Pavlovic v AAI Limited t/as AAMI
[2022] NSWPICMP 408
•19 October 2022
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Pavlovic v AAI Limited t/as AAMI [2022] NSWPICMP 408 |
| CLAIMANT: | Mrdjan Pavlovic |
INSURER: | AAI Limited t/as AAMI |
| REVIEW Panel | |
| PRINCIPAL MEMBER: | John Harris |
| MEDICAL ASSESSOR: | Dr Michael Hong |
| MEDICAL ASSESSOR: | Dr Atsumi Fukui |
| DATE OF DECISION: | 19 October 2022 |
CATCHWORDS: | MOTOR ACCIDENTS – The claimant suffered injury in a motor accident on 20 November 2017; the issue was the extent of any permanent impairment of psychiatric injury; the claimant was re-examined by both Medical Assessors and did not admit to prior psychological injury despite reported histories over three years in the early 2000’s; the claimant was diagnosed with an adjustment disorder and somatic symptom disorder; permanent impairment assessed at 8% with an allowance for treatment effects; observations made of the claimant’s unsatisfactory responses to questioning showing a degree of evasiveness; Held – claimant’s whole person impairment assessed at not greater than 10%. |
| DETERMINATIONS MADE: | The Review Panel revokes the certificate of Medical Assessor Sidorov dated 5 September 2021 and issues a new certificate that the following injuries caused by the motor accident give rise to a whole person impairment which is NOT GREATER THAN 10%: · adjustment disorder with mixed anxiety and depressed mood, and · somatic symptom disorder with predominant pain. |
REASONS
BACKGROUND
Mr Mrdjan Pavlovic (the claimant) suffered injury in a motor accident on 20 November 2017 when the insured vehicle struck the rear of his vehicle (the motor accident). The exact circumstances of the motor accident are in dispute.
AAI Ltd (the insurer) is liable for the driver of the other motor vehicle for liability to pay to Mr Pavlovic any damages under the Motor Accidents Compensation 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 Act.[1]
[1] See ss 57 and 58 of the MAC Act.
Section 44(1)(c) of the MAC Act provides that the 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.[2]
[2] 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 Sidorov dated 5 September 2021.[3]
[3] Claimant’s bundle, page 172.
Medical Assessor Sidorov found that there was no psychological injury caused by the motor accident.
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 Act and Schedule 1, cl 14F(2) of the Personal Injury 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 (the Commission).
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.[6]
[6] Section 41(2) of the PIC Act.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[7]
[7] Rule 128 of the PIC Rules.
The review is by way of new assessment of all matters with which the medical assessment is concerned.[8]
[8] Section 63(3A) of the Act.
The parties provided respective bundles of documents for the Panel’s consideration.
MEDICAL ASSESSMENT UNDER REVIEW
This review is from the assessment of Medical Assessor Sidorov dated 5 September 2021 who determined that the claimant did not sustain a psychological injury caused by the motor accident. The Medical Assessor noted multiple inconsistencies in the claimant’s presentation and was “notably vague and inconsistent in his history and presentation during the assessment”. After summarising various reports and materials, the Medical Assessor concluded that injury caused by the motor accident was not established.
SUBMISSIONS
Insurer’s submissions dated 11 September 2020[9]
[9] Insurer’s bundle, p 1.
The insurer referred to various inconsistencies in the evidence including:
(a) that the prior CTP claim, psychiatric treatment or diagnosis were not disclosed to Dr Gertler, and
(b) that prior treatment and assessments were not disclosed to Dr Dixon or
Professor Fearnside.The insurer submitted:[10]
“The Claimant cannot be taken at his word. As such, the Assessors must consider only objective evidence when assessing the Claimant.”
Claimant’s submissions dated 18 October 2021[11]
[10] Insurer’s bundle, p 2.
[11] Claimant’s bundle, p 167.
These submissions were filed seeking a review of the Medical Assessment. The claimant referred to the psychological treatment from Dr Protulipac, psychologist and Dr Blagoje Kuljic, psychiatrist. The psychiatrist diagnosed anxiety and depression as a reaction to chronic pain. He noted that Dr Gertler diagnosed an adjustment disorder with depressed mood.
The claimant accepts that causation of psychological injury was in dispute given the contrary opinion of Dr George. In those circumstances the Medical Assessor failed to provide adequate reasons why he came to the opinion that the claimant did not sustain a psychological injury.
The claimant submitted that the Medical Assessor’s findings were that the claimant’s inconsistency was such that there could be no diagnosis of injury made. It submitted that there were otherwise multiple aspects of the claimant’s history and presentation observed by the Medical Assessor that would warrant the making of a psychiatric diagnosis.
EVIDENCE
Pre-existing conditions
The claimant suffered a motor accident on 26 August 2001 alleging that he suffered various physical injuries and “shock, anxiety, nervousness” and disturbed sleep.[12] Proceedings for damages were commenced in the District Court. The claimant then alleged that he suffered “psychological and psychiatric sequelae”.[13]
[12] Insurer’s bundle, p 11.
[13] Insurer’s bundle, pp 39, 41.
Adrienne Margarian, psychologist provided a report dated 1 October 2003.[14] The psychologist recommended that Mr Pavlovic undergo psychological counselling to address his symptoms of trauma and depression.
[14] Insurer’s bundle, p 106.
Dr McClure, psychiatrist provided an opinion dated 1 June 2004 as part of the Medical Assessment Service for permanent impairment resulting from the earlier motor accident.[15]
[15] Insurer’s bundle, p 72.
Dr McClure stated:[16]
“The history suggests that Mr Pavlovic has been seen by psychiatrists regularly for almost 21/2 years. He has been tried on a number of medications, none of which has particularly suited him. He remains symptomatic. He is preoccupied with his physical symptoms.”
[16] Insurer’s bundle, p 80.
The doctor concluded that Mr Pavlovic suffered from a chronic adjustment disorder with mixed anxiety and depressed mood and had a 5% whole person impairment. Dr McClure also assessed that the psychological injury affected both past and future earning capacity.[17]
[17] Insurer’s bundle, p 87.
Dr Reid assessed the physical injuries resulting from the earlier motor accident finding that they did not give rise to an impairment greater than 10%.[18]
[18] Insurer’s bundle, 100.
Contemporaneous evidence
The police report confirmed that the insured driver failed to stop, and rear ended the claimant’s vehicle.[19] The police called the ambulance who attended the police station and conveyed Mr Pavlovic to hospital.
[19] Claimant’s bundle, page 350.
The ambulance report referred to chest and back pain. It was noted that there were minor scratches to bumper bar with no airbag deployment.[20]
[20] Claimant’s bundle, page 304.
Hospital records on the day report chest and trunk pain with an examination described as “unremarkable”.[21]
[21] Claimant’s bundle, page 359.
The claim form dated 8 January 2018 confirms the nature of the motor accident reported to the police. The symptoms are consistent with what is recorded by the general practitioner.[22]
[22] Claimant’s bundle, page 560.
General practitioner
Mr Pavlovic attended his general practitioner on 28 November 2017 complaining of pain in the neck, both shoulders, chest and back. Mersyndol forte tablets were prescribed.[23] The clinical notes record regular attendances for pain.
[23] Claimant’s bundle, page 182.
In February 2018 Mr Pavlovic was complaining of anxiety and insomnia.[24] In September 2018 the general practitioner noted that Mr Pavlovic was “depressed”.[25]
[24] Claimant’s bundle, page 184.
[25] Claimant’s bundle, page 189.
Treating evidence
The clinical notes of Dr Zoran Protulipac, psychologist, show extensive treatment over a number of years with minimal, if any, resolution of psychological symptoms.[26] Dr Protulipac diagnosed the claimant with a major depressive disorder[27] and otherwise suffering from post-traumatic stress disorder (PTSD), anxiety and depression due to his reaction to chronic pain.[28]
[26] Claimant’s bundle, pp 5 - 166.
[27] Claimant’s bundle, p 109, 153.
[28] Claimant’s bundle, p 102.
In December 2018 Dr Blagoje Kuljic, treating psychiatrist, opined that the claimant suffered from anxiety and depression as a rection to his chronic pain.[29]
[29] Claimant’s bundle, p 363.
In late 2018 Dr Marc Coughlan, neurosurgeon, opined that the claimant had a disc herniation at C5/6 and required cervical discectomy and fusion.[30]
[30] Claimant’s bundle, p 362.
Qualified evidence
Dr Fearnside, neurological surgeon, assessed a variety of soft tissue injuries and assessed cervical spine radiculopathy. The doctor assessed impairment at 34%.[31]
[31] Claimant’s bundle, p 322.
Dr Dixon, orthopaedic surgeon, provided a report dated 19 February 2019.[32] The doctor also assessed cervical radiculopathy and assessed impairment at 24%.
[32] Claimant’s bundle, p 377.
Dr Casikar, neurosurgeon, did not accept that the arm symptoms related to pathology at C5/6 and did not support Dr Coughlan’s request for surgery.[33] The doctor diagnosed whiplash injury and depression.
[33] Claimant’s bundle, p 385.
Dr Martin Allan, psychiatrist, provided a report dated 24 September 2018.[34] The doctor opined that Mr Pavlovic suffered from a major depressive disorder and somatic symptom disorder with predominant pain.
[34] Claimant’s bundle, p 500.
Dr Gregory McGroder, physician, could not identify any objective evidence of a physical injury and opined that the claimant suffered from “significant psychological problems”.[35]
[35] Claimant’s bundle, p 507.
Dr Andrew Keller, physician, provided a report dated 8 April 2019.[36] The doctor opined that there was no objective evidence of ongoing injuries attributable to the motor accident.
Dr Keller observed:[37]“It is difficult to determine Mr Pavlovic’s genuine physical status due to the inconsistencies in both history and presentation. It is possible that he is entirely unrestricted and that this would be better assessed outside of the clinical setting.”
[36] Insurer’s bundle, p 149.
[37] Insurer’s bundle, p157.
Dr Graham George, psychiatrist provided a report dated 23 April 2019.[38] The doctor described Mr Pavlovic’s presentation in the following terms:
“At best, Mr Pavlovic provided what would best be described as a minimal history and on different occasions could not provide an answer to reasonably basic question.
In view of his presentation, there was a question over his validity as an accurate historian. At the outset, my initial impression, and my final impression, was that Mr Pavlovic should be subjected to forensic psychological testing to test the validity of his general presentation and alleged psychopathology.”[38] Insurer’s bundle, p. 158.
Dr George noted that Mr Pavlovic did not volunteer any information concerning the 2001 motor accident. Based on the “paucity of response provided”, Dr George did not make a psychiatric diagnosis.
Dr Robert Gertler, psychiatrist, provided a report dated 10 September 2018. He noted
Mr Pavlovic does not recall the actual impact of the 2017 accident and was briefly unconscious. In December last year, he experienced a panic attack. Mr Pavlovic has a poor sleep pattern and sleeps separately from his wife. He has no appetite and has a fluctuating weight. He is depressed and hopeless. Prior to the accident, Dr Gertler noted that
Mr Pavlovic enjoyed good physical and emotional health. He was extremely active, enjoyed skiing, hunting for pigs and deer, and was very social, going out with friends regularly.
Dr Gertler diagnosed an adjustment disorder and opined that he had an uncertain prognosis. He also provided WPI with ratings 2, 3, 2, 2, 3, 5. He rated Mr Pavlovic's concentration, persistence and pace as 3.
RE-EXAMINATION
Mr Pavlovic was examined by both Medical Assessors on 4 October 2022. The claimant’s solicitor advised the Commission that an interpreter was not required for the examination.
The joint examination report is as follows:
“History
Psychosocial history and pre-accident history
Mr Pavlovic has had two car accidents.
Mr Pavlovic was born in the former Yugoslavia and came to Australia in 1998. There was no developmental trauma reported. He is not aware of a family history of mental illness.
He does not have drug or alcohol problems.
He reported having high blood pressure after the 2017 accident.
Around mid-way during the assessment, The Panel asked Mr Pavlovic about his psychiatric history and history of treatment before 2017. He said he was ‘fine’.
The Panel made specific enquiries regarding the accident in 2001. Mr Pavlovic confirmed he had an accident in Smithfield and said that he suffered right knee problems and applied for compensation.
The Panel asked Mr Pavlovic what psychiatric symptoms and treatment he had in 2001, such as counselling and psychiatric medication. With each question, his response was mostly ‘I cannot confirm or deny’.
The Panel discussed with Mr Pavlovic that after 2017, he has been assessed by several psychiatrists, and each one recorded that he had no prior psychiatric problem. There was a psychiatrist report in relation to the 2001 accident. The Panel asked him why he did not discuss the 2001 psychiatric injury with the other assessors. His response was that he could not confirm or deny the psychiatric history at that time.
Mr Pavlovic reported he had no depression or anxiety symptoms before 2017, and that he had been well for years, but he could not be more precise than that.History of the motor accident
On 20 November 2017, Mr Pavlovic recalled he was working and driving by himself. He had stopped at the traffic light, and he was rear-ended. He reported he lost consciousness briefly. He said the other driver ran away.
He drove to the police station to give a statement and started feeling dizzy, so the police called an ambulance, and he was taken to St Vincent's Hospital and observed for 6 to 7 hours. His airbag was not deployed. He does not know if the car was repaired or has been written off by the insurer as it was a company car.
He suffered chronic physical problems, predominantly affecting his neck, back and shoulders. He has headaches and spasms, particularly in the left arm. He has been told he suffered C5/6 disc injury. He still suffers from dizziness sometimes. He said that he tends to lean on the right leg more now, his back is very sensitive, and feels like he cannot do anything. He said there had been a discussion about C5/6 disc fusion, and he has not had any surgery since the subject accident.
In terms of Mr Pavlovic's current physical tolerance, he reported he can walk 30 minutes sometimes, but not every day. He mostly just walks in his backyard around the pool. If he does not feel good he would hang onto something. He thinks he might be able to lift 2 or 3 kg, but he is not sure how much exactly.
Mr Pavlovic reported he wakes up with pain, and has to do everything ‘gently’. He stated pain affects everything, his sleep, walking and everything he does. He has to constantly change his posture. If he holds a bottle, he has to hold it close to the body to minimise pain.
Physically, he reported that his symptoms were the worst during 2021. He stated that his body shut down, he could not even wipe himself after he opened his bowel, his wife had to use a belt to help him walk and he could not support himself without her help.History of symptoms and treatment following the motor accident
During the accident, Mr Pavlovic recalled that he was not worried. Then he started to worry because he could not feel his body well and started having “strange pain”. Then depression and anxiety became a problem. After the accident, Mr Pavlovic reported that he feels worthless, that he is a ‘nobody’ and he has ‘lost everything’. He developed depression and anxiety, because of the physical injury and pain. He explained he had a great career and a future before the subject accident, but now everything is gone.
He recalled his anxiety and depression commenced within weeks of the 2017 accident.
He described having shame and stated he cannot work because of his physical injuries and pain. He is hoping that he could have an operation and become better and then he would be able to go back to work.
After the subject accident, he said he lost confidence in driving. He can drive for about 30 to 40 minutes now, and after that, he becomes very tired. He tends to only drive on familiar roads. He prefers to be the driver as he knows when the turns are coming and he can brace himself. Being a passenger is more problematic because he does not know when the car is to turn. He does not use trains or buses and said that he cannot hold onto things on public transportation as he is not steady on his feet.Details of any relevant injuries or conditions sustained since the motor accident
Mr Pavlovic has not had further car accidents or sustained other psychological injuries.
Current symptoms
He reported having depressed mood with amorphous symptoms. He finds it difficult to answer whether his depression is constant or intermittent.
He has reduced enjoyment and motivation.
He recalled he was 79 to 82 kgs before the 2017 accident. He gained weight after the subject accident, up to 92 kgs, then started losing weight, recently he is 78 kg. He has a poor appetite.
His sleep is poor as a result of pain during the night. He does not have nightmares.
He is easily fatigued.
He feels anxious and has had panic attacks.
He has been irritable.
He reported being quiet and socially withdrawn.
He denied having had suicidal ideation or being physically aggressive.Current and proposed treatment
Mr Pavlovic is currently taking:
· Agomelatine
· Diazepam 5 mg, 2 tablets daily
· Mersyndol forte, 1 to 1.5 tablets daily
· Tixol
He had treatment with Zoran Patulipac, psychologist, and he stated that the last session was a long time ago.
He has recently been consulting Dr Blagoje Kuljic, psychiatrist, every 4 weeks. He reported he feels better with treatment.
Clinical Examination
Mental State examination
Mr Pavlovic was assessed by an audio-visual link using the MS Teams platform. He was at home during the assessment.
The assessment took 75 minutes.
Mr Pavlovic’s long hair was tied back. He had a full beard and a worried expression. He spoke spontaneously and was generally talkative. There was no latency. He was moderately restricted in his affect.
He spoke with an accent and was easy to comprehend. He provided a detailed history, apart from his 2001 history. There were no difficulties in staying within a topic. He maintained a normal pace and speed. There was no overt cognitive impairment.Current functioning
Mr Pavlovic is living with his wife. They have no dependents.
He spends most of his time at home in his room and would spend some time looking at photos. He spends a little time in the backyard, watching birds.
Before the subject accident, he said he liked to go hiking, bird watching, driving, being in nature. He is no longer able to do these activities except for bird watching. He said hiking is too physically demanding. He walks in the backyard and sometimes feels dizzy, then he has to lie down or go back to his room.
The groceries are delivered to his home and his wife does all the cooking. He said that he has a good diet because his wife cooks. He said that if his wife goes away, she would leave food for him, which he would heat to eat.
He does not do shopping as he does not want to go out. He said he tried to do some housework, but his wife did not like the way he did it and there were some arguments, so he is not doing much housework now.
Mr Pavlovic's parents and sister are in Australia, but he is not having much contact with them. He saw his parents in March 2022, and a couple of months before that. He saw his sister a few weeks before, and the time before was in 2021. He is no longer in contact with any friends.
He has been married for 11 years, they have not separated, but the relationship is not good because they argue. He reported that six months ago their relationship further deteriorated, and they have become ‘cold’ towards each other, and they now sleep in different rooms.
Employment history:
Mr Pavlovic was still at school in Yugoslavia and was not engaged in any work.
He then came to Australia and finished year 10. He went to TAFE, but he did not finish his training. He worked in the electrical trade and in construction.
After the first accident in 2001, Mr Pavlovic was off work, but he does not remember for how long he did not work. He went back to work doing construction and building maintenance and reported that he was self-employed between 2004 and 2017. He worked 8 hours a day, five to six days a week.
After the subject accident in 2017, Mr Pavlovic had been certified fit for around 25 hours of work per week, and he said that he looked for suitable work in a similar field but could not find any work. He has worked since 2017.Comments of consistency
The Panel discussed Mr Pavlovic's 2001 accident and psychological injury with him and noted his responses. He was vague and when pressed for clarification and he responded with ‘I cannot confirm or deny’.
Determinations
Diagnosis and reasons
The Panel concludes that Mr Pavlovic has developed an Adjustment Disorder with Mixed Anxiety and Depressed mood, and Somatic Symptom Disorder with predominant pain.
His symptoms fulfill the DSM-5 diagnostic criteria for an Adjustment Disorder:Criterion A: Mr Pavlovic developed emotional and behavioural symptoms in response to an identifiable stressor, within 3 months of the subject accident.
Criterion B: His psychological symptoms are clinically significant, as evidenced by marked distress that is out of proportion to the severity or intensity of the stressor. The Panel have considered his previous psychological history and the cultural factors that might influence his symptom and presentation.
Criterion C: This is not merely an exacerbation of an underlying condition and does not meet the criteria for another disorder
Criterion D: Mr Pavlovic's symptoms do not represent normal bereavement reaction.
Criterion E: His psychological symptoms have not resolved after 6 months, as the physical injuries and chronic pain arising from the subject MVA perpetuated his psychological distress.Mr Pavlovic's symptoms fulfil all of the DSM-5 diagnostic criteria for Somatic Symptom Disorder (with predominant pain):
Criterion A: Pain is distressing and has a significant disruption to his daily life, and everything he does.
Criterion B: Mr Pavlovic devoted excessive time and energy to his health. Pain is present all the time and significantly interferes with everything he does day-to-day.
Criterion C: Mr Pavlovic's somatic symptoms and pain symptoms have persisted for more than 6 months.Causation and reasons
Mr Pavlovic has a previous psychiatric disorder according to the available medical evidence. He stated he had maintained remission for years before the subject accident in 2017, and could not be precise with his previous symptoms, impairment or treatment.
The onset of his current psychological symptoms is directly related to the subject MVA in 2017 and associated physical injuries. The Panel has not identified other contributing factors in the relevant timeframe.
Having analysed Mr Pavlovic's history, The Panel determined the subject MVA has more than a negligible contribution to his current psychological injury.
Permanency of impairment
Permanent impairment is defined in the AMA4 Guides 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.’
Mr Pavlovic's impairment is permanent and entrenched, and unlikely to change substantially and by more than 3% in the next year, with or without medical treatment.
The Panel noted that Mr Pavlovic focused well during the 75-minute assessment, and there was no significant cognitive problem elicited, and therefore rated 2.
The Panel noted that Mr Pavlovic looked for work but could not find work within his physical restrictions. He wants to work but finds that he cannot do so physically. He also reported anxieties around people. From a psychological perspective, The Panel considered he has reduced work capacity and rated 3.Degree of permanent impairment Psychiatric Impairment Rating Scale
Current PIRS
Psychiatric diagnoses 1. Adjustment disorder with mixed anxiety and depressed mood 2. Somatic symptom disorder with predominant pain 3. 4. Psychiatric treatment description Antidepressant medications
Psychiatrist
Psychologist
Category Class Reason for Decision 1. Self Care and Personal Hygiene 2 Mr Pavlovic reported neglecting his self-care. He said he skips meals and relies on premade meals, e.g. from his wife. He showers daily. He does not need prompting with his self-care and personal hygiene.
2. Social and Recreational Activities 3 He used to have an active social life and went out with his friends regularly.
He stopped attending social gatherings or recreational activities with his friends.
3. Travel
2 Mr Pavlovic is anxious when he leaves home and avoids crowded places.
4. Social Functioning
2 Mr Pavlovic's relationship with his wife has been strained as he starts arguments with her, without separation or domestic violence.
He is anxious and socially avoidant, and no longer has contact with his friends.5. Concentration, Persistence and Pace 2 Mr Pavlovic reported having reduced concentration.
He does not engage in any intellectually demanding tasks.
His mental state examination is consistent with mild impairment score of 2.6. Adaptation
3 From a psychological perspective, he can manage a low stress employment at around 20 hours per week within his physical capacity. He would predominantly work on his own to minimise contact with people.
List classes in ascending order: 222 233
Median Class Value: 2
Aggregate Score: 14
% Whole Person Impairment: 7 %
*%WPI = Percentage Whole Person Impairment
Psychiatric Impairment Rating Scale - Pre-existing/subsequent impairment
Mr Pavlovic has not sustained a subsequent injury.
He has a past psychiatric history.
Category
Class Reason for Decision Self-care & Personal Hygiene
1 Mr Pavlovic reported he had no impairment before the subject accident.
Social & Recreational Activities
1 He had various social and recreational activities with his friends and he said he had no problems with recreational activities.
Travel
1 No impairment before the subject accident. He said he loved driving.
Social Function
1 No impairment before the subject accident.
He described having good relationships with his wife, friends and family.Concentration, Persistence & Pace
1 No impairment before the subject accident reported.
Adaptation
1 He was working full-time at the time of the subject accident.
List classes in ascending order:
1 1 1 1 1 1
Median Class Value: Aggregate Score:
1 6
Whole Person Impairment:
0%
Apportionment
Nil.
Effects of Treatment
A mild treatment effect of 1%.Mr Pavlovic has gained some symptomatic relief with treatment.
CONCLUSION
DEGREE OF PERMANENT IMPAIRMENT CAUSED BY THE MOTOR ACCIDENT
8%.”
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[39] and Insurance Australia Ltd v Marsh.[40]
[39] [2021] NSWCA 287 at [40], [41] and [45].
[40] [2022] NSWCA 31 at [11], [21] and [64].
The Panel adopts the joint examination report of the Medical Assessors. Given the complexity and detail of the joint reasons of the Medical Assessors it is unnecessary to add further reasons save as to comments on the claimant’s consistency.
The claimant’s responses to the questioning of his prior psychological condition showed a degree of evasiveness which was unsatisfactory. The prior psychological condition extended at least over two and one-half years in the context of prior litigation. In these circumstances the Panel had reservations in accepting the entirety of the claimant’s account of his current symptomatology. Noting this reservation, the Panel, for the reasons outlined in the joint examination report, have found that there was psychological injury and resulting permanent impairment caused by the motor accident.
Conclusion
The certificate issued by Medical Assessor Sidorov is revoked. A replacement certificate is attached at the commencement of these Reasons.
0
2
0