O'Hara v Insurance Australia Limited t/as NRMA Insurance

DETERMINATION OF REVIEW PANEL
CITATION:	O'Hara v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 569
CLAIMANT:	Clive O’Hara
INSURER:	Insurance Australia Ltd t/as NRMA
REVIEW PANEL
PRINCIPAL MEMBER:	John Harris
MEDICAL ASSESSOR:	Paul Friend
MEDICAL ASSESSOR:	Thomas Newlyn
DATE OF DECISION:	4 August 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; review of Medical Assessment Certificate (MAC); motor accident; passenger where father died in vehicle; assessment of permanent impairment of psychiatric injury; no relevant principles in assessment of psychological impairment; Held – claimant’s degree of permanent impairment assessed at not greater than 10%; MAC revoked.
DETERMINATIONS MADE:	Medical Assessment – Permanent Impairment 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% *The assessment made by the Review Panel under s 63(4) of the Motor Accidents Compensation Act, 1999* is as follows:** 1. The Review Panel revokes the certificate of Medical Assessor Rikard-Bell dated 13 May 2024 dated and issues a new certificate that the following injury caused by the motor accident give rise to a whole person impairment which is not greater than 10%: · Chronic Major Depressive Disorder.

REASONS

BACKGROUND

Mr Clive O’Hara (the claimant) was injured in a motor accident on 13 May 2017 when the claimant’s father died. The claimant’s father was driving the vehicle which lost control and collided into a metal pole.[1]
[1] Insurer’s bundle, p 19. This guy
Insurance Australia Ltd trading as NRMA (the insurer) is liable to pay Mr O’Hara any damages under the Motor Accidents Compensation Act 1999 (the MAC Act).
The present dispute between the parties is whether the degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act.[2]
[2] See ss 57 and 58 of the MAC Act.
Section 44(1)(c) of the MAC Act provides that the State Insurance Regulatory Authority may issue guidelines with respect to the assessment of the degree of permanent impairment of an injured person as a result of an injury caused by a motor accident.
The Motor Accident Permanent Impairment Guidelines (the Guidelines) were issued pursuant to s 44(1)(c) for the assessment of permanent impairment. The Guidelines adopt the fourth edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA 4). Where there is any difference between AMA 4 and the Guidelines, the Guidelines are definitive.[3]
[3] Clause 1.2 of the Guidelines.
The present application is a review of a medical assessment pursuant to s 63 of the MAC Act. The medical assessment the subject of this review was conducted by Medical Assessor Rikard-Bell (the medical assessment). Medical Assessor Rikard-Bell assessed the permanent impairment of the psychological injury caused by the motor accident at 5%.
The application for referral of a medical assessment to a Review Panel (the Panel) was made by the insurer within 28 days after the parties were issued with the original certificate for the medical assessment for which the review is sought.[4]
[4] Section 63(7) of the MAC Act.
The delegate of the President referred the medical assessment to 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 63(2B) of the MAC Act.
Pursuant to s 63(3) of the MAC Act and Schedule 1, cl 14F (2) of the Personal Injury Commission Act 2020 (the PIC Act), the Panel consists of two Medical Assessors and a Member of the Motor Accidents Division of the Personal Injury Commission (Commission).

MEDICAL ASSESSMENT UNDER REVIEW

This review is from the Medical Assessment Certificate issued by Medical Assessor
[6] Claimant’s bundle, p 3.
Rikard-Bell when it was determined that the motor accident caused a Prolonged Grief Disorder.[6]
The Medical Assessor noted no history of serious illnesses, injuries or conditions and no family history of psychiatric illnesses. It was noted that the claimant did not have a memory of the accident when his father died but remembered needing help getting out of the vehicle.
The Medical Assessor noted that the claimant was in Year 11, performance throughout high school had been satisfactory although the claimant was mainly focused on sport. The claimant played rugby league for the Tenda blue team and rugby union for the Griffith black team.
The Medical Assessor noted some irritability with his brother, was able to focus and read adequately in terms of concentration and participated in social and recreational activities with no impairment. There was a finding of moderate impairment for adaptation based on the claimant missing the bus to school in the morning. The Medical Assessor found mild impairment of self-care and personal hygiene, travel and social functioning.

CONDUCT OF THE REVIEW

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 Merit Reviewer or a Medical Assessor.[7]
[7] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the 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 review is by way of new assessment of all matters with which the medical assessment is concerned.[9]

[9] Section 63(3A) of the MAC Act.

STATUTORY PROVISIONS

The provisions of the Civil Liability Act 2002 (the CL Act) apply to the Motor Accident Injuries Act 2017 in determining issues of causation. Particularly ss 5D and 5E of the CL 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.”
[10] See s 3B(2) of the Civil Liability Act 2002.
[11] [2021] NSWSC 13 (Raina) at [65].
Clause 1.7 of the Guidelines provides:
“There is no simple common test of causation that is applicable in 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 the sole cause as long as it is a contributing cause, which is more than negligible.”

SUBMISSIONS

Insurer’s submissions dated 20 December 2022[12]

[12] Insurer’s bundle, p 10.

The insurer submitted that any physical or psychological injuries sustained in the motor accident had fully resolved.
The insurer referred to the various medical evidence setting out the physical injuries. It is unnecessary to summarise this aspect of the submissions.
The insurer referred to the opinion of Dr Baron-Levi who considered that the claimant had initially been emotionally affected by the accident and the death of his father but considered the presentation inside September 2020 to be at a subclinical level with no diminution in academic performance and anxiety within the normal range.
It was considered that the claimant’s mother remained overly anxious about her son and may have over reported the level of anxiety.
The insurer noted that the claimant had had undergone medical treatment in respect of the injuries and that school records prior to the accident showed the claimant’s grades were below average, was easily distracted and his attendance was poor.
The insurer referred to the report of Dr Hussein on 26 July 2017 recorded that the claimant was a normal active child involved with normal activities. Dr Giblin in his report noted the claimant was off school for a few weeks and two months off football was but was now playing as a prop. In September 2020 Dr Keller noted that the claimant was active in the Griffith rugby tipping playing with the under 15’s which was significantly above his age and was also training in basketball and football twice a week with no physical restrictions.

Insurer’s submissions dated 4 July 2024[13]

[13] Insurer’s bundle, p 694.

These submissions opposed leave to review the medical assessment certificate.
The insurer noted the claimant travelled away from his residence to school and rugby practice by the Clontarf Foundation was because he was a minor and not capable of driving himself.
The insurer noted that the claimant reported his participation in rugby league and rugby union teams, has friends and a girlfriend for the past six months and that the relationship was progressing well. He reported that he occasionally meets up with friends over the weekend and is close to his mother. The insurer submitted that there was no basis to assert that there was a class 3 impairment in respect of social functioning.
The insurer referred to the school records which indicate that prior to the accident the claimant’s grades were below average, was easily distracted and his attendance was poor. The insurer noted that the claimant attended school no more than two days at a time and returned to football two months after the accident. It submitted that a proper application of clause 1.221 of the Guidelines means that the claimant most likely satisfies a class 2 impairment in respect of adaptation.

Claimant’s submissions dated 17 June 2024[14]

[14] Claimant’s bundle, p 1.

These submissions sought leave to review the medical assessment.
The claimant submitted that the Medical Assessor erred in the assessment of travel by failing to consider that he travels to school through a private foundation as opposed to by bus.
The claimant submitted that the history taken in respect of social functioning was incorrect and noted the history taken in the proceedings in relation to the claimant’s brother that there was excessive fighting which constituted domestic violence between the brothers and should be assessed as class 3.
The claimant submitted that the excessive absenteeism from school warrants a class 4 assessment for adaptation.

EVIDENCE

The parties filed bundles of documents for the Panel’s consideration.

Pre-existing conditions

The claimant’s pre-accident records from the Griffith Aboriginal Medical Service refer to minor illnesses.[15]
[15] Insurer’s bundle, pp 115-153.
The 2016 NAPLAN results showed low test performances in reading, writing and numeracy with a satisfactory performance in spelling.[16] School reports in 2016 were consistent with the NAPLAN results[17] and noted absences affecting performance.[18]
[16] Insurer’s bundle, p 428.
[17] Insurer’s bundle, p 455.
[18] Insurer’s bundle, p 457.
The report for the first semester of 2017 showed some improvements describing the claimant is tackling “learning task positively” and responding “well to praise”.[19]
[19] Insurer’s bundle, p 465.

Contemporaneous medical evidence

The ambulance report noted the claimant suffered facial injuries, bruising and/or lacerations to the chest, abdomen and legs with the claimant being trapped for an extended period.[20]
[20] Insurer’s bundle, p 93.
The hospital discharge summary noted the claimant was involved in a high-speed motor accident sustaining facial, teeth and thigh injuries.[21]
[21] Insurer’s bundle, p 159.
A medical certificate provided by Dr Hussain dated 26 July 2017 noted that the motor accident caused facial, teeth and thigh injuries.[22] The clinical note of the GP dated 26 July 2017 referred to the claimant as a “normal active child” who was “involved normal activities as usual”.[23]
[22] Insurer’s bundle, p 25.
[23] Insurer’s bundle, p 156.
The claim form dated 28 July 2017 was completed by the claimant’s mother. The form noted that the claimant suffered various injuries including to the face and psychological injury.[24]

Qualified opinions

[24] Insurer’s bundle, p 22.

Dr Giblin

Dr Peter Giblin, orthopaedic surgeon, was qualified by the claimant and provided a report dated 26 February 2018.[25] The doctor noted a history that the claimant was hospitalised for one week, was off school for a few weeks and two months off football but was now back playing football as a prop.
[25] Insurer’s bundle, p 32.
Dr Keller, occupational physician, was qualified by the insurer and provided a report dated
[26] Insurer’s bundle, p 64.
18 September 2020.[26] The doctor noted that the claimant can lift 50kg weights at the gym and was independent in self-care tasks.
Dr Keller opined that the motor accident caused small glass lacerations to both eyes which had healed and soft tissue strains to the left shoulder, right ankle and possibly to the abdomen that had all recovered.

Dr Baron-Levi

Dr Jeffrey Baron-Levi, clinical psychologist, was qualified by the insurer and provided a report dated before September 2020.[27]
[27] Insurer’s bundle, p 71.
The doctor noted a history that the claimant informed him that he did not feel any different than before the accident although he was emotional at his father’s funeral. The claimant reported mostly positive memories of his father but reported feeling sad when he thought about him.
The doctor noted pre-accident school reports with poor achievements in science, history and geographic geography and comments that the claimant was disengaged from classroom activities.
The doctor noted the school report in 2020 which reported the claimant as a dedicated student with strong organisational and time management skills. The doctor stated:[28]
“I am of the view that his current presentation was at a subclinical level as evidenced by the fact that there did not appear to be a diminution of his academic performance, that Clive rated his level of anxiety within the Normal range, his overall level of self-esteem in the High range and he continued to train and play rugby league. There may be an issue with his school attendance which could be related to either his low level of academic functioning in most classes or to concern for his mother. I suggest that Ms Nayden O’Hara was understandably concerned for Clive’s well-being following his involvement in the motor vehicle accident and the subsequent death of his father.”
[28] Insurer’s bundle, p 79.
The doctor observed that the claimant’s mother remained overly anxious about the claimant and there was the possibility that she may have over reported his level of anxiety.

Police records

The police report noted the motor accident with the fatality of the claimant’s father. There is reference to a nine-year-old male being trapped in the motor vehicle and two other children suffering injuries.[29]
[29] Insurer’s bundle, p 59.

Clontarf Foundation

Records produced by the Clontarf Foundation show the claimant’s travel to carnivals, morning training (basketball, swimming, rugby league and cricket), employment forums, camps and health sessions.[30]
[30] Insurer’s bundle, pp 627-633.

Other medical assessments

A medical assessment certificate of Medical Assessor McGlynn found no evidence of a fractured jaw and assessed facial scarring at 2%.[31]
[31] Insurer’s bundle, p 643.
A medical assessment certificate of Medical Assessor Cameron found that the motor accident caused various soft tissue injuries with no assessable impairment.[32]
[32] Insurer’s bundle, p 649.
A replacement medical assessment certificate of Medical Assessor Nichols found that the motor accident caused “damaged teeth” with no assessable impairment.[33]
[33] Insurer’s bundle, p 684.

Other medical assessment – claimant’s brother

A medical assessment certificate of the claimant’s brother dated 13 May 2024 diagnosed a separation anxiety disorder with an assessment of 7% permanent impairment caused by the motor accident. The claimant stressed the history provided by the claimant’s brother which noted excessive fighting between the siblings.

MEDICAL EXAMINATION

Both Medical Assessors medically examined the claimant on 28 July 2025. The examination report is as follows.

Who attended the assessment
Mr O’Hara attended by video teleconference. He attended with his stepfather John Whetu.
Mr Whetu was present throughout the examination but took no part in the examination.
Mr O’Hara was in his lawyer’s office in Griffith.

HISTORY

Psychosocial history and pre-accident history
Mr O’Hara was born in Griffith Base Hospital and has always lived in Griffith. He has a younger brother, Shane, who is aged ten years.
He has a one-year-old sister, Ava, from his mother’s subsequent relationship. He does not know where Ava’s father is living.
Mr O’Hara currently lives with his stepfather and stepmother who he refers to as Nan and Pop. They also live in Griffith. There is no-one else living in the house.
He has lived with Nan and Pop for a couple of weeks following a significant argument with his mother.
He was living with his father, mother and younger brother Shane in Griffith at the time of the motor accident. He attended Griffith Public School and was in Year 4 at the time of the motor accident.
He changed to enrol in Lake Wyangan Public School, outside Griffith, for the second semester of Year 4 in 2017 because when he repeatedly asked about the motor accident, when he returned to school, which he found distressing.
He attended Griffith Public School for Years 5 and 6.
He is currently enrolled in Year 12 at Murrumbidgee Regional High School which he has attended since Year 7.
Previous medical history
Mr O’Hara reported that he had not experienced any adverse events, significant illness or undergone any surgery prior to the motor accident on 13 May 2017.
Substance Use
Mr O’Hara does not use tobacco products but vapes every day. A vape cartridge lasts about a month.
He drinks alcohol on special celebrations such as parties and birthday parties where he will drink a ten pack of beer or bourbon mixers.
He does not use any illegal substances and does not consume tea or coffee.
He usually has a glass or cup of cola drink after dinner.
He will consume an energy drink after playing football and before football training, usually two to three times each week.

History of the motor accident
The motor accident occurred when Mr O’Hara was a passenger in the front seat of a vehicle being driven by his father. His brother Shane was in the back seat.
The supplied documents state that Mr O’Hara’s father lost control of the vehicle and collided with a power pole. His father died at the scene of the motor accident.
Mr O’Hara was asleep at the time of the motor accident and woke up with the vehicle lying on its left hand side and saw his father above him.
He believes that ambulance officers had arrived by the time that he woke up. They told him that his father had died.
He believes a door, presumably the driver’s side door, was opened and he was pulled out by ambulance officers.
His memory is that he was taken to the airport near Leeton and then flown to Canberra and admitted to Canberra Hospital.
History of symptoms and treatment following the motor accident
He has some memories of being in Canberra Hospital.
He had pain, particularly in his legs and felt faint, when he tried stand up, so he used a wheelchair for mobility.
He had X-rays and scans.
There are two operating theatre reports dated 14 May 2017. One report was for removing a broken incisor tooth and splinting tooth 21 to 22. The second report was for a washout and removal of foreign bodies (glass fragments) in both anterior thighs.

It is not clear whether this was undertaken in one or two surgical procedures.
Mr O’Hara had counselling from the school counsellor at Griffith Public School as described in the supplied documents.
He had some counselling in Year 8 from an external counsellor but stopped attending because he felt that he could not communicate with the counsellor. He has not seen the school counsellor in secondary school.
He trialled sleeping tablets but they made him too drowsy.
His stepmother has suggested he take antidepressant medications but he has not tried them.
The Discharge Referral from Canberra Hospital states that he was admitted on
13 May 2017 and it appears he was discharged on 17 May 2017.
Mr O’Hara was driven home by his stepfather Pop.
Mr O’Hara was unable to describe how he felt when he arrived home other than he was in pain.
He resumed school one day each week, but cannot how long he had away from school.
He was “emotional” and “stressed out”, if he was asked about the motor accident. He described “blanking out”, crying and going silent at those times
He did not want people to ask questions about the motor accident.
He was repeatedly angry about “little things” such as if someone pushed him or called him a name which did not bother him before the motor accident. He had repeated arguments with his mother. His mother complained that she could not talk to him and he felt that he could not talk to her.
He described attending Lake Wyanga Public School as good because no-one knew him and no-one asked him questions about the motor accident. He initially felt a bit awkward, until he got to know a couple of boys who played football.
Mr O’Hara ceased playing rugby league and rugby union for a period of time but cannot say for how long.
He subsequently resumed playing both these sports and also played touch football in summer.
It appears that he was attending school for about three hours each day in Year 5 and possibly Year 6.
He had days off from school when he did not have the motivation to get out of bed and felt “really” depressed.
It appears he attended school on the days when there was football training after school. It appears that he might be at school three days each week. He said that he attended the whole day, but that is not clear because he had difficulty getting out of bed in the morning.
He had a poor appetite and initially lost weight. He did have his teeth wired for a period of time, but cannot say for how long. The poor appetite continued after the wiring was removed.
Mr O’Hara stated that he was attending school five days each week when he commenced at Murrumbidgee Regional High School but he continued miss days at school.
When asked directly, he reported that he had difficulty getting to sleep, sometimes not getting to sleep until 5.00am. He was mostly getting out of bed 10.00am to 12.00pm and sometimes later.
He remained angry and irritable, including at football if the referee made a bad decision.
He relocated to live with his stepfather and stepmother after a “big fight” with his mother who he said was repeatedly calling him names like “gronk” and “a piece of shit”. This made him feel very bad or “like shit”.
He repeatedly thought about his father. When he lay down in bed at night he would think about the motor accident and felt that if he had been awake, he may have been able to prevent it. He felt very guilty about his father’s death as a consequence.
He also had thoughts of suicide, from time to time, as a way of getting away from everything.
He does not have plans, has never attempted suicide and says he would not do it. He has discussed these thoughts with a cousin.
Details of any relevant injuries or conditions sustained since the motor accident
Mr O’Hara has not been involved in any new accidents of any kind or undergone any surgery unrelated to the motor accident.
He had two teeth knocked out at the front of his upper jaw in 2024 playing football.
One tooth was replaced and appears to be surviving. The other tooth was removed.
He has been given a denture to wear but avoids wearing it because it is uncomfortable.
He has not had any other significant injuries playing football since the motor accident.
Current symptoms
Mr O’Hara current symptoms as very similar to what is described above.
He thinks about the motor accident and his father and feels guilty that he was asleep at the time when he lies down in bed.
He continues to have thoughts about suicide, as described above.
He has difficulty getting to sleep and may not get to sleep until 5.00am and wakes up late.
He can wake several times during the night but usually gets back to sleep.
He misses days at school because more depressed, has no motivation and does not want to get up.
He travels to school on the minibus provided by the Clontarf Foundation.
He does not like travelling on the school bus because it is crowded. He needs to repeatedly get on and off the bus to let others on and off. He does not like noisy environments.
The Clontarf bus is more flexible in its operating hours, so he can travel go to school later if required.
He has had ongoing problems with concentration and focus and doing his schoolwork since the motor accident. He described sitting in the classroom and zoning out.
He continues to have a poor appetite.
He is now getting assistance from what appears to be a specialist Indigenous support person for a couple of hours each week which he finds helpful.
Current and proposed treatment
Mr O’Hara is not currently undergoing any treatment.
CLINICAL EXAMINATION
Mental state examination
Mr O’Hara was alert and orientated, on time and cooperative with the assessment to the best of his abilities.
He was casually, but reasonably dressed and had a beard.
He responded to questions without delay
He had no evidence of thought disorder or hallucinatory phenomena.
He found it difficult to recall many of the events following the motor accident, particularly his emotional state and it was not until towards the end of the examination that he was able to describe thinking about his father, feeling guilty about the motor accident, and to be more precise about the number of days and frequency that he missed school.
Mr O’Hara described feeling depressed, sad, stressed and irritable. He has had frequent arguments with his mother and an intense final argument led to him relocating to live with his stepmother and stepmother.
He is more easily irritated but generally does not get into fights at school.
He has poor appetite and had a period of weight loss closer to the time of the motor accident. His appetite remains poor.
His struggles to focus and concentrate particularly at school.
Current functioning
Mr O’Hara as stated previously struggles to get to sleep and to get up in the morning. He only sometimes eats breakfast but does eat lunch and dinner.
His stepmother cooks dinner but when he lived at home with his mother he would help his mother cook dinner.
He is not as hungry as he was previously.
He makes his bed and cleans his room and attends to his personal care.
His stepmother washes his clothes. He tends to buy his lunch at school.
When he lived at home with his mother he did more chores, including washing his own clothes, because his mother had to care for his baby sister.
He has no difficulty showering, including after football training.
He has a general lack of motivation and difficulty getting out of bed.
Mr O’Hara has continued to play rugby league and played rugby union until the end of 2024 but ceased that because the playing days conflicted.
He plays touch football in summer.
He trains for rugby league twice each week from about 5.00pm to 6.30pm.
He, about one month ago, was suspended for the rest of the current football season and for about half of the next rugby league season. This followed an incident with a referee whom he described as making “a stupid call”. He was pushed over and got up “snapping”. He was very angry and was going to fight the referee but his teammates pulled him away before he could strike the referee.
He continues to attend football training twice each week as described above.
He does not know if he can watch the football games but has not attempted to do so.
He feels feel a bit down that he cannot play football.
Mr O’Hara follows the Sydney Rabbitoh’s rugby league team. He has always followed this team.
He watches the games and enjoys watching the games.
He has watched the State of Origin games including this year but it appears he has a varying level of concentration during the game.
Mr O’Hara has had his Learner’s licence for a couple of months and practises driving with his uncle.
He finds it difficult to drive, if there is noise in the vehicle such as from his sister.
Immediately after the accident he felt nauseated if he travelled by motor vehicle and tended to go to sleep.
He described feeling “okay when he travelled as a passenger in a motor vehicle but became anxious if there was noise in the vehicle or if the driver was driving too fast”.
Mr O’Hara was asked about the involvement he has had with the Clontarf Foundation regarding travelling to school camps, a fishing camp and to various sporting events including in Wagga Wagga, Narrandera, Gogeldrie Weir, Wollongong, Darlington Point, Tuggerah and Orange. He agreed that he had travelled to these places on a minibus. He would travel with a group of boys. He did not report any difficulty travelling this way.
He does not catch the school bus to school. He is collected by the minibus from the Clontarf Foundation and they collect a couple of other boys on the way to school. He finds the bus more comfortable because he does not like the crowds, noise or standing on the school bus.
Mr O’Hara as noted has had a very poor relationship with his mother which has finally led to him relocating to live with his stepfather and stepmother.
He has an okay relationship with his brother. They have “normal brother fights”.
He talks to and has a good relationship with his cousins and his stepmother and stepfather.
Mr O’Hara has had difficulty with concentration since the motor accident. He describes in the classroom zoning out and getting distracted. He is now doing better at school now that he is having the help from the Indigenous support teacher.
Mr O’Hara reported that he tends to get bored watching television and will then look at Instagram, Youtube or Snapchat on his mobile telephone but will also become bored which leads to him sitting in his room, try to relax, text his cousins and sometimes visit them.
He does not try to read anything apart from what is required for schoolwork.
Mr O’Hara states that he is now attending school from 9.00am to 3.00pm five days each week but specific questioning elicited that he does not attend 1-2 days each week or most weeks. He misses the days wherein he feels more depressed, unmotivated and struggles to get out of bed.
He continues to have difficulty falling asleep.
He is transported to school by the Clontarf Foundation bus.
After school he will catch the Clontarf Foundation bus home or go into town with his friends and walk home or text somebody to come to collect him and take him home.
Mr O’Hara did form a relationship after the motor accident but that has ended. He describes them being on a break and does not know whether the relationship will reform.
He does not talk to his mother’s subsequent partner and does not know where that person is living.
Mr O’Hara was working in a pizza restaurant from 4.00 to 9.00 pm about four days a week. He was driven to and from by a neighbour but now has ceased that job because there was no way to get to work.
Mr O’Hara is enrolled in Year 12 at school.
Comments of consistency
Mr O’Hara’s account was generally consistent throughout the examination. He could not remember some events and time frames, but this was consistent with his age at the time of the motor accident and symptoms following the motor accident.
Mr O’Hara’s account was generally consistent with the content of the supplied documents.
He described more depressive symptoms compared to Personal Injury Commission’s Certificate of Assessor Rickard-Bell.
He described ongoing psychiatric/psychological symptoms sufficient to reach criterion for a psychiatric diagnosis which is inconsistent with the report of Dr Jeffrey Baron-Levi.

REVIEW OF DOCUMENTATION
Summary of relevant documentation
The Personal Injury Commission Certificate by Assessor Christopher Rikard-Bell dated 13 May 2024 states that the father of Clive O'Hara deceased in the motor accident on 13 May 2017.
Mr O'Hara's father was of Fijian origin, born in Australia and fostered by an Aboriginal family and resided in Dubbo.
He met Mr O'Hara's mother when they were age 18 years. He was then working for a company and visited Griffith.
His development was normal and was progressing satisfactory from kindergarten to Year 4 when motor accident occurred.
Mr O'Hara was a front seat passenger in the motor accident. His father was the driver and his brother Shane and another passenger, Joshua, were also in the vehicle.
The vehicle left the road and collided with a pole. His father died at the site of the motor accident. Mr O'Hara was asleep at the time.
Mr O'Hara was initially taken to the local hospital and then medevacked to the Canberra Hospital, ACT.
He remembered that he needed help to get out of the vehicle and that the seatbelt had to be cut.
He has had one nightmare of the motor accident.
He was subsequently subjected to teasing and asked many questions about the motor accident, which was upsetting and distressing.
He completed Year 4 at the Anglican School in smaller classes. He returned to Griffith Public School for Years 5 and 6.
He Is currently in Year 11 of Murrumbidgee High School, having commenced in Year 7.
His performance in high school was satisfactory, even though he mainly focused on sport.
He has had 10 treatment sessions with a psychologist since the motor accident, which was not helpful.
He has been quieter and more withdrawn since the motor accident, whereas previously he was bubbly and talkative. He does not enjoy himself as much as he did previously.
His current symptoms are difficulty initiating sleep and waking up in the morning.
His mood is irritable and sad.
He does not like thinking about his father.
He enjoys playing football and plays for the same football club for which his father played.
He misses his father.
He feels negative about himself. He has feelings of emptiness. He has tried to block out his memories of his father because he does not to the motor accident.
He currently wakes up at 11 am and is taken to school by the Clontarf Foundation. His brother will catch the bus to Griffith Public School. On particular days he and his brother are collected from school by football coaches and attend rugby league training.
He sometimes goes to the Police Citizens Youth Club (PCYC). He usually plays football on a Saturday.
He has been in a relationship for over the past six months. Occasionally he will see his friends.
He has had poor school attendance over the past 12 months.
The Clontarf Foundation provides him with male role figures.
He is cooperative at school, functions adequately and has an adequate social network.
Assessor Rikard-Bell make a diagnosis of Prolonged Grief Disorder.
He assigns a whole person impairment of 5%, assigning class 1 to social and recreational activities and concentration, persistence and pace, class 2 to self-care and personal hygiene, travel and social functioning and class 3 to adaptation.
Assessor Rikard-Bell states that although Clive can dress, feed and manage himself but needs prompting to shower and clean his teeth.
There are arguments with his brother. He can be irritable but generally relationships in the family secure.
He can focus, read, adequately research topics of interest on his mobile telephone and read articles.
He attends the PCYC and plays rugby league and rugby union. He is somewhat reluctant to interact with friends as much as he should.
He has a girlfriend and occasionally meets with friends at weekends.
He requires to be transported to and from school by the Clontarf Foundation to attend school.
He misses the bus to school in the morning.
He has motion sickness, is anxious travelling in a vehicle, winds down the window and worries about a further motor accident.
The ambulance report dated 13 May 2017 records a Glasgow Coma Score of 15 on three occasions. The car was wrapped around a power pole. The patient was in the passenger seat at the bottom and trapped by confinement. His deceased father was trapped above him.
He remained fully conscious and aware what was happening. He complained of pain in his abdomen as it was pressed against the pole. He was able to move his feet.
The records from the Canberra Hospital, ACT contain the following:
The report of the CT scan of the cervical spine dated 13 May 2017 states no acute spinal fracture identified. Ground glass opacification and interlobular thickening in the lung apices may relate to the expiratory phase that raises the possibility of pulmonary contusions, given the setting of trauma.
The report of the x-ray of the lower extremities dated 13 May 2017 states there are extensive semi-opaque multiple foreign bodies projecting over the mid to distal thigh with right side predominance. There is no underlying bone or joint abnormality or acute displaced fractures. There are radio opaque foreign bodies over the medial aspect of the proximal left thigh.
There is a trace of bilateral fluid in the knees and multiple radio opaque foreign bodies in the anterior thighs bilaterally.
The report of the x-ray OPG-Dental dated 13 May 2017 states there is no overt fracture of TMJ or mandible.
The dental fractures are less readily apparent on the OPG than clinically. The teeth otherwise appear satisfactory.
The report of the CT scan of the abdomen and pelvis concludes that there is contiguous mural thickening of the second, third and fourth part of the duodenum and proximal jejunal loops in the central to right upper abdomen with evidence of small bowel. Malrotation is likely congenital, however in the setting of trauma, duodenal and jejunal wall thickening is consistent with bowel wall contusion.
No other abdominal visceral injury identified.
The clinical notes from the Griffith Aboriginal Medical Service from 7 May 2008 to 24 November 2017 contained the following:
The entry dated 30 August 2016 states “he was playing with Kids vehicle and pulled by someone to stop crush with other vehicle”. He has pain in the left chest wall and some redness and tenderness over the mid-axillary line of the fourth and fifth ribs.
He was referred for X-rays of his ribs.
The entry dated 31 August 2016 states his mother was informed by telephone there was no fracture.
The entry dated 18 May 2017 states he was recently involved in a motor accident. His wound was cleaned and dressed. He was prescribed Keflex suspension and ibuprofen suspension.
The entry dated 22 May 2017, states the wires in his jaw fell out yesterday. Advice was sought from the maxillofacial department at the Canberra Hospital.
The discharge summary from paediatric surgery at Canberra Hospital for the admission on 13 May 2017 states he had removal of glass from the anterior of both thighs.
He clinically had multiple broken teeth.
The further clinical notes from the Griffith Aboriginal Medical Service from 29 November 2017 to 24 January 2021 include the following:
The entry dated 31 May 2019 states that since the motor accident 2017 he has had right ankle pain on and off and has been walking with an everted foot. This particularly occurs after playing sports.
The entry dated 28 August 2019 states that Lorraine Sutton, the counsellor, received a text message from Lily Duxbury, close friend of Simone, Clive's mother. It stated that Simone was unable to make the counselling appointment as her little one was at home sick.
Simone had also said she cannot handle any talk about her husband's death. She wanted Lily to accompany her for counselling support.
The entry dated 30 October 2019 states his mother is worried about him since the motor accident, both mentally and physically.

He is disengaged, spends a lot of time in his room, sleeps a lot, does not want to play with other kids but sometimes goes out to play. He prefers to isolate himself and play on his phone.
He is having trouble with his ankles. His ankles are weak and he stumbles or has an ankle turn.
He has stomach problems and can only eat certain foods.
His mother is worried about the effect on his brain and she needs to say something to him several times before he understands what she is saying. He can find it hard to focus and interpret information.
The entry dated 24 January 2021, states he feels that he still has some glass in his legs.
The entry dated 24 January 2021 states that Clive's brother Shane had a speech appointment today. His mother raised mental health concerns about both children.
The entry dated 30 July 2021 states he had a MVA incident nightmare and anger issues.
The report by Dr Celine Hamid, Paediatric surgeon, dated 21 June 2017 states he has had 2-3 episodes, where he has presented to the GP and had bits of glass removed from his upper thighs. His wounds are healing and he has no trismus.
The dental wire fell off a week after discharge.
There is one area that potentially may have a small piece of glass which was attempted to be removed but Clive was in pain and was not very cooperative.
It was suggested to wait till it “pops out” a bit more and then get the GP to remove it.
The operating theatre report dated 14 May 2017 states the procedure was to remove a broken incisor after discussion with mother and to splint the tooth 21 to 22 with a wire to be removed in two weeks. He would need a soft diet for two to six weeks.
The operating theatre report dated 14 May 2017 states this was for washout and removal of foreign bodies from both anterior thighs.
The wounds were explored and scrubbed.
The Year 3 NAPLAN scores are:
·Reading - band one
·Writing - band three
·Language and conventions - band four
·Numeracy - band two

He was below the school average for all domains except language conventions which was above the school average and below the national average. The national averages were all above the school average.
The school report from Griffith Public School for Year 3, 2016, first semester is as follows:
·English achievement basic, effort two
·Mathematics achievement basic, effort two
·Science and technology, achievement basic, effort three
·History and geography, achievement basic, effort three
·Personal development, health and physical education, achievement sound, effort three
·Creative arts, achievement sound, effort three
·Social development report states that he follows the school rules sometimes and but is always respectful to teachers.

The comments are that he seems disengaged and lacking in motivation. He places a tremendous amount of effort into the organisation and presentation of his work. He is starting to show more willingness to participate in classroom activities. His absences from school have limited his academic progress. He enjoys sharing ideas during group activities. He would benefit from making sure he does not leave any classwork unfinished. He uses school equipment resources in an appropriate respectful manner.
He had seven full day absences, two partial day absences and seven unexplained absences.
The school report from Griffith Public School for Year 3, second semester 2016 as follows:
·English: achievement sound, effort two
·Mathematics: achievement basic, effort two
·Science and technology: achievement basic, effort two
·History and geography: achievement basic, effort two
·Personal development health and physical education: achievement basic, effort two
·Creative arts: achievement basic, effort two

Social development states that he mostly sometimes follows school and classroom rules. He is always cooperative and respectful with teachers.
His commitment to learning is mostly sometimes with one rarely and one always.
The comments are that he is disengaged from class activities which is impacting his ability to achieve the desired outcome. He has impeccable book work presentations. He shows commitment to his work depending on the activity and if he wants to participate.
He could improve by paying more attention to the instructions being delivered.
He is beginning to play with his friends and starting to initiate conversations with his peers.
He Is making improvements socially but this is still an area in which he needs further development.
He often appears tired which affects his ability to learn and to be focused throughout the day.
His lack of resilience and immaturity also affects his ability to work independently on tasks.
He has attained basic academic results this semester.
He had 15 full day absences, 23 partial day absences and 12 unexplained absences.
The report from Griffith Public School for Year 4, 2017 first semester is as follows:
·English: achievement basic, effort three
·Mathematics: achievement basic, effort two
·Science and technology achievement: basic, effort three
·History and geography achievement basic, effort three
·Personal development health and physical education: achievement basic, effort three
·Creative arts: achievement basic, effort four

The comments are that he is a happy and popular member of his class. He enjoys being with his friends in the playground and he takes most learning tasks positively.
He responds well to praise when following school and class rules.
He is beginning to understand that hard work leads to success.
He can confidently use computers and an iPad and has continued to develop in his ability to use word processing programs.
He had 32 full day absences, 16 partial day absences and 18 unexplained absences.
The school report from Lake Wyanga Public School, second semester Year 4 2017, is as follows:
·English: achievement basic
·Mathematics: achievement basic
·Science and technology: achievement basic
·History: achievement basic
·Geography: achievement basic
·Creative arts: achievement competent
·Personal development health and physical education: achievement competent
·Italian: achievement not applicable

He is assessed as satisfactory for effort on all domains except personal development health and physical education where it was assessed as very good.
It states he has a fantastic with a sense of humour and perceptive nature.
He enjoys exploring new information developing new skills. He is able to seek help from the teacher.
He has developed some friends and is learning a variety of conflict resolution skills.
He needs to improve his speed with tasks as he often does not complete them in the allocated time. He would improve with listening carefully to feedback.
The whole days absence were 18, partial days absent were three.
The report from Griffith Public School Year 5 2018, first semester is as follows:
·English: achievement sound, effort four
·Mathematics: achievement limited, effort two
·Science and technology: achievement basic, effort four
·History and geography: achievement sound, effort three
·Personal development health and physical education: achievement sound, effort five
·Creative arts: achievement sound, effort three

The comments were that is he was quiet and polite. He is social with his peers and participates in sporting activities. At the beginning of the year he did not participate often in group discussion unless asked to feeling uncertain of the topic.
He has become more active in group discussions as the semester has progressed. He is gradually developing the confidence to make contributions to class lessons.
He made some strong friendships this semester with students who have similar interests. He is respected by his classmates.
He displays the school values, especially when representing the school in sport.
He is capable of more improving but his poor attendance often hinders this.
His full day absences were 25, partial 14, and unexplained 18.
The school reports from Murrumbidgee Regional High School for 2020 show there were 11 partial absences and 64 total absences.
The school report from Murrumbidgee Regional High School for semester one, 2020 is as follows:
Quest: He is a dedicated student who approaches quest lessons with enthusiasm. His classwork demonstrates a sound understanding of concepts and content in both English and history topics. He has displayed strong organisational time management skills and is encouraged to continue developing these abilities to improve his results in the future.
Mathematics: He is a polite and friendly student who demonstrates a basic understanding of integers, decimals, fractions, and percentages this semester. His progress in mathematics is largely impacted by his unsatisfactory attendance.
He should be encouraged to attend class regularly to complete set tasks to the best of his ability.
Discovery: He is an outgoing student. He requires encouragement to listen to instructions and focus on his work in class.
He has a basic understanding of the water cycle.
His attendance was 50% this semester, which has meant he has missed out on key ideas, which has prevented him from completing the semester one assessment task.
Italian: He is polite and capable student. He found this subject challenging.
He can often be chatting in class.
His research task was quite impressive.
He should remain focused at all times if he is to improve.
He should revise vocabulary and language structures at home on a regular basis and concentrate on writing skills.
Personal development, health and physical education: He has demonstrated a fundamental understanding of the key concepts in the theory component.
He has satisfactory teamwork and cooperative skills in game situations and has sound movement skills that he has been able to adapt across different contexts.
His casual approach and lack of sustained diligence and effort and completion of the assessment task has impacted on his ability to meet outcomes.
Visual arts: He is a capable student. He found the individual nature of this course challenging.
It is difficult to assess his academic progress this semester due to lack of attendance.
Technology Mandatory: He has worked well in technology mandatory this semester and demonstrated a basic understanding of the design process through class activities.
He is demonstrating the ability to work safely with a range of cooking equipment during practical tasks.
This is based on non-assessable class work to gauge his level of understanding.
He could improve his achievement by asking questions if he is having difficulty.
The counsellor referral form from Murrumbidgee Regional High School for
3 March 2020 states he suffered trauma from his father's death, which meant he is struggling with stressful situations and can become reactive if not treated seriously.
His mother is protective of him and can come across as abusive on phone to staff.
The notes from school counselling in 2019 from Griffith Public School include:
The entry dated 20 February 2019 states his mother Simone was complaining the Griffith Public School and the school counsellor were not supporting her son. She wants the school to provide regular counselling for Clive which they are not doing.
He was involved in a fatal car accident two years ago in which his father was killed. She took him out of Griffith Public School enrolled him in Lake Wyanga Public School. He received some counselling while he was there.
She re-enrolled him at Griffith Public School in 2018,. She believes he was not offered counselling. Matthew Daniels Aboriginal Education liaison officer said Clive is a boy at risk, and Simone's mental health is not good.
The entry dated 20 February 2019 states Clive has friends in class and in the playground. He is happy to be in the class.
He does not find learning activities easy, especially mathematics and lacks persistence and effort.
He gets angry easily. He does not have a good attendance.
His teacher commented that communication with his mother is usually good, although she can get angry in communications with the school.
The entry by Julia Hopp dated 18 February 2019 states this was a conversation with Clive's mother. It states that communication became agitated. His mother stated that it is 22 months since Clive's father died and he has not broken down yet.
I explained that everyone grieves differently. He appeared to be fine when he was seen lately and did not want to come. She started shouting and said if I don't have the time or patience to see him she will take him to Headspace.
She was advised she is at liberty to do what she wishes and Clive is welcome to come back.
She would not listen, kept shouting, stated you haven't lost your father. I said I actually had she said well you weren't nine. I said no, I was six.
She kept shouting at me and then slammed down the phone.
The entry dated 15 February 2019 by Julia Hopp stated that she had not seen Clive much and he said he did not want to see her that much.
He told me an incident with Shakaria when she was rude, swearing and insulting his late father.
We decided instead of getting upset, shouting and swearing like the other person, you should say I'm not listening to you and you have no manners.
He will collect his award for sports captain today.
The further entry dated 15 February 2019 by Julia Hopp states she telephoned his mother who stated she wanted her to see Clive regularly. She was advised that she could not see him regularly due to the number of schools that she had to attend.
The entry dated 15 June 2018 by Julia Hopp states Clive is happy and smiling. He feeling better and has been writing his notebook and drawing pictures.
He is spending lots of time playing online video games, but should sometimes spend time outside as well as looking at screens.
The entry dated 12 June 2018 states this was a telephone call to Clive's mother. She thanked me and appreciated that I had seen him.
She asked if he could be seen twice each week. I said I could try to do that depending on whether I have to go to other schools and I have to work responsibly with children. I could only see him regularly for a while.
The Personal Injury Commission certificate by assessor Michael McGlynn dated 31 January 2024 states that Clive O'Hara has facial soft tissue injury scarring of 2%, which is not greater than 10%.
The Personal Injury Commission Certificate of Assessor Ian Cameron dated
3 February 2024 states the injuries of cervical spine - soft tissue injury, right ankle - soft tissue injury, right knee - soft tissue injury, right and left lower extremity (thighs and legs) - soft tissue injury has a whole person impairment of zero percent.
Personal Injury Commission Certificate by Assessor Paul Nichols dated
4 February 2024 states the injuries of damaged teeth unspecified is resolved and there is no assessable permanent impairment.
The Personal Injury Commission combined certificate by Assessor Cameron dated 6 February 2024 states the injuries to the face, cervical spine, right ankle, left knee and right and left lower extremities and damaged teeth and facial scarring have a whole person impairment of 2%.
The report by Dr Jeffrey Baron-Levi clinical neuropsychologist dated 24 September 2020 concludes:
His mother's report of his post-accident behaviour suggested he had symptoms anxiety following the motor accident and was grieving for his father.
His symptoms are at a subclinical level.
His mother's report on the child behaviour checklist are that anxious/depressed behaviours, withdrawn/depressed behaviours, somatic complaints and thought problems were all significant concern to her and placed in the clinical range compared to his peers.
His mother's rating of his anxiety on the Spencer children's anxiety scale placed obsessive compulsive disorder, social phobia, panic attack/agoraphobia, separation and generalised anxiety all within the clinical range compared to boys of his age.
Clive's reporting on the same measure rated obsessive compulsive, panic attack/agoraphobia and generalised anxieties elevated but at a subclinical level.
He rated social phobia, separation anxiety and physical injury fears in the normal range.
His measure of self-esteem placed him in the high range compared to his peers.
I am of the opinion that his current presentation was subclinical level as evidenced by the fact that he did not appear to be a diminution of his academic performance and he rated his anxiety in the normal range and his self-esteem in the high range and was able to train and play rugby league.
There is an issue with school attendance which may be related to either his low level of academic functioning or to concern for him.
His mother is understandably concerned about his well-being following his involvement in the motor vehicle accident subsequent death of his father.
There are issues with Clive's academic standing his social and behavioural development before the subject accident. His testing on the auditory verbal learning test showed he performed below average on immediate recall of verbal information suggesting problematic learning ability.
I am of the view that his mother is overly anxious about her son and it is possible she overreported his level of anxiety.
His mother was concerned that he may be depressed but there was no evidence of that.
Clive during the interview was reactive in mood, established an easy rapport and maintained a good level of eye contact.
The records from the Clontarf Foundation contain the following:
The records from the Clontarf Foundation show that he attended various sporting carnivals between 31 July 2020 and 7 September 2023. These were mostly for rugby league but also cricket and golf.
The records from the Clontarf from 7 February 2020 to 14 February 2023 shows that he attended morning training for various sports including cricket on 14 February 2023, something is described as mixed on 29 November 2022 and on 18 October 2022.
He was attending during 2022, attending training for basketball, swimming, cricket.
He was attending training during 2021 for Oztag/touch, basketball, rugby league, swimming, and cricket.
During 2020, he attended training for basketball, league, Oztag/touch, other, cricket. These were all for afternoon training.
The records of the Clontarf Foundation show that he attended various camps described as Year 7 Induction Camp, Year 7 and 8 Overnight Camp, Top Trainer's Camp, Wade Fishing Comp, Year 9 and 10 Wollongong Camp, Wagga Cricket Camp and Employment Forum Camp between 20 February 2020 and 31 August 2023.
The records of the Clontarf Foundation state that on 1 April 2023 he was working part-time, usually as a pizza hand at a pizza restaurant in Hanwood.
The records from the Clontarf Foundation employment history shows there were worksite visits on 4 September 2023 and 18 March 2021. He attended employment forums on 30 August 2023 and 28 July 2023.
He attended a workshop/training, casting competition and talk with New South Wales Fisheries on 30 July 2022.
The training activities appear to have occurred in Griffith.
The camps were variously in Wagga, Narrandera, Gogeldrie Weir, Wollongong, and Darlington Point.
The sporting games/carnivals were variously in Tuggerah, Wagga, Darlington Point, Orange, Young, and several in Griffith.

DETERMINATIONS

Diagnosis and reasons
The Review Panel considered all the available information including the content of the supplied documents and the information obtained at this examination.
The Review Panel determined that Mr O’Hara reached criterion for the condition of a Chronic Major Depressive Disorder which has been present since the motor accident.
He reaches criterion as follows.
He is depressed most or every day, feels empty and sad.
He has lost interest and pleasure in activities most days.

He had a period of significant weight loss. He has a poor appetite every day.
He has difficulty falling asleep at night.
He has a lack of motivation.
He feels very guilty about what occurred in the motor accident, feeling that he may have prevented it if he was awake.
He has impaired concentration every day.
He has thoughts about suicide which were recurrent but does not have any plans and has not attempted deliberate self-harm.
These symptoms have caused and continue to cause distress and impairment in social and school functioning and day to day interactions.
This condition is not attributable to the physiological effects of a substance or another medical condition.
The condition is not better explained by a diagnosis of schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder or other unspecified schizophrenia spectrum or other psychotic disorder.
There has never been a manic or a hypomanic episode.
Assessor Christopher Rikard-Bell, in his report dated 13 May 2024, made a diagnosis of Prolonged Grief Disorder.
The Review Panel determined that Mr O’Hara had more depressive symptoms than would be consistent with that diagnosis.
The Review Panel noted that Mr O’Hara did not describe sufficient symptoms to reach criterion for the diagnosis of Post Traumatic Stress Disorder.
His symptoms exceed criterion for a diagnosis of Adjustment Disorder with a Depressed Mood.
He has ongoing psychiatric/psychological symptoms sufficient to reach criterion for a psychiatric diagnosis and not at a subclinical level as stated in the report of Dr Jeffrey Baron-Levi.
Causation and reasons
Mr O’Hara had no impairment of his functioning prior to the motor accident.
He developed various psychiatric/psychological symptoms, being easily irritated, following the motor accident.
It is common for adolescents to become irritable when depressed.
Mr O’Hara has not suffered any subsequent significant traumatic event unrelated to the motor accident. The ongoing irritability, including the repeated arguments with his mother arise from the injuries sustained in the motor accident.
The Review Panel determined that the condition of Chronic Major Depressive Disorder arises from the injuries sustained in the motor accident.
Summary of injuries referred by the parties
The following injuries WERE caused by the motor accident:
·Chronic Major Depressive Disorder.

PERMANENCY OF IMPAIRMENT
Permanent impairment is defined in the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) (p.315) as follows:
“Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment.
A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment.”
The Review Panel determined that Mr O’Hara’s condition is stable and permanent.
It has been over eight years since the motor accident.
He has had some counselling treatment but no other treatment.
No new treatment is proposed for his condition.
It is very unlikely at this stage that any intervention would lead to a significant change in his mental state.
The Review Panel determined the condition is stabilised and permanent and unlikely to change substantially and by not more than 3 % in the next year with or without medical treatment.
Degree of permanent impairment Psychiatric Impairment Rating Scale
The determination as to permanent impairment is made in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Motor Accident Guidelines.
Remember to include specific reasons for the assigned class for each area of function. This should relate to the findings in your Clinical Examination section.

Psychiatric diagnoses

1. Chronic Major Depressive Disorder

Psychiatric treatment description

Treatment by the school counsellor in Primary School

Treatment by an external counsellor in Secondary School.

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	2	Mild impairment. Mr O’Hara does miss breakfast. He does have a lack of motivation. He did not describe any difficulty with showering, but he does lie in or on his bed for long periods of time, particularly if he is not going to school. He relies on his stepmother to wash his clothes. He now relies on his stepmother to cook the evening meal with which he previously helped his mother. Mr O’Hara is aged 17 years and it is not age appropriate for him to be fully independent in his self-care, personal hygiene and daily activities.
2. Social and Recreational Activities	2	Mild impairment. Mr O’Hara can go to football training and prior to being suspended, played football each week. He also played touch football in summer. He appears to be not as outgoing as he was prior to the motor accident and spends a lot of time at home in his room.
3. Travel	2	Mild impairment. Mr O’Hara can drive on his Learner’s licence but cannot cope with noise in the vehicle. He avoids travelling on the school bus because it is crowded and he must repeatedly get on and off the bus. He is more comfortable, and it is less noisy if he is travelling on the Clontarf bus. He can walk home after meeting his friends in town after school.
4. Social Functioning	3	Moderate impairment. Mr O’Hara has relocated from living with his mother, brother and younger sister because of repeated arguments including a recent very intense argument. The relationship with his mother which was the most important relationship in his life after the death of his father. He was not in a relationship at the time of the accident. His subsequent relationship has ended.
5. Concentration, Persistence and Pace	2	Mild impairment. Mr O’Hara does attend school but struggles to concentrate and focus. His concentration and focus have improved since receiving assistance from an Indigenous support teacher. He describes zoning out and blanking out at school and at home and not being able to maintain his concentration on television programs or social media. Nonetheless he was able to sit through an examination which lasted almost 1½ hours and answer the questions to the best of his ability.
6. Adaptation	3	Moderate impairment. Mr O’Hara misses one to two days each week at school. He attends school for full days when he does attend school. The starting times for school are variable in Year 12. He misses school because he has a lack of motivation and interest and feeling more depressed.
List classes in ascending order: 2, 2, 2, 2, 3, 3
Median Class Value: 2
Aggregate Score: 14
% Whole Person Impairment: 7 %

*%WPI ^{= Percentage Whole Person Impairment}
Apportionment – pre-existing/subsequent impairment
Mr O’Hara did not have any impairment in his pre-accident functioning.
He has not experienced any subsequent trauma or other adversity unrelated to the events and injuries sustained in the motor accident.
There is no need to do a pre or post accident apportionment.
Effects of treatment
Mr O’Hara has had counselling with the school counsellor and an external counsellor in Year 8. There has been no benefit from the counselling.
Current whole person impairment 7 %
Apportionment   0 %
Effects of treatment   0 %
Final whole person impairment     7 %

CONCLUSION – PERMANENT IMPAIRMENT
Degree of permanent impairment caused by the motor accident
7%
Permanent impairment ratings take your symptoms into account, however the percentage permanent impairment is not a direct measure of disability.
A finding of zero percent (0%) permanent impairment indicates that there was an injury caused by the motor accident and that there may be continuing symptoms, however, pursuant to the relevant Guides and Guidelines, permanent impairment arising from the injury is assessed at 0%.”

FINDINGS

The review is a new assessment of all matters with which the medical assessment is concerned.
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[34] and Insurance Australia Ltd v Marsh.[35]
[34] [2021] NSWCA 287 at [40], [41] and [45].
[35] [2022] NSWCA 31 at [11], [21] and [64].
The Panel adopts the extensive reasons provided by the Medical Assessors. We confirm that the impairment is based on the evaluation at the time of the medical assessment (cl 1.21 of the Guidelines) and we have relied on the combined clinical expertise of the Medical Assessors when examining the claimant.
The certificate issued by Medical Assessor Rikard-Bell is revoked. A replacement certificate is attached at the commencement of these Reasons.

[2025] NSWPICMP 569

4 August 2025