QBE Insurance (Australia) Limited v Georgopoulos
[2025] NSWPICMP 703
•12 September 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | QBE Insurance (Australia) Limited v Georgopoulos [2025] NSWPICMP 703 |
CLAIMANT: | Christos Georgopoulos |
INSURER: | QBE Insurance (Australia) Limited |
REVIEW PANEL | |
SENIOR MEMBER: | Susan McTegg |
MEDICAL ASSESSOR: | Wayne Mason |
MEDICAL ASSESSOR: | Alan Doris |
DATE OF DECISION: | 12 September 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; assessment of threshold injury under section 1.6(3); the claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) found the claimant sustained post-traumatic stress disorder and alcohol use disorder caused by the accident (a non-threshold injury); insurer sought review; Held – alcohol use disorder resolved; having regard to decisions of David v Allianz Australia Ltd, and Lynch v AAI Ltd can satisfy test as to threshold injury at any time since accident; found alcohol use disorder (resolved) is a non-threshold injury; claimant also suffered post-traumatic stress disorder (a non-threshold injury); certificate of MA confirmed. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Assessment of threshold injury Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel affirms the certificate of Medical Assessor Fukui dated 18 July 2024. |
STATEMENT OF REASONS
INTRODUCTION
On 18 July 2023 Mr Christos Georgopoulos (the claimant) was driving his motor vehicle when it was T-boned on the passenger side by the insured vehicle (the accident).
Mr Georgopoulos lodged an Application for personal injury benefits dated 1 August 2023 in relation to injury allegedly sustained in the accident.
QBE Insurance (Australia) Limited is the relevant insurer with liability to pay statutory benefits to Mr Lee under the Motor Accident Injuries Act 2017 (the MAI Act).
Mr Georgopoulos’ claim is governed by the provisions of the MAI Act. At the time of the accident statutory benefits for treatment and care under the MAI Act ceased after 26 weeks if the person’s only injuries resulting from the accident were threshold injuries.
On 20 February 2024 the insurer issued a Liability Notice - Benefits after 26 Weeks declining the claim for statutory benefits on the basis the injury sustained by the claimant was a non-minor (threshold) injury for the purposes of the MAI Act.
On 23 February 2024 the claimant requested an internal review of the minor (threshold) injury decision.
The insurer issued a Certificate of Determination – Internal Review dated 14 March 2024 affirming the decision that the injuries met the definition of minor (threshold) injury for the purposes of the MAI Act.
The claimant filed an application with the Personal Injury Commission (Commission) seeking a medical assessment to resolve the minor (threshold) injury dispute between the parties.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be medical assessment matters, including “whether the injury caused by the motor accident is a threshold injury for the purposes of the Act” and whether treatment provided or to be provided to the injured person was or is reasonable and necessary in the circumstances and relates to the injury caused by the motor accident.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1]
[1] Section 7.20 of the MAI Act.
The dispute as to threshold injury in respect of the psychological injury was referred by the Commission to Medical Assessor Fukui.
The insurer has sought a review of the certificate of Medical Assessor Fukui.
DOCUMENTS BEFORE THE REVIEW PANEL
On 6 June 2025 the insurer, in response to a direction from the Panel uploaded to the portal documents indexed and paginated from pages 1 to 33 (insurer’s documents).
On 27 June 2025 the claimant uploaded to the portal a bundle of documents indexed and paginated from pages 1 to 313 (claimant’s documents).
On 11 July 2025 the insurer with the consent of the claimant uploaded to the portal an application to lodge additional documents together with records paginated from pages 1 to 76 (ALAD). These documents are admitted where they are treating records and where they were before Medical Assessor Fukui.
THRESHOLD INJURY- STATUTORY PROVISIONS
The Motor Accident Injuries Amendment Act 2022 (the MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From
1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
Any reference in these reasons to “minor injury” is a reference to a “threshold injury” and any reference to the word “minor” referring to the injury alleged to have occurred in the accident is a reference to “threshold”.
A threshold injury is defined in s 1.6 of the MAI Act. Section 1.6(1)(a) of the MAI Act defines a “threshold psychological injury” as:
“A psychological or psychiatric injury that is not a recognised psychiatric illness.”
Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a threshold psychological or psychiatric injury.
Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) provides the following:
“Each of the following injuries is included as a threshold injury for the purposes of the Act:
(a)acute stress disorder,
(b)adjustment disorder.”
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the MAI Act. Version 9.3 of the Guidelines commenced on 6 December 2024 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4 Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
In respect of threshold psychological or psychiatric injury the Guidelines also provide:
“5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”
ASSESSMENT UNDER REVIEW – MEDICAL ASSESSOR FUKUI
In a certificate dated 18 July 2024 Medical Assessor Atsumi Fukui certified the following injuries caused by the accident were not threshold injuries for the purposes of the MAI Act:
· post-traumatic stress disorder, and
· comorbid alcohol use disorder.[2]
[2] Insurer’s documents p 16
The injury referred for assessment was post-traumatic stress disorder.
Medical Assessor Fukui reported the claimant was a 53-year-old single man who worked full time as a freight porter for Qantas. He was born and raised in Sydney by his mother; his father having died when he was eight years old. He had always worked.
He underwent cardiac stenting in December 2023 and is on medications including Clopidogrel and medications for hypercholesterolemia and hypertension. There were no previous work or motor vehicle accidents. Pre accident he maintained his fitness and engaged in an active lifestyle. He was a non-smoker and social drinker.
He had a history of post-traumatic stress disorder after encountering an armed robbery whilst in a pub in 2011. He reported he saw a psychologist once and other than sleeping tablets was not prescribed medication. He stated he did not suffer from ongoing symptoms from this incident.
The accident occurred when a vehicle came from a side street and T-boned the passenger’s side of the claimant’s vehicle. He hit his head on the window which smashed. Police and Ambulance attended.
He attended St George Hospital the next day when he was diagnosed with concussion and a right shoulder muscular injury. He experienced nightmares which disturbed his sleep and flashbacks for two to three months after the accident. He experienced anxiety, was hypervigilant in the car and anxious. He became irritable and angry and the relationship with his partner deteriorated; they ultimately separated. His relationship with family and friends also deteriorated. He reported feeling depressed with low mood. He reported poor motivation and decline in energy. He had avoided socialising. He returned to work after eight months off work. He only drives short distances including the 10 minutes to his work. He does not go near the accident site. Excess alcohol use commenced about a month after the accident to help him sleep. He was drinking alcohol daily and on weekends drinks all day and consumes a bottle of scotch. He had recently suffered blackouts.
Medical Assessor Fukui diagnosed post-traumatic stress disorder noting the claimant met Criterion A having been involved in an accident from which he suffered concussion and physical injuries. He hit his head on the window which smashed. The accident had a clinically significant impact on his wellbeing. She also diagnosed Alcohol Use Disorder.
In relation to the history of post-traumatic stress disorder from 2011 she found his symptoms had been in full remission. He had been working for 20 years for Qantas, was in a long-term relationship, was socially engaged and maintained an active life. She considered his current presentation was a new condition unrelated to the incident 12 years earlier.
REVIEW PROCEDURE
The insurer lodged an application for review of the medical assessment of Medical Assessor Fukui on 12 August 2024 within 28 days of the date on which his certificate was made available to the parties.
On 16 September 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Panel.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[3]
[3] Rule 128 of the PIC Rules.
The review is by way of a new assessment of all matters with which the medical assessment is concerned.
On 14 August 2025 the Panel agreed an examination was required.
EVIDENCE BEFORE THE REVIEW PANEL
Medical Assessment Certificate of Medical Assessor Cameron
In a certificate dated 16 October 2025 Medical Assessor Cameron certified the following injuries were threshold injuries for the purposes of the MAI Act:
· head – soft tissue injury;
· cervical spine – soft tissue injury;
· thoracic spine – soft tissue injury;
· lumbar spine – soft tissue injury, and
· right shoulder – soft tissue injury.[4]
[4] Insurer’s documents p 25
Application for personal injury benefits
In the Application dated 1 August 2023 the claimant described the injuries sustained as “back, neck, shoulder, head, concussion”.[5]
[5] Claimant’s documents p 4
Photograph of the claimant’s vehicle
A photograph of the claimant’s classic car shows significant damage to the passenger side of the vehicle, in particular, to both doors which are stored in with no glass in either side window.
Pre-accident treating medical evidence
Dr Kirlous, general practitioner (GP)
On 30 December 2011 Dr Kirlous reported a history of an armed hold-up five weeks earlier at Bexley. He reported poor sleep, low self-esteem, irrational fear and panic attacks. He diagnosed post-traumatic stress disorder.[6]
[6] Claimant’s documents p 80
On 27 March 2021 Dr Kirlous reported the reason for contact was “stomatitis and post-traumatic stress disorder”.
Notwithstanding attendances for other medical conditions there is no other pre-accident reference to post-traumatic stress disorder.
On 29 July 2025 Dr Kirlous references “insomnia” and on 30 August 2021 he reported anxiety in the context of concern by the claimant about COVID-19 vaccination and its side effects.[7]
Post accident treating medical evidence
[7] Claimant’s documents p 61
Ambulance record
NSW Ambulance attended the accident on 18 July 2023. The report states:
“52yr male, MVA - muscular pain O/A: Pt standing on footpath, moving and ambulating freely. GCS15. B/G: Pt was driver in vehicle travelling approx 40-50km/hr when he was impacted on passenger side B-pillar by car travelling approx 20-30km/hr. Pt self-extricated from vehicle post impact. Bystanders contacted ambulance. O/E: Pt c/o mild bilateral lateral lumbar back pain, aching in nature, non radiating, non aggravating, non relieving. Pt denied head strike - denied LOC, denied C-spine pain on palpation, moving head freely, denied altered sensation, denied other pain. Pt declined full physical assessment. …There was pain from multiple body parts. ….”[8]
[8] Claimant’s documents p 42
St George Hospital
A discharge summary dated 19 July 2023 reported the claimant had been brought to the hospital by family due to abnormal behaviour and low mood following the accident the day before. CT scan of the brain was normal. He was assessed in respect of concussion and a right shoulder muscular injury.[9]
[9] Claimant’s documents p 147
Dr Samuel Merrick issued a Certificate of capacity/certificate of fitness dated 19 July 2023 certifying the claimant unfit for work until 31 July 2023 with concussion.[10]
[10] ALAD p 1
Dr Kirlous, general practitioner
The claimant consulted Dr Kirlous on 24 July 2023.[11] He reported:
“MVA on 18/07/2023 another car T- boned his car on the passenger side went to hospital next day because he was confused, headache, neck and right shoulder pain with pins and needles in right arm and back muscle pain forget things , agititaed , constent headache ,with feelin nausea but no vomiting.”
[11] Claimant’s documents p 60
On 28 July 2023 Dr Kirlous diagnosed post-traumatic stress disorder, noting the claimant was a very stressed patient with poor sleep, irrational fear and depressed mood.[12] He issued a Certificate of capacity/Certificate of fitness in which he certified the claimant unfit for work and diagnosed:
“Concussion, PTSD (post-traumatic stress disorder), Right Subacromial Bursitis and right bicipital tendon effusion. Exacerbation of cervical spines disc injury with left C7 nerve root compression and Exacerbation of lumbar facet joints arthritis.”[13]
[12] Claimant’s documents p 60
[13] Claimant’s documents p 151
On 18 August 2023 and on 8 September 2023 Dr Kirlous issued Certificates of capacity/Certificate of fitness where the diagnosis was in similar terms to the earlier certificate.[14]
[14] ALAD p 9
Helen Fotiades, psychologist
In an Allied health recovery request (AHRR) dated 12 September 2023 Ms Fotiades recorded:
“Adjustment Disorder with mixed anxiety and depressed mood with post-traumatic stress symptoms. DASS score indicates Severe Stress, Extremely Severe Anxiety and Moderate Depression symptoms.
Symptom onset was since injury on the 18th of July 2023. Symptoms reported are: disrupted sleep and when does sleep deeply dreams of the accident, decreased energy/motivation, fluctuating appetite and weight increased, down mood, triggered with minimal trigger/anger, grief with losing his car purchase day before incident and loss of funds as under insured, rumination of negative thoughts and the accident repeating, worry he’ll have another accident, withdrawn, anxiety symptoms with difficulties taking a breath, tension and increased heart rate a few times, headaches weekly more initially, fear with driving/more cautious, decrease in confidence with driving and in general, decreased trust in some friends, decreased concentration, forgetful, pain in right shoulder/worry that it will persist, tingling in his finger tips, has increased drinking to daily with binging at times, gambling at times due to boredom which is out of character and inability to relax.”[15]
Medico-legal reports
[15] Claimant’s documents p 303
Dr Richa Rastogi, psychiatrist
Dr Rastogi assessed the claimant at the request of his solicitors.[16] In a report dated
27 August 2024 she reported he presented with adjustment disorder with anxious distress and post-traumatic features associated with the accident. She also reported a history of comorbid alcohol abuse disorder. She noted he reported distress and prominent anxiety with panic attacks, poor stress coping and rumination stemming from the accident. Dr Rastogi found the claimant did not meet the criteria for post-traumatic stress disorder.[16] Claimant’s documents p 9
Dr Rastogi re-examined the claimant on 18 March 2025.[17] She diagnosis adjustment disorder in remission with residual anxiety. She stated:
“He reports improvement with treatment with his depression being in recovery. There is presence of mild social phobia affecting his social interaction but he does not fulfill criteria for social anxiety disorder or generalised anxiety disorder. He also reports mild anxiety whilst driving but is able to drive however avoids the accident site. He is working full time but not at the Tarmac. He displays poor stress coping and irritability. His alcohol abuse disorder is in remission. He has a good prognosis.”
[17] Claimant’s documents p 20
Dr James Bodel, orthopaedic surgeon
In a report dated 7 November 2024 Dr Bodel diagnosed soft tissue injury to the head and neck, a rotator cuff injury to the right shoulder with a probably partial thickness tear of the supraspinatus tendon and a soft tissue injury to the lumbar spine.[18]
SUBMISSIONS
[18] Claimant’s document p 31
Insurer’s submissions
The insurer provided submissions dated 20 June 2024 in respect of the substantive threshold injury dispute.[19]
[19] Insurer’s documents p 15
The insurer submits there is a pre-existing history of post-traumatic stress disorder:
· on 30 December 2011 Dr Kirlous, GP reported the claimant was involved in an armed robbery from which he developed post-traumatic stress disorder. His symptoms included poor sleep, low self-esteem, irrational fear and panic attacks;
· on 27 March 2012 Dr Kirlous recorded a further complaint regarding post-traumatic stress disorder;
· on 29 July 2015 Dr Kirlous diagnosed the claimant with insomnia, and
· 30 August 2021 Dr Kirlous diagnosed the claimant with anxiety.
The insurer submits there is no evidence that the prior diagnosis of post-traumatic stress disorder had resolved before the accident.
The insurer notes the diagnosis of Ms Helen Fotiades as recorded in the AHRR dated
11 September 2023 was adjustment disorder with mixed anxiety and depressed mood with posttraumatic stress symptoms, which is a threshold injury.The insurer provided submissions dated 12 August 2024 in support of the application for review.[20]
[20] Insurer’s documents p 1
The insurer submits there was a pre-existing and active psychiatric condition at the time of the accident. The insurer highlights the following:
(a) on 30 December 2011 Dr Kirlous diagnosed with post-traumatic stress disorder following an armed robbery. His symptoms included poor sleep, low self-esteem, irrational fear and panic attacks;
(b) Dr Kirlous recorded a further complaint regarding post-traumatic stress disorder on 27 March 2012;
(c) The claimant was diagnosed with insomnia on 29 July 2015 as per the clinical entry of Dr Kirlous, and
(d) The claimant was diagnosed with anxiety on 30 August 2021 as per the clinical entry of Dr Kirlous.
The insurer submits the claimant has not established he was exposed to actual or threatened death or harm and nor do his self-reported behaviours following the accident indicate he believed he had been exposed to such a threat as per Criterion A of the DSM-5 diagnostic criteria for post-traumatic stress disorder.
The insurer submits the claimant does not meet Criterion B of the DSM-5 diagnostic criteria which requires “recurrent” intrusive memories or dreams related to the traumatic event. The insurer notes Medical Assessor Fukui reported the flashbacks had resolved and the claimant no longer experienced nightmares, only dreams.
The insurer submits the claimant does not meet Criterion C of the DSM-5 diagnostic criteria which requires “persistent avoidance of stimuli associated with the traumatic event” where the claimant returned to driving after just one month.
The insurer submits Medical Assessor Fukui did not address how the claimant satisfied the DSM-6 diagnostic criterion for alcohol use disorder.
Claimant’s submissions
The claimant provided undated submissions in response to the application for review.
The claimant submits Medical Assessor Fukui addressed the history obtained in the clinical records and took it into account. Furthermore, the brief reference to symptoms in 2012, 2015 and 2021 occurred over a period of nine years. The claimant also notes that the entry in 2021 is COVID-19 related, the entry of 29 July 2021 of insomnia with no further explanation and the entry on 27 March 2012 is a diagnosis with no reported symptoms.
The claimant submits that Criterion A is satisfied, and whether or not the claimant was upset at the damage to his car, he was, in fact, exposed to serious injury.
In relation to the resolution of flashbacks and the cessation of nightmares the claimant submits if they had been recurrent in the past then Criterion B is satisfied.
In relation to Criterion C the claimant notes whilst he has returned to driving, he prefers to avoid it if he can and limits his driving to short distances. The claimant also notes he does not go near the accident site, showing avoidance of the stimuli.
The claimant submits Medical Assessor Fukui provided an adequate path of reasoning in support of the comorbid diagnosis of Alcohol Use Disorder.
THE MEDICAL EXAMINATION
Mr Georgopoulos is a 54-year-old man who lives alone in an apartment in a southern Sydney suburb. He is working full-time as a leading hand with Qantas Freight at Mascot airport where he has been employed for 23 years.
Psychosocial history
Mr Georgopoulos was born in Sydney and described a normal birth and development. His father ran a shop and was killed during a robbery when Mr Georgopoulos was five years of age. He said he has heard many stories about his death and does not know what is correct. His mother died in 2000 of an acute myocardial infarction. He has a 53-year-old sister with whom he maintains a good relationship.
He grew up in Redfern and described a reasonable childhood apart from the loss of his father. He denied any form of abuse throughout childhood. He attended Randwick Boys High School where he completed year 12 but said he did not do particularly well in school.
On leaving school he completed two years of an apprenticeship as a motor mechanic but did not complete it. He then worked for six or seven years as an offsider in the building industry. He operated a car detailing franchise for two years and then ran a car rental facility at Mascot airport for another two years. In 2001 he commenced work with Qantas in freight handling and continues working there full-time.
Mr Georgopoulos stated he had been involved in a number of longer-term relationships and had been engaged when he was younger. He lived with his most recent partner for 10 years and that relationship ended 9 or 12 months after the accident. He said they tried to have children together and attempted IVF without success. He stated rather fatalistically that it did not work out and "was not meant to be”. He consoled himself by seeing his sister's children.
Leisure activities prior to the accident consisted of going to the gymnasium two or three times per week. He said he participated in a poker game with friends once a week. He mentioned as a younger person he was very good at karate and had even been an amateur boxer. He said these activities were mainly related to maintaining fitness and he had never suffered a head injury or been knocked out.
He specifically denied any pre-existing work injuries or motor vehicle accidents. He said he may have developed lower back pain while working in the building industry, but it was never the subject of a worker's compensation claim. He denied any history of problems with the law.
Medically, he acknowledged a problem with cholesterol and said he required a stent in a coronary artery in December 2023. He had suffered chest pain for a few weeks and thought it was gastro-oesophageal reflux; he believes he was lucky he made it to hospital when he did. He said he uses medication for blood pressure and cholesterol. He has also been on a blood thinner since the stent was inserted. He presented at interview with a bandaged right hand and said he had tripped and fallen last week and injured his right wrist. He said he can work because he can use the scanner rather than lift heavy items. He noted knee surgery as an adolescent for a meniscus tear and said he has had a few cysts removed from the back of his neck.
Mr Georgopoulos was questioned about past psychiatric history. He initially denied having any psychological problems. He was reminded of his involvement in an armed hold-up at the North Bexley pub in 2011. He explained he had forgotten about it. He said he was one of a number of people who were in the hotel at that time, and he did have a gun pointed at him, but he was not individually threatened. He said he attended one psychological counselling session organised by the publican. He denied ongoing symptoms and specifically denied nightmares, flashbacks or disturbed sleep. He has continued to frequent hotels. It did not give rise to a compensation claim. The psychiatrist members of the panel do not believe he suffered post-traumatic stress disorder at that time.
Mr Georgopoulos was questioned about a diagnosis of insomnia in the GP record in 2015. He said he has no specific memory of sleep difficulty at that time and suggested it may have been associated with an adjustment to shiftwork. He was also questioned about an entry regarding anxiety in 2021. He explained he had been reluctant to undergo COVID-19 vaccination and had refused two injections. However, his employer made it clear he could not remain employed if he did not get vaccinated. He said the anxiety was in relation to any possible negative side effects of the COVID-19 vaccine at that time. The psychiatrist members of the panel were satisfied with his responses to these issues and do not believe they represented any pre-existing psychiatric condition.
He denied any family history of psychiatric illness. He was also questioned about a bad property investment in 2019; he said he lost approximately $30,000 after purchasing a home unit off the plan and then having to sell it at a loss. He acknowledged he was not happy about this but denied significant depression or anxiety.
Current medications consist of Restavit (Doxylamine 25 mg) one at night, and Seremind (lavender oil 80 mg) to help with sleep. He uses Ibuprofen as needed for pain. He denied the use of an antidepressant or an antianxiety agent. He was unable to provide details of the cholesterol and hypertension medication or the blood thinner.
He denied the use of cigarettes, recreational drugs and coffee. He said he does not gamble. Mr Georgopoulos did drink alcohol regularly with friends at hotels prior to the accident but said his consumption was not excessive. Following the accident, he drank alone at home and estimates for three months he was drinking enough to make himself drunk every day. Currently he has one schooner of beer at the hotel alone once a week when he has a day off; he said he does not get together with friends at the hotel and does not drink alone at home.
History of the accident
Mr Georgopoulos was driving a 1975 XB GT Ford Falcon which he had purchased less than one week earlier for $100,000 which was under-insured. He said he was travelling to get new tires fitted. As he was proceeding along Kingsgrove Road a lady emerged from a side street in a four-wheel drive vehicle fitted with a bull bar and T-boned the passenger side of his car. He said he smashed his head against the driver’s side window and was momentarily knocked out. His next memory was being on the foot path leaning against a pole with a bystander splashing water on his face. He said the car was written off and it is now in storage.
He said police and ambulance attended but he did not want to go to hospital because he was afraid equipment from his car would be stolen if he was not present. He travelled to the depot with the tow truck driver and arranged to be collected by a friend. The paramedics at the scene advised him to go to hospital but he declined. He said he was in shock and was not thinking straight.
History of symptoms and treatment
Physical injuries consisted of neck pain, right shoulder pain and exacerbation of lower back pain. He said his right shoulder was making a clicking noise which has stopped. The other pain has eased but it can be set off by activity.
His sister visited the following morning and was worried that he was confused and forgetful. She insisted he attend hospital because of low mood, poor concentration, slowness to react, nausea and loss of appetite. CT brain was performed which indicated no abnormality. He was discharged on minor analgesics and a head injury fact sheet.
Initially he said he was in shock and would not get out of bed. He said he was forgetful and had great difficulty in controlling his anger. He said he was always thinking about the motor accident. When asked to describe this he said he gets a blood rush and a sense of heat. This can happen in bed, and he wakes up in a sweaty state with a feeling of panic. Thoughts and images of the motor accident intrude into his consciousness when he is awake. He said he becomes very panicky while driving if a vehicle comes too close which sets off thoughts of the accident and makes him even more anxious. He described nightmares of the accident which he finds distressing and which wake him up.
He said the nightmares continued frequently for a good 10 months after the accident as was the case with flashbacks. He said there has been no flashbacks for the last few months. He said things do set him off if he is driving, such as another car coming to close or seeing a vehicle like the one that hit him.
He described significant anger following the accident. He said he tended to take this out on his partner, and this resulted in the end of the relationship. She left him 9 to 12 months after the accident because of his anger and drinking. He also described getting into a fight in a hotel. He described being set off by images of motor accidents on television. He described an exaggerated startle response and said he is extremely hypervigilant while driving. He initially described broken sleep. He currently works from 1pm until 9pm; he tries to go to sleep by midnight and generally sleeps all night although he can be woken by pain or a nightmare.
Mr Georgopoulos summarised his psychological injuries by saying "I am not the same person anymore". He said he has lost his relationship and has lost his sexual desire. He said he is doing his best to get better, but he struggled to make it to the appointment. He described social withdrawal and said he has no interest in getting together with friends.
Treatment has consisted of referral to psychologist Ms Helen Fotiadis. He initially saw her weekly or fortnightly. The consultations are ongoing, and he said he now attends every three or four weeks. He indicated the treatment is funded by the insurer. She provides advice on anxiety and anger management and provides him with practical techniques. He appears to have found the breathing work particularly helpful because it integrates well with his past martial arts training. He described counting in his head while he is stationary at traffic lights in an effort to deal with his fear of being rear ended. He said he feels like he is making progress with the sessions. He has not consulted a psychiatrist or used psychotropic medication.
Injuries or conditions since the accident
Denied.
Current symptoms
Mr Georgopoulos complained he is not himself. He said he has a short fuse and startles easily. He continues to experience intermittent nightmares and wakes up in a sweaty state. He has episodes he describes as a blood rush with heat; these are autonomic reactions best regarded as trauma related anxiety episodes. There have been few if any flashbacks in the last 10 months, but intrusive recollections continue. He continues to be avoidant of driving and is set off by external reminders. He continues to be detached and estranged from others and has diminished interest in significant activities. His irritability and anger outbursts have reduced but still occur and were evident throughout the interview. He continues to be hypervigilant while driving and described an exaggerated startle response. He also has problems with concentration. Mood symptoms did not meet the level of major depressive disorder. Alcohol consumption is one schooner of beer per week.
Current and proposed treatment
Mr Georgopoulos will continue to consult his general practitioner Dr Kirlous and his psychologist Ms Fotiadis. He uses over-the-counter medications Restavit and Seremind to assist with sleep, plus intermittent Ibuprofen for pain. He has no plans to consult a psychiatrist or to use psychotropic medication but is not averse to doing so.
Mental State Examination
Mr Georgopoulos is a 54-year-old left-hand-dominant man whose appearance is consistent with his stated age. He was neatly dressed. He was located alone in a room in his lawyer’s office in the Sydney CBD. He was identified from his photograph on his NSW driver license. He was interviewed using the Microsoft Teams application with a good internet connection. The interview commenced at 12pm and concluded at 1.10pm.
He was cooperative with the interview. However, his responses to questions were brief and contained minimal information. It was necessary to ask repeated questions which at times caused him to become irritated. He seemed to find it difficult to provide a clear description of his internal thoughts and feelings and possibly has some degree of alexithymia. He was clearly very distressed immediately following the accident and provided an account of trauma related symptoms consistent with post-traumatic stress disorder. The severity of these symptoms has reduced over time, but they are certainly still present.
He appeared to be insightful regarding the negative impact of the use of alcohol on his condition and has been able to satisfactorily bring that under control.
Mr Georgopoulos was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.
Current functioning
Self-care and personal hygiene: Mr Georgopoulos said he does not have a shower every day but does so more frequently than every second day. He relies on his sister to do the laundry for him. He does not do a lot of cooking and obtains healthy microwavable meals in the supermarket. He eats egg whites but avoids yolks. He also eats fruit. He believes he has lost a little bit of weight and could afford to lose a little bit more.
Social and recreational activities: Mr Georgopoulos said he does nothing and stays away from his mates in the pub. He has one quick schooner on his own on his days off. He has a close friend who is married with children, and he meets with him when their days off work coincide. He does not go out to clubs or entertainment venues.
Travel: Mr Georgopoulos can drive in the local area. He can travel for between 20 and 30 minutes alone in the car. He can use public transport and believes he would be able to travel by air.
Social functioning: Mr Georgopoulos said his relationship ended 9 or 12 months after the accident because of his anger and drinking. He gets along well with his sister. He is not active in seeing friends.
Concentration, persistence and pace: Mr Georgopoulos watches the South Sydney rugby league football team games on television. He said he has difficulty concentrating and prefers not to read. He enjoys documentaries and educational shows on television.
Adaptation: Mr Georgopoulos is working a full week and occasionally does overtime. He relies on his sister for assistance with laundry and does his own housekeeping.
Consistency of presentation
Mr Georgopoulos’ presentation was internally consistent, consistent with the documentation provided and consistent with the diagnosis made. The panel explored past psychiatric history and determined that there were no significant psychiatric conditions prior to the motor accident.
PANEL DETERMINATION
Diagnosis
Mr Georgopoulos described symptoms consistent with post-traumatic stress disorder that persisted for at least 12 months following the accident. Some of these symptoms are currently occurring at significantly reduced levels but are still present to the extent that supports the diagnosis.
The Panel finds Mr Georgopoulos meets DSM-5-TR criteria for post-traumatic stress disorder as follows:
Criterion A: The insurer submits he was not exposed to "actual or threatened death or serious injury" and that his distress arose from damage to his car. The panel note he was involved in a frightening and unexpected motor accident that resulted in brief loss of consciousness and a diagnosis of concussion. This satisfies the condition threatened serious injury. The ongoing driving-related anxiety is further evidence of fear of serious injury. Criterion A is met.
Criterion B: He described intrusive distressing memories, recurrent dreams, flashbacks, intense distress at cues and marked physiological reactions to cues and triggers. All of these symptoms were present for at least 12 months, and many are continuing although flashbacks have significantly reduced in frequency. Criterion B is met.
Criterion C: Mr Georgopoulos described attempts at avoiding external reminders of the accident and attempts to avoid thoughts and feelings of the accident.
Criterion D: Mr Georgopoulos described a persistent negative emotional state, diminished interest and participation in significant activities, and feelings of detachment and estrangement from others.
Criterion E: Mr Georgopoulos described irritability and angry outbursts, hypervigilance, exaggerated startle response and problems with concentration.
Criterion F: Duration has been greater than one month.
Criterion G: There has been distress in social functioning and time-limited impairment in occupational functioning.
Criterion H: The condition is not attributable to a substance or another medical condition.
Mr Georgopoulos does not currently meet the DSM-5-TR criteria for alcohol use disorder because he consumes only two standard drinks of beer per week. This condition has resolved.
He did meet criteria for alcohol use disorder subsequent to the accident as follows:
Criterion A. He displayed a problematic pattern of alcohol use leading to clinically significant impairment and distress, as manifested by the following, occurring within a 12-month period:·he used larger amounts over a longer period than was intended;
·he had a craving or strong desire to use alcohol;
·he failed to fulfil major role obligations at work or home;
·he continued to use despite recurrent social or interpersonal problems due to alcohol; and
·he continued use despite knowledge that it caused an ongoing problem.
Causation
The test for causation was addressed by Wright J in In Briggs v IAG Limited trading as NRMA Insurance[21] where he stated at [35]:
[21] Briggs v IAG Limited Trading as NRMA Insurance [2022] NSWSC 372.
“The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principles were intended to be applied when a medical assessment was being made in relation to causation of minor injuries. Clauses 6.5 to 6.7 provided:
‘Causation of injury
6.5An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues.
6.6Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
1.The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2.The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.
6.7There 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.”
The question is whether the accident could have caused or contributed to the claimant’s psychological injury and whether it in fact did so.
The Panel finds Mr Georgopoulos was involved in a frightening motor accident that resulted in brief loss of consciousness and a diagnosis of concussion. The Panel is satisfied that the accident could and did cause the diagnosed psychological injury.
The Panel finds post-traumatic stress disorder was caused by the accident.
Threshold injury
Post-traumatic stress disorder is not a threshold injury as defined by s 1.6(1) of the MAI Act or Part 1 cl 4(2) of the Motor Accident Injuries Regulation 2017.
The Panel finds post-traumatic stress disorder caused by the accident is a non-threshold injury.
Alcohol use disorder is a non-threshold injury as defined in the MAI Act and the MAI Regulation. In accordance with the reasoning in David v Allianz Australia Ltd [2022] NSWPICMP 6 and in Lynch v AAI Ltd [2022] NSWPICMP 6 that the claimant can satisfy the test as to a non-threshold injury at any time since the accident the Panel finds that the alcohol use disorder (resolved) is a non-threshold injury.
PANEL CONCLUSION
The Panel affirms the certificate of Medical Assessor Fukui dated 18 July 2024.
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