Dr Elmahadi as being a PTSD. This is consistent with the DASS assessment conducted by Mc McColl. She considered it showed severe stress and extremely severe anxiety.[25]
[21][1994] 1 VR 436, 444.
[22]PCB 47
[23]PCB 43, attendance on 23 September 2019
[24]PCB 45
[25] PCB 55
19As to the impairment consequences flowing from the injury, I start with the right hip. That right hip injury caused the plaintiff to be isolated and walk with a walking stick as of mid-January 2020. She was in pain and required ongoing daily medication. As set out above, it led to her being unable to perform a number of activities around the home and in particular to care for her children as she would have wished. She was also not able to return to work, in part, because of her physical injury and inability to walk to work. It is to be recognised this was also because of her psychiatric state.
20As to that, the impairment consequences flowing from the psychiatric injury were that she was having regular day and nightly flashbacks, intrusive thoughts, she had a lack of sleep, was depressed and anxious, and irritable.[26] She was on medication, variously Lexapro and Diazepam. She was struggling to attend work, in part because of her psychiatric condition, which required her to be in a similar location as to when she was struck. This necessarily impacted on her ability to commence a PhD in 2020. I accept, however, that this was in part to do with her physical injury at this stage.
[26]PCB 43
21However, it seems clear on the medical evidence that the plaintiff’s psychiatric condition was improving. That much is made clear in Dr Serry’s reporting.[27] It is also supported by Dr Ogunleye, who records a similar history, which he noted in a report dated 15 December 2020. There is particular weight to be given to this history, given that Dr Ogunleye was the plaintiff’s treating psychiatrist and took this history at a time within a year of the second accident. It was at a time when litigation of this nature was not even in contemplation. It is an even more compelling piece of evidence, because Dr Ogunleye asked the plaintiff why she came to the view her condition was improving after the first accident. She told him that things began substantially worsening after the second accident.[28] He considered she had a very good insight into her difficulties. I note he made no contradictory statements when this history was put to him to indicate it was an incorrect assessment of her mental state. Ms McColl also, in the recording of symptoms as of January 2020, recorded that there was progress in terms of anxiety, functional capacities and what I take to be a reduction in daytime flashbacks, than rather nighttime flashbacks alone. These recordings and opinions from medical practitioners, both treaters and also expert medico-legal opinion, all seem to strongly suggest there was some improvement in the plaintiff’s condition as at January 2020. She was being appropriately treated at that point in time and I consider the material to in no way suggest there would be any worsening of her condition at about mid-January 2020 from a psychiatric perspective. Given this, I consider it is possible to make findings that, as at mid-January 2020, the plaintiff suffered from PTSD. It involved nighttime flashbacks. It compromised her ability to return to work. She had anxiety, which was improving and she was requiring medication for both depression and anxiety. The physical consequences of her injury were such as I have described above.
[27]PCB 156
[28]PCB 105
22Now turning to answer the second question.
What injury and impairment consequences did the Plaintiff sustain in the second accident?
23For the below reasons, I accept the plaintiff sustained injury arising from the second motor vehicle accident. I find that injury is a severe PTSD. I come to that finding, firstly on the basis of Dr Elmahadi’s referral to Dr Ongunleye.[29] It was suggested that the referral was made as a continuation of treatment in respect of the first accident. I do not accept that submission given my finding that the plaintiff’s condition was in fact improving as of mid-January 2020. There was no material in Dr Elmahadi’s reports or from Ms McColl that suggests the plaintiff was going to be referred to a psychiatrist prior to the second accident. The fact that Dr Elmahadi considered a referral to a psychiatrist necessary and in the referral letter noted the condition had become a severe PTSD, indicates strongly that there was a new and worsened injury which now needed treatment by a psychiatrist. Secondly, the medication that the plaintiff was being prescribed by Dr Elmahadi had increased substantially and Cymbalta had been doubled in dose[30]. Further, the PTSD checklist/K10/DASS scoring sheets, all indicated a worsening of the condition.[31]
[29]DCB 29
[30] DCB 29
[31] PCB 216 - 219
24Third, the counselling notes from Ms McColl indicate that the quality of the flashbacks had changed and in cross-examination the plaintiff described this as being where she was seated in the back of her car with her father in the front seat, and she was warning him of his impending doom but he would not or could not listen. It was powerful and compelling evidence. Fourth, the medical reporting all appears one way. For example, Dr Serry, in his second report,[32] described:
“At that assessment, I concluded that the [plaintiff] had developed a PTSD as a result of the two accidents with a comorbid moderately severe adjustment disorder with anxious and depressed mood.”[33]
He considered her conditions having large part arisen as a result of the second accident.
[32]PCB 149
[33]PCB 149
25Dr Serry noted at PCB 160:
“I am of the opinion that if not for the second accident, the [plaintiff] would have made a progressive if not complete recovery from the injuries sustained in the first accident. I gained the impression that the trajectory for the [plaintiff] between the first and second accidents was one of improvement.”[34]
[34]PCB 160
26Dr Schutz similarly considered that the current psychiatric condition he found, which was a PTSD, was 50 per cent contributed to by the second accident.
27For all those reasons, I consider the plaintiff suffered a severe PTSD, or otherwise expressed as a PTSD with much more severe symptomology, as a result of the second accident. The impairment consequences which flow from that are worsened flashbacks, nightmares, anxiety and depression; an abnormal grief reaction; an inability to return to medical studies. The defendant submitted that the plaintiff’s third affidavit was “convenient” because it mentioned the plaintiff’s ultimate desire to complete her PhD and then return to her medical studies. The defendant suggested this raised a matter which had not been deposed to before, nor did it find expression in other materials contained in the evidence. On the first point the defendant is correct. The plaintiff had not previously deposed to losing her ability to go back to her medical degree and career. However, the medical reporting is replete with reference to the plaintiff’s desire to return to her medical degree at some stage.[35] Its omission from the affidavit material is of minor moment. [36] I reject the defendant’s submission.
[35]DCB 14, Dr Barmare; Dr Serry, PCB 156 at paragraph [6], PCB 148; PCB 197
[36] Juma v Kone Elevators Pty Ltd [2024] VSCA 217
Can the isolated injury and impairment consequences be considered permanent?
28Turning to the fourth question, can the isolated injury and impairment consequences flowing from the second accident be considered permanent?
29The defendant submitted that the plaintiff’s condition had improved and was not therefore stable for the purposes of making a determination as to serious injury. I would reject that submission. It is undoubted that the plaintiff has had some improvement as a result of time and treatment since the second accident. However, the medical evidence seems to speak with one voice that the condition has largely stabilised. First, Mr Schutz reports, “She cannot go back to medicine due to her physical limitations and mental health issues.”[37] Although he reports that her mood had improved in the last 18 months, he then goes on to say she developed PTSD as a result of the first accident which had been significantly aggravated by the death of her father.[38] Mr Schutz stated that her symptoms were chronic and entrenched and that they would have an impact on her functioning and quality of life for the foreseeable future.[39] Dr Serry opined, that the plaintiff was likely to remain symptomatic for the foreseeable future.[40] I also note that she continues to have EMDR treatment with Dr Rose and has had constant and consistent prescriptions of medication under the care of Dr Ogunleye and Dr Elmahadi. All this suggests that, while there has been some modest improvement in the plaintiff’s condition, as Dr Schutz says, it is entrenched for the foreseeable future. On that basis, I consider the injury and impairment consequences following from the second accident are permanent.
[37] PCB 197
[38] PCB 203
[39]PCB 203
[40] PCB 157
Can the injury and impairment consequences be defined as constituting a severe mental or behavioural disturbance?
30I find that the impairment consequences sustained by the plaintiff arising from the second motor vehicle accident are sufficient to satisfy the definition contained in the Act. I am conscious that, in making this assessment, all relevant factors must be brought to account.[41] Here, the plaintiff has lost the ability to return to her medical course. She had done two years of that medical degree, indicating a level of commitment and seriousness to that career. Her work in academia had revolved around cervical screening; a health-related area. She expressed a desire one day to work as a physician in public health. As I have indicated above, references to that career are replete in the medical reporting. The plaintiff’s evidence was not ever seriously under challenge for reliability or consistency. I would note that the plaintiff gave evidence in a way which I consider to be forthright and truthful. She gave no indication of seeking to evade any questions and made concessions where appropriate. I consider her a witness of truth and I accept her evidence. In this regard, then, I do consider she has lost the ability to go back to work in medicine. This is primarily because she cannot bring herself to go into traumatic situations. She would be faced with such situations regularly in hospitals. This is because after the second accident, she was required to be almost constantly at the hospital for two weeks until her father ultimately died after she gave the instruction to turn off life support. That represents a narrowing of her employment and occupational pathways. For a young person who was achieving professional qualifications, this is a significant blow. This is not to deny the fact that the plaintiff might well have a career in academia with a PhD studied either part time or full time, but the fact she simply cannot go back to work as a medical practitioner or physician is a significant blow and weighs heavily on the scales in her favour. In addition, I find she suffers from flashbacks of an incredibly intrusive and traumatic nature, where she imagines herself in the back of the car trying to warn her father of his impending doom. Her evidence on this point was harrowing. To live through this on a regular basis some four years after his passing, I consider to be a serious consequence. This also has an effect on her ability to sleep and maintain her mood. There is no doubt she has had some improvement in her mood, but the ongoing lack of sleep is another significant factor which must be weighed in her favour. In addition, the requirement for ongoing EMDR and medication supports a finding her impairment consequences are severe.
[41]Transport Accident Commission v Katanas (2017) 262 CLR 550
31It was submitted by the defendant that the treating doctors and counsellors had made no distinction between the injuries and their consequences. So much can be accepted. In fact, it would be the usual course that therapeutic clinical practitioners would be focused on treatment of the global patient condition rather than the legal requirements which arise under the Act. To this extent, practitioners such as Dr Serry, Dr Pokharel and Dr Schutz, are far better placed to make such assessments. To this extent, Dr Serry opines that the current situation the plaintiff faces is almost entirely the result of the second accident. This is on a history which he takes of improving psychological symptoms after the first accident. Dr Schutz comes to a slightly different view that 50 per cent of the current symptomology is related to the second accident. I consider that even if Dr Schutz’s opinion was to be preferred, the contribution made by the second accident to her symptoms currently are so significant that they would warrant a finding of serious injury. However, I make it clear that I find the opinion of Dr Serry to be preferred, as it more closely aligns with the recordings of Dr Elmahadi and Ms McColl, who had recorded the improvement after the first accident and before the second. Dr Pokharel’s reporting is consistent with those of Dr Elmahadi and Ms McColl in that she experienced an exacerbation of a resolving PTSD after her father’s transport accident.
32For these reasons, I find the plaintiff has sustained a severe long-term mental or severe long-term behavioural disturbance which can be defined as a severe PTSD arising from the second accident. I will grant the plaintiff a serious injury certificate and hear the parties as to ancillary orders.
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