Nazer v Allianz Australia Insurance Limited
[2025] NSWPICMP 627
•20 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Nazer v Allianz Australia Insurance Limited [2025] NSWPICMP 627 |
CLAIMANT: | Ramiz Nazer |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
SENIOR MEMBER: | Susan McTegg |
MEDICAL ASSESSOR: | Gerald Chew |
MEDICAL ASSESSOR: | Steven Yeates |
DATE OF DECISION: | 20 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; assessment of whole person impairment (WPI); claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) certified all injuries referred for assessment not caused by the accident; Held – certificate of MA revoked; claimant suffered major depressive disorder and somatic symptom disorder with predominant pain caused by the accident resulting in 8% WPI. |
DETERMINATIONS MADE: | CERTIFICATE Whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10% Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Matthew Jones dated · major depressive disorder, and · somatic symptom disorder with predominant pain. |
REVIEW PANEL REASONS FOR DECISION
INTRODUCTION
On 2 February 2021 Mr Ramiz Nazer (the claimant) whilst driving his vehicle stopped to allow a vehicle in front to make a right-hand turn when a truck failed to stop and collided with the rear of his vehicle causing him to sustain injury (the accident).
Mr Ramiz Nazer has brought a claim for common law damages under the Motor Accident Injuries Act 2017 (the MAI Act).
Allianz Australia Insurance Limited (the insurer) is the relevant insurer with liability to pay any damages to Mr Nazer under the MAI Act.
Section 4.11 of the MAI Act provides that there is no entitlement to damages for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%.
This dispute is in relation to whether the degree of permanent impairment sustained by
Mr Nazer as a result of the injury caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act.A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1]
[1] Section 7.20 of the MAI Act.
The dispute as to permanent impairment in respect of the claimant’s psychological injury was referred to Medical Assessor Matthew Jones. He issued a certificate dated
8 November 2023.
DOCUMENTS CONSIDERED BY THE REVIEW PANEL
The Review Panel issued a Direction to the parties on 10 December 2024 (the Direction) requiring each party to file an indexed, paginated bundle of documents. In response to this Direction the solicitor for the claimant uploaded to the portal a bundle of documents paginated from pages 1 to 447 (claimant’s documents). The solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 50 (insurer’s documents).
RELEVANT LEGAL AUTHORITY
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.[2]
[2] Clause 1.2 of the Guidelines.
Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:
“6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1.The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2.The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.
6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
CERTIFICATE OF MEDICAL ASSESSOR JONES
The injuries referred to Medical Assessor Jones for assessment were:
· psychological sequalae – anxiety, depression and post-traumatic stress disorder.
Medical Assessor Jones issued a certificate dated 8 November 2023 in which he certified all the injuries referred for assessment were not caused by the accident and an assessment of the degree of permanent impairment of these injuries is therefore not required.[3]
[3] Claimant’s documents p 10.
Medical Assessor Jones reported Mr Nazer had been living in a unit by himself for four to six weeks. Prior to that he lived with his family including his wife and three children aged 11, 9 and 6. It was reported Mr Nazer said the separation occurred because since the accident his wife had some issues with him staying home and having no income. Mr Nazer reported his brother was renting the property for him and was looking after him by bringing him food, doing some shopping and cleaning up. Mr Nazer informed Medical Assessor Jones that he had not worked since 19 February 2021 and was in receipt of workers compensation payments arising out of the accident.
Mr Nazer reported he was stopped waiting for a vehicle ahead of him to turn right when a truck smashed into the rear of his Hi-Ace van pushing it into the car in front. He reported,
“…his seatbelt locked on his chest and his head hit the windscreen. He said for about five to seven minutes he was not sensing anything and that when he opened his eyes he was on the grass. He said he was all right…the boss picked him up and he had the next day off work.”
Mr Nazer reported he had pain in his lower back, both shoulders leg and neck. He had been referred to a specialist Dr Simon McKechnie and was told he might need an operation, but he refused because there is no guarantee of success.
Medical Assessor Jones reported Mr Nazer saw a psychologist Medhat Metry over one year earlier. He saw a psychiatrist Dr Ashraf Philips who gave him some tablets, but he had not seen him for about three months. He reported following the accident, at nighttime the accident would “kick in [his] mind”. He reported he would scream in the night and wake up thinking about the accident although he no longer does so. He did not report any other symptoms and the ruminations about the accident and nightmares have ceased.
Mr Nazer reported shutting himself off from the outside world, and he felt hopeless and helpless with no future. Medical Assessor Jones reported he had a pain-focused presentation.
Medical Assessor Jones reported the psychological and emotional symptoms were consistent with the claimant’s reported level of pain and physical dysfunction. He reported he appeared to have had a more recent change in mood and behaviour related to marital problems noting he appeared to be significantly affected by his recent separation from his wife and disconnection from his children.
Medical Assessor Jons concluded the claimant sustained a probable post-traumatic stress disorder caused by the accident which had resolved. He found no ongoing, active psychiatric disorder.
REVIEW PROCEDURE
The claimant has sought a review of the medical assessment of Medical Assessor Jones.
The application was lodged on 7 December 2023 within 28 days of the date on which the certificate of Medical Assessor Jones was made available to the parties.[4]
[4] Section 7.26(1)(b) of the MAI Act.
On 15 February 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Review Panel (the Panel).[5]
[5] Section 7.26 of the MAI Act; claimant’s bundle p 9.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[6]
[6] Rule 128 of the PIC Rules.
The review is by way of a new assessment of all matters with which the medical assessment is concerned.
On 26 March 2025 the Panel agreed an examination was necessary.
EVIDENCE BEFORE THE PANEL
Application for personal injury benefits
In the Application for personal injury benefits dated 22 February 2021 Mr Nader described his injuries as follows:
· discal injury to neck;
· radiculopathy into right upper limb;
· injury to right shoulder;
· injury to mid-back;
· discal injury to lower back, and
· radiculopathy into both lower limbs; psychological disorder (anxiety, depression, and post-traumatic stress disorder).
Medical evidence
Medhat Metry psychologist [7]
[7] Claimant’s documents p 61 – 75.
On 11 March 2021 Mr Metry reported Mr Nazer provided a history of depression and anxiety symptoms since the accident including depressed mood, frustration from pain, loss of interest, sleep disturbance, stress, anxiety, negative thoughts, flashbacks, excessive worries irritability, loss of confidence, hopelessness, poor motivation, loss of libido, short temper, agitation, low self-esteem, difficulty concentrating, and anger problems. He reported he felt extreme fear at the time of the accident, he thought he was going to die, and he reported sleep disturbance associated with nightmares. Mr Metry provided psycho education, relaxation skills and breathing exercises.
On 25 March 2021 Mr Metry reported Mr Nazer was irritable, anxious and depressed. He appeared to be physically uncomfortable.
On 8 April 2021 Mr Metry reported Mr Nazer was extremely angry during the session and appeared to be irritable, agitated, anxious and depressed. Similar symptoms were reported on 15 April 2021, 22 April 2021, 20 May 2021, 3 June 2021, 29 July 2021, 12 October 2021, 26 October 2021, and 9 November 2021. On 23 November 2021 Mr Metry also reported
Mr Nazer preferred to be alone. Similar symptoms were reported on 21 December 2021,
4 January 2022, and 1 February 2022, Treatment included cognitive behavioural therapy (CBT).In a report dated 25 March 2021 Mr Metry diagnosed depression and symptoms of post-traumatic stress disorder.[8]
[8] Claimant’s documents p 141.
Dr Ashraf Philips, psychiatrist
Dr Philips saw Mr Nazer on 25 November 2021.[9] In his report he stated since the accident
Mr Nazer had a fear of driving and irritability. His appetite was disturbed. He described flashbacks, frequent nightmares, and a startle response. His sleep was disturbed by pain. He also reported hypervigilance, a lack of concentration and short-term memory disturbance.[9] Claimant’s documents p 432.
Dr Philips thought the claimant’s symptoms were suggestive of a depressive episode with anxiety and post-traumatic stress disorder symptoms although a differential diagnosis was an adjustment disorder.
On 30 September 2022 Dr Philips reported Mr Nazer continued to have anxiety and depressive symptoms driven by worry about his financial situation.[10] He was also said to be anxious about his mother’s health overseas. His sleep was disturbed by pain and by anxiety. He was irritable and tended to isolate himself. Dr Philips concluded Mr Nazer continued to present with symptoms suggestive of a depressive episode with anxiety and post-traumatic stress disorder symptoms.
[10] Claimant’s documents p 436.
On 2 December 2022 Dr Philips reported Mr Nazer was irritable, intolerant to the noise of his children, and his mood was depressed.[11] He noted he had been taking Paroxetine 20mg with some improvement of symptoms.
Medico-legal evidence
[11] Claimant’s documents p 437.
Dr Ben Teoh, psychiatrist
Dr Teoh assessed the claimant via Telehealth on 12 August 2022 and provided a report.[12]
[12] Claimant’s documents p 54.
Dr Teoh reported following the accident Mr Nazer had persistent pain affecting his lower back, right shoulder and neck. He has not been able to do activities that he used to enjoy, including mowing the lawn, helping his wife and playing with the children. He required assistance for self-care and could not drive long distances. He reported insomnia and nightmares; he was irritable and argumentative. His relationship with his wife was strained and he worried about his physical condition and future.
Dr Teoh diagnosed a major depressive disorder and assessed a 22% whole person impairment (WPI).
Dr Robert Breit, orthopaedic surgeon
Dr Breit assessed the claimant at the request of the insurer and provided a report dated
9 June 2022. He considered the claimant’s claim of gross pain and disability was inconsistent with the mechanism of injury, the objective pathology and the claimant presentation. He considered the claimant may have had some neck discomfort but was not convinced he had any ongoing issues.
Dr Con Kafataris, Injury Management Consultant
Mr Nazer was assessed by Dr Kafataris at the request of iCare Workers Insurance on
9 November 2022.[13][13] Insurer’s documents p 50.
Dr Kafataris reported Mr Nazer rates himself as having improved “70%”. He noted that level of improvement was surprising given the level of incapacity. He reported Mr Nazer presented with chronic back pain following the accident. He reported the MRI scan suggested internal disc disruption but no evidence of significant radiculopathy. He thought Mr Nazer presented with evidence of abnormal illness behaviour and considered he was fit for suitable duties for at least 20 hours per week.
Medical review panel certificate
A Medical Review Panel reviewed a certificate of Medical Assessor Bodel dated
20 September 2023 and issued a new certificate deterring that the following injuries were caused by the accident and gave rise to a WPI of 0%:· cervical spine – soft tissue injury, aggravation of underlying degenerative change, and
· lumbar spine– soft tissue injury, aggravation of underlying degenerative change.
The Review Panel determined the following injuries were not caused by the accident:
· left leg – soft tissue injury;
· right leg – soft tissue injury;
· cervical spine – disc bulge/soft tissue injury radiculopathy;
· left hand – soft tissue injury;
· right hand – soft tissue injury;
· lumbar spine - annular tear, disc bulge and nerve root impingement/soft tissue injury with radiculopathy;
· right shoulder – soft tissue injury with radiculopathy and referred pain from the neck, and
· thoracic spine – discal injury/soft tissue injury with radiculopathy.
SUBMISSIONS
Claimant’s submissions
The claimant provided undated submissions in support of the application for review.[14]
[14] Claimant’s documents p 1.
The claimant submitted the findings of Medical Assessor Jones were inconsistent with the preponderance of treating evidence including that of Dr Kafataris, Mr Metry and Dr Philips which demonstrate contemporaneous and consistent complaints of post-accident psychological sequelae. The claimant submits they are also out of step with the findings of Dr Teoh who diagnosed a major depressive disorder and assessed 22% WPI.
The claimant submits that Medical Assessor Jones speculated that the claimant’s psychological symptoms “have resolved” yet states he had ongoing psychological symptoms in the form of mood and behaviour issues attributable to his marital problems. The claimant argues Medical Assessor Jones ignored the claimant’s ongoing pain responses, his loss of earning capacity, the effect of same on his marriage and other multifactorial factors stemming from the accident.
The claimant submits Medical Assessor Jones failed to put to him any inconsistencies he identified between the claimant’s instructions, his own findings and the findings of Dr Teoh, Dr Asraf and Mr Metry.
It is submitted Medical Assessor Jones engaged in an exercise of mere speculation with regard to his negative conclusions as to the cause of the claimant’s post-accident psychological injuries and impairments.
The claimant refers to cl 6.31 of the Guidelines which demonstrates that the evidentiary onus in relation to establishing the existing of an objectively demonstrable pre-existing symptomatic impairment is a high standard which must rise above the standard of “mere speculation”.
Insurer’s submissions
The insurer provided submissions dated 11 January 2024 in response to the application for review.[15]
[15] Insurer’s documents p 2.
The insurer notes the claimant himself conceded he had no ongoing psychiatric problems related to the accident and had ceased attending Dr Philips.
The insurer submits causation has always been in issue and submits Medical Assessor Jones adequately considered the relevant evidence and established his path of reasoning.
The insurer submits that the existence of competing opinions does not establish error, noting that Medical Assessor Jones considered all the material referred to by the claimant in their review submissions. It is submitted after utilising the appropriate test for causation Medical Assessor Jones relied upon his clinical examination findings pursuant to the Guidelines to determine no ongoing psychiatric injury.
MEDICAL EXAMINATION
Background
Mr Nazer was assessed by Medical Assessors Yeates and Chew by videoconference through MS Teams on 1 August 2025. Mr Nazer was present at his lawyer’s office and was assisted by an Arabic interpreter.
Psychosocial history and pre-accident history
Mr Nazer was born in Cairo, Egypt, and raised with his mother, father, and three siblings. He is the youngest of four. Mr Nazer’s father was employed in a management role by the Egyptian army, while his mother stayed at home. His father passed away when Mr Nazer was about eight. The family home was in Cairo, and they had enough money, food, and clothing. Mr Nazer mentioned they were generally materially comfortable. He denied any domestic violence within the family and described himself as a healthy child and young person. Mr Nazer also denied experiencing any physical, sexual, or emotional trauma inside or outside the family.
He stated he was not exposed to war or war-like conditions and described his early life as positive, noting that he was free to play and attend school. He comes from a Coptic Christian background and was not persecuted for his religion in Egypt.
Mr Nazer attended a local public primary school in Egypt and completed high school and middle school. He had a circle of friends at school and was never suspended or expelled. He described himself as an average student.
After finishing high school, he immediately started work as a truck driver. He migrated to Australia in 2007 to reunite with his twin brother, who had arrived previously. Although
Mr Nazer migrated as a single man, he married in Australia in 2012 and has three children from that relationship. He studied business management for between 6 and 12 months after arriving in Australia, then began working for a trucking company, driving 6-ton trucks. He denied having any previous motor vehicle accidents. He has always lived in Sydney and raised his children in a home in Revesby. His children are currently aged 13, 11, and 8.
Mr Nazer now lives alone in a rented property in Padstow. Before that, he lived with his wife and three children, but their relationship broke down, leading to separation in 2024.
Mr Nazer denied any previous contact with Mental Health professionals prior to the accident. He has never had a psychiatric admission nor experienced suicidal ideation, intent, or attempt. His care needs are managed by his general practitioner (GP) Dr Anif Kanawati. He takes no current medications, and he is otherwise medically well.
There is no history consistent with a primary psychotic illness or bipolar effective disorder. There is no family history of major mental illness, addictions, or completed suicide. Mr Nazer smokes tobacco but does not drink alcohol or take illicit drugs. He does not gamble. There is no forensic history.
History of the accident
On 2 February 2021, Mr Nazer was performing morning work duties in a Toyota HiAce on Punchbowl Road around 6.00am. He stated that the road was quiet. Mr Nazer mentioned that after passing through some traffic lights, there were two vehicles ahead of him, one turning right and the other stopped. He said a semi-trailer suddenly appeared from behind and collided into the back of his van, causing him to strike the vehicle in front. His head hit the windscreen, and the seatbelt he was wearing locked to restrain him. He said that a driver from the vehicle in front helped him exit his van, and he then felt dazed for a few minutes. The police did not attend the scene, and Mr Nazer declined an ambulance. He contacted his employer to inform them of the accident and that he could no longer complete his deliveries because the van was completely written off. Mr Nazer mentioned that another delivery driver arrived and collected the goods from his van for delivery as arranged. He also stated that the airbags did not deploy. Lastly, Mr Nazer felt that the driver of the truck that collided with him from behind was impolite.
History of symptoms and treatment following the accident
Mr Nazer mentioned that he developed back pain several days after the accident, which required analgesia. However, he returned to work after a few days of absence and saw his GP for the pain. His GP organised an MRI and diagnosed disc issues. Mr Nazer also reported persistent neck pain, managed with over-the-counter analgesics. Additionally, he experienced knee pain, which did not require surgery. He consulted a pain specialist,
Dr Simon McKechnie, for optimisation of his pain management strategies.In conjunction with the pain symptoms, Mr Nazer said that he began to experience persistent low mood, feelings of worthlessness, and occasional transient suicidal ideation. He mentioned that he was unable to work due to pain, which contributed to his feelings of worthlessness. He explained that he ruminated over the accident and became enduringly frustrated about its impact on his life. He said he lost around 15 kg.
He was referred to a psychiatrist, Dr Ashraf Phillips, whom he saw twice in person and then had seven or eight subsequent telephone consultations. He mentioned he was prescribed psychotropic medications but does not know their names. He was also referred to a psychologist, Dr Medhat Metry, whom he saw fortnightly for several years and continues to see approximately monthly. Mr Nazer reported sleep disturbance caused by pain and low mood.
Details of any relevant injuries or conditions sustained since the accident
There are no other relevant injuries or conditions sustained since the accident.
CLINICAL EXAMINATION
Mental state examination
The mental state examination showed a Middle Eastern man who was bearded and wearing a beanie, socially appropriate and with rapport developing to a reasonable degree. He was dressed casually and interviewed via teleconference with an interpreter present to translate from his native Arabic. His mood was described as low, and the affect was somewhat flattened, with brief moments of spontaneous levity and reflexive smiling mixed with several episodes of frustration. The thought content was reality-based, with no signs of psychosis or current suicidality, but filled with lamentations about the impact of the accident on his mood and life due to ongoing pain. The thought form was normal. His speech was grammatically correct, well-structured, and spontaneously elaborated. According to the interpreter, his language was appropriately structured in Arabic. His judgement was not acutely impaired, and there were no perceptual disturbances. The cognition was broadly normal, with no formal testing performed. His insight was limited.
Current functioning
Mr Nazer currently lives alone in a rented unit in Padstow, where he showers daily and eats pre-prepared meals he buys from the supermarket. He cleans his own home and does domestic chores such as laundry and simple maintenance.
He is not part of any structured social activities, groups, or other recreational pursuits. He receives few invitations and mainly sees friends outside of his home.
He travels by car (as driver and passenger) and public transport without limitations from psychological symptoms, including an overseas trip to Egypt to visit his mother, which he took with his children.
Mr Nazer separated from his wife in 2024, who he says left him due to the insufficient income he was providing. The relationship officially ended in September 2024. He says he sees his children approximately monthly and can meet with them by arrangement with his ex-wife. He does not watch television and, after attending to his daily activities, spends the rest of his time on his phone and sleeping. He describes a subjective concentration deficit. He works casually for five to six hours per day, two and a half days per week.
DETERMINATIONS
Diagnosis
Mr Nazer presents with symptoms and signs consistent with two psychiatric conditions. There is evidence of major depressive disorder caused by the accident. This manifests as a chronic low mood, hopelessness, passive and active suicidal ideation, and pathological guilt. This required consultations with a psychiatrist and the prescription of an unspecified psychotropic medication. There is also a diagnosis of somatic symptom disorder with predominant pain secondary to the accident.
Major Depressive Disorder – DSM 5-TR
Mr Nazer meets the criteria for major depressive disorder as follows:
“A. Five (or more) of the following symptoms have been present during the same 2-week
period and represent a change from previous functioning; at least one of the symptoms
is either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective
report (e.g., feels sad, empty, hopeless) or observation made by others (e.g.,
appears tearful). (Note: In children and adolescents, can be irritable mood.)
This criterion is satisfied as Mr Nazer has both subjective and objective features of persistent low mood.
2. Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by either subjective account or observation).
This criterion is satisfied as Mr Nazer has clear features of diminished interest in pleasurable activities on more days than not.
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than
5% of body weight in a month) or decrease or increase in appetite nearly every day.
(Note: In children, consider failure to make expected weight gain.)
There is evidence of significant weight loss (up to 15kg); this criterion is satisfied.
4. Insomnia or hypersomnia nearly every day.
Mr Nazer described features of mood-driven insomnia, satisfying this criterion.
5. Psychomotor agitation or retardation nearly every day (observable by others, not
merely subjective feelings of restlessness or being slowed down).
There was no evidence of psychomotor agitation; this criterion is not satisfied.
6. Fatigue or loss of energy nearly every day.
Mr Nazer has persistent feelings of anergia nearly every day, satisfying this criterion.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
Mr Nazer feels persistently worthless and has a loss of self-regard, satisfying this criterion.
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either
by subjective account or as observed by others).
This criterion is satisfied as Mr Nazer describes subjective concentration deficits.
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without
a specific plan, or a suicide attempt or a specific plan for committing suicide.
Mr Nazer has experienced transient suicidal ideation, but did not describe recurrent or persistent suicidal ideation. This criterion is not satisfied.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
There is evidence of impairment in social and occupational function.
C. The episode is not attributable to the physiological effects of a substance or another
medical condition.
The condition is not otherwise attributable to another medical condition or substance use.”
Somatic symptom disorder with predominant pain
Mr Nazer also shows signs of somatic symptom disorder with predominant pain, as indicated by persistent and difficult-to-manage pain, especially in his back. He exhibits a significant level of distress related to his pain and a disruption to his daily routine. Additionally, he is preoccupied with his pain and has excessive thoughts about it. There is evidence of him dedicating considerable energy and time to his symptoms, which have persisted for several years.
Mr Nazer meets the criteria for somatic symptom disorder - DSM 5-TR - as follows:
“A. One or more somatic symptoms that are distressing or result in significant disruption of daily life.
This criterion is satisfied by Mr Nazer’s persistent back pain, knee pain and neck pain.
B. Excessive thoughts, feelings, or behaviours related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
Mr Nazer has devoted excessive time and energy to his pain symptoms satisfying this criterion.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).
The symptoms have been present for more than 6 months, satisfying this criterion.
Specify if:
With predominant pain (previously pain disorder):
This specifier is for individuals whose somatic symptoms predominantly involve pain.”
Causation
The test for causation is defined by clauses 6.6 and 6.7 of the Guidelines. The Panel finds the nature of the accident could cause the physical injury and consequential psychological injury reported by the claimant.
Mr Nazer had no pre-accident history of psychological illness. Mr Nazer first developed back pain within a few days of the accident on 2 February 2021 and shortly thereafter in conjunction with the pain symptoms he reported experiencing persistent low mood, feelings of worthlessness, and occasional transient suicidal ideation. The claimant’s history is supported by the history and symptom complaint recorded by Mr Metry psychologist on
11 March 2021.The Panel finds that the motor accident did cause the psychological injury defined by the diagnosis of persistent depressive disorder. The causality between the psychiatric conditions and the accident is demonstrated by the timeline linking symptoms to the accident, with noticeable functional impairments, especially in social and occupational areas, beginning after the accident. There is a consistent mechanism connecting the accident and its consequences.
Comments on consistency
There were no identifiable inconsistencies.
Permanent Impairment
The Panel assessed WPI using the Psychiatric Impairment Rating Scale as follows:
| Psychiatric diagnoses | 1. Somatic Symptom Disorder with predominant pain | 2. Major depressive disorder |
| 3. | 4. | |
| Psychiatric treatment description | Psychotropic medication, psychotherapy | |
| Category | Class | 2. Reason for Decision |
| 1. Self-care and Personal Hygiene | 2 | Mr Nazer currently lives alone in a rented unit in Padstow, where he showers daily and eats pre-prepared meals he buys from the supermarket. He cleans his own home and does domestic chores such as laundry and simple maintenance. |
| 2. Social and Recreational Activities | 3 | Mr Nazer is not part of any structured social activities, groups, or other recreational pursuits. He receives few invitations and mainly sees friends outside of his home. He can leave home without a support person. |
| 3. Travel | 1 | Mr Nazer travels by car (as driver and passenger) and public transport without limitations from psychological symptoms, including an overseas trip to Egypt to visit his mother, which he took with his children |
| 4. Social Functioning | 3 | Mr Nazer separated from his wife in 2024, who he says left him due to the insufficient income he was providing. The relationship officially ended in September 2024. He says he sees his children approximately monthly and can meet with them by arrangement with his ex-wife. |
| 5. Concentration, Persistence and Pace | 2 | Mr Nazer does not watch television and, after attending to his daily activities, spends the rest of his time on his phone and sleeping. He describes a subjective concentration deficit. |
| 6. Adaptation | 2 | Mr Nazer works casually for 5 to 6 hours per day, 2½ days per week in his pre-accident occupation of truck driver, requiring comparable skill and intellect. |
| List classes in ascending order: 1,2,2,2,3,3 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 13 | ||
| % Whole Person Impairment: 7% | ||
*%WPI = Percentage Whole Person Impairment
Pre-existing/subsequent impairment
There was no pre-existing impairment.
Effects of treatment
There has been a modest but incomplete improvement from treatment, thus an adjustment for the effects of treatment is indicated by the addition of 1%.
The Panel finds the claimant has sustained a final WPI of 8% as a result of injuries caused by the accident.
CONCLUSION
The Panel revokes the certificate of Medical Assessor Matthew Jones dated
8 November 2023 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a WPI of 8%:· major depressive disorder, and
· somatic symptom disorder with predominant pain.
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