QBE Insurance (Australia) Limited v Gadd

DETERMINATION OF REVIEW PANEL
CITATION:	QBE Insurance (Australia) Limited v Gadd [2022] NSWPICMP 376
CLAIMANT:	Jennifer Gadd
INSURER:	QBE Insurance (Australia) Limited
REVIEW Panel
MEMBER:	Belinda Cassidy
MEDICAL ASSESSOR:	Samuel Lim
MEDICAL ASSESSOR:	Wayne Mason
DATE OF DECISION:	27 September 2022
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999 (1999 Act); medical assessment of whole person impairment (WPI) and claimant’s review under section 63 of the 1999 Act; original Assessor (Samuell) had assessed 0% WPI; claimant was grandmother of 19 year old girl killed when she was walking home after a night out; the deceased had lived with her mother at her grandmother’s home until the age of 14 and had remained closely connected to her grandmother at the time of her death; the 62 year old claimant sustained pure mental harm in the form of a Major Depressive Disorder; Held – claimant’s WPI 15%; no issue of principle.
DETERMINATIONS MADE:	The Review Panel: 1. Revokes the certificate of Medical Assessor Samuell dated 30 July 2021. 2. Certifies that the degree of Ms Jennifer Gadd’s permanent impairment resulting from the injury she sustained following the death of her granddaughter in an accident on 24 September 2017 is greater than 10%.

STATEMENT OF REASONS

Introduction

Jennifer Gadd is the grandmother of Natasha Gadd. On 24 September 2017, at about 4.30 in the morning, Natasha was walking home with friends along Henry Lawson Drive when a speeding vehicle mounted the footpath. Natasha was struck and died at the scene[1].
[1] This history is taken from the medical reports (in particular the report of Dr Rickard-Bell). The Panel has not been provided with a copy of any liability notice, police report or other material in respect of the accident.
On or about 19 March 2018, Ms Gadd made a claim for damages arising out of the pure mental harm she sustained as a result of Natasha’s death at the age of just 19.
The claim was made against QBE, the third-party insurer of the vehicle that hit and killed Natasha, the driver of which apparently fled the scene.
QBE has admitted liability for the claim, that is QBE accepts that its driver was at fault and caused the accident and the death of the claimant’s granddaughter.
A dispute has arisen between QBE and Ms Gadd as to Ms Gadd’s entitlement to damages for non-economic loss. The medical dispute that will determine Ms Gadd’s entitlement was referred to the Personal Injury Commission (the Commission) and considered by Assessor Samuell who certified Ms Gadd did not have an entitlement to non-economic loss. Ms Gadd then lodged an application seeking a review of that decision.
A delegate of the President of the Commission determined there was reasonable cause to suspect a material error in the assessment and the President has convened this Panel to conduct the Review.

Legislative framework

The claim

Ms Gadd’s claim and entitlements to compensation are governed by a combination of the provisions of the Motor Accident Compensation Act 1999 (the MAC Act) and the provisions of Part 3 of the Civil Liability Act 2002 (the CL Act).
The CL Act enables the recovery of damages in situations where a claimant’s only injuries arise from the mental or nervous shock experienced in connection with a person being “killed, injured or put in peril” in circumstances where either the claimant was at the scene of the accident and witnessed it, or the claimant is a close family member of the person killed[2]. Close member of the family is defined[3] as a parent of the person killed or someone with “parental responsibility” for the victim.
[2] Sections 29 and 30.
[3] In section 30(5) of the CL Act.
The claimant can only recover damages if her mental harm “consists of a recognised psychiatric illness”[4].
[4] Section 31 of the CL Act.
Damages for non-economic loss are limited and restricted by the provisions in Part 5.3 of the MAC Act. For example, non-economic loss damages are limited to a maximum amount under s 134[5] and entitlement to those damages is restricted by s 131 to persons who have a greater than 10% whole person impairment (WPI) as a result of the injuries sustained in the accident.
[5] The current maximum as of October 2021 is $590,000.
If there is a dispute about the degree of the claimant’s WPI, damages for non-economic loss cannot be awarded and disputes must be referred to a Medical Assessor for determination[6].
[6] See s 132 and s 44(1)(c) of the MAC Act.
Part 3.4 of the MAC Act provides for the assessment of medical disputes by the Commission including provisions relevant to an original medical assessment such as Assessor Samuell, further medical assessments and the Review of medical assessments by this Panel[7].
[7] Sections 61, 62 and 63 of the MAC Act.

Permanent impairment assessment

Permanent impairment is to be assessed in accordance with the Motor Accident Permanent Impairment Guidelines (the Guidelines)[8] which, for physical injuries, are largely based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides).
[8] Section 133. The current version of the Guidelines is Version 1 which is effective from 30 November 2017.
The Guidelines include a chapter entitled “Mental and behavioural disorders” and require the assessment to be undertaking in accordance with the psychiatric impairment rating scale (PIRS) and that the AMA4 Guides are to be used as “background or reference only”[9].
[9] Clause 1.203 of the Guidelines.
The PIRS requires a psychiatric diagnosis to be undertaken first in accordance with whatever the current edition of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD)[10].
[10] Clause 1.213 of the Guidelines.
The PIRS provides[11] for the consideration of any psychiatric condition present before the accident in question:
“In order to measure impairment caused by a specific event, the medical assessor must, in the case of an injured person with a pre-existing psychiatric diagnosis or diagnosable condition, estimate the overall pre-existing impairment using precisely the method set out in this part of the Guidelines, and subtract this value from the current impairment rating.”
[11] Clause 1.218 of the Guidelines.
The PIRS provides in clause 1.219 for six areas of function:
1.219.1   self-care and personal hygiene;
1.219.2   social and recreational activities;
1.219.3   travel;
1.219.4   social functioning (relationships);
1.219.5   concentration persistence and pace, and
1.219.6   adaptation.
The PIRS then provides at 1.220 for five classes with a descriptor for each which is “illustrative rather than literal criteria” and which is based on:
“… a history of the injured person’s pre-accident lifestyle, activities and habits, and then [an assessment of] the extent to which these have changed as a result of the psychiatric injury”.
The impairment may be adjusted for treatment[12] that is treatment such as medication being consumed to treat the psychiatric condition.
[12] See clauses 1.222 – 1.223 of the guidelines.
Once all six areas of function have been categorised into a particular class, the median class score is determined, the aggregate score is determined and the median and aggregate is converted to provide a WPI percentage[13].
[13] See clauses 1.225 – 1.228 and table 17.

Assessment under review

Assessor Samuell examined Ms Gadd on 21 July 2021 and his certificate and reasons are dated 30 July 2021. He records that he was asked to assess the claimant’s “Psychiatric condition – complicated grief; major depression; alcohol misuse”.
Assessor Samuell takes the following history:
(a)   the claimant receives the carer’s payment in order to look after her sick and frail mother who lives close by;
(b)   she has a history of psychological disorder stemming from when her son was two and she took the medication for 20 years although was reducing it at the time of the accident;
(c)   she has a history of diabetes, emphysema and a stroke 10 to 15 years ago;
(d)   she drinks a couple of stubbies of full-strength beer ever couple of days and smokes 40 – 50 cigarettes a day;
(e)   she lives with her son, daughter, granddaughter and husband;
(f)    she has never held a driver license;
(g)   there was domestic violence in her family home and her mother left her father which resulted in the claimant leaving school early to support her family;
(h)   the claimant had worked as a cleaner at Fairfield Hospital, and
(i)    six years before the accident a nephew died from suicide and a year later her sister died of emphysema.
The claimant’s daughter Charmain gave birth to Natasha at the age of 16 and Natasha and Charmain lived with the claimant for 14 years. She heard about the accident, and Natasha’s death, when Charmain came to her home and told her about it.
The claimant reported the following complaints:
(a)   sleep is affected, she only sleeps for two or three hours before she wakes but she does not have nightmares;
(b)   her mood is disturbed and she is down and sad most of the time;
(c)   poor control of diabetes due to stress;
(d)   she has seen four different counsellors with limited satisfaction;
(e)   she is taking a number of medications including Anafranil (an antidepressant) and Circadin for sleep;
(f)    she had lost weight from 99 to 86 kg;
(g)   she had no difficulty concentrating, and
(h)   she was not suicidal and had only been suicidal once in her life when her partner was having an affair with Ms Gadd’s sister.
On examination the claimant was said to look older than her years (61 at that time) and she was tearful and depressed and the content of her speech “was dominated by themes of helplessness and hopelessness”.
The claimant reported continuing to care for her mother including shopping and paying her bills. She cooks and cleans and showers every day. She found lockdown hard as she could not see her children and grandchildren every day.
Assessor Samuell considered the claimant’s condition was permanent. He diagnosed a major depressive disorder, alcohol use disorder and considered there may have been a background of obsessive compulsive disorder.
He rated the claimant as having a class one impairment for all six areas of function which resulted in a 0% WPI.

Matter summary and submissions

Claimant’s submissions

The claimant points to the following errors in Assessor Samuell’s assessment and comments as follows:
(a)   self-care and personal hygiene – the claimant took issue with the categorisation of class one which was based on one fact, that the claimant had been showering every day, but the Assessor had not asked her about her eating patterns, cooking arrangements, personal maintenance and care;
(b)   social and recreational activities – the Assessor did not disclose what the claimant’s pre-injury level of functioning was and what it has been since the accident other than to comment that Covid restrictions prevented her resuming activities;
(c)   travel - the Assessor does not record what the claimant’s access to the community was like before the accident and what it has been since;
(d)   social functioning – the Assessor has simply said there was no impairment without taking a proper history of the claimant’s pre and post-accident interaction with friends. While he has a history that Ms Gadd continues to care for her mother the claimant says this is not relevant to this category;
(e)   concentration, persistence and pace – limited enquiries were made and no enquiry was made about her activities before and after the accident such as watching television or reading books;
(f)    adaptation – the Assessor misdirected himself by only considering the claimant’s continued care for her mother and that he should have inquired as to her pre-injury roles and functioning within her own household, and
(g)   the Assessor did not give consideration to the effect of treatment.

Insurer’s submissions

The insurer submits that cl 1.220 of the Guidelines provides that the classes for each of the six areas of function are described through common examples and are not literal criteria and responds to the claimant’s arguments as follows:
(a)   self-care and personal hygiene – the Assessor noted in the body of the report (as opposed to the table summary) the claimant’s ability to cook and clean as well as shower and says there is no evidence to suggest a higher category;
(b)   social and recreational activities – the Assessor had the claimant’s pre-accident history and the report of Dr Rickard Bell and had clearly considered her pre-injury functioning;
(c)   travel – the insurer refers to the claimant’s history of not having driven and being reliant on others to transport her;
(d)   social functioning – the insurer says that while the Assessor noted the claimant had difficulty with the COVID lockdowns (commencing in 2020) as she could not socialise with her children and grandchildren the implication is that after the accident and before the lockdowns, the claimant did socialise with her family;
(e)   concentration, persistence and pace – the Assessor was entitled to rely on the claimant’s self-report that she had no concentration difficulties;
(f)    adaptation – the Assessor considered Ms Gadd’s housekeeping, managing her personal affairs and other responsibilities under the current functioning heading in his reasons, and
(g)   treatment – the Assessor did note that the claimant was not having current treatment other than taking medication prescribed before the accident.
The insurer argued that the even if there were deficiencies in the reasons of Assessor Samuell, there was no suggestion the clamant would have been assessed at greater than 10%.

Procedural matters

The Panel issues directions to the parties on 14 June 2022 seeking a bundle of all the documents the parties were intending to rely on in the assessment. The claimant provided a bundle (identified as document AD3 in the Commission’s electronic file) and the insurer also provided a bundle (identified as document AD4).
The Panel conducted a teleconference on 4 August 2022 and determined it would conduct a re-examination of the claimant by Medical Assessors Lim and Mason on

29 August 2022. No further directions were issued to the parties.

Review of the evidence

Treating evidence

The claim form is dated 19 March 2018 and indicates the motor accident occurred at 4:20am on 24 September 2017 on Henry Lawson Drive, Milperra.
The injuries were listed as “psychological” and treatment was said to have been provided by a psychologist at Villawood Medical Centre. There is a past history of depression noted and employment was listed as home duties.
Dr Priscilla Oei of the Villawood Medical Centre is the claimant’s general practitioner (GP) and on 1 March 2018 she completed the medical certificate in support of the claim form. She says:
(a)   she has been the claimant’s GP since 2000;
(b)   she examined the claimant on 1 March 2018;
(c)   she diagnosed “Mental health condition – depression and anxiety in context of death of family member – constantly teary and low mood, panic attacks, poor sleep, poor appetite, anhedonia”;
(d)   there was no medical condition identified that would affect the management of the condition;
(e)   it was uncertain when the claimant would be fit for work, and
(f)    she had recommended family support, antidepressant, PRN anxiolytic, psychology and said, “may require psychiatry review in the future”.
There is a report from Dr Oei dated 8 June 2018 which records:
(a)   the claimant’s first attendance was on 25 September 2018 (clearly an error and a reference to 2017);
(b)   she was extremely distressed, required sedation and grief counselling was provided. She had a background of depression;
(c)   she will often present as teary and emotional and reports low mood. She has a bereavement disorder with complex grief and features of anger and denial, and
(d)   she was commenced on a mental health care plan in December 2017 and requires further psychological intervention.
Notes from the Villawood Medical Centre have been produced and in the past history section[14] is a list of past conditions which include depression in May 2002, hypertension in September 2006, high cholesterol in August 2008 and chronic obstructive pulmonary disease (COPD) in July 2012.
[14] Page 26 of the claimant’s bundle.
The notes include a list of scripts written for medications[15]. In 2002 a script was provided for Anafranil 25mg one before bed and after meals. This was changed to twice a day after meals in May 2004. This regime remained in place for scripts on

21 March 2017, 22 August 2017 and was changed to permit 50mg to be taken at night in December 2017.
[15] Commencing at page 26 of the claimant’s bundle.
The claimant was also prescribed Stelazine 2 mgs, three times a day in May 2002. Stelazine is an antipsychotic medication. In June 2004 the dose was reduced to one tablet before bed but returned to three times a day in August 2007. This regime remained in place until 4 November 2016 at which stage the prescriptions for this medication appear to have ceased and no alternative has been prescribed.
The claimant weighed[16] 99 kg in July 2002, dropped to 90.5 kg in July 2009 but increased to 107 kg in November 2010. There were two measurements of 100 kg and 103 kg in 2011 and similar weights recorded in 2012 and 2013. In 2016 the claimant remained under 100 kg and on 21 March 2017 she weighed 89.3kg and she was 90kg on 22 August 2017, 90.3kg in January 2018, 87kg on 27 September 2018 and 89kg on

10 April 2019.
[16] Observations of the claimant’s weight, temperature, pulse and blood pressure commence at page 48 of the claimant’s bundle.
Handwritten clinical records commence December 1984 and include the following relevant entries:
(a)   31 October 1992- commenced on Tofranil (imipramine) 10 mg 3 times daily. Panic attack 2 days ago;
(b)   3 November 1992 - increased to 20 mg TDS;
(c)   25 November 1992 - clomipramine 25 mg TDS and Stelazine 1 mg TDS;
(d)   18 June 1993 - Stelazine 2 mg TDS;
(e)   7 July 1993 - Stelazine 2 mg 4 times daily and clomipramine 50 mg in the morning and 25 at night ;
(f)    21 June 1995 - Xanax prescribed. Zoloft not so good;
(g)   9 May 1996 – depression;
(h)   24 May 1996 - panic attack and unable to breathe, and
(i)    19 September 2002 - medications continuing basically unchanged.
The record continues until 3 August 2009 in parallel with the printed records including the following:
(a)   10 July 2002 – lethargy, depressed mood, panic attacks;
(b)   19 September - 2002 brother with bowel cancer, very upset, unable to eat and sleep;
(c)   6 November 2003 – anxiety / depression;
(d)   5 January 2004 - depressed mood, poor sleep, low self-esteem irrational fear;
(e)   12 May 2004 - anxiety / depression;
(f)    9 August 2005 - anxiety / depression letter to Dr Robert Diamond (psychiatrist);
(g)   10 July 2006 – anxiety / depression;
(h)   1 December 2006 - early morning wakening, poor sleep, depressed mood, low self-esteem, panic attacks;
(i)    31 August 2007 – stress at work, new manager picking on her, teary, crying, can’t handle any more, on her nerves, can’t go to work. Counselling - past history of attack at work, can smell the man again getting panic attacks;
(j)    3 September 2007 – nervous anxiety settling from stress at work on Stelazine (antipsychotic);
(k)   2 August 2008 – transient ischaemic attack – CT scan of brain? for ENT off balance ? to see neurologist;
(l)    9 January 2009 – mental health care assessment and plan;
(m)     19 February 2009 – upset and crying has not been taking her medications;
(n)   During 2010/11 diagnosed with diabetes and referred to dietician. The referral says the claimant has increased in weight from 86kg to 102kg (page 231);
(o)   8 May 2012 – needs antidepressant;
(p)   1 December 2012 – diabetes not controlling well – to see dietician;
(q)   2 July 2012 – obesity, high blood pressure, chronic obstructive pulmonary disease (COPD);
(r)    17 April 2015 – feeling very tired, getting worse lately;
(s)   6 September 2016 – poor control of COPD, was in ED. Anxiety ? sister died;
(t)    22 December 2016 – feeling tired;
(u)   24 May 2017 - trying to lose weight 90 kg;
(v)   17 July 2017 – Depressed not on Stelazine for two months – not available at the market, anxious / uptight, sleeping OK, low mood / sad, not suicidal, lives with son and daughter supportive. Mum lives close. Partner in same house no relationship, now taking Anafranil 1 daily. Dose changed to one, twice a day after meals to 1, twice a day with meals;
(w)   26 July 2017 – anxiety / depression, very teary and worried about weight loss, anxious +, has lost 2 kg this week, appetite as normal, and
(x)   29 July 2017 - low oxygen and significant COPD – quite likely contributing to weight loss and significant stress over granddaughter Jai-Lynn.

The claimant attended after the accident as follows:
(a)   25 September 2017 - reported 19-year-old granddaughter died as a result of hit-and-run 2 days ago. Not coping. Diazepam 2 mg 3 times daily maximum; husband will supervise;
(b)
8 November 2017 - anxious, irritable, poor sleep, not eating, tearful

01/12/2017 symptoms continuing; Anafranil increased from twice to 3 times daily;
(c)   9 December 2017 – the GP completed a mental health plan referring the claimant to psychologist Ms Kopravica with a bereavement disorder for diagnostic assessment, psychoeducation, CBT and skills training. There was also a similar referral to psychologist Ms Cat;
(d)   5 January 2018 – claimant will follow up with psychologist next week;
(e)   10 January 2018 - psychologist Ms Koprovica diagnosed complex grief with elements of depression and post-traumatic stress. Does not want to live but will do so for the trial to see the guy sentenced. Denial and anger;
(f)    14 May 2018 - hospitalised overnight with diplopia. Refused MRI on the basis of cost. Stemetil 5 mg;
(g)   22 September 2018 - grieving, very teary, still has lots of family support, poor concentration;
(h)   22 October 2018 - subclinical hyperthyroidism;
(i)    15 November 2018 reactive, alert and not teary. Still grieving. Not sure psychologist has helped. Accepted new mental health care plan, and
(j)    10 April 2019 seen by psychologist but not happy. Not keen to talk today because of death in family. Depressed.
There are a number of further consultations at regular intervals the main thrust of which is complex or significant grief and anger at the driver’s actions until 1 March 2018. There was a reference to the driver being sentenced in February 2018.
There have been a number of other issues in 2018 including dizziness which was investigated by Dr Beran neurologist. He provided a letter dated 5 June 2018 to the claimant’s GP concerning Ms Gadd’s complaint of double vision in her right eye but normal vision in the left which he considered “impossible” and led him to doubt her history. The claimant complained of memory disturbance and so he administered a “mini mental state examination” for which she scored 30 out of 30. The medical members of the Panel note that while this does not indicate any impairment of memory on bedside screening, the mini mental state examination can be insensitive to milder forms of cognitive dysfunction. He requested bloods tests and MRI of the brain and an EEG.
On 12 June 2018 Dr Beran again wrote to the claimant’s GP after the MRI and the EEG suggesting she had inadequate diabetes management, some ischaemic changes in the brain which he considered to be a legacy of her smoking but there was nothing acute on the imaging. He appears to have given her a serious talking to about her smoking habit and arranged to see her in a month however a third letter reveals

Ms Gadd did not attend.
The records of the Villawood Medical Centre show that the claimant was still reporting symptoms of tearfulness, anxiety and depression in September 2018 and

November 2018 and April 2019 which is where the GP notes end. There have been no updated records provided.

Medico legal evidence

There is no medico-legal evidence from the claimant. There are no reports from any psychiatrists or psychologists who have provided treatment to the claimant. Leaving aside the assessment of Assessor Samuell there is no new evidence presented by either party in over three years.
The insurer relies on a report from Dr Rickard-Bell dated 1 August 2019[17].
[17] A3 at page 6 of the insurer’s bundle.
Dr Rickard-Bell has a history of treatment up until 2019 having reviewed the GP’s notes and records.
The history of the accident record by Dr Rickard-Bell is that the claimant’s daughter (Charmain Lee) was notified 10 minutes after the accident and came to the accident scene observing ambulance personnel attempting to resuscitate Natasha. The driver absconded but was found and charged three days later.
Dr Rickard-Bell notes:
“The impact of the accident on Ms Gadd has been a devastating loss with loneliness, grief and low mood. She finds it difficult to imagine a positive future. She believes that she would benefit from some grief counselling which could also help the whole family.”
A history was obtained from the claimant as follows:
(a)   employment – the claimant ceased work as a cleaner in 2007 in order to take care of her mother;
(b)   she had no serious past illnesses other than diabetes, hypertension and high cholesterol;
(c)   she was diagnosed with agoraphobia when she was 26, was prescribed Anafranil (an anti-anxiety medication) and struggled to leave home and had panic attacks. She overcame this by working at Fairfield Hospital;
(d)   she had some minor work-related issues but no legal issues;
(e)   before the accident she cared for herself and her mother, related to her husband and family and could concentrate without any problems, she socialised, went to the club and played the poker machines. She cared for her children and travelled without issues;
(f)    she avoids going to the shops because Natasha worked at Woolworths;
(g)   living at home with Ms Gadd and her husband Greg are her four children (Matthew, Melissa, Amanda and Charmain) and some of her grandchildren, and
(h)   her mother is 87 and lives independently nearby however she does need supervision. Ms Gadd takes her to the shops and appointments and cooks for her.
The claimant says she went to her GP who referred her to a psychiatrist for grief counselling, she had counselling with a psychologist but thought it did not help. She is taking no medication other than the Anafranil which has been a long-term medication.
The claimant outlines her current routine. She wakes up at about 8.30 am, her grandchildren come to her home to get ready for school and she helps them. Her daughter Amanda collects the children and takes them to school. During the day she does the housework, speaks to her mother (whom she visits twice a week). Amanda collects the children and brings them to Ms Gadd’s home where they may have dinner. Ms Gadd prepares the dinner.
The claimant reports difficulty with sleep, a reduced appetite, weight loss of 15 kg. She has had suicidal thinking and has seen a psychiatrist but did not find it helpful. Thirty years ago, she had agoraphobia but overcame this.
The claimant was co-operative but tearful and explained that Charmain lived with her until Natasha was about 13. She has been distraught since the accident and devastated. She cries constantly and finds it difficult to concentrate.
Natasha was a healthy happy child and was school captain in primary and high school as well as a prefect and sports captain. For her first 13 years, Natasha had constant contact with Ms Gadd as they were living together. Charmain has two other children.
Dr Rickard-Bell diagnosed a complicated grief reaction with alcohol misuse as well as major depression. He says she was well before the accident but now has ongoing psychiatric symptoms including disturbed sleep, low mood, decreased appetite and weight loss. He considered she would benefit from some further treatment.
Dr Rickard-Bell assessed the claimant as being in class two for five of the six functions and class three for concentration, persistence and pace. Her median class value was 2 with the aggregate score of 13 which corresponds to a WPI of 7%.

RE-EXAMINATION

Who attended the assessment?

Ms Gadd attended the audio-visual assessment alone. She was located in the bedroom of her Villawood home. She said her husband was present elsewhere in the home. The assessment was conducted by Assessors Lim and Mason.

History

Psychosocial history and pre-accident history

Ms Gadd is a 62-year-old woman who lives in Department of Housing accommodation in Villawood. She receives a carers pension because she is looking after her 92-year-old mother who lives independently nearby. She lives with her 62-year-old husband Gregory. He has recently had to leave work as an officer at the Villawood Detention Centre because of his mental state. Also living in the household are her 32-year-old daughter Melissa and 30-year-old son Matthew who both work at the Villawood Detention Centre.
Ms Gadd was born at Bankstown Hospital. She said her birth was normal and developmental milestones were normally attained. Her father died at 47 years of age of an acute myocardial infarction in 1975. Her 92-year-old mother lives independently nearby. Ms Gadd said her mother is not too bad considering she has had carcinoma of the bowel and some form of cancer of the head. She said her parents separated when she was 13 years of age and that she was happy they parted because they were fighting all the time. She is the fourth of five children with older brothers aged 70 and 68, an older sister who died at 67 years of age in 2015, and a younger brother aged 58 years. Apart from her parents fighting she described a happy safe childhood and denied physical, emotional or sexual abuse while she was growing up.
She attended Villawood Primary School and then Bass High School. She said she did not want to go to school, was often naughty and often ‘jigged’ school because she wanted to stay home to help her mother. She said she was not treated badly at school, did her school work okay and achieved average results but left as soon as she could at the age of 14.
Subsequent to that she worked at a news agency for two or three years and then had her daughter Charmain at 20 years of age with her then partner William Lee. She said they were in a relationship for four or five years and that he left her for her sister when Charmain was six weeks old. As a result, she did not speak to her sister for a number of years but they eventually repaired their relationship because Mrs Gadd stated her sister needed her. Ms Gadd made it very clear that she was the carer in the family who looked after everybody.
She subsequently commenced a relationship with Mr Greg Gadd when Charmain was 12 to 18 months of age. Charmain continued to live with her, while she and Greg went on to have three children together, Amanda aged 39, Melissa 32 and Matthew 30. She said the marriage with Greg had been good until recently but acknowledged there had not been an intimate relationship for a long time. The claimant describes aspects of her marital situation which the Panel have considered, but will not be included in these reasons to protect the privacy of the claimant’s husband.
Ms Gadd was asked about past psychiatric history. She denied drug use and any form of deliberate self-harm as an adolescent. When her first husband William Lee left her for her sister, she took an overdose of tablets and was treated overnight in the emergency department with charcoal. She said she had no psychological or psychiatric treatment following that. When her son was an infant, she was playing with him on the floor and talking to him and she had a sudden impulse to hurt him. She felt that was not right and sought help. Around that time, she had also developed panic attacks and could not go outside. She saw a psychiatrist, Dr Samad of Fairfield and was commenced on the antidepressant agent clomipramine 50 mg and the antipsychotic agent trifluoperazine 2 mg three times daily. At that time clomipramine was the antidepressant of choice for the treatment of obsessive-compulsive symptoms. She went on to say she took on a foster child for 18 months which she said helped her get over things. The child went back to his parents after a family meeting, and she had no further contact.
Ms Gadd was asked how she coped at work with her anxiety symptoms (panic attacks). She said she was able to hide in the cleaners’ room or toilet if she had a panic attack. She said in recent years she had been unable to obtain trifluoperazine (the supply was discontinued in 2017) and she has managed without it. She continued to use clomipramine but had reduced the dosage to 25 mg every two or three days immediately prior to Natasha's death and had planned to stop it. Ms Gadd denied any panic attacks or depression in the year prior to Natasha's death. She said she had not consulted a psychologist or a psychiatrist during that time. She also denied any family history of psychiatric illness.
With regard to work, Ms Gadd said she commenced work at Fairfield Hospital in 2000 and left work in 2014. She said she worked in positions as a cleaner and a supervisor of cleaning staff. She was questioned about injuries at work and said on one occasion a patient got her in a head lock and she took two days off. There was another instance of a needlestick injury from a garbage bag which required another two days off. These events were subject to worker's compensation claims which involved treatment only. She was asked about a difficult time with a manager in 2007. She said because a supervisor was not present, she called the assistant director of nursing who put another cleaner in a role that precluded Ms Gadd from working with a preferred partner. She said that subsequent to this, she experienced a transient ischaemic attack and was hospitalised for a week. She was then offered a position closer to home at the Fairfield Community Centre and she worked there for two years, Monday to Friday, from 6.00am to 2.30pm as a cleaner. She said she stopped this work in 2014 when her mother became ill and she had to look after her.
Ms Gadd was asked about the domestic arrangements in regard to Charmain and her children, especially Natasha. She said they lived with her until Natasha was 14 years of age. Charmain and Natasha then moved to their own Department of Housing accommodation in the immediate area. After Natasha, Charmain had two more children, Monique and Charlize. Ms Gadd lived with Charmain, Natasha and Monique however Charlize was born after Charmain had moved to her own home. She said following the move, Charmain would come every day and spend the day with her and then the children would come to her house after school. She said even after Charmain moved out, they often all had the evening meal together. She added that when Natasha commenced part-time work before and after her HSC she would often call in once or twice daily between jobs for a meal or for a rest. She said Natasha would often just lie on her bed.
With regard to substance use, Ms Gadd smokes 50 cigarettes a day. She acknowledged she suffers from chronic obstructive pulmonary disease and that this level of cigarette consumption is not wise. With regard to alcohol, she consumes between 6 and 20 stubbies of normal strength beer per week; she usually drinks on two days/week and has a number of alcohol free days. She denied the use of recreational drugs and pain killers and said she does not now have a gambling problem although still plays the poker machines.
Recreational activities before the motor accident consisted of reading and going for walks. She also enjoyed attending the Chester Hill Bowling Club or RSL Club where she would participate in dancing and karaoke. She said she played the poker machines quite heavily, often spending $400 per week. She said she particularly enjoyed family get-togethers which usually occurred on a monthly basis.
With regard to forensic matters, she said the police took her into custody during a difficult period with her husband Greg. She said she had cut up all his clothing. She said they attended a marriage counsellor for two sessions which she described as useless because Greg managed to make it seems like it was her fault.
Ms Gadd’s past medical history is as follows:
(a)   abdominal hysterectomy 1993;
(b)   type 2 diabetes 2004;
(c)   hypertension 2006;
(d)   hypercholesterolaemia and mild CVA 2008;
(e)   cholecystectomy 2011, and
(f)    chronic obstructive pulmonary disorder 2012.
Ms Gadd currently suffers from diabetes, hypertension, hypercholesterolaemia, obesity and emphysema. Current medications consist of Xigduo (dapagliflozin/metformin) 5/1000 mg twice daily for diabetes, Sevikar (olmesartan/amlodipine) 40/10 mg daily for hypertension, simvastatin 20 mg for cholesterol, Anoro Ellipta (umeclidinium/vilanterol) 62.5 mcg / 25 mcg powder for inhalation daily for pulmonary disease, aspirin 100 mg daily as a blood thinner, and Ventolin puffer as needed. She is currently taking clomipramine 50 mg for depression.

Pre-accident functioning

Ms Gadd said before the accident she was living a normal happy life. She stated she was doing “everything” which included the housework and cleaning and was happily busy in her life. She visited her mother at least four days a week to provide care and at times stayed all night with her. Her daughter Charmain came each day to visit her and stayed until her children came home from school. She said they often stayed for dinner and Natasha behaved as if she still lived there. From a psychiatric point of view, she was no longer using the antipsychotic agent trifluoperazine and said she was reducing the dosage of the antidepressant clomipramine. She denied symptoms of anxiety or depression.
Self-care and personal hygiene: Ms Gadd said she had a bath regularly, did the laundry and wore clean clothing. There was no problem with her appetite. While she had weighed over 100kg in periods before the accident, the records suggest she had lost weight and was 90kg shortly before the accident. She was unimpaired from a psychiatric perspective.
Social and recreational activities: Ms Gadd said she enjoyed reading. She enjoyed going out for dancing and karaoke at the Chester Hill Bowling Club or the Chester Hill RSL Club. In addition, she would go to the club with her husband to have a drink and play the poker machines. She also said the extended family would get together approximately monthly for barbecues or to celebrate birthdays. She was unimpaired from a psychiatric perspective.
Travel: Ms Gadd did not have a driver's licence and did not drive a motor vehicle. She used taxis or Uber but preferred to get a lift from her husband, her daughter or Natasha. She had no difficulty using public transport. She had flown to Queensland for a holiday but said she was anxious on the plane. She was unimpaired from a psychiatric point of view.
Social functioning: Ms Gadd said that she and her husband Greg got along alright although there had been no intimacy for a number of years. She said she always had family members around and felt quite happy with her family life, with the exception of her intimate relationship with her husband. She was mildly impaired from a psychiatric perspective due to the issues with her husband.
Concentration, persistence and pace: Ms Gadd said she enjoyed reading novels. She preferred love stories such as Mills and Boone. She enjoyed watching the series Home and Away on television. She said she had no difficulty with following a recipe and did not need a list to go shopping. She managed the family finances by going to the bank and paying the bills at the Post Office. She was unimpaired from a psychiatric perspective.
Adaptation: Ms Gadd had stopped work to look after her mother in 2014. She received the carers benefit and was her mother's full-time carer. She said she had no difficulty managing the housework and cooking for her family. Her husband and son looked after the outside of the home. She was unimpaired from a psychiatric point of view.

History of the motor accident

Ms Gadd said she was asleep when, at around 6.00am, there was a knock at the door by her daughter Charmain. She had granddaughters Monique and Charlize with her. When she told her Natasha had been killed by a hit-and-run driver, Ms Gadd said she was so shocked she could not move. She said she felt numb and experienced it as a nightmare. She said she then went into protection mode and made it her task to help the family get through it. She said she supressed her own distress and focused on everyone else. She added she made it a point to disconnect from Facebook because she did not want to see messages or images of what had happened. She said she fell apart and was crying all the time but tried to present a stiff upper lip to the family.

History of symptoms and treatment following the motor accident

Ms Gadd said she went to the GP and asked if she could be referred to somebody because she was unable to get through the day without crying all the time. She said she just could not stop crying. She said she could not get to sleep and would lie awake until after midnight waiting for Natasha to come through the window. When asked what she meant she explained her beliefs that ‘spirits’ come at midnight, but Natasha never came to her. She said she still stays up until midnight waiting for her to come because she is unable to say inside herself that Natasha is gone. She added she is still unable to talk about Natasha in the past tense because she does not want to believe she has died. She said it has been particularly getting on top of her over the last 12 months. She said she does her best to help Charmain and her other grandchildren but all she really wants to do is lie down where Natasha had last laid down on her bed when she was 18.
Ms Gadd went on to say that she would see Natasha every day even after she had moved to her own home. She recalled Natasha would see Ms Gadd between jobs and have something to eat or a rest. She remembered that Natasha had cleaned her chandelier the day before the subject motor accident and she has not touched it since. She remembers saying "goodbye Tash, see you, love you". Natasha had worked a couple of jobs in order to get a special car. She said that car remains in Charmain’s front yard rotting away because no one will drive it.
Ms Gadd said she thinks about Natasha's injuries every night. She wakes between 1.00am and 3.00am and has a couple of cigarettes. She was aware of the parasuicidal nature of this habit. She said she lies awake for three or four hours and finally gets up around 8.00am or 9.00am. She often sleeps for an hour and a half during the day if she has had a particularly bad night. When specifically asked she said she did develop suicidal thoughts and wanted to end it all but said she could not put the family through that. She said she eats lunch only sometimes but does have dinner every evening. She currently weighs 84 kg and is relying on the needles (Ozempic) to help lose weight but these are not available until next year. She said she has to push herself to do any activities. She said if she becomes tearful at home, she goes out to the clothes line and pretends to be doing something. She denied any traumatic dreams. She said she does think about it all the time. While she is washing up, she hears Natasha saying to her "What’s for tea Nanny, what’s for tea?”
When asked about treatment she said she had been referred to three psychiatrists. This appears to be incorrect, and the records produced suggest Ms Gadd was referred to two psychologists who were working at the medical centre with her GP Dr Oei. The claimant said the first was a young girl who did not have any idea of what it felt like to lose somebody. She saw her for two or three sessions at Villawood but felt it was useless. She said she saw another girl on two occasions and said “all she wanted to do was talk about my bowels” so she did not go back. The medical members of the Panel were satisfied that Ms Gadd is not a sophisticated person and did not understand the difference between a psychologist and a psychiatrist. There is no evidence before the Panel of any treating psychiatric consultation after the motor accident.
She said her GP prescribed diazepam to enable her to attend Natasha’s funeral. Since then she had increased the dosage of clomipramine to 75 mg daily and is currently taking 50 mg daily.
Ms Gadd described joining an online help group called "no one left behind" which she attended for about 12 months. She thought she would find support for her grief but said she discontinued because she could not stand people having fun and moving on with life to deal with real problems. She said on a couple of occasions she phoned Lifeline and Beyond Blue for support but has not continued to do so.

Details of any relevant injuries or conditions sustained since the motor accident

The claimant denies any further relevant psychological or psychiatric injuries or conditions. The claimant does have a number of physical issues including emphysema. The Medical Members of the Panel have been careful during their examination of the claimant to ensure they have focused on the claimant’s mental health presentation.

Current symptoms

Ms Gadd continues to ruminate on Natasha's death. She said she cannot keep thoughts of her out of her mind. She continues to stay awake until after 12 midnight in the hope that Natasha's spirit will come to her. She feels constantly depressed at the thought of what happened to Natasha. She continues to experience passive suicidal ideation but would not act on these thoughts. She is frequently tearful although she tries to hide this from her family. She has disrupted sleep which consists of initial insomnia and early morning wakening. She sometimes sleeps during the day. The Assessors noted she had created a memorial for Natasha in her lounge which dominates the entire room. She described intermittent panic attacks. She said these occurred every few weeks and can be triggered by going to Woolworths where Natasha worked, or seeing children in the school uniform Natasha wore. She said she is not interested in doing anything or going out. She spends her time lying around on the lounge of her bed. She has restricted the care she provides to her mother, going only twice weekly and paying to get extra care in. She said she no longer goes out to shopping centres for window shopping because she does not want people asking how she is. She runs in and out quickly if she has to get groceries.

Current and proposed treatment

Her current treatment consists of medication in the form of clomipramine. There is no further proposed treatment.

Clinical examination

Mental state examination

Ms Gadd is an overweight right-hand dominant 62-year-old woman who appeared to be older than her stated age. She was identified from her Medicare card. The interview was conducted using the Microsoft Teams application with a reasonable internet connection. She was initially located alone in her bedroom. She was using her mobile phone and when the charge started to run down she had to transfer to the lounge room where she sat on the lounge in front of a large installation which was a memorial to Natasha.
She was depressed in appearance and was frequently tearful throughout the interview. She described ongoing suicidal ideation with no intention of putting it into practice because of how it would affect her family. She was constantly preoccupied with her granddaughter Natasha and described ruminating about her death the entire time. She described disrupted sleep including initial insomnia and early morning wakening. She said she had lost weight, but it is not clear if this was due to depressed appetite or the impact of diabetic medication. She complained of memory problems, but this seemed intermittent. At times she had a good recall of history and at other times she had difficulty recalling events in the past. There is a possibility her transient ischaemic attacks may have contributed to her problems with recall, although these would also be consistent with her depressed mental state. Her rate of speech was slowed and her range of affect was restricted to the depressive spectrum. She displayed no positive emotion or humour throughout the entire interview.
Ms Gadd described recurrent intrusive recollections and ruminations regarding her granddaughter. She was clearly distressed by the death. She made efforts to avoid facing the fact that her granddaughter had died. She had withdrawn from friends and activities and felt detached and estranged from others and there was a persistent inability to experience positive emotions. There were problems with concentration and sleep beyond those the Panel member notes were evident from the GP notes before the accident. The medical members of the Panel consider this is consistent with a significant major depressive disorder and in excess of those described by her GP before the accident.
Ms Gadd was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.

Current functioning

Ms Gadd said she currently spends her time at home either sitting on the lounge or lying on her bed. She goes to care for her mother once or twice weekly. She continues to look after the family members who live with her at home.
Self-care and personal hygiene: Ms Gadd said she has a bath three or four times per week because she cannot be bothered to make the effort. She said she spends her time mainly in her pyjamas and slippers. She said she is able to go to the corner shop to get supplies or kebabs in her slippers and dressing gown because she could not be bothered getting dressed. This is due to the decreased motivation that occurs as a result of her mental state. She said she does the laundry and cooks for the family members who live at home, her husband, daughter and son. She is mildly impaired.
Social and recreational activities: Ms Gadd said that she does nothing at all. She does not see any friends. She does not go out to the shops with friends to have coffee. When asked about entertainment venues, she said she goes with her husband Greg to the club once or twice weekly, plays the poker machines and has a drink and then comes home without relating to other people or having a meal. She does not go dancing or participate in karaoke. She said she does not have family get togethers which she did in the past due to her mental state which affects her motivation and enjoyment of these activities. These gatherings were very important to Ms Gadd but since Natasha’s death she does not have the energy or motivation to initiate them. She is moderately impaired.

Travel: Ms Gadd has never held a drivers licence. She believes she could use public transport but has not done so; she said she could not be bothered catching a bus. She also does not do any walking. This is partly because her emphysema is deteriorating. She uses a taxi or Uber if she has to go anywhere but prefers to travel by car with a family member driving. She is mildly impaired.
Social functioning: Ms Gadd is still living with her husband Greg and the two younger children. Her daughter Charmain continues to visit every day from Monday to Friday and her children come to the house after school. She said she no longer initiates family functions, so these functions do not occur and as a result the family has all drifted apart since Natasha's death. She is mildly impaired.
Concentration, persistence and pace: Ms Gadd said she is unable to read a book because she simply cannot keep her mind on the contents. She said she listens to what is on television but finds it difficult to concentrate on it; her favourite program is Home and Away. She does the budgeting for the family home but tends to forget when things are due. She said she has lost interest with keeping on top of things and finds she is quite a bit slower at completing tasks. There was clinical evidence of impaired concentration throughout the interview. She is moderately impaired.
Adaptation: Ms Gadd said she continues to care for her mother but goes to see her much less frequently, now only once or twice weekly, because she cannot cope with her. She manages this by getting extra outside help. She continues to care for the family, although at a reduced rate and pace. She said she is not able to manage the shopping as she did in the past. She is moderately impaired.

Comments of consistency

Ms Gadd’s presentation was internally consistent, consistent with the documentation provided and consistent with the diagnosis made. There was no evidence of symptom exaggeration throughout the interview. Throughout the interview Ms Gadd often appeared to provide incomplete answers to questions only to provide the requested information in another context later in the interview. The panel was of the view that
Ms Gadd was not psychologically sophisticated and did her best to cooperate with the interview in an honest manner.
The Panel notes the claimant has significant physical issues including deteriorating emphysema. The Panel has been careful to consider only the effect of the claimant’s psychological injury when undertaking the impairment assessment.

impairment assessment

Diagnosis and reasons

Ms Gadd suffered from a pre-existing psychiatric condition which had its onset approximately 30 years ago when she experienced ego-dystonic impulses to harm her youngest child. She consulted a psychiatrist and was commenced on antidepressant and antipsychotic medication. Subsequent to that she developed a panic disorder and was for a period of time agoraphobic. With the aid of medication, she was gradually able to overcome this and was able to commence work as a cleaner at Fairfield Hospital in approximately 2000. This continued until about 2014 when she stopped work to become a carer for her mother.
The panel formed the view that Ms Gadd suffered from a pre-existing persistent depressive disorder with episodes of major depressive disorder and anxious distress. At the time of the subject motor accident, she had ceased using the antipsychotic medication and said she was in the process of reducing her antidepressant medication. There was also a pre-existing alcohol use disorder with a binge pattern of drinking.
As a consequence of the subject motor accident in which her granddaughter was killed by a hit-and-run driver Ms Gadd developed symptoms consistent with a DSM-5 major depressive disorder. Criterion A is met in that she has depressed mood most of the day nearly every day, has markedly diminished interest or pleasure in most activities nearly every day, has experienced significant weight loss, has insomnia, has difficulty with concentration and has recurrent passive suicidal ideation. Criterion B is met in that the symptoms cause significant distress and impairment. Criterion C is met in that the symptoms are not due to a substance or another medical condition. Criterion D is met in that the condition is not better explained by another psychiatric diagnosis. Criterion E is met in that there has never been manic or hypomanic episode. The pre-existing alcohol use disorder continues and appears not to have been exacerbated by her granddaughter's death.
The Medical Members of the Panel are comfortably satisfied that in their clinical judgment, the claimant suffers from a major depressive disorder and notes that both Assessor Samuell and the insurer’s expert Dr Chris Rikard-Bell have also diagnosed that condition.

Causation and reasons

The panel established that Ms Gadd had a close personal relationship with her granddaughter Natasha. They lived together until Natasha was 14 years of age and

Ms Gadd saw Natasha daily after school and intermittently on weekends after she had moved out. There is no doubt that she loved her granddaughter and was very proud of her.
While the claimant had pre-existing mental health issues, the Medical Members of the Panel are of the view that in their clinical judgment, these were not a significant feature of the claimant’s pre-accident state.
The panel was of the view that the loss of her granddaughter and the nature of her death was sufficiently traumatic to cause the condition major depressive disorder. There were some elements of post-traumatic stress disorder in Ms Gadd's presentation, but she did not satisfy DSM-5 diagnostic criteria for that condition.

Statement about permanent impairment

Permanent impairment is defined in the AMA4 Guides (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.”
It is now five years since the subject motor accident. The claimant briefly attempted therapy with two or three different psychologists which she found unsatisfactory for various reasons. She has been treated by her GP with the antidepressant clomipramine. She has not sought psychiatric treatment. Her condition is unlikely to improve by more than 3% in the next year with or without further treatment. Her condition is now well stabilised.

Current whole person impairment

Psychiatric diagnoses	Major Depressive Disorder
Psychiatric treatment description	Psychological consultation GP consultation Clomipramine 50 mg

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	2	Ms Gadd said she has a bath of 3 or 4 times per week. She said she spends her time mainly in her pyjamas and slippers. She said she is able to go to the corner shop to get supplies or kebabs in her slippers and dressing gown because she could not be bothered getting dressed. She said she does the laundry and cooks for the family members who live at home, her husband, daughter and son. She is mildly impaired.
2. Social and Recreational Activities	3	Ms Gadd said that she does nothing at all. She does not see any friends. She does not go out to the shops with friends to have coffee. When asked about entertainment venues she said she goes with her husband Greg to the club once or twice weekly, plays the poker machines and has a drink and then comes home without relating to other people or having a meal. She does not go dancing or participate in karaoke anymore. She said she does not have family get togethers which she did in the past due to the impacts on her mental state on her motivation and ability to enjoy these events. These gatherings were very important to Ms Gadd, but since Natasha’s death, the claimant does not have the energy or motivation to initiate them She is moderately impaired.
3. Travel	2	Ms Gadd has never held a drivers licence. She believes she could use public transport but has not done so; she said she could not be bothered catching a bus. She also does not do any walking. This is partly because her emphysema is deteriorating. She uses a taxi or Uber if she has to go anywhere but prefers to travel by car with a family member driving. She is mildly impaired.
4. Social Functioning	2	Ms Gadd is still living with her husband Greg and the two younger children. Her daughter Charmain continues to visit every day from Monday to Friday and her children come to the house after school. She said she has no family functions and the family has all drifted apart since Natasha's death. She is mildly impaired.
5. Concentration, Persistence and Pace	3	Ms Gadd said she is unable to read a book because she simply cannot keep her mind on the contents. She said she listens to what is on television but finds it difficult to concentrate on it; her favourite program is Home and Away. She does the budgeting for the family home but tends to forget when things are due. She said she has lost interest in keeping on top of things and finds she is quite a bit slower at completing tasks. There was clinical evidence of impaired concentration throughout the interview. She is moderately impaired.
6. Adaptation	3	Ms Gadd said she continues to care for her mother but goes to see her much less frequently, now only once or twice weekly, because her mental state affects her ability to maintain her former level of involvement. She manages this by getting extra outside help. She continues to care for the family, although at a reduced rate and pace. She said she is not able to manage the shopping as she did in the past. She is moderately impaired.
List classes in ascending order: 2 2 2 3 3 3
Median Class Value: 3
Aggregate Score: 15
% Whole Person Impairment: 15%

Pre-existing impairment

Psychiatric diagnoses	Persistent depressive disorder with episodes of major depressive disorder and anxious distress
Psychiatric treatment description	Psychiatric consultation GP consultation Clomipramine 75 mg Trifluoperazine 2 mg

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	1	Ms Gadd said she had a bath regularly, did the laundry and wore clean clothing. There was no problem with her appetite although she weighed 102 kg. She was unimpaired.
2. Social and Recreational Activities	1	Ms Gadd said she enjoyed reading. She enjoyed going out for dancing and karaoke at the Chester Hill bowling club or the Chester Hill RSL club. In addition, she would go to the club with her husband to have a drink and play the poker machines. She also said the extended family would get together approximately monthly for barbecues or to celebrate birthdays. She was unimpaired.
3. Travel	1	Ms Gadd did not have a driver's licence and did not drive a motor vehicle. She used taxis or Uber but preferred to get a lift from her husband, her daughter or Natasha. She had no difficulty using public transport. She had flown to Queensland for a holiday although said she was anxious on the plane. She was unimpaired.
4. Social Functioning	2	Ms Gadd said that she and her husband Greg got along alright although there had been no intimacy in recent years. She said she always had family members around and felt quite happy with her family life with the exception of her intimate relationship with her husband. She was mildly impaired.
5. Concentration, Persistence and Pace	1	Ms Gadd said she enjoyed reading novels. She preferred love stories such as Mills & Boone. She enjoyed watching the series Home and Away on television. She said she had no difficulty in following a recipe and did not need a list to go shopping. She managed the family finances by going to the bank and paying the bills at the Post Office. She was unimpaired.
6. Adaptation	1	Ms Gadd had stopped work to look after her mother in 2014. She received the carers benefit and was her mother's full-time carer. She said she had no difficulty managing the housework and cooking for her family. Her husband and son looked after the outside of the home. She was unimpaired.
List classes in ascending order: 1 1 1 1 1 2
Median Class Value: 1
Aggregate Score: 7
Pre-existing % Whole Person Impairment: 0%

Other matters concerning impairment assessment

Apportionment was necessary for the pre-existing condition persistent depressive disorder with intermittent major depressive episodes and anxious distress. Pre-existing impairment was calculated at 0%.
There is no evidence that treatment has been effective so no allowance is made in respect of any treatment.

Conclusion

For the reasons set out above, the claimant has a WPI of 15%.
It therefore follows that the Panel therefore must revoke the certificate of Assessor Samuell and certify that the claimant has a WPI of greater than 10% as a result of the psychological injury she sustained following the death of her granddaughter Natasha.

[2022] NSWPICMP 376

27 September 2022