QBE Insurance (Australia) Limited v Ford

DETERMINATION OF REVIEW PANEL
CITATION:	QBE Insurance (Australia) Limited v Ford [2025] NSWPICMP 788
CLAIMANT:	Shannon Ford
INSURER:	QBE Insurance (Australia) Limited
REVIEW PANEL
MEMBER:	Jeremy Lum
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Surabhi Verma
DATE OF DECISION:	13 October 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); alleged psychiatric injuries when vehicle in the opposite direction crossed into path of claimant’s vehicle causing collision; original Medical Assessor diagnosed post-traumatic stress disorder and assessed 17% whole person impairment (WPI); Review Panel noted history of opioid addiction (with methadone treatment) dating back to 2003 which was ongoing and present at the time of the motor accident; Review Panel satisfied claimant had a pre-existing opioid use disorder which contributed to increased anxiety and panic attacks; Review Panel satisfied motor accident caused a panic disorder; Held – panic disorder assessed at 8% WPI; pre-existing opioid use disorder assessed at 1% WPI; final impairment caused by the motor accident was 7% WPI; MAC revoked; new certificate issued.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Atsumi Fukui dated 3 June 2024 and issues a new certificate as follows: (a) The Review Panel certifies the following injury was caused by the motor accident: (i) panic disorder. (b) The Review Panel finds that the above injury results in a whole person impairment of 7% which is NOT greater than 10%.

STATEMENT OF REASONS

BACKGROUND

Shannon Ford (the claimant) was involved in a motor accident on 25 December 2020. She was driving home in her car when a vehicle in the opposite direction crossed onto her side of the road and collided with her car.
The claimant was transported by ambulance to Gosford Hospital complaining of neck, shoulder and back pain. She also had psychological symptoms.
She made an application for personal injury benefits with QBE Insurance (Australia) Limited (the insurer), the third-party insurer of the vehicle that she says caused the accident.
A medical dispute arose about whether the degree of the claimant’s whole person impairment (WPI) is greater than 10% WPI. If there is a dispute about the degree of a claimant’s WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
[1] See Division 4.3 of the MAI Act.
On 3 June 2024, Medical Assessor Atsumi Fukui found that the claimant suffered from
post-traumatic stress disorder and major depressive disorder caused by the motor accident. The Medical Assessor assessed the claimant’s WPI at 17% which is greater than 10%.
The claimant lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Fukui’s assessment. This was allowed by the President’s delegate (Ms Tajan Baba) and this Panel was convened to conduct the review.

MEDICAL ASSESSMENT UNDER REVIEW

Medical Assessor Fukui was referred the following injuries for assessment:
· post-traumatic stress disorder and major depressive disorder.
The Medical Assessor noted a background history of childhood trauma with exposure to domestic violence and sexual assault. She also had a history of substance use disorder, including intravenous heroin and cannabis use. She commenced a methadone programme in 2004 and continues to take methadone. The Medical Assessor stated that there were no prior formal diagnoses, although symptoms of anxiety and depressive symptoms have been documented in her medical records.
Following the motor accident, the claimant had flashbacks and nightmares. She stopped driving and experienced anxiety when travelling as a passenger in a car. She can however travel by using other modes of transport. She was staying at home most of the time and stopped socialising. Her relationship with her partner declined due to her irritability and unwillingness to engage in activities. They separated 18 months ago. She speaks to her mother on an irregular basis.
Treatment comprised of seeing a psychologist with 10 appointments per year. Her last appointment however was six months ago. She has not seen a psychiatrist. She smokes medicinal cannabis leaves and describes this as helping with sleep and reduced her levels of anxiety, stress and hypervigilance. She was prescribed diazepam 5mg twice daily in addition to the methadone maintenance programme.
The claimant reported no longer having any significant symptoms from her physical injuries. Although decreasing in frequency, she continues to experience anxiety, intrusive thoughts about the accident with flashbacks and nightmares. There are occasional panic attacks. She continues to have poor motivation and low energy with feelings of worthlessness and has lost self-confidence. She feels sad but denied thoughts of self-harm or suicidal ideation.
The claimant reported not working and has not worked since the accident. She stated she could possibly work a few days a week.
The Medical Assessor diagnosed the claimant with post-traumatic stress disorder and comorbid major depressive disorder as a result of the motor accident. The Medical Assessor did not consider that the accident caused an exacerbation of her pre-existing anxiety and depressive symptoms. Under the psychiatric impairment rating scale (PIRS) the claimant’s WPI was assessed at 17% (2,2,2,3,3,4).
The Medical Assessor stated that there was no evidence of any pre-existing impairment.

SUBMISSIONS
Insurer
Generally

The insurer’s position is that the claimant current psychological symptoms relate to her significant pre-existing history of psychiatric illness including a longstanding history of depression, anxiety, chronic post-traumatic stress disorder as well as drug and alcohol dependence. In addition, in a report dated 4 October 2018, psychiatrist Dr Vickery diagnosed the claimant with a panic disorder with agoraphobia, social anxiety disorder and major depressive disorder.
The insurer also questions the claimant’s consistency of presentation as the claimant presented as a “vague and unsure historian” when examined by Dr Synnott in August 2023.

Insurer’s review application

Pre-existing history and diagnoses

In its review application submissions, the insurer submits that Medical Assessor Fukui failed to consider the pre-accident history of childhood trauma and domestic violence. There was also a long history of drug abuse, including opioid addiction, bipolar disorder, chronic post-traumatic stress disorder, anxiety and depression.
In addition, the insurer refers to a previous motor accident on 20 October 2017 and the claim file of NRMA. Within this file, there was an employment services assessment report dated

22 July 2014 and a job capacity assessment report dated 10 November 2014. These referred to anxiety, depression, bipolar disorder and drug dependence, dating back to 2003.
More recently, in the pre-accident clinical notes of Reliance Medical Centre, the insurer refers to entries on 27 December 2018, 15, February 2018 and 14 September 2018 which referred to anxiety, depression and panic attacks. There was reference to a sleeping problem and being on Xanax.
The insurer says the Medical Assessor was incorrect to find that the claimant “did not have a prior formal psychiatric diagnosis” and “was not under any psychological or psychiatric care prior to the subject motor accident”.

PIRS assessment

The insurer takes issue with the PIRS categories of travel and adaptation.
For travel, the insurer says the Medical Assessor did not consider the general practitioner record of Erina Fair Medical Centre dated 23 March 2023 which recorded the claimant “doing community service for driving without licence”. Hence the insurer contends that the Medical Assessor was wrong to rely on the claimant’s history that “She stopped driving her car due to anxiety”.
For adaptation, the insurer says the histories recorded by Dr Wallace and Dr Porteous indicate that the claimant was unemployed at the time of the accident. Or, in the alternative, the claimant’s well documented peripatetic work history. It is therefore submitted that the Medical Assessor was incorrect to find that the claimant was working at the time of the accident.

Claimant

The claimant’s original submissions state that she sustained significant anxiety and depression arising out of post-traumatic stress disorder caused by the motor accident. The claimant relies on the report of psychiatrist Dr Frank Chow dated 11 April 2023 who assessed the claimant at 17% WPI.

REVIEW OF THE EVIDENCE

General observations

The Panel confirmed with the parties that the insurer’s review application which comprised of the insurer’s review submissions and the claimant’s original WPI application and the insurer’s original WPI reply contained all the information that the parties relied upon in the review proceedings.
Following the Panel’s preliminary conference on 16 April 2025, the Panel identified a number of documents that are required.
In response, the insurer provided the following:
·        clinical notes of Reliance Medical Practice dated various;
·        visit notes of Dr A Shaabani – 1 March 2021;
·        Wyong Hospital Discharge Referral – 20 June 2018;
·        Gosford Hospital Discharge summary – 11 July 2019;
·        Dr F Malak Centrelink Medical Certificate – 19 December 2018;
·        Dr F Coetzee Centrelink Medical Certificate – 5 September 2022, and
·        Dr A Shaabani referrals to Dr R Singhe – 17 October 2021 and 6 November 2021.
The Panel will not refer to or summarise every document that is before it. Below is a summary of the documents relevant to the permanent impairment dispute.
The Reliance Medical Practice record contains pre-accident entries of the claimant being involved in a previous motor accident in October 2017. She was a pedestrian hit by a car and suffered pain in her shoulders and arms with a headache. She attended hospital where X-rays revealed an avulsion fracture of her right humerus. In 2018, she had anxiety and panic attacks which were exacerbated in stressful situations. She also had a sleeping problem and pain in her cervical spine and right shoulder. Discharge summary from Wyong Hospital stated drug misuse and placement on methadone 60-85mg. In 2019, she continued to experience panic attacks and was very stressed after the loss of a baby after eight weeks. She had many seizures in the last few years which included an attendance to Emergency. Discharge summary from Gosford Hospital stating that she was punched by her neighbour and had her twelfth tooth knocked out. CT brain showed no abnormality. In November 2020, she was assaulted by “boys” causing her bruises and a flare of her stress and anxiety.
The post-accident entries included an entry in January 2021 which acknowledged a history of anxiety and depression which the subject motor accident made worse. In 2022, there was documented trouble with her partner and her “life falling apart”. Further entries of feeling very anxious, depressed, irritable and emotional. No suicidal thoughts. Noted being on methadone program.
Dr Graham Vickery, psychiatrist, report dated 4 October 2018 – noted a history of opioid addiction since 2004 and is on a methadone programme. Seen counsellors over the period of 2002 to 2012 when she was in an abusive relationship and was diagnosed with complex post-traumatic stress disorder. Treated with antidepressant medication for anxiety and depression. Miscarriage in 2018 with claimant stating “I really wanted a child and I’ve been in a very bad headspace after that and I feel like it has broken me”. Motor accident in October 2017 where she was “clipped by a car and went over the bonnet and was on the ground”. Diagnosed major depressive disorder and panic disorder with agoraphobia caused by the miscarriage and the housing stressors. Social anxiety disorder was pre-existing. These amounted to 2% WPI. Impairment from the 2017 motor accident was assessed at 0% WPI.
Medical Assessor David Crocker, MAS certificate dated 15 March 2019 – for the
20 October 2017 motor accident, assessed musculoskeletal injuries as 12% WPI.
Medical Assessor Atsumi Fukui, Commission’s certificate dated 16 June 2022 – diagnosed Ms Ford with post-traumatic stress disorder caused by the subject accident. Noted pre-accident history of domestic violence in her early childhood and at the hands of her ex-partner. She suffered from anxiety and depression. Also past history of substance abuse disorder from her mid-teens to mid-twenties. Admission into a drug and alcohol rehabilitation facility where she was labelled with “bipolar disorder”. However this was not considered to be a formal psychiatric diagnosis. Ms Ford was considered to have no formal psychiatric history. Has not been under the care of a psychiatrist pre-accident but has seen a few psychologists over the years. Previous motor accident in 2017 caused anxiety, hypervigilance and panic attacks. Prescribed Valium and Xanax but stated there was no functional impairment and she continued to drive and work. Miscarriage in 2018 and was prescribed benzodiazepines but continued to drive and work. Ceased benzodiazepines two years prior to the subject motor accident. Medical Assessor accepted that Ms Ford was working, functioning well, was not prescribed any medications and was not under and psychological care before the subject accident. Diagnosed post-traumatic stress disorder as a result of the subject accident which included an exacerbation of her anxiety and depressive symptoms. This was a non-minor injury under the 2017 Act.
Dr Frank Chow, psychiatrist, report dated 11 April 2023 – noted a history of pre-existing depression and anxiety as well as opioid addiction. There was trauma in her teenage years and was raped when she was 19. She was also injured in a motor accident as a pedestrian in 2017 and injured her left shoulder. She saw a psychologist. She has been on antidepressants on and off over the years and was later prescribed Xanax and Valium intermittently to aid with sleep and anxiety. In the December 2020 subject accident, she sustained physical and mental injuries and received psychological treatment including taking Valium, methadone and medicinal cannabis. Dr Chow diagnosed post-traumatic stress disorder and major depressive disorder. PIRS assessment was 22% WPI with scores of 2,2,3,3,3,5. Pre-existing impairment was 5% with scores of 1,1,2,2,2,2. Total impairment as a result of the subject accident was 17% WPI.
Dr Inglis (Howe) Synnott, psychiatrist, report dated 15 August 2023 – found Ms Ford to be a vague and unsure historian with discrepancies between her account and the information in the documentation. Ms Ford reported as not acknowledging her pre-accident psychiatric difficulties. No confidence in the accuracy and veracity of Ms Ford’s history and was unable to provide an assessment of psychiatric impairment.

RE-EXAMINATION REPORT

At the initial preliminary conference on 16 April 2025, the Panel determined that the claimant be re-examined on 13 June 2025. Unfortunately, the claimant did not attend this appointment which has resulted in delay. The appointment was subsequently rescheduled to
15 September 2025.
The re-examination report of Medical Assessors Baker and Verma is below:
“Who attended the assessment
Ms Ford (the claimant) attended the assessment by MS Teams, unaccompanied; she was re-examined by Assessors Baker and Verma. The claimant did not have a support person during the re-examination. The claimant was at her home. She was the leaseholder of the department of housing lease related to her accommodation.
History
Psychosocial history and pre-accident
The claimant was born at Gosford Public Hospital on 9 April 1984. She was 41 years of age at the time of this assessment. The claimant said that her father was from England, United Kingdom and that she had no contact with him since primary school, until she was about 20 years of age. She said he died when she was 22 years of age. She sent flowers to his funeral but did not attend. She said this was an appropriate farewell as she had not known him well during her life.
The claimant stated that her mother was not diagnosed with Bipolar 1 Disorder until the claimant was an adult. She mentioned her mother was often elevated in mood and displayed erratic behaviour. The claimant noted that her relationship with her mother was poor during her childhood and early adulthood. Later in life, her mother received psychiatric treatment, and their relationship, when well, was mutually kind, affectionate, and caring. She said her mother was about 66 years old at the time of this re-examination. The claimant reported that her younger brother was around 39 years of age. She stated she had no contact with her younger brother for many years. She mentioned he was approximately 39 years old and worked as a wall and floor tiler. The claimant said recently she had discovered that her mother was Indigenous and a First Nations person. The claimant said she was beginning to re-investigate her First Nations heritage about the time of this re-examination.
The claimant said that, due to her mother’s attempts to leave her father, she attended about five primary schools from Kindergarten to Year 2. She explained that her development was disrupted by her father and mother’s behaviour. While a child, the claimant said she did not understand what had happened to her. She mentioned that she progressed to high school at Woy Woy and then Umina. She admitted that she would skip school and spend time in youth refuges. She said she was an avid reader, but her maths skills were poor. She enjoyed reading fiction, true crime, and fantasy novels before the accident.
The claimant was asked about her early development, and she stated she had not suffered from childhood sexual abuse. She said she had not had broken bones or experienced physical abuse as a child. She explained that her mother and father were emotionally neglectful of her. She described the home between her mother and father as unhappy, marked by frequent verbal anger.
The claimant said that her mother re-partnered and that she had a better relationship with her and her second partner.
Drug and alcohol history
The claimant stated that she first started using illicit substances at around 12 years old. She mentioned that she began smoking cannabis at that time. She reported that she progressed to her first intravenous injection of heroin when she was about 14. She indicated that her maximum heroin use was approximately four injections daily. She later joined a methadone replacement program and intermittently used injectable heroin during the early phase of the program. She stabilised her opioid use disorder with a daily oral dose of 70mg of Methadone. She now receives her medication from a private pharmacy that has extended late-night opening hours. She is supplied with four takeaway doses each week. She was participating in this program before the accident and continued on it after the accident until the re-examination.
The claimant said that between about 22 and 25 years of age, she used cocaine frequently; however, she reported that this was not her preferred substance, and she continued to use methadone to stabilise her substance use disorder.
The claimant mentioned that she has used drugs and alcohol from a young age. She reported that her alcohol consumption increased over the past 12 months. At the time of the re-examination, she was drinking cola mixed with Woodstock bourbon whiskey, about two to three cans daily. The claimant said she smoked about 40gms of tobacco per fortnight. She said she would roll her own cigarettes with her non-dominant left hand. She said she had also been prescribed medicinal cannabis and she smoked this about twice daily. She said she does not gamble.
Employment History
The claimant said she started work at about 14 years and 9 months as a take-away chicken shop assistant. She then progressed to working as a check-out operator for Woolworths at around 16 years of age. The claimant said she then began working as a waitress in cafés until she was about 17. She further stated that she was employed by a bus company and worked in the office for Premier Coaches until she was about 19. The claimant mentioned that her career was then interrupted by her substance use disorder, leading her to seek drug and alcohol detoxification and rehabilitation. She reported completing a short rehabilitation program. The claimant said she then worked as an assistant in nursing at an aged care facility, helping residents with personal hygiene, including washing, showering, dressing, and linen changes. She stated she did not enjoy this work and stopped after about six months. The claimant said her substance use disorder recurred, and after three years of heavy substance use, she applied for a Disability Support Pension (DSP), which was refused due to her substance use disorder. She explained she had to meet the mutual obligation requirements set by the Australian Government. Eventually, she was offered employment in Gosford at a call centre, starting around May and ending around November 2020. She mentioned her role involved making cold calls to sell pest control products, working five days a week for about 38 hours. She said she did not enjoy this role and left about a month before the motor accident in 2020. She has not worked in any role since.
Prior offences
The claimant said that before the age of 25, she had committed a driving without a licence offence and was charged with “Affray” when she struck a man with her hands. She said she was convicted and sentenced to 100 hours of community service.
Prior Motor Accidents
The claimant said that prior to the motor accident she was involved in 2017, she was walking as a pedestrian across the street. She said she made eye contact with the driver coming out of a driveway onto the road, in Erina, NSW. She said she was hit by the car and thrown onto the bonnet of the vehicle. She was transferred by ambulance to Gosford Hospital. She stated she injured her left shoulder and, due to overuse of her other shoulder, both shoulders were affected. She mentioned she is ambidextrous with a preference for her right hand. She said she rolled her cigarettes with her left hand and crocheted with her right hand.
The claimant said that around 2021, she experienced a minor motor accident. She said she was hit in the rear of her car by another vehicle. She stated she was not injured in this accident and did not lodge a claim. She also did not seek medical attention related to this incident.
The claimant lodged a claim concerning the 2017 accident and stated she received a lump sum payout.
Medical history
The claimant said that she had an aunty who died around 2012. She mentioned she had a close friend who passed away in about 2018. She stated that she has come to terms with these two significant deaths. She reported that she has also lost other people, including her father, but she did not consider these losses significant and did not grieve over them, as she had not shared a strong emotional connection with these individuals before or after the motor accident in 2020.
The claimant said she had been pregnant three times. Once when she was about
17 years old, and twice after she had been in a relationship with her partner for about four years. She stated she has no children. She explained her first two pregnancies ended in miscarriages, and she has since resolved her grief over these losses. She also mentioned one pregnancy where she was diagnosed with a ‘blighted ovum.’ She said she did not grieve the loss of this pregnancy either, as she understood the nature of the diagnosis.
The claimant reported experiencing a seizure, with a recent incident involving a new seizure. She said her general practitioner referred her for investigation by a neurologist. She mentioned she has been placed on a waiting list and is awaiting a neurological review. She acknowledged that addressing this issue is important for her. She also said she is not able to drive because she had a seizure.
History of motor accident
The claimant said that she had been to visit her partner’s family for the festive season around Christmas. She said that she was driving home from her partner’s parents’ home in Belmore to her home in Erina. She said she could remember that she was around Ryde when the accident occurred. She said she saw a car that was driving on the wrong side of the road. She said she was hit by the other car and her car spun because of the collision.
The claimant said she was not knocked unconscious in the accident. She said her Pandora bracelet was dislodged from her arm due to the spinning of the car. The claimant said that she heard the airbags in her car go off.
The claimant reported difficulty breathing and panicking due to dust from the airbags floating in the cabin of her car. She said she immediately became angry at the other driver. She unfastened her seatbelt and walked over to the other driver. As she approached, she started yelling, ‘What the fuck did you do that for!’
The claimant said she then commenced looking around and realised that her car was on the median strip. The claimant said that she became angry and fearful. She said the driver of the other car was intoxicated with alcohol. The ambulance and police both attended. She said the driver kept on coming up to her and touching her body. She said that she saw that a female police officer was watching what was happening but did not prevent the man from assaulting her by his frequent touching.
The claimant said she was breath tested at the scene of the accident. She said she was transferred by ambulance to Royal North Shore Hospital. She said she was admitted to the emergency room for assessment.
The claimant then stated that the time till attendance was very long. She became frustrated and she left her emergency room bed to call her partner. She said she spent about 30 minutes trying to find him outside of the emergency room. She eventually located her partner and she decided not to return to her bed in the emergency room. She went with her partner to his parents’ home and stayed overnight.
The following day after the accident, the claimant left her partner’s parents' home and took a train to Temora, NSW. Her mother’s partner (stepfather) greeted the claimant at the train station and took the claimant to her mother’s home. She remained at her mother’s home for about two weeks.
The claimant said that she was at her mother’s home for about one day, and she decided to present to the Temora District Hospital Emergency Room, because she did not have any supply of methadone. The attending medical practitioner organised for her to receive her usual dose of methadone 70mg daily.
Physical injury and symptoms
The claimant said that after two weeks, she returned home to her own home in Erina. She said that she had continued to experience pain and that she had recurrent episodes of panic. She described a physical injury to her breast. She said she had central chest pain and she thought she might have had a fractured sternum. The claimant said she presented to Gosford Hospital on about three occasions with complaints about these conditions. She was reassured that she had not had a fractured sternum, and she was not provided with any treatment for her injured breast.
The claimant attended her general medical practitioner for review of her injuries. She was referred to a clinical psychologist.
Psychological Injury Symptoms
The claimant developed the following psychological symptoms because of the motor accident.
The symptoms that meet DSM-5-TR F 41.10 panic disorder as listed below.
A.     Recurrent unexpected panic attacks, a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time (four or more) of the following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating.
3. Trembling or shaking.
4. Sensation of shortness of breath or smothering.
6. Chest pain or discomfort.
13. Fear of dying.
B.     At least one of the attacks has been followed by one month (or more) of one or both of the following:
1. Persistent concern or worry about additional panic attacks or their consequences.
2. A significant maladaptive change in behaviour related to attacks.
The claimant said that since the accident she had made significant maladaptive changes to her life. She had stopped driving as she would experience panic when in a car. She would shift position and become fearful of the driver (partner) crashing into another car.
The claimant said that she and her partner were in frequent verbal arguments and at the time of this re-examination. This relationship had ceased with her partner having his name removed from the lease and communication between them stopping.
The claimant changed her mode of transport to travel by bus after taking two 5mg diazepam tablets before each trip outside her home. Her diazepam was supplied in a restricted quantity of 15 tablets per fortnight. She stated she usually needed to leave the house to collect her methadone and receive doses three days a week.
The claimant said she had continued to remain on her methadone dose of 70mg daily. She said that as she had experienced more anxiety, she had asked her methadone prescribing doctor to increase her dose of methadone; however, this had not occurred prior to this assessment.
The claimant reported that whilst she had become more anxious, she had increased her consumption of alcohol, and she was drinking about three cans of cola mixed with Woodstock bourbon whisky each day to try to reduce her panic disorder symptoms.
The claimant had received a medical prescription for medicinal cannabis. She said she had commenced smoking cannabis twice daily to try to reduce her panic disorder symptoms.
Treatment
Physical Injury
The claimant had sustained a physical injury. She reported that she had injured her breast in the accident. She said she received conservative treatment for this injury.
The claimant said that she was using a moderate dose of methadone at 70mg daily. This dose is commonly used as a pain relief treatment in people with chronic physical pain. The claimant said she thought she had fractured her sternum; however, the investigation did not demonstrate any fractures.
Psychological treatment
The claimant was referred by her general medical practitioner to see a clinical psychologist. She attended sessions roughly every two weeks, completing about ten sessions in total. During this time, she received cognitive behavioural therapy (CBT), eye movement desensitisation and reprocessing therapy (EMDR), mindfulness training, and relaxation skills training. The claimant stated she was not prescribed any antidepressant medication that might be used for panic disorder, depression, or posttraumatic stress disorder. She also mentioned that she had not been referred for admission to a psychiatric hospital for any psychological reasons.
The claimant said that she continued her attendance at her Methadone Treatment program. She said she had spoken to her case manager at this service in relation to her condition. She said she had spoken to her medical practitioner about her increased anxiety, and a restricted supply of diazepam 5mg, 15 tablets per fortnight, was prescribed. The claimant said that she had demonstrated caution with the use of diazepam, an anxiolytic medication, with methadone, a long-acting opioid. Diazepam 5mg tablet is an evidence-based treatment for panic disorder.
The claimant organised a prescription of medicinal cannabis. She smoked medicinal cannabis twice each day. Medicinal cannabis is not an evidence-based treatment for panic disorder.
Mental state examination
The claimant presented as an unkempt woman who had not groomed herself before the re-examination. She said she had lost interest in her self-care and personal hygiene, and she maintained a lesser standard of self-care and personal hygiene than she had before the motor accident.
The claimant reported that she had recurrent tremors, which indicated she was having a panic attack. She said she would smoke tobacco, drink alcohol, or use cannabis as a means to stop a full attack.
The claimant was cordial in the assessment and provided relevant answers to questions asked, spontaneously supplying details. She said she still experienced chest pain, and she still fears thinking about travel and leaving the house unless “essential.” She explained that essential trips include access to her pharmacist for her methadone prescription, access to her local shops about 500 metres from her house to buy tobacco and access to her medical practitioner when she had to attend for in person medical appointments.
The claimant said she was frequently anxious and that she would often experience panic episodes, mainly managed by avoiding going outside her home and not walking in crowds. She described a friend she has known for many years who helps her at times and when she needs to go grocery shopping.
The claimant did not spontaneously report a depressed mood during the 90-minute re-examination. However, she described and was observed having a panic attack around the 60-minute mark. She smoked a cigarette but was unable to fully settle, remaining mildly agitated and tremulous throughout the session.
The claimant did not report suicidal thoughts or plans. She mentioned feeling angry memories about the accident and avoiding thinking about the incident. She did not report any suicidal ideations.
The claimant was alert and not drowsy during the assessment. She was insightful into her condition and her judgment was normal. She did not report any psychotic symptoms or delusional ideas.
She cried while thinking about her partner leaving the relationship. She said she has a supportive friend who visits and checks on her several times weekly.
Diagnosis
Panic disorder is a common anxiety disorder that presents in relation to trauma.
The symptoms that meet DSM-5-TR F 41.10 panic disorder as listed below:
A.      Recurrent unexpected panic attacks, a panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time (four or more) of the following symptoms occur:
1. Palpitations, pounding heart, or accelerated heart rate.
This criterion is meet as the claimant attended general hospital on repeated occasions for recurrent palpitations.
2. Sweating.
The claimant reported recurrent episodes of sweating whilst having panic.
3. Trembling or shaking.
The claimant reported repeated episodes of hand and arm tremors and was observed during the re-examination to have a panic attack with tremors in her hand, prompting her to request a pause. She attempted to alleviate her panic by smoking a cigarette during the remainder of the re-examination.
4. Sensation of shortness of breath or smothering.
The claimant reported that she had difficulty breathing when she was having a panic attack and she had difficulty managing her breathing during each episode.
6. Chest pain or discomfort.
The claimant stated she had recurrent episodes of central crushing chest pain that she thought could have been a fractured sternum or something serious that required emergency room presentation on repeated occasions after the accident. She had been repeatedly examined for heart disease, and she said on each presentation, she was advised she did not have any heart condition.
13. Fear of dying.
The claimant said she was afraid of dying from the pain, which is a common symptom in people who suffer panic disorder.
The claimant stated that since the accident, she had made significant changes to her life. She had stopped driving because she experienced panic when in a car. She would shift her position and become fearful that the driver (her partner) might crash into another vehicle. She changed her mode of transport to buses, taking diazepam 5mg—two tablets—before each trip outside the home. Her diazepam was supplied in a limited quantity of 15 tablets per fortnight.
She mentioned that she usually had to leave the house to collect her methadone and receive doses three times per week. The claimant said she continued to take her methadone at a dose of 70mg daily. She explained that, as her anxiety increased, she asked her prescribing doctor to raise her methadone dose, but this had not happened before this assessment.
The claimant reported that, despite her increased anxiety, she had begun drinking about three cans of cola mixed with Woodstock bourbon whisky each day to help manage her panic symptoms. She also received a medical prescription for medicinal cannabis and had started smoking cannabis twice daily in an effort to reduce her panic disorder symptoms.
The claimant was assessed for post-traumatic stress disorder. The claimant had been diagnosed with posttraumatic stress disorder by other medical practitioners and assessors. The Medical Assessors attended the re-examination and both agree that the claimant does not meet the criteria for posttraumatic stress disorder. The Medical Assessors both agree that the claimant fails to meet the criteria for Criterion A for DSM-5-TR F43.10 posttraumatic stress disorder. The reasons for this are as follows:
·   The claimant did not experience exposure to actual or threatened death, serious injury or sexual violence. The claimant’s behaviour at the time of the accident was to exit her car and approach the other driver whilst ‘yelling.’
·   The claimant left the emergency room by herself.
·   The claimant returned to her partner’s parents’ house and was not identified by his parents as needing to return to hospital.
·   The claimant the following day travels to her mother’s house by country train where she remains for the next two weeks.
·   The claimant attends the district hospital for continuation of her methadone 70mg prescription. The medical practitioner did not refer her to a larger hospital (Wagga base hospital) for urgent or emergency treatment during the two weeks the claimant was with her mother.
·   The claimant was able to travel to her own home in Erina without incident after she left her mother’s home.
·   The claimant did have other symptoms consistent with an anxiety disorder (Panic Disorder.)
The Medical Assessors noted that the claimant did report symptoms of posttraumatic stress disorder, including nightmares, hypervigilance, and increased startling. However, the claimant did not report all the criteria required for a diagnosis of posttraumatic stress disorder. For these reasons, the diagnosis was not confirmed.
The claimant was assessed for DSM-5-TR F32.0 major depressive disorder. Although the claimant reported symptoms of Panic disorder, she did not report or demonstrate in the mental state examination enough symptoms to diagnose major depressive disorder. Importantly, the claimant did not report spontaneous or demonstrate having a depressed mood with a depressed affect or loss of interest in her recreational activities, which she could respond to with a positive interested and enjoyable mood. She also did not report suicidal thoughts or plans during the re-examination, either spontaneously or through direct questioning. For these reasons, the diagnosis was not confirmed.
The claimant was assessed for DSM-5-TR F 40.248 Specific Phobia – driving. The Medical Assessors agree that, while the claimant is avoidant of driving at the time of the re-examination, criterion G for this disorder is not met. Criterion G, as documented in DSM-5-TR, states: ‘The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety and avoidance of situations associated with panic-like symptoms...’.
For these reasons, this diagnosis was not confirmed.
Consistency of presentation
The claimant presented as an affable woman who looked older than her stated age. She spoke in a matter-of-fact manner and was not inconsistent with her report of symptoms. She was asked about many details in her past medical history. She said she would “tell it as it is” and that if she were upset she would tell the doctor before leaving. She was asked to report any symptoms consistent with prolonged grief or other symptoms of major depressive disorder. She did say she had a difficult life and a difficult early life. She attributed her difficulties to her parents. She said she had received counselling regarding her substance use disorder, and she understands that Methadone stabilises her opioid use disorder.
The claimant was hopeful about learning more about her First Nation heritage and culture through her mother, who was now available to impart this knowledge. She said she did not know much about First Nations people; she had not ever celebrated NAIDOC week or any of the women’s business traditions.
The claimant was asked about the deaths she had recently experienced, and she said that at the time of the re-examination, these deaths were not significant. She said the last considerable death was in 2018, and she had resolved the loss of this friend.”

RELEVANT PROVISIONS

Permanent impairment

Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (Guidelines).
Version 10 of the Guidelines applies to the review.
The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.

Permanent impairment is assessed in accordance with Chapter 6 of the Guidelines. Specifically, the assessment of psychiatric impairment draws from the chapter “Mental and behavioural disorders” which commence at cl 6.201 of the Guidelines.

Causation of injury

It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition.
Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:
“6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
Further, the provisions of the Civil Liability Act 2002 apply, in particular ss 5D and 5E.

FINDINGS

The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[2]
[2] Section 7.26(6) of the MAI Act.
The evaluation should only consider the impairment as it is at the time of the assessment.[3]
[3] Clause 6.21 of the Guidelines.
The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[4]
[4] Section 7.26(7) of the MAI Act.
The Panel refers to the above re-examination report of Medical Assessors Baker and Verma. The Panel reconvened on 3 October 2025 and discussed the re-examination report findings before collectively making the below determinations.

Causation

The Panel accepted that the motor accident contributed to the development of the diagnosis of panic disorder. While the claimant experienced episodes of panic attacks in the past, the Panel was satisfied that the circumstances of the accident worsened her psychological state so that she now presents with symptoms that met the criteria for the psychiatric diagnosis of panic disorder.
The Panel considered Dr Vickery’s diagnoses in 2018 which included panic disorder however felt that the claimant’s pre-existing condition was more representative of an opioid use disorder which was the dominating presentation. The Panel has accounted for this in the assessment of the claimant’s pre-existing impairment in the PIRS table below.
The Panel was therefore satisfied that the panic disorder was causally related to the motor accident.

Permanency of impairment

The claimant’s psychological injury as a result of the accident commenced in 2020. She had received psychiatric treatment from her medical practitioner and psychological treatment from her psychologist as well as ongoing support from her methadone program case manager.
The claimant’s psychological injury had remained present for more than four years since the accident. The injury is well stabilised and unlikely to change by more than 3% WPI with or without medical treatment within the next 12 months.
For these reasons, the claimant’s psychological injury is now permanent.

Degree of permanent impairment – Psychiatric Impairment Rating Scale

Current impairment

Psychiatric diagnoses	1. Panic disorder	2.
Psychiatric treatment description	Evidence-based psychological treatment and evidence-based psychiatric treatment as an outpatient, provided by a general medical practitioner, and clinical psychologist.

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	2	The claimant appeared as an unkempt woman who had not groomed herself prior to the re-examination. She had not washed or brushed her hair and was wearing lightly soiled clothing. She was independent in her activities of daily living; she said she performed her washing of clothes, dishes, and linen more slowly than before the accident. She was able to cook meals and maintain adequate nutrition since the accident. She mentioned she could go to her local shops for essential items alone when there were not expected to be a crowd. She would receive assistance with her groceries from her friend when visiting larger shopping centres. She stated she lived alone and would shower daily and vacuum when required. She was assessed as having a mild impairment, Class 2, according to this table of functioning.
2. Social and Recreational Activities	2	The claimant said that she was frequently visited by two friends. She mentioned that one of her friends enjoyed visiting and chatting with her. She reported that her other friend would visit to help around the house and check on her wellbeing. The claimant said she enjoys watching Tik Tok videos and Netflix movies. She also stated that she has stopped reading novels, true crime, and fantasy books for pleasure. She was assessed as having a mild impairment, classified as Class 2, according to the table of functioning.
3. Travel	2	The claimant stated that she had ceased driving since the motor accident. She mentioned she could leave her house alone after taking two 5mg diazepam tablets to manage her anxiety. She said she could catch the bus to her pharmacy for collection and dosing of her methadone medication. She also said she could visit her medical practitioner if she was alone but preferred to travel with the support of her friend. She reported that she would remain anxious and experience panic attacks if the driver of the car came too close to the vehicle she was travelling in. She was assessed as having a mild impairment, classified as Class 2, according to this table of functioning.
4. Social Functioning	3	The claimant said that she and her partner had separated since the accident. She said she was often to agitated and overwhelmed by her panic attacks. She said that she had arguments with her partner and that he was unable to accept the changes the claimant had undergone since the accident. She said that they had permanently separated before the re-examination. She said the reason for the separation was because of her psychological injury caused by the accident. The claimant reported that her relationship with her mother had improved over recent years and the accident had not disrupted this relationship. The claimant was assessed as having a moderate impairment, Class 3, according to the table of functioning.
5. Concentration, Persistence and Pace	2	The claimant reported that she was less interested in reading. She stated that it was easier to watch movies than read. She said without prompting that she was able to perform the complex task of lining her mobile phone to her television such that she could watch movies. The claimant said that she was interested in her movies and Tik Tok. She could watch whole lengths of movies. The claimant was re-examined for 90-minutes. She was able to concentrate, persist with answering questions and maintained a consistent slow pace throughout the duration of the assessment without prompting or need for more than one brief pause whilst she lit a cigarette and then continued to talk about her psychological injury. She was able to maintain her own finances and was able to pay bills without difficulty. The claimant was assessed as having a mild impairment, Class 2, according to this table of functioning.
6. Adaptation	4	The claimant had not found any new employment since the accident. She was required to complete her mutual obligation requirements for the Australian Government Job Search payment. She said she was currently on a medical certificate for three months due to her anxiety and increased psychological injury symptoms in the leadup to the re-examination. The claimant was erratic in her attendance due to her psychological injury for any work-like role or employment. She would require extended periods on a medical certificate when she was unable to continue her routine fortnightly Job Seeker requirements. The claimant was assessed as having a severe impairment, Class 4, for this table of functioning.
List classes in ascending order: 2 2 2 2 3 4
Median Class Value: 2
Aggregate Score: 15
% Whole Person Impairment: 8%

*%WPI ^{= Percentage Whole Person Impairment}

Apportionment – pre-existing impairment

DSM-5-TR F11.20 Opioid use disorder – severe

The claimant had a well-established opioid use disorder. Her opioid use disorder remained current while she faced other distressing events in her life. The claimant had used other substances throughout her life – however, her self-reported substance of choice was “heroin,” an opioid with a long-standing history of causing an opioid use disorder. For these reasons, the pre-existing impairment was classified as DSM-5-TR F11.20 Opioid use disorder – severe. The claimant continued to have an opioid use disorder before, during, and after the accident. She was prescribed methadone, a long-acting opioid that stabilises her opioid use disorder but does not put it into remission. The use of methadone is a harm minimisation treatment that allows the opioid use disorder sufferer to engage in other activities instead of spending substantial time obtaining opioids.

Degree of permanent impairment – Psychiatric Impairment Rating Scale

Pre-existing condition

Psychiatric diagnoses	1. Opioid use disorder	2.
Psychiatric treatment description	Evidence-based psychological treatment and evidence-based psychiatric treatment as an outpatient, provided by a general medical practitioner, and clinical team.

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	1	The claimant was living with her partner of about four years before the accident. She was able to cook meals and maintain her rented accommodation. She was able to maintain her self-care and personal hygiene; she was independent in her self-care and personal hygiene. She could maintain her long-term medical regime and was dependable in her capacity to attend for her methadone dosing and take-away pick-ups each week for many years without complications. The claimant was assessed as having a minor impairment Class 1 for this table of functioning.
2. Social and Recreational Activities	1	The claimant reported she was able to socialise in public with her partner. She was able to visit her partner’s parents for social events and Christmas celebrations. She was able to attend her mother’s home in rural NSW. She enjoyed reading and watching TikTok videos and Netflix movies. She did not describe any other hobbies or interest before the accident. The claimant was assessed as having a minor impairment Class 1 for this table functioning.
3. Travel	1	The claimant said she was able to drive her car without restriction before the motor accident. She said she was able to drive to her partner’s partners home and she was able to drive alone in Sydney traffic without impairment. The claimant was able to use public transport like bus and train services without impairment. She was assessed as having a minor impairment, Class 1, according to this table functioning.
4. Social Functioning	1	The claimant was living with her partner of four years. They had both of their names on the Department of Housing lease, of the rented home. The claimant was re-establishing her relationship with her mother prior to the accident. She was able to maintain her relationship with her partner’s partners without difficulty. She reported that she had a small group of friends with whom she could socialise without difficulty. The claimant was assessed as having a minor impairment Class 1 under this table functioning.
5. Concentration, Persistence and Pace	1	The claimant said she was able to read and enjoy reading her true crimes and fantasy novels, without impairment. She said she was able to enjoy and follow her favourite authors and interests. She said she could watch Netflix movies and Tik Tok videos without difficulty. She reported she maintain her own finances and was able to pay bills without difficulty. The claimant was assessed as having a minor impairment Class 1 under this table functioning.
6. Adaptation	4	The claimant said she had difficulty maintaining routine employment. She said she had become erratic in her capacity to attend any workplace. She could attend once each fortnight for her Job Seeker mutual requirements. The claimant said she had been provided a job after many years of no employment. She was able to attend for about six months which was the same as her job prior many years prior. She said she left her work about one month prior to the accident. She was asked as to the reason for leaving work. She said she could not remember why she had left however she did not enjoy having to make cold call calls to ask people to buy things. She was erratic in her subsequent attendance at the Gosford call centre and had not returned to any other role prior to the motor accident. The claimant was assessed as having a severe impairment Class 4 for this table of functioning.
List classes in ascending order: 1 1 1 1 1 4
Median Class Value: 1
Aggregate Score: 9
% Whole Person Impairment: 1%

*%WPI ^{= Percentage Whole Person Impairment}

Effects of treatment

The claimant had no effects of treatment for his assessable psychological injury caused by the motor accident or pre-existing condition.
The claimant’s assessable psychological injury had not entered remission at any time from the date of the accident in 2020 until the date of the re-examination in 2025.
The assessment of treatment effects was 0%WPI.

CONCLUSION

The Panel concludes that the claimant’s injury caused by the motor accident results in a WPI of 7% which is not greater than 10%.
Accordingly, the certificate issued by Medical Assessor Fukui dated 3 June 2024 is revoked. A new certificate is issued at the front of this determination.

[2025] NSWPICMP 788

13 October 2025