QBE Insurance (Australia) Limited v Rabah
[2025] NSWPICMP 570
•5 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | QBE Insurance (Australia) Limited v Rabah [2025] NSWPICMP 570 |
CLAIMANT: | Anas Rabah |
INSURER: | QBE Insurance (Australia) Limited |
REVIEW PANEL | |
SENIOR MEMBER: | Susan McTegg |
MEDICAL ASSESSOR: | Christopher Canaris |
MEDICAL ASSESSOR: | Ankur Gupta |
DATE OF DECISION: | 5 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); section 1.6(3); assessment of whole person impairment (WPI); the claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) assessed 24% WPI as a result of post-traumatic stress disorder (PTSD) and major depressive disorder caused by accident; insurer sought review; insurer relied upon surveillance footage and bank statements; insurer asserted no psychological injury caused by accident; insurer asserted evidence claimant unreliable; Held – MAC revoked; claimant had sustained PTSD and persistent depressive disorder caused by the accident resulting in 18% WPI. |
DETERMINATIONS MADE: | Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 Whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10% 1. The Review Panel revokes the certificate of Medical Assessor Atsumi Fukui dated · post-traumatic stress disorder, and · persistent depressive disorder (dysthymia). |
REVIEW PANEL REASONS FOR DECISION
INTRODUCTION
On 29 May 2018 Anas Rabah (the claimant) alleges he sustained injury as a pedestrian in a motor vehicle accident (the accident).
Mr Rabah has brought a claim for common law damages under the Motor Accident Injuries Act 2017 (the MAI Act).
QBE Insurance (Australia) Limited (the insurer) is the relevant insurer with liability to pay any damages to Mr Rabah under the MAI Act.
Section 4.11 of the MAI Act provides that there is no entitlement to damages for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%.
This dispute is in relation to whether the degree of permanent impairment sustained by
Mr Rabah as a result of the injury caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act.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 permanent impairment in respect of the claimant’s psychological injury was referred to Medical Assessor Atsumi Fukui. She issued a certificate dated
19 December 2023.
DOCUMENTS CONSIDERED BY THE REVIEW PANEL
The Review Panel issued a Direction to the parties on 10 February 2025 (the Direction) requiring each party to file an indexed, paginated bundle of documents. In response to this Direction the solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 293 (insurer’s documents). The solicitor for the claimant uploaded to the portal a bundle of documents paginated from pages 1 to 313 (claimant’s documents).
On 28 April 2025 the insurer with the leave of the panel uploaded to the portal an Application to Lodge Additional Documents including additional submissions addressing the following documents relied upon by the claimant:
· claimant's statements dated 18 March 2025;
· bank statements of St George bank for the period 25 February 2024 to
24 August 2024 and 25 August 2024 to 24 February 2025;· the claimant's passport;
· statement of Hussein Choukair dated 13 March 2025, and
· statement of Firas Chalal dated 13 March 2025.
On 9 April 2025 the panel directed the claimant to upload to the portal the clinical records of any general practitioner consulted by the claimant in the period from the date of accident to date. On 2 May 2025 the claimant uploaded clinical records of Darlinghurst Medical Centre, Lakemba Family Healthcare, and emails between Bowrey lawyers and Lakemba Family Healthcare (ALAD 2 May 2025).
On 6 May 2025 the claimant sought the Panel’s approval to file submissions in reply, witness statements and documents in reply to the insurer's further submissions dated 28 April 2025, addressing questions raised by the insurer about bank account records. In response the insurer stated it may need to provide further submissions to address any additional “witness statements and documents” to be provided by the claimant. Member McTegg on behalf of the Panel caused the following message to be sent to the parties:
“I note the claimant seeks leave to file submissions in reply, witness statements and documents in reply to the Insurer's further submissions dated 28 April 2025, addressing questions raised by the insurer about bank account records. The insurer has indicated it may wish to provide submissions in response.
Where the evidence is relevant to the issues in dispute between the parties the Panel will not deny leave, but it is likely to result in the deferral of the medical examination. In the circumstances the claimant is asked to confirm he wishes to rely on the further evidence.”
The claimant’s response to that message was as follows:
“Given the insurer’s approach to this case the writer is too concerned about the claimant’s mental health to risk the assessment being deferred and therefore will not put in the further evidence.”
The claimant was examined by Medical Assessors Canaris and Gupta on 20 May 2025. It became apparent a further medical examination was required to obtain further history from the claimant. On 30 May 2025 the Panel advised a further examination was scheduled to take place on 8 July 2025 via videoconference. Having regard to the claimant’s earlier request to provide further evidence and submissions in response to the insurer’s further submissions dated 28 April 2025, the Panel issued the following directions to the parties:
(a) on or before 18 June 2025 the claimant is to upload to the portal in one indexed and paginated bundle and further submissions in reply, witness statements and documents sought to be relied upon in this assessment, and
(b) on or before 27 June 2025 the insurer is to upload to the portal in one indexed and paginated bundle any submissions in reply to the additional evidence relied upon by the claimant.
On 6 June 2025 the claimant uploaded to the portal an Application to Lodge Additional Documents attaching further submissions of the claimant dated 6 June 2025, a statement of the claimant dated 6 June 2025, and a statement of Firas Chahal dated 5 May 2025 (ALAD
6 June 2025).On 1 July 2025 the insurer uploaded to the portal an Application to Lodge Additional Documents attaching further submissions from the insurer dated 1 July 2025 (ALAD
1 July 2025).
RELEVANT LEGAL AUTHORITY
Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
The Guidelines were issued pursuant to Division 10.2 of the MAI Act. Clause 6.213 of the Guidelines requires the impairment to be attributable to a psychiatric diagnosis recognised by the current edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5) or the current edition of the International Statistical Classification of Diseases & Related Health Problems (ICD). The assessment of mental and behavioural disorders must be undertaken in accordance with the psychiatric impairment rating scale (PIRS) as set out in the Guidelines.
Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:
“6.6 Causation 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.
6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
CERTIFICATE OF MEDICAL ASSESSOR FUKUI
In a certificate dated 19 December 2023 Medical Assessor Fukui certified the following injuries give rise to a permanent impairment of 24%:
· post-traumatic stress disorder, and
· major depressive disorder.[2]
[2] Insurer’s documents p 13.
The injuries referred to Medical Assessor Fukui for assessment were:
· post-traumatic stress disorder and major depressive disorder.
Medical Assessor Fukui reported Mr Rabah denied a significant medical history. He had a fractured left wrist following a fall. She reported he denied a psychiatric history other than one session with a counsellor in 2011 following a breakup with a counsellor. She also reported a history of prior motor vehicle accidents which he described as minor, although one rear-ender resulted in a lower back injury which improved after treatment.
Medical Assessor Fukui reported following the accident on 29 May 2018 Mr Rabah injured his shoulder, leg and hand. He was assessed at St Vincents Hospital and discharged home.
She noted gradual onset of symptoms including flashbacks, nightmares, fragmented sleep, anxiety and hypervigilance, panic attacks, racing thoughts, inability to focus and concentrate, depressed mood, lack of motivation, anergia, and anhedonia, loss of appetite with fluctuating weight, withdrawal from activities he enjoyed, neglected self-care, stopping things with friends and talking to his family overseas and exercises.
He reported he was “stressed out” and suffered poor sleep after the accident. He self-isolated. He thought the accident was “life threatening” and that he was going to die when he saw the trailer coming towards him. He could not remember when symptoms started. He experienced flashbacks of the accident and stopped doing things. He neglected self-care, he could not care for his dog and gave it away. He stopped seeing friends and talking to his family overseas. He stopped exercising and he suffered nightmares. He became exhausted and extremely anxious, on edge and hypervigilant. He was unable to concentrate and focus.
Mr Rabah reported he travelled to Berlin to stay with his older sister and underwent psychological sessions via telehealth in 2020. He subsequently went to Sao Paulo to stay with his younger sister. He stayed on a farm which he found helpful. He was prescribed medication by his sister’s father-in-law. He remained isolated. After two years living overseas, he returned to Australia in November 2022. He has had ongoing treatment with psychiatrist Dr Jensen.
Medical Assessor Fukui reported in 2020 Mr Rabah was riding his bicycle wearing a helmet when he fell off his bike. He attended St Vincent’s Hospital and had a CT scan of his brain. He was told he had concussion.
Medical Assessor Fukui reported poor self-care, he eats canned food and does not cook. His uncle helps him. He drives to appointments in his local area. He prefers public transport to driving. He is socially isolated and maintains contact with only two friends. He has poor concentration and focus and is unable to do anything productive.
Medical Assessor Fukui diagnosed post-traumatic stress disorder and major depressive disorder and assessed a whole person impairment (WPI) of 24%.
REVIEW PROCEDURE
The insurer has sought a review of the medical assessment of Medical Assessor Fukui dated 19 December 2023.
The application was lodged on 16 February 2024 within 28 days of the date on which the certificate of Medical Assessor Fukui was made available to the parties.[3]
[3] Section 7.26(1)(b) of the MAI Act.
On 26 March 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 Review Panel (the Panel).[4]
[4] Section 7.26 of the MAI Act; claimant’s bundle p 9.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[5]
[5] 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 8 April 2025 the Panel agreed an examination was necessary.
EVIDENCE BEFORE THE PANEL
Application for personal injury benefits
In the Application for personal injury benefits dated 14 June 2020 the claimant described the accident as follows:
“On this day 29 May 2018 at approximately 5am I signed in at the gate of the warehouse and subsequently drove my car into the warehouse premises, then noticed that my co-worker (Kevin) was driving my daily truck. I stepped out of my car and asked Kevin why he was driving my truck. He advised me that he was instructed by the office. I walked back to my car and opened my door. Kevin proceeded to drive, suddenly and without warning, as the truck veered to the edge of the warehouse, the back of the trailer hit me and I was subsequently crushed under the truck.”[6]
Medical evidence
Pre-accident medical evidence
[6] Insurer’s documents p 36.
Clinical notes of Earlwood General Practice
On 4 July 2013 Dr Koumoulas, general practitioner (GP) reported the claimant fell off a truck at work when he was delivering at Canterbury Hospital. He sustained a fractured wrist and hurt his hip/thigh and mid back.[7]
[7] Insurer’s documents p 121.
On 20 August 2015 Dr Koumoulas reported the claimant could not do long hours because of hand/back and neck injuries. He also noted the claimant had a previous injury to the wrist with metal work and chronic back and hip pain post fall.
On 27 August 2015 the claimant saw Dr Cho of Earlwood General Practice for a cervical lymph node which would intermittently increase in size. He reported:
“needs referral to Valerie- psychologist - for depression has seen a different psychologist - not happy with this person, wants to change, very anxious and paranoid about health.”[8]
[8] Insurer’s documents p 116.
The claimant addressed this referral in his statement dated 8 November 2023.[9] He states whilst he did see a counsellor one time after he broke up with a girlfriend, he does not recall the visit on 27 August 2015 with Dr Cho, he does not recall being diagnosed with anxiety or depression and states he did not see a psychologist on referral from Earlwood General Practice. Mr Rabah said his mood recovered after the breakup.
[9] Claimant’s documents p 184.
Dr Porteous assessed the claimant in respect of a motor vehicle accident on 21 March 2016 (the 2016 accident) and provided a report dated 12 October 2016.[10] Mr Rabah alleged he sustained injury to his neck and lumbar spine in a rear end collision. Dr Porteous diagnosed musculoskeletal strain to the cervical and lumbar spine. At that time Dr Porteous reported he “can-do self-care” but that cooking, cleaning, and washing dishes would often aggravate his condition.
[10] Insurer’s documents p 133.
Medical Assessor Ashwell assessed the claimant in relation to a treatment dispute arising out of the 2016 accident and issued a certificate dated 21 February 2018.[11] He reported the claimant came to Australia in 2007, he studied and then went into truck driving. He stated at the time of the injury the claimant was a construction worker/tip driver for PND Civil Group.
[11] Insurer’s documents p 143.
He determined that the proposed discectomy/laminectomy and rhizolysis and L5/S1 did not relate to injuries caused by the 2016 accident.
Medical Assessor Ashwell recorded:
“He states that prior to the motor vehicle accident he would go surfing, skateboard riding and attend a gym 3-4 times per week. He has generally not been able to do these activities though he has tried at a gym but since cancelled his membership.”
He also reported Mr Rabah stated he had suffered from anxiety and depression and had been reviewed by a psychologist. Medical Ashwell assessed a 5% WPI arising out of the 2016 accident.
In his statement dated 8 November 2023 Mr Rabah states after the 2016 accident he had back and neck pain which affected his mood at times.[12] Mr Rabah states he has no independent recollection of telling Medical Assessor Ashwell that he suffered from anxiety and depression and had been reviewed by a psychologist. Mr Rabah states he went back to the gym, was doing hydrotherapy and had returned to driving holidays, hiking and camping before the accident.
[12] Claimant’s documents p 184.
Post-accident medical evidence
The claimant attended St Vincent’s Hospital on 29 May 2018 after the accident.[13] It was reported he was hit by a truck (semi-trailer) at low speed. He reported the truck struck his right shoulder and right leg; he was knocked to the ground and the truck partially reversed over him. He had nil loss of consciousness and nil head strike.
[13] Claimant’s documents p 93.
On 30 May 2018 Dr Rena Alexandrou reported the claimant’s involvement in the accident and reported he was aware of how close the wheels had come to crushing him.[14] She reported he had a history of superficial abrasions and bruising and was experiencing back and neck pain. She acknowledged his previous injury to the back and neck. She noted “unable to sleep thru the night”.
[14] Claimant’s documents p 51.
On 25 July 2108 Dr Evelina Vinchenzo reported the claimant felt mentally unable to go to work, was sweating, thinking of the accident/flashbacks. His mood was described as swinging.[15]
[15] ALAD 2 May 2025 p 34.
The claimant was referred to Dr Jennifer Menon clinical psychologist who he saw initially on 15 August 2018.[16] In 2018 Dr Menon provided an undated report to Dr Vinchenzo.[17] She reported she saw the claimant for seven appointments following a workplace accident resulting in post-traumatic stress symptoms, avoidance behaviours, anxiety and insomnia. She reported his mood had improved but he continued to experience distress related to his accident. She encouraged him to visit family overseas for support.
[16] ALAD 2 May 2025 p 32.
[17] Claimant’s documents p 54.
Mr Rabah was referred to the Sydney Clinic by his GP on 25 October 2018.
Mr Rabah saw Dr Kim Maquire psychiatrist on 21 November 2018.[18] Her clinical notes reported the claimant was traumatised, he had bad dreams and insomnia. She reported at the time of the accident he was stuck, screaming, seeing tyres coming towards him. His car jammed the progress of the truck. He reported the employer was unsupportive. Nightmares started two or three days after the accident, he had insomnia since the accident and wakes screaming at night. He reported being triggered when he sees trucks, he had vivid recall of the accident including flashbacks, panic attacks, hypervigilance, social withdrawal, reduced pleasure in activities, and thoughts of not wanting to be alive. He feels easily overwhelmed, is socially withdrawn and has reduced pleasure in usual activities. Dr Maguire reported the claimant saw a psychologist for one session a few years ago related to a breakup with girlfriend. Dr Maguire diagnosed post-traumatic stress disorder and depression.
[18] Claimant’s documents p 57.
Dr Maguire started the claimant on Circadin (Melatonin – a sleep-inducing agent) and Valdoxan (Agomelatine – an antidepressant) 25 mg at night which she later switched to Lexapro (Escitalopram – another antidepressant) with Quetiapine. Clinical notes report trials of Mirtazapine and later Efexor (Venlafaxine – an antidepressant) with his dose going up to 450 mg daily which resulted in significant improvement.
On 8 March 2019 Dr Lynette Wallace reported the claimant was an inpatient at The Sydney Clinic under the care of Dr Maguire.[19] On 22 May 2019 Dr Wallace reported the claimant was still off work with depression. He was prescribed Lexapro.
[19] ADAL 2 May 2025 p 21.
On 15 January 2020 Dr Wallace reported the claimant was considered a suicidal risk.
On 30 January 2020 Dr Maguire sought approval for an inpatient admission for treatment of the claimant’s post-traumatic stress disorder and major depressive disorder. In May 2020 it seems Mr Rabah was admitted to The Sydney Clinic.
In an exercise physiology report dated 30 January 2020 the claimant was noted to be highly symptomatic, to have poor daily routines with inability to complete activities of daily living (ADLs), to have poor concentration, and to be socially isolative.
In a Closure Report dated 3 June 2020 Kairros Services reported the claimant was to have commenced the Career Enhancement Training Program in January that year but “did not demonstrate the ability to job seek independently” because he “did not have the focus, ability to concentrate or the motivation to participate in job seeking”.
On 13 July 2020 Mr Rabah attended St Vincents Hospital following a syncope whilst walking.[20] The claimant found himself on the ground. Three days later he was referred for a CT of the brain with a history of blurred vision in the right eye and persistent headache. On 14 August 2020 Dr Mosalski reported:
“Details regarding the actual fall were hazy; therefore, it is difficult to categorise his TBI… His CT scan was unremarkable… I spoke with Anas about his TBI and how I feel he most likely fits into the mild traumatic category with concussion symptoms, but it is hard to determine.”[21]
[20] ALAD 2 May 2025 p 409.
[21] Claimant’s documents p 84.
Furthermore, he stated:
“The majority of mild TBI patients, 85% at three months have fully recovered and I
think Anas will fit into this category.”
A work capacity assessment dated 29 July 2020 confirmed the claimant had no capacity for work.
On 16 September 2020 Dr Wallace reported the claimant was planning a move to Europe to live with his sister. The claimant’s next attendance on Dr Wallace was on 16 February 2023 when she reported his mental situation was unchanged.[22]
[22] ALAD 2 May 2025 p 431.
A work capacity assessment dated 13 March 2023 confirmed Mr Rabah had no capacity for work.
On 2 May 2023 Dr Candice Jensen, psychiatrist reported Mr Rabah had recently returned from overseas, having stayed with a sister in Germany and in Brazil with another sister for a year.[23] She diagnosed depressive episode, post-traumatic stress disorder, dissociative episodes and anxiety – panic attacks and social anxiety. She noted trials of antidepressants, financial stresses and reported his home was messy because he lacked the motivation to clean up. She noted he was on Fluoxetine 20mg daily and Seroquel 25mg. She recommended reducing Seroquel to 12.5mg. She also recommended psychology treatment for a minimum of 6 to 12 months. She reported Mr Rabah was thinking about studying having been accepted for a Bachelor of Business. He was unsure if he was mentally ready.
[23] Claimant’s documents p 160.
On 12 September 2023 Dr Jensen reported the claimant was grinding his teeth and clenching his jaw due to his anxiety and possibly also as a side effect from the psychotropic medication.[24]
[24] Claimant’s documents p 187.
Dr Jensen provided a report dated 17 September 2024.[25] She had seen the claimant on numerous occasions since he was referred in March 2023. She diagnosed post-traumatic stress disorder, major depressive disorder, panic disorder, generalised anxiety disorder and social anxiety disorder with low mood, lack of energy, poor motivation, sleep issues and lack of enjoyment in activities as well as social anxiety, generalised anxiety, panic attacks and post-traumatic stress disorder symptoms including nightmares, flashbacks, sleep disturbance, avoidance behaviour, fearfulness, and feeling unsafe. She reported his self-care was poor and he had significant dental issues. She reported he did not engage in social activities; he had a limited friend group and struggled with relationships. She described his concentration as impaired and concluded he had no capacity for employment.
[25] Claimant’s documents p 265.
Dr Jenson reported Mr Rabah was taking Sertraline (an antidepressant) 100mg, Propranolol 10mg, Melatonin 4mg daily but with minimal improvement with medication. She reported she had referred him to the Black Dog Institute for consideration of rTMS (repetitive Transcranial Magnetic Stimulation) for his major depressive disorder. He had been trialled on multiple medications with very limited change in symptoms.
Surveillance
Procare undertook surveillance of the claimant on 15, 16 and 17 April 2024 when he was observed walking, attending a bank and shops including Supercheap Auto store. On
17 April 2024 the claimant attended the Ilma Centre and Marine Repairs where he remained for about two hours. It is unclear if he was undertaking work.Further surveillance was undertaken on 6, 7 and 8 May 2024. On 6 May 2024 the claimant was seen to attend Bankstown Central. On 7 May 2024 he is seen to attend the Punchbowl Masjid Mosque.
Surveillance was also undertaken on 29 July 2024.[26] On 29 July 2024 the claimant is seen to attend a prayer hall/mosque before attending the premises of Ilma Collision Centre and Marine Repairs. Mr Rabah is seen to undertake work-related activities at the workshop during the day including moving vehicles and using various tools as he worked on a Range Rover.
[26] Insurer’s documents p 219.
On 30 July 2024 the claimant is seen to attend a prayer hall/mosque before attending the premises of Ilma Collision Centre and Marine Repairs where he is seen moving between workshops and vehicles. He is also seen wearing gloves and moving different vehicles.
On 31 July 2024 and 8 August 2024, the claimant is seen to attend the premises of Ilma Collision Centre and Marine Repairs where he remains all day and appears to be working.
On 9 August 2024 the claimant is seen to attend Vision Islam, Bankstown Central before attending the premises of Ilma Collision Centre and Marine Repairs where he remains and appears to be working until 12.32 pm when he attended the Daar Ibn Abbas Mosque in Condell Park with a co-worker. He then returned to the workshop where he remained until 5.30 pm.
On 12 August 2024 the claimant attended Vision Islam before arriving at Ilma Collision Centre and Marine Repairs where he was observed to work on various vehicles in the workshop.
On 16 December 2024 the claimant attended Bankstown Shopping Centre on his own and engaged with shop attendants.
The claimant was not observed on 17 December 2024.[27] On 18 December 2024 the claimant is seen to travel by bus to Sydenham where he boarded a train for Bondi Junction. He is seen wearing a collared shirt, sweater and pants.
Medico-legal evidence
[27] Insurer’s documents p 272.
Dr Doron Samuell, psychiatrist
Dr Samuell assessed the claimant for EML, the workers compensation insurer. He provided a report dated 24 November 2019.[28] He did not express an opinion as to diagnosis but concluded Mr Rabah had the capacity to return to work on a full-time basis with a restriction of no driving.
[28] ALAD 2 May 2025 p 377.
Dr Brian Potter, psychiatrist
Dr Potter assessed the claimant for the insurer and provided a report dated 29 May 2023.[29]
[29] Insurer’s documents p 94.
Dr Potter reported the accident in a workplace carpark involved Mr Rabah becoming stuck under the rear tyres of a truck and trailer. He was able to crawl out and attend hospital where he was examined. After a couple of hours, he caught an Uber home.
Mr Rabah reported he got worse, detailing a decrease in activity and social engagements. He reported bad dreams and bad thoughts. He had difficulty in focusing and reading. He spent a couple of weeks at the Sydney Clinic. He reported the claimant travelled overseas to visit his sister in Germany. At that time, he had sessions online with a psychologist in Holland. He subsequently stayed with another sister in Yugoslavia and another in Brazil before he returned to Australia in November 2022.
Dr Potter noted the claimant was on Fluoxetine and Quetiapine. Dr Potter contended that the claimant gave no clear history of features of post-traumatic stress disorder. Dr Potter concluded the claimant was a troubled individual who needed psychological assessment. He may have had a truck accident which left him with post-traumatic stress disorder, but he could not confirm that diagnosis. Dr Potter reported the nature of the accident remained unclear as was the subsequent history of travelling overseas between 2020 and November 2022.
Dr Potter reviewed the claimant on 21 November 2024.[30] He reported the claimant provided a “poverty of history in a difficult to understand manner”. He noted the claimant was on the antidepressant Pristiq as well as Melatonin. Dr Potter accepted the possibility of a diagnosis of post-traumatic stress disorder but considered a definite diagnosis to be elusive. He diagnosed an adjustment disorder with features of depression and anxiety. He accepted
Mr Rabah had continued to live a debilitated life since the accident and felt the prognosis was guarded.[30] Insurer’s documents p 177.
Dr Potter provided a supplementary report dated 29 January 2025 after viewing the vocational assessment report of Professor Bright and the surveillance reports of Procare.[31]
[31] Insurer’s documents.
Dr Potter noted that psychiatric reports rely on the integrity of the history given by the individual. He noted from the documents reviewed it was not possible to accept the history Mr Rabah had given to him. Dr Potter stated with a biased history and presentation it is not possible to offer an informed psychiatric diagnosis or to accept Mr Rabah’s history of dysfunction.
Dr Jeff Bertucen, psychiatrist
Dr Bertucen assessed the claimant at the request of his lawyer and provided a report dated 22 May 2023. Dr Bertucen concluded:
“In my opinion, Mr Rabah is suffering chronic post-traumatic stress disorder and major depressive disorder. Given the absence of any pre-existing or underlying psychiatric conditions, I consider that these conditions have been substantially caused by the effects of the subject accident, which was traumatic and involved a perception of possible serious injury or even death.”
Dr Bertucen noted the claimant to be on Fluoxetine (an antidepressant) 40 mg in the morning and Quetiapine (an antipsychotic/mood stabiliser/calmative) 50 mg at night. He assessed a 22% WPI with a class 2 rating for travel and for concentration, persistence, and pace, class 3 for self-care and personal hygiene, for social and recreational activities, and for social functioning, and class 5 for adaptation. There was no deduction for pre-existing impairment or adjustment for treatment effects.
Dr Bertucen reviewed the claimant and provided a report dated 4 November 2024.[32] He reported Mr Rabah had persisting psychological symptomologies including depressed mood and demotivation, social phobic anxiety and reclusiveness, sleep disturbance and panic episodes.
[32] Claimant’s documents p 286.
Dr Bertucen noted the claimant was seeing Dr Candice Jensen, psychiatrist, and was taking Sertraline 100 mg daily, Melatonin 4 mg at night, and Lyrica (pregabalin) 75 mg at night.
Dr Bertucen reported Mr Rabah had not seen his friends (two close friends) in over three months but sometimes they send him messages. He was demotivated to speak to his family. Mr Rabah reported he cannot concentrate and rarely cooks for himself. He still owned several cars but only drives the Defender but in local areas. His sleep remained poor, and he still experienced intrusive and distressing recollections of the accident.
Dr Bertucen reported no regular social network, no interests or hobbies, and had become demotivated with regards to his previous interest in cars. He displayed features of self-neglect.
Dr Bertucen concluded Mr Rabah had no psychological capacity to return to any kind of employment. He considered the accident was the substantial contributor to his incapacity.
Dr Bertucen was asked to consider whether there was a pre-existing impairment. However, he noted the difficulties referred to predate the accident by three years or so and did not consider they constituted a “psychiatric illness”.Dr Bertucen assessed a 24% WPI rating him as class 2 for travel, class 3 for self-care and personal hygiene, for social and recreational activities, for social functioning, and for concentration, persistence, and pace, and class 5 for adaptation with no deduction for pre-existing impairment or adjustment for treatment effects.
Vocational Assessment Report
Professor Jim Bright undertook a vocational assessment on 24 June 2024.[33] He reported the claimant completed a Diploma in Film Production and worked as a television producer in Dubai for several years. He then retrained as a truck driver and had worked in that capacity since.
[33] Insurer’s documents p 148.
Prof Bright reported the claimant only did limited driving because he would be “annoyed” and because he believed that he was “scared and clumsy”. He was able, however, to use public transport.
Prof Bright reported Mr Rabah said he saw a psychologist on one occasion after the breakup of a relationship, possibly around 2016. He reported Mr Rabah denied any history of head injury.
He was noted to be taking Pristiq (Desvenlafaxine – an antidepressant) 200 mg daily which was to be changed to another medication.
Prof Bright reported Mr Rabah had a lack of motivation, and it was a struggle to do basic tasks such as cooking and cleaning. He reported he had lost hope and struggled with sleeplessness. He reported a poor memory and reported sometimes staying in bed for days. He was reportedly unable to focus. He used to be extremely active but was no longer.
He initially said he had no friends but later when specifically asked said that he had last seen his friend who owned a classic car in December 2023. He also had a friend who would drop in as well as another friend who took him to Paddy’s Market in Haymarket on Sundays.
He was noted to be casually attired although he supported several days beard growth.
He underwent symptom validity testing and was considered to have performed unusually poorly on the Test of Memory Malingering, on tests relating to somatic complaints, and on the Structured Inventory of Malingered Symptomatology. He was considered to be deliberately underperforming. He was also noted to have scores on tests of non-verbal reasoning to be “so low as to be entirely implausible” and “inconsistent with independent activities of daily living which [he] confirmed he is capable of undertaking” and “also so low he would be incapable of following the proceedings in this assessment or any other” because of “the degree of exaggeration and underperformance and motivated responding suspected”.
Prof Bright also noted he made no mention of symptoms typically associated with post-traumatic stress disorder such as flashbacks, intrusive memories, or dissociative states. In relation to problems with concentration, he was noted to have “no difficulty in following the proceeding through a 90-minute assessment always providing answers that were entirely appropriate for the question was asked”. He further noted the claimant’s capacity to travel long distances overseas. He contended the capacity to undertake such travel and to live independently suggested he was capable of doing some work.
Dr Russel Davies, psychiatrist
Dr Davies assessed the claimant at the request of EML, the workers compensation insurer on 18 May 2023 and on 16 October 2024.[34]
[34] Claimant’s documents pp 267 and 275.
Dr Davies diagnosed post-traumatic stress disorder and major depressive disorder. He documented nightmares, intrusive imagery of the event in which he felt helpless and powerless, episodes in which he would “zone out”, poor concentration, fluctuating sleep with periods of sleep fragmentation, depressed mood, low energy, anhedonia, and lack of motivation, marked avoidance symptoms relating to time spent outside his home and anxious trepidation in proximity to moving vehicles, he regarded his prognosis as poor. In 2023 he was on fluoxetine.
At the time of his assessment on 16 October 2024 Dr Davies reported the claimant was seeing Dr Candice Jensen every two to four weeks and he had been on Desvenlafaxine which had changed to another medication. Mr Rabah had been referred for rTMS but it had not taken place. Dr Davies reported the claimant lived alone with little in the way of external supports.
He reported Mr Rabah spent protracted periods of time inside. Whereas Mr Rabah looked well-groomed in 2023, he looked unkempt in 2024. During a period of protracted neglect, he became infested with headlice and had to shave his head. He had not showered for two weeks. He ate canned food, including baked beans, canned spaghetti and occasionally an egg. He reported Mr Rabah limited travel outside the house to occasional trips to the supermarket or to doctors’ appointments. He could drive locally. Mr Rabah reported no friends come to the house although Dr Davies referred to an individual with whom the claimant had some contact but who he had not seen for two months. Dr Davies reported a complete abandonment of all hobbies and interests and no interest in intimate relationships. He reported poor concentration. Dr Davies reported some apparent limitations to his working memory.
Dr Davies reported the claimant was generally unkempt and there was evidence of psychomotor slowing with reduced speech rate and prosody. He reported mood and affect were clearly depressed. He noted no functional improvement since his earlier assessment, 18 months earlier.
Dr Davies assessed 22% WPI rating the claimant as class 2 for self-care and personal hygiene and for travel, class 3 for social and recreational activities, for social functioning, and for concentration, persistence, and pace, and class 5 for employability (adaptation). There was no deduction for pre-existing impairment or adjustment for treatment effect.
Claimant’s statement re surveillance
Mr Rabah provided a statement dated 18 March 2025.[35] He states he has not worked since the accident and has not been paid any wages. He states he sees his GP and also consulted Dr Jensen by telehealth fortnightly. He takes the following medication daily:
· 5mg Olanzapine;
· 10mg Escitalopram;
· 0.5mg Clonazepine, and
· 100mg Setraline.
[35] Claimant’s documents p 195.
Mr Rabah says to understand the surveillance it is necessary to know about his friends and his cars. Mr Rabah says he has been a car enthusiast for many years and still owns four vehicles which he owned before the accident. They are:
· a blue 2001 Porsche, registration No. EU10B;
· a grey body/black roof 2003 Land Rover Defender, registration No. DF24SC;
· a 1987 VW Caravelle van with historical plates, and
· a 2017 Honda Goldwing Motorbike which is unregistered.
Mr Rabah says his two close friends Hussein Choukair and Firas Chahal have helped by storing those vehicles at their business premises. He says these friends have supported him since the accident and they are the friends to whom he referred when he was assessed by Medical Assessor Fukui.
Mr Rabah states Hussein owns the business Ilma Collision Centre. His Caravelle has been stored there since at least September 2020.
Mr Rabah states Firas owns and operates Al Chahal Group trading as ACG Kitchens and Joinery located in a factory unit complex at Guildford West. He states it is in the same complex as Omega Automotive but other than to say hello he does not know the people at Omega Automotive and has never worked there.
Mr Rabah states when he moved to Bankstown in about mid-2023, he was able to store his Porsche in his car space and the Defender in visitor parking. Hussein continued to store the Caravelle and Firas stored the bike.
Mr Rabah says following a minor accident in 2023 Hussein agreed to repair both the Defender and the other car involved, a Kia, for no charge.
Mr Rabah states in early 2024 because the Caravelle and the Defender were taking up space in his workshop Hussein asked the claimant to repair them and get them out, as he was considering selling the shop. He states the Caravelle was rusty, he took off the windows and rubbers and some panels and Hussein repaired the body over a year.
On 15 April 2024 Mr Rabah says he bought 5 litres of engine oil at Supercheap Auto. He planned to use it to service his Porsche but as of 18 March 2025 he had not used the oil which remained in his car with the receipt. He said he couldn’t organise himself to do it.
He states it was not correct that his Porsche was parked at Omega Automotive Centre on the afternoon of 16 April 2024. He was, in fact, visiting ACG Kitchens, the business owned by Firas. He states there is no video of him working at Omega Automotive because he has never worked there.
Mr Rabah says he went to Supercheap with Hussein on 17 April 2024 to buy a Toolpro tool set to work on his own vehicle at Hussein’s workplace, noting if he was employed he would not be required to buy his own tools. He states the occupant of a Silver Toyota he is seen talking to on 17 April 2024 is Hussein’s wife.
Mr Rabah states when he was at Hussein’s workshop, he did move cars around out the front and did cleaning and helped others when asked. However, he asserted he was not working for wages and nor was he going there every day.
Mr Rabah notes the surveillance on 6 to 8 May 2024 was undertaken over 65 hours but only 22 minutes of footage was obtained which shows the claimant shopping or attending the mosque at Punchbowl. Mr Rabah states at the mosque he listens to music or religious readings which he finds calming.
Mr Rabah notes the surveillance on 29 to 31 July and 8, 9 and 12 August 2024 was undertaken over 141 hours but only two hours of footage was obtained. He disputes he was engaged in work-related activities.
He says the footage on 29 July 2024 which shows him removing a bumper from a grey Range Rover would have occurred when he was helping Hussein. He also notes he is seen to move his Porsche and another car for Hussein.
Mr Rabah states the footage on 30 July 2024 shows him attending the mosque before driving to a 7Eleven at 8.21am to buy a coffee. He later attends Hussein’s shop and is filmed helping some employees move cars in the street.
On 31 July 2024 Mr Rabah says he is observed at Hussein’s shop working on his Caravelle. He states he washed and then sanded the Caravelle. He also moved a car for Hussein before driving home in his Porsche at 5.25pm.
Mr Rabah states he worked on his Caravelle at Hussein’s shop. He tried to strip the gold paint but couldn’t do it because he didn’t have the skills. He states Hussein asked him to stop and did it for him before having it spray painted red. It was then towed to Firas’s warehouse.
On 8 August 2024 Mr Rabah states he attended morning prayers at the mosque and then worked on his Defender at Ilma Collision Repairs.
On 9 August 2024 he again attended the mosque and worked on his Defender at Ilma Collision Repairs.
On 12 August 2024 Mr Rabah states he is filmed reinstalling trim on his Caravelle. He later helped Hussein replace rubber seals on the door frame of a grey Range Rover, helped by Hussein’s little boy.
Mr Rabah notes the surveillance on 16, 17 and 18 December 2024 was undertaken over 56 hours but only 17 minutes of footage was obtained. On 16 December 2024 Mr Rabah was at home other than two hours when he was observed at Bankstown Shopping Centre.
Mr Rabah said on 18 December 2024 he attended his general practitioner at Darlinghurst to renew his work capacity certificate. Mr Rabah provided a copy of the certificate signed by
Dr Ankur Krishna dated 18 December 2024. He travelled by bus to Sydenham and then train to Bondi Junction.Mr Rabah provided some detail about his travel in 2024 and 2025. He visited his father and younger brother in Syria in January 2024 after discussing it with Dr Jensen. On 23 January 2025 he travelled to Syria and saw his father and was reunited with his mother who he had not seen since 2017. Mr Rabah states he stayed in Damascus for 38 days. Whilst there he had a panic attack and attended Al-Rashid Hospital where his heart was checked. He also consulted a psychiatrist who prescribed medication.
Whilst he said in July 2023 that he did not have a TV anymore; he noted by 16 December 2024 when he saw Dr Davies he had an old Aldi TV that he was given by his uncle which did not work properly, and he later threw out.
Mr Rabah said he enquired about a Bachelor of Business course but did not complete the paperwork and does not have the energy to do so.
Statement of Hussein Choukair
Mr Choukair provided a statement dated 13 March 2025.[36] He has been friends with the claimant since 2008.
[36] Claimant’s documents p 261.
Mr Choukair describes the claimant as energetic, talkative and happy before the accident but now he is slow and depressed and has to be reminded to do things.
Mr Choukair states he owns a business called Ilma Collision Centre which was previously called Ilma Collision and Marine Repairs.
He said in 2024 he had casual labour working for him. He states the claimant has never worked for him, noting he does not have the skills and knows less than an apprentice.
Mr Choukair states when Mr Rabah went to Germany some years ago, he said he might be away one to two months and he offered to store his cars, which he described as classics, at his shop.
Mr Choukair said Mr Rabah was away for something like two years and when he returned, he was supposed to help prepare the cars for painting. Mr Choukair said he would call the claimant and say, “are you coming in today or not?”. He said it got to the point he wanted him to finish the cars because they were taking up space. Mr Choukair said Mr Rabah would come in and do things on the cars but everything he did he had to re-do. He states he had to keep reminding him and sometimes he would “disappear” for months.
Mr Choukair stated eventually the cars were finished and they left.
Statement of Firas Chahal
Mr Chahal provided a statement dated 13 March 2025.[37]
[37] Claimant’s document p 263.
Mr Chahal stated he understood the claimant’s situation and he couldn’t sleep if he just left him by himself and let him become homeless. He said, “it breaks my heart how he is now”.
Mr Chahal states Mr Rabah is a good friend to whom he has lent a lot of money since the accident. He states Mr Rabah has not worked for him in any way.
Mr Chahal said often on a Sunday he takes the claimant to Paddy’s Market where he has some businesses. He said they have coffee together.
Mr Chahal said he owns and operates ACG Kitchens and Joinery. He has three warehouses including one at Fairfield West. He stated he stored a motorbike for the claimant there and an old, wrecked VW for a while. He said the VW was fixed up and repainted by Hussein and then returned to his premises.
Mr Chahal said Mr Rabah comes to ACK Kitchens at Fairfield West and hangs around. He said he also says hello to the guy from Omega Automotive Centre but does not work for Omega.
Bank statements and passport
The claimant provided copies of his St George Bank Statements for the period 25 February 2024 to 24 August 2024 and 25 August 2024 to 24 February 2025 and a copy of his passport.
SUBMISSIONS
Insurer’s submissions dated 2 August 2023
The insurer provided submissions dated 2 August 2023.[38] The insurer submitted there was no indication a psychological injury was sustained in the accident.
[38] Insurer’s documents p 4.
The insurer noted the initial attendance on Dr Kim Maguire was on 21 November 2018, six months after the accident. Mr Rabah left Australia in 2020 and travelled to Germany, Yugoslavia and Brazil, returning to Australia in November 2022.
The insurer submitted following the subsequent accident on 13 July 2022 the claimant returned to St Vincent’s Hospital with a persistent headache on 15 July 2020. Dr Mosalski rehabilitation physician diagnosed a mild traumatic brain injury with concussion symptoms in a report dated 14 August 2020. Symptoms reported by the claimant to Dr Mosalski were dizziness, headaches, poor memory to verbal information, poor concentration, small personality changes and significant fatigue.
The insurer submits the histories recorded by Dr Bertucen in his report dated 22 May 2023 are inconsistent with the information recorded by other treating and medico-legal practitioners.
The insurer submits there are significant issues with the claimant’s credibility.
The insurer also disputes the diagnosis of post-traumatic stress disorder on the basis the claimant does not meet the DSM-V Criteria A which requires exposure to a stressor such as death, threatened death, actual or threatened serious injury. The insurer submits the accident was not of sufficient severity where the claimant was able to immediately self-extricate and then later self-discharged from hospital the same day.
Insurer’s submissions dated 25 August 2023
The insurer provided further submissions dated 25 August 2023.[39]
[39] Insurer’s documents p 10.
The insurer refers to the clinical notes of Earlwood General Practice on 27 August 2015 which state:
“needs referral to Valerie- psychologist - for depression has seen a different psychologist - not happy with this person, wants to change, very anxious and paranoid about health”.
On 21 February 2018 Medical Assessor John Ashwell recorded the following in his certificate dated 21 February 2018:
“He states he has also suffered from anxiety and depression. He has been reviewed by a psychologist.”
The insurer submits there is a pre-existing permanent impairment having regard to the history recorded by Dr Porteous in his report dated 12 October 2016. The insurer submits based on that history the claimant’s pre-existing condition would have been assessed as class 3 for self-care and personal hygiene and class 2 for adaption prior to the accident.
The insurer also notes that three months prior to the accident on 16 February 2018 Medical Assessor Ashwell reported the claimant had not been able to go surfing, skateboard riding and attend a gym three to four times a week. Accordingly, the insurer submits that the claimant would have been assessed as class 3 for social and recreational activities under the PIRS scale prior to the subject accident.
Insurer’s submission dated 17 February 2025
The insurer provided further submissions dated 17 February 2025.[40]
[40] Insurer’s documents p 287.
The insurer submits the Review Panel cannot rely on the subjective reporting of the claimant’s symptoms and functioning having regard to the following:
· there is objective evidence of exaggeration and malingering based on the objective tests carried out by Professor Bright on 24 June 2024;
· that the claimant is able to attend to grocery shopping on his own despite the history recorded by Medical Assessor Fukui;
· that the claimant has returned to some form of employment since the accident, working at Ilma Collision Centre and Marine Repairs;
· that no weight should be given to paragraph 58 of the claimant’s statement dated 14 July 2023 in circumstances where he was seen engaged in some form of employment at Ilma Collision Centre and Marine Repairs;
· that no weight should be given in paragraph 55 of the claimant’s statement that “I can’t concentrate on the road for long enough to make it safe” as the claimant was seen driving a vehicle whilst under surveillance;
· that no weight should be given to paragraph 54 of the claimant’s statement dated 14 July 2023 that “I don’t have a TV anymore”, where Dr Davies reported on
16 October 2024, “He puts on the television but is not really aware of what he is watching”;· that the claimant has the capacity to engage and interact with his co-workers at Ilma Collision Centre and Marine Repairs;
· that the claimant is able to leave his home on his own and travel to various places in Sydney, either by vehicle, bus or train;
· that the claimant involves himself in community pursuits since the accident, attending “Vision Islam” and a prayer hall/mosque;
· that the claimant appears to be well groomed and dressed based on the surveillance depicting him travelling from Bankstown to Bondi Junction on
18 December 2024;· that the claimant is able to travel on his own outside his local area;
· that no weight should be given to paragraph 49 of the claimant’s statement where he was talking on the mobile phone during the period of surveillance;
· that no weight should be given to the history recorded by Dr Davies that the claimant “does not involve himself in any community pursuits and is profoundly withdrawn” in light of the surveillance material depicting the claimant attending Vision Islam and a prayer hall/mosque, and travelling from Bankstown to Bondi Junction; and
· that no weight should be given on the assessment and opinion of Dr Bertucen in circumstances where the histories recorded are inconsistent with the surveillance.
Insurer’s submission dated 28 April 2025
The insurer provided additional submissions dated 28 April 2025.
Social and recreational activities
The insurer referred to the report of Dr Davies dated 16 October 2024 where the claimant reported little social contact, no involvement in community pursuits and that he was withdrawn. The insurer submits the following attendances prior to and following the examination with Dr Davies referred to in the bank statements of St George Bank are inconsistent with those assertions:
· 7 October 2024 – Island Dreams Café in Lakemba;
· 8 October 2024 – Outdoor and General at Punchbowl;
· 12 October 2024 – Coles in Potts Point;
· 17 October 2024 – Coles Bankstown;
· 18 October 2024 – Woolworths in Lakemba and Field of Fruits in Bankstown;
· 21 October 2024 – St George Bank in Bankstown and 7-Eleven in Bankstown, Gosford and Turramurra;
· 22 October 2024 – 7-Eleven in Bankstown, Paradise Grocery in Lakemba, Woolworths in Lakemba, Akther Akram (a restaurant) in Lakemba, Coles in Bankstown and Mataam Al Mandi (a restaurant) in Lakemba, and
· 23 October 2024 – Coles in Bankstown, 7-Eleven in Bankstown and Sal Dental Australia in Lakemba.
The insurer refers to the medical report of Dr Jeff Bertucen, psychiatrist, dated
4 November 2024 where the doctor assessed Class 3 on the basis of the following:"Mr Rabah states that he shops locally (mostly at off peak hours) but otherwise does not engage in any external socialising or receive visitors at home. He claims that he has become demotivated with regards to previous interests of classic cars"
The insurer refers to the bank statements of St George Bank where the claimant has attended the following locations prior to and following the medical examination with
Dr Bertucen:· 25 October 2024 – Mumtaz Spices in Auburn;
· 28 October 2024 – Haven Specialty Coffee in Ultimo (27.3km from the claimant’s home in Bankstown);
· 28 October 2024 – MAGS News in Glenmore Park (56km from the claimant’s home in Bankstown);
· 9 November 2024 – Macquarie Fields Woolworths (21.6km from the claimant’s home in Bankstown) where he made four EFTPOS debit withdrawals, and
· 15, 18 and 19 November 2024 - Vision Islam International on three consecutive business days which appears to be a charity providing courses to adults.
In addition, the insurer refers to paragraph 4 where the claimant attended Coles in Potts Point (30.1km from the claimant’s home in Bankstown), 7 Eleven in Gosford (79.7km from the claimant’s home in Bankstown) and 7 Eleven in Turramurra (27km from the claimant’s home in Bankstown).
The insurer submits the above attendances are inconsistent with the claimant’s assertion that he only shops locally and does not engage in any external socialising, noting his attendances at Vision Islam International and at the suburbs of Ultimo, Glenmore Park, Macquarie Fields, Potts Point, Gosford and Turramurra.
The insurer refers to the medical report of Dr Brian Potter, psychiatrist, dated
21 November 2024 where the doctor recorded the following history relevant to this PIRS category:"He has no social engagement, seeing people, catching up with people, or going out with people. He used the term “nothing”. He did previously."
The insurer submits the bank statements of St George Bank prior to and following the medical examination with Dr Potter indicates that the claimant attended Woolworths in Macquarie Fields, Pet Barn in Punchbowl, Coles in Bankstown, Vision Islam International and Son Trang Supermarket in Bankstown and attended Vision Islam International on three consecutive business days. It is submitted that these attendances do not reflect the claimant doing “nothing”. The insurer also submits this evidence is not consistent with the statement of Firas Chalal.
Social functioning
In respect of social functioning the insurer notes Dr Davies assessed this PIRS category as a Class 3 on the following basis:
"Mr Rabah describes very little social functioning or social contact. Most friendships have been abandoned. There is no interest in intimate relationships."
Dr Bertucen assessed this PIRS category as a Class 3 on the following basis:
"Mr Rabah states that he has become disconnected from the mainstream of human society and does not interact with neighbours and sees his previously close friends infrequently (every few months). He has had no intimate relationships since the last interview. He remains in contact with his uncle and family overseas".
Dr Potter recorded the following history relevant to this PIRS category:
"He has contact with his family via phone calls and messages. When asked who is in his family he offered succinctly that they are spread all over the world. He has the two sisters in Germany and Brazil. He maintains no contact with other family members.
He stated having two close friends, when asked about his relationship with friends.
Sometimes they check on him. He described everyone has a busy life and he is having less contact.”
The insurer submits these histories are inconsistent with the evidence of Mr Chahal and with the entries in the claimant’s bank statements which suggests the claimant attended cafes, restaurants, and at Vision Islam International on three consecutive business days.
Further the insurer submits the claimant has demonstrated the capacity to travel overseas on his own to Brazil, Syria and Damascus, noting he conceded he did not need help from Firas during his trip to Damascus in 2025.
The insurer submits the claimant has maintained or pursued an intimate relationship since the accident given the transactions shown on the St George Bank statements as follows:
· 31 December 2024 - $2,650 for “Dimond ring Dimond ring Julia Haremza” and “Ring Ring Julia Haremza”;
· 3 January 2025 - $1,000 for “Ring Ring Lydia Laura Sirianni”, and
· 9 January 2025 – $1,800 for “Ring Ring Mrs Marcia Gail Surman”.
Concentration, persistence and pace
Dr Davies assessed this PIRS category as a Class 3 on the basis of the following:
“He struggles to read. He puts on the television but is not really aware of what he is watching and more appears to represent a background distraction of noise. He was visibly distracted with evidence of psychomotor slowing in the course of our meeting today.”
Dr Bertucen assessed this PIRS category as a Class 3 on the basis of the following:
"Moderate impairment of concentration, memory and information processing. He maintains that he is unable to focus on reading, loses personal effects and forgets recent conversations and appointments”.
Medical Assessor Fukui assessed this PIRS category as a Class 3 on the basis of the following:
"His concentration and focus are poor. He is forgetful. He cannot read more than two pages of a book due to poor concentration. He does not bother watching television."
The insurer submits the histories recorded by Drs Davies and Bertucen are inconsistent with the claimant's responses to the surveillance material. Further, the insurer submits the assertion of impaired memory is not consistent with his statement dated 18 March 2025 where he recalls someone asking him a question as to whether he worked at Ilma Collision Centre and Marine Repairs during the period of surveillance undertaken on 29 to 31 July 2024, and 8, 9 and 12 August 2024.
In his statement dated 18 March 2025 the claimant indicated he was able to recall an incident three months earlier when he allegedly remembered a man and a woman walking together and filming him after he had his shoes repaired at Bob’s Shoe Repairs. The insurer submits this is inconsistent with an impaired memory and concentration.
Further, the insurer refers to the claimant’s statement dated 18 March 2025 where he indicated that “I got the bus to Sydenham and then the train to Bondi Junction. I got off at Bondi. I remember that a man was following me – he said something to me on the train and watched me”. The insurer submits the claimant’s recall of this incident is inconsistent with an alleged impaired memory and concentration.
Adaption
The insurer refers to a transaction entry of 21 October 2024 referred to in the statements of St George Bank where the claimant received a refund from the Australian Taxation Officer of $6,027.43 for the financial year ended 30 June 2024. The insurer submits that it is unclear how the claimant had deductions to warrant a tax refund where he was reportedly not engaged in any employment in the 2024 financial year.
Claimant’s submissions
Claimant’s submissions dated 29 August 2023
The claimant provided submissions dated 29 August 2023 in support of the permanent impairment claim.[41]
[41] Insurer’s documents p 16.
It is submitted when the accident occurred the claimant had been knocked to the ground and it was only the presence of the claimant’s vehicle which caused the truck to stop, narrowly avoiding crushing the claimant beneath its wheels.
It is asserted not long after the accident the claimant began having nightmares of being trapped under a trailer. On 30 May 2018 Dr Vinchenzo reported the claimant was “unable to sleep thru the night” and in October 2018 Dr Menon reported post-traumatic stress symptoms, avoidance behaviours, anxiety and insomnia. On 21 November 2018 Dr Maguire reported nightmares started two or three days after the accident. In February 2020 the claimant was admitted to the Sydney Clinic.
In relation to the subsequent fall on 13 July 2020 when the claimant fainted whilst shopping it is noted the CT scan of the brain of 15 July 2020 reported “no intracranial abnormality”. The claimant submitted there is no objective evidence of a subsequent impairment.
The claimant submits that he sought psychiatric treatment in the immediate period after the accident. The claimant relies upon the assessment of Dr Bertucen.
Claimant’s submissions dated 8 November 2023
The claimant provided submissions dated 8 November 2023 in respect of the alleged credit issue.[42] The claimant submits he disclosed the prior history in his statement and to Dr Potter. It is noted the insurer relies upon a single entry of 27 August 2015, almost a decade ago. The claimant addressed those submissions stating he does not recall any psychological diagnosis or referral following his consultation with Dr Cho on 27 August 2015.
[42] Claimant’s documents p 24.
The claimant also submits that the Guidelines provide the impairment must be attributable to a psychiatric diagnosis and that the evidence of Dr Porteous and Dr Ashwell relied upon by the insurer relates to physical complaints only.
Claimant’s submissions dated 6 March 2024
The claimant provided submissions dated 6 March 2024 in response to the application for review.[43]
[43] Claimant’s documents p 1.
In relation to the assertion that there was an alleged pre-existing impairment the claimant submits there is no evidence of such an impairment at the time of the accident. It is submitted that the fact that the claimant saw a counsellor once after a relationship breakdown in 2015 falls far short of a mood, or anxiety disorder or psychiatric condition.
Notably the report of Dr Porteous was dated 12 October 2016 and some of the information was no longer correct at the time of the accident. The claimant submits in 2018 he was working 10-hour shifts as a truck driver and performing overtime. Further, the claimant states in 2018 before the accident he went 4-wheel driving and camping and took his girlfriend to the Hunter Valley. He stated he had back pain but not depression. He was caring for himself and his home without difficulty.
The claimant submits the reports of Dr Porteous, some seven years prior to the assessment by Medical Assessor Fukui and five years prior to the assessment by Medical Assessor Ashwell are not relevant in assessing the claimant’s permanent impairment at the time of the assessment. Nor are they relevant in determining the pre-existing impairment.
The claimant takes issues with the assertion by the insurer that he had credibility issues. It is argued that the claimant disclosed his very limited psychological issue many years prior to the accident and at the time of the accident was psychiatrically healthy.
The claimant argues he cannot be criticised for reporting he had a concussion rather than a traumatic brain injury, noting that Dr Mosalski was uncertain about the presence of a mild traumatic brain injury.
Claimant’s submissions dated 24 March 2025
The claimant provided submissions dated 24 March 2025.[44]
[44] Claimant’s documents p 301.
The claimant submits that whilst there have been minor variations in what the claimant has been able to do and has done over time it is not surprising where his condition has not been static over the time which has elapsed since the accident.
The claimant submits the insurer undertook an extraordinary amount of surveillance on the claimant, 331 hours but have reported on less than 4.5 hours of surveillance obtained over 15 days. It is submitted the surveillance material is explained in detail by the claimant.
The claimant submits it beggars belief that he would sustain some pretence about his mental state for a period of seven years where:
· he was previously employed and socially active;
· he was cared for by relatives abroad from September 2020 to November 2022;
· the insurer’s desktop investigation report shows pre-accident Instagram imagery of the claimant surfing, sailing, riding his motorbike and visiting Paris with friends which can be compared with 2024 surveillance footage of him collecting a discarded frypan from the street and attending a bottle recycling machine to obtain food vouchers;
· he has become impoverished and has housing insecurity, moving from a studio in Potts Point to a flat in Bankstown and recently to his uncle’s granny flat in Wiley Park, and
· his friends Hussein and Firas attest to him being a changed person since the accident.
CLAIMANT’S RESPONSE TO INSURER’S SUBMISSIONS DATED 28 APRIL 2025
Claimant’s evidence in response
Statement of the claimant dated 6 June 2025
Mr Rabah provided a statement dated 6 June 2025 in response to the insurer’s submissions dated 28 April 2025.[45]
[45] ALAD 6 June 2025 p 7.
Mr Rabah stated he has not done any work for wages since the accident. He stated he made an error when he completed his 2023-2024 tax return which he has been trying to amend and has amended multiple times. Mr Rabah attached to his statement the history of lodgements with the Australian Taxation Office which verifies his attempts to amend his taxation return. He states he has now been informed Employers Mutual Limited, the workers compensation insurer withheld $15,354 from his workers compensation payments of $53,838. He believes that was too much tax and accounts for the tax refund he received. Attached to the claimant’s statement are Notices of Amended Assessment for the year ended 30 June 2024 dated 21 October 2024 and 10 February 2025 which show an amended taxable income of $53,835, tax assessed in the sum of $7,964.35, PAYG credit received of $15,354 and a refund payable to the claimant of $5,966.94.
In relation to the items nominated by the insurer on his bank statement the claimant advises:
· haven Speciality Coffee is where he had had coffee with Firas at the markets;
· he recalls travelling to Gosford with Firas in 2024 and whilst he does not recall travelling to Macquarie Fields, if he did so, it would have been with Firas;
· if he spent $20 or $30 at a Bankstown or Lakemba restaurant he would have been buying lunch or a takeaway for himself. Mr Rabah stated he does not go out for social gatherings in restaurants anymore;
· payments of $5 and $10 to “Vision Islam” are small donations to the mosque;
· he does not have a girlfriend. Following the accident in May 2018 and before he left Australia in September 2020, he had a short relationship with a girl who was his neighbour in Kings Cross, but it lasted only a few weeks. Mr Rabah states he has not had any romantic relationships since then, and
· Mr Rabah states he bought three rings in late 2024 and early 2025 when his friend Firas asked him to buy rings for his family because he owed him money. He states Firas chose the rings and bought them on Facebook Marketplace from the claimant’s account. He stated he believed the names of the three women are the seller’s names.
Statement of Firas Chahal dated 5 May 2025
Mr Chahal provided a statement dated 5 May 2025.[46]
[46] ALAD 6 June 2025.
He stated in late 2024 or early 2025 he asked the claimant to buy rings for his mum and two sisters. He stated at the time Mr Rabah had received some lump sum compensation and owed him lots of money as he had helped him after his accident because he could not work. He said the rings cost a lot less than the amount he is still owed by the claimant. Mr Chahal said he does not know the names Julie Haremza, Lydia Sirianni or Marcia Gail Surman but they might be the names of the women the rings were bought from.
Mr Chahal said he had taken the claimant with him to the Central Coast, although he does not remember the date. He said he tries to get him out, by asking him to tag along with him.
Mr Chahal said purchases at Haven Coffee in Ultimo in October 2024 was probably when he took the claimant for coffee at the markets.
Mr Chahal confirmed that his business premises for ACG Kitchens and Joinery are at Unit 3, 191 Fairfield Road, West Guildford and that the claimant has never worked for his business.
Claimant’s submissions in response dated 6 June 2025
The claimant provided submissions in response dated 6 June 2025.[47]
[47] ALAD 6 June 2025 p 1.
The claimant notes that the insurer had referenced 19 entries from the claimant’s St George Bank account in the period 7 October to 23 October 2024. Eleven entries relate to local supermarkets, convenience stores or fruit shops near the claimant’s then home in Bankstown. One is a Coles at Potts Point near the claimant’s GP who he must attend to obtain Certificates of Capacity for the workers compensation insurer. One is a local dentist, and one is his local bank.
On 7 October 2024 the claimant spent $18.20 at a café in Lakemba on the day he does his supermarket shopping.
On 19 October 2022 (incorrectly described in submissions as 22 October) the claimant spends $20.30 and $30.45 at two different restaurants. It is noted that both restaurants do take away meals and the purchases are consistent with solo meals. The claimant attaches an extract from Menulog for Mataam Al Mandi in Lakemba showing single serve main courses at $27. The claimant disputes these purchases are evidence of social activities or community activities.
On 21 October 2024 there is a record of purchases at a 7-11 store in Turramurra and Gosford. Whilst the claimant cannot recall these purchases it is submitted, they are not inconsistent with travelling with his friend Firas and fall well short of evidence of a normal or unrestricted social life.
The references on 27 October 2024 relate to having coffee at Ultimo (Sydney Markets) with Firas and then accompanying him to Macquarie Fields.
The claimant’s evidence verifies that payments of $5 and $10 on 15, 18 and
22 November 2024 are not in relation to attendances at a charity providing courses but charitable donations to the mosque.The purchase of three rings in late 2024 and early 2025 are explained by the claimant and Mr Chalal in their respective statements.
The claimant’s statement dated 6 June 2025 provides the real explanation for the tax refund and evidences the difficulty he experienced in attempting to prepare his own tax return, which it is submitted is evidence of the impairment of his concentration, persistence and pace.
The claimant notes Procare Investigations conducted 331 hours of surveillance from January to December 2024 yet reported on less than 4.5 hours of that surveillance conducted over 15 days. The claimant submits the insurer should withdraw its allegations of fraud directed at the claimant, where he sustained significant psychiatric injury in the accident and the continued unsustainable allegations are causing him considerable distress.
INSURER’S FURTHER SUBMISSIONS
Insurer’s submissions dated 1 July 2025
The insurer provided further submissions dated 1 July 2025.[48]
[48] ALAD 1 July 225 p 1.
The insurer submits there appears to be no dispute the claimant was able to attend his local supermarkets, convenience stores, fruit shops, Coles at Potts Point, his local dentist and his local bank. The insurer submits there is no evidence the claimant has not been able to attend and travel to these locations on his own and also to engage with people.
In relation to paragraph 4 of the claimant’s submissions dated 6 June 2025 the insurer:
· queries the entry dated 19 October 2022 when the bank statements cover the period 25 February 2024 to 24 February 2025. The Panel assumes this was a typographical error;
· notes that the purchase on 19 October 2024 for $30.45 is reportedly not consistent with an extract from Menulog showing single main courses at $27 from Mataan Al Mandi, and
· notes there appears to be a concession that the claimant is able to travel to Akther Akram and Mataam Al Mandi on his own and was able to engage with people when attending these restaurants.
In relation to paragraph 5 of the submissions dated 6 June 2025 the insurer submits there appears to be a concession by the claimant that he was able to travel to Turramurra and Gosford, locations not within his local area and he was able to engage with people through the purchase of items at those venues.
In relation to paragraph 6 of the submissions dated 6 June 2025 the insurer submits there appears to be a concession by the claimant that he was able to travel to Sydney Markets and Macquarie Fields, not being locations within his local area.
In relation to paragraph 8 of the submissions dated 6 June 2025 the insurer seeks the following information:
· copies of the Facebook Marketplace messages between the claimant and Julia Haremza, Lydia Sirianni and Marcia Gail Surman in relation to the purchases of the three rings on 31 December 2024, 3 January 2025 and 9 January 2025;
· did the claimant view/see the three rings prior to the purchases? If so, where did the claimant view/see the three rings? and
· if the rings were purchased online and were not viewed/seen, how did the claimant obtain the rings from Julia Haremza, Lydia Sirianni and Marcia Gail Surman.
The insurer seeks full copies of the claimant’s 2024 Individual Tax Returns including the original lodged and the amendments thereafter.
However, the Panel notes it is not appropriate for the insurer to request access to documents in the course of a medical review and nor is it appropriate for the Panel to draw conclusions from the failure of the claimant to respond to these requests.
The insurer maintains there continues to be significant issues in relation to the claimant’s credit and the assessment of permanent impairment should be based on the objective tests carried out by Professor Bright, the surveillance material of Procare Investigations, the claimant’s bank statements, the claimant’s passport showing his dates of travel since the accident and the various concessions made by the claimant and Mr Chahal in relation to their friendship and the claimant’s ability to travel outside his local area since the accident.
MEDICAL EXAMINATION
Psychosocial history and pre-accident history
The claimant is a 40-year-old single truck driver who has not worked since his accident on
29 May 2018.Mr Rabah denied any other history of psychiatric illness. He used to love camping, sailing, surfing, and going out.
He had been otherwise medically well apart from “back pain but I was managing” though this had recurred last year.
He does not drink alcohol, smoke, or use drugs. He does not gamble.
Mr Rabah denied any history of problems with the law. He had no other claims history apart from a back injury in a motor vehicle accident after being rear ended at traffic lights.
He knew of no family history of psychiatric illness.
Mr Rabah was born in Syria. He is the eldest of five children. His parents are both still in Damascus. His father had been a politician while his mother worked in property development. He saw his childhood as “normal – not hing special – normal upper middle class”. He completed year 12 in Syria and came to Australia in 2006 and studied TV production. He has done talk shows here and in Dubai and Abu Dhabi. He returned to Australia in 2015 and “did one talk show for SBS” and “during my studies I did deliveries for my family’s food supply business – I decided I like truck driving, and I got my licence…”.
Mr Rabah had no periods of unemployment before his accident.
He was married at one point saying, “I loved women a lot – I had so many relationships”. He had been three years with one woman but broke up shortly after they married in 2013. He has no children.
History of the accident
On 29 May 2018, Mr Rabah went to work. Following a conversation with a co-worker he walked toward his car when his co-worker drove a truck towards him. The trailer knocked him to the ground, and he fell under the trailer. He narrowly missed being crushed beneath the wheels of the trailer because the movement of the truck was impeded by his vehicle. He said of his time of entrapment, “It felt like forever, but I think it went for a couple of minutes”. He said there was meant to be CCTV footage which had “disappeared for some reason”. He was put in a taxi and sent to St Vincent’s Hospital where he was checked out and sent home after an overnight stay.
History of symptoms and treatment following the accident
He sustained “some scratches and I had some pain in my head” but seems to have sustained minor injuries only.
Mr Rabah said he was “fine the first couple of days and then things started to come gradually – for some reason I got triggered – things start from there”. He experienced, “A really fast heart rate – dry mouth – really bad dreams”. He said of one of the dreams, “It was like I was in a war zone and crushed by horses… stuck in carriages… suffocated…”.
Mr Rabah described “this feeling like my brain is tapping”.
Turning to the surveillance footage. The insurer submitted that the claimant has returned to some form of employment since the accident having regard to the surveillance footage which shows him engaged in work activities at Ilma Collision Centre and Marine Repairs. In his statement dated 18 March 2025 Mr Rabah reported he owned four vehicles at the time of the accident which were stored by his friends Mr Choukair and Mr Chahal at various times. He stated in early 2024 Mr Choukair, the owner of Ilma Collision Centre and Marine Repairs asked the claimant to undertake work on the Caravelle and the Defender so they could be moved out of his workshop. The claimant concedes he undertook some work on those vehicles; he did some cleaning and helped others when asked as well as moving cars around out the front. Mr Choukair confirmed he wanted the cars moved and he asked the claimant to come in and work on his vehicles, although he also states everything he did he had to re-do and he had to keep reminding him to come in noting sometimes he would “disappear” for months. This is consistent with the claimant’s assertion that there were periods of time when he did not leave home. Mr Choukair states Mr Rabah has never worked for him, noting he does not have the skills and knows less than an apprentice.
Whilst the surveillance footage shows the claimant involved in activity at Ilma Collision Centre and Marine Repairs the Panel accepts that those activities were largely undertaken on his own vehicles, over a short period of time and having regard to the evidence of
Mr Choukair are not evidence of employment.The Panel accepts the claimant has never worked at Omega Automotive and his presence in the vicinity of Omega Automotive was because he was visiting ACG Kitchens the business owned by his friend Mr Chalal.
The insurer submits the history reported by Dr Davies in his report of 16 October 2024 that the claimant did not involve himself in community events, that he had abandoned all hobbies and interests and limited trips outside the house to the supermarket and doctors’ appointments was inconsistent with the surveillance footage.
It is apparent that the claimant has maintained his friendship with his two close friends
Mr Chalal and Mr Choukair, although the evidence suggests that may be because neither
Mr Chalal nor Mr Choukair have given up on the claimant. Mr Chalal states he couldn’t sleep if he just left the claimant by himself and left him to become homeless noting “it breaks my heart how he is now”. Mr Chalal confirmed he tries to get the claimant out by asking him to tag along with him explaining the claimant’s attendances at Ultimo, Macquarie Fields and Gosford. He stated he takes the claimant to Paddy’s Market where he has some business and to his warehouse at Fairfield West.There is no suggestion the claimant denied having these friends, noting on 17 September 2024 Dr Jensen referred to a limited friend group, and on 4 November 2024 Dr Bertucen referred to his two close friends. Whilst Dr Davies suggested the claimant had little external support at the time of his examination on 16 October 2024, he did refer to an individual who the claimant had not seen for two months. The Panel considers the history obtained by
Dr Davies downplays the support provided to the claimant by his two friends as evidenced by the surveillance footage and their statements. However, it is also clear that there have been periods of time when the claimant has isolated himself at home and disappeared for months, in the words of Mr Choukair.The Panel accepts the claimant’s evidence as to the lack of intimate relationships post-accident, other than a relationship of a few weeks in September 2020. The submission by the insurer that the claimant has pursued an intimate relationship since the accident given the purchase of three rings has been nullified by the evidence of Mr Rabah and verified by Mr Chalal.
Whilst the insurer emphasises various entries in the claimant’s St George Bank Account statements the entries largely relate to the claimant’s attendances at local supermarkets, or other stores near the claimant’s home at Bankstown, and the reference to a Coles at Potts Point is consistent with the claimant’s attendance on his nearby GP and other attendances related to a local dentist and another the local bank. Attendances at Turrumurra, Gosford, and Ultimo occur on occasions when the claimant has accompanied his friend Mr Chalal as outlined in his statement. It is uncertain whether the claimant drove to Glenmore Park where Mr Rabah cannot recall doing so, although it should be noted he does not deny it. The claimant does not dispute that he has attended prayers at the mosque and that payments to Vision Islam were small charitable donations to the mosque.
When considering the surveillance footage, it is significant that the surveillance footage only yielded 4.5 hours of film notwithstanding 331 hours of surveillance from January to December 2024.
The insurer relies upon the claimant’s attendances at local supermarkets, other stores, his dentist, his bank, his GP at Potts Point and cafes and restaurants in his local area to submit the claimant can engage with people and travel outside his local area. The Panel agrees with the claimant that these attendances fall well short of evidence of an unrestricted social life. However, the Panel also accepts there has been evidence of some exaggeration in the histories reported by various medical practitioners given that the claimant has demonstrated some capacity to interact with other workers at Ilma Collision Centre and Marine Repairs, he is able to leave home on his own and travel to various places, he has some involvement in community pursuits given his attendance at the mosque, and he has in recent times been able to attend to his own grocery shopping. This conclusion is tempered by the knowledge that medical assessments undergone by the claimant have occurred at different times over a number of years and where the severity of the claimant’s condition has varied over time.
The Panel has considered the report of Prof Bright. He undertook psychometric testing and concluded the claimant’s response on three separate psychometric instruments was unusual and suggested the claimant was deliberately underperforming. Whilst there may have been an element of underperforming by the claimant at the time of the psychometric testing the Panel prefers the opinion of the various treating medical practitioners over the last seven years including Dr Maguire, psychiatrist, Dr Wallace, and Dr Candice Jensen each of whom have considered Mr Rabah was struggling with post-traumatic stress disorder and depression sufficient to result in hospital admission and to require psychotropic medication.
The Panel finds the overall evidence indicates an ongoing psychiatric illness.
DIAGNOSIS
The claimant’s presentation is consistent with a diagnosis of posttraumatic stress disorder. In terms of DSM-5-TR criteria, the accident as described was a Criterion A event in that he had good reasons for believing that he was at risk of serious harm. There is evidence of involuntary, intrusive, and distressing reliving of the accident although his dreams are not a specific replaying of the event as is often the case (Criterion B). There is persistent avoidance of stimuli associated with the traumatic event in that he is an anxious passenger in cars and can manage only limited driving (Criterion C). There is evidence of negative alterations in cognitions and mood manifested in his flat mood, evidence of numbing, and withdrawal from activities he once enjoyed (Criterion D). There is evidence also of marked alterations and arousal and reactivity marked by high anxiety, difficulty with concentration, and sleep disturbance (Criterion E). His symptoms have been present for over seven years (Criterion F), cause him clinically significant distress and psychosocial impairment in that he is not working, is socially withdrawn, and is not attending fully to self-care (Criterion G). Finally, his symptoms are not attributable to the physiological effects of a substance or to another medical condition (Criterion H).
The Panel considers there is also present a comorbid diagnosis of persistent depressive disorder (dysthymia). In terms of DSM-5-TR criteria, the Panel noted the presence of depressed mood for most the day for more days than not over many years (Criterion A) with evidence of poor appetite, insomnia, low energy, poor concentration, and feelings of hopelessness (Criterion B) which seemed never to have been absent for any significant interval over this time (Criterion C). He may at times have met criteria for a major depressive episode although this is not essential to the diagnosis (Criterion D) and there had never been a manic, hypomanic, or cyclothymic presentation (Criterion E). Similarly, there had never been a schizoaffective disorder, schizophrenia, schizophrenia spectrum or other psychotic disorder (Criterion F). His symptoms were not attributable to the physiological effects of a substance or to another medical condition (Criterion G). Finally, his symptoms cause clinically significant distress and psychosocial impairment manifest in incapacity to work, social withdrawal and isolation, anxiety, and the like (Criterion H).
CAUSATION
The insurer submitted there was no indication the claimant sustained a psychological injury in the accident on 29 May 2018. Whilst there is no mention of a psychological injury in the Application for personal injury benefits dated 14 June 2020 the Panel notes that on
30 May 2018 Dr Alexandrou reported the claimant was unable to sleep through the night and on 25 July 2018 Dr Vinchenzo reported the claimant felt mentally unable to go to work, was sweating when thinking of the accident, referenced flashbacks and described his mood as swinging. The claimant was referred to Dr Menon, clinical psychologist who he saw for the first time on 15 August 2018. She obtained a history of psychological symptoms, avoidance behaviours, anxiety and insomnia following the accident. Dr Menon encouraged the claimant to visit family overseas for support.Likewise, Dr Maguire psychiatrist reported the claimant was traumatised, had bad dreams and insomnia when he saw him for the first time on 21 November 2018. He obtained a history of nightmares starting two or three days after the accident, insomnia since the accident, flashbacks and panic attacks. Dr Maguire diagnosed post-traumatic stress disorder and depression.
Whilst there was a reported referral for depression prior to the accident as referenced in the clinical notes of Dr Cho of 27 August 2015 the claimant, in his statement dated
8 November 2023 recalls seeing a counsellor one time after he broke up with a girlfriend but does not otherwise recall being diagnosed with anxiety or depression. Medical Assessor Ashwell reported the claimant was suffering with anxiety and depression in his certificate dated 21 February 2018 following the 2016 accident. Mr Rabah has no independent recollection of suffering from anxiety and depression or of seeing a psychologist but in any event, states following his recovery from the 2016 accident he returned to driving holidays, hiking and camping.Although there had been psychological symptoms present before the accident, the history on offer and the documentary evidence indicated that the claimant’s post-accident presentation was considerably more persistent and pervasive than what had previously been present with the emergence of symptoms following the accident specific to that event indicating that the accident was a substantial cause of the claimant’s post-traumatic stress disorder and persistent depressive disorder.
PERMANENT IMPAIRMENT
Permanency of impairment
The continuous presence of psychological symptoms over seven years despite treatment indicates that the claimant’s condition has stabilised. At the same time, the Panel noted that he reported some improvement in his functioning particularly while being pressed on issues of consistency emanating from the insurer’s submissions and accompanying documentation/surveillance. The Panel considered that a substantial change in his level of impairment or change greater than 3% over the next year was unlikely.
The Panel assess the claimant’s permanent impairment in accordance with the PIRS as follows:
| Psychiatric diagnoses | 1. Posttraumatic stress disorder | 2 Persistent depressive disorder (dysthymia) |
| 3. | 4. | |
| Psychiatric treatment description | He sees a psychologist and psychiatrist and is on a reasonable psychotropic regime. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 3 | At the first interview, he provided the following history: He would now “just stay at home in my room” doing “nothing”. He had “a very bad period” towards the end of last year and did not shower, clean his teeth, or look after himself. He said his lawyer came to his home, gave him money, and helped look after him. He would “shower once a week now – I have new clothes – I have new shoes – I moved out of the house and I’m saying with my uncle – I could stay in my room doing nothing – my uncle forces me out and my friends force me out – my friend takes me to the city to the markets, and we drink coffee – we buy fruits…”. He said he started to live with his uncle in March – until then he had been living on his own in an apartment but was effectively evicted because his apartment was in a squalid state. He managed to get food via the Salvation Army, dumpster diving, and getting food from the community centre. His uncle is also old and unwell – he said he tried to do some cleaning for him but “just couldn't”. He has lost several teeth because even now he rarely cleans his teeth. He does no cooking for himself or cleaning for himself and his uncle prepares the meals as well as doing his washing. He believes he is now eating well though he had “had a period where I was eating once a day”. He thinks his weight has not changed. At the second interview, he provided the following history: He does his own shopping which he does on his own. He said, “I think the last few months I have been having changes with the medication – I’m extremely happy with the present medication – the medication I’m taking now is so good – I did mention I had fear walking the street and I had fear driving – now I wouldn’t say normal but it’s much better – I remembered our appointment today… so yes, I am better – now I can go shopping – I used to feel so afraid when I walked on the street… now I feel more calm… I’m not crazy – I’m having a condition and I’m not ashamed of it anymore – I’m trying to get better…”. The Medical Assessors noted no obvious evidence of neglect. Whilst the Panel obtained a history of improvement in functioning at the second interview the Panel notes this is consistent with the condition waxing and waning over time and his response to medication. The Panel assesses a moderate impairment noting he got evicted because he was living in squalid conditions and was reliant on the Salvation Army. He cannot live independently without regular support. He cannot prepare his own means and relies upon his uncle or take away for meals. He does no cleaning or cooking for himself and his uncle does his washing. He showers once a week and has lost several teeth because he rarely cleans his teeth. |
| 2.Social a2. 2. Social and Recreational Activities | 3 | At the first interview, he provided the following history: He would now take himself out to Coles or Aldi but “it’s not that easy” to make himself venture out and see people. He said of his outing to the city, “It’s like a highlight for me” and he would do this “at least twice a month” though he would not venture out if he was on his own. He has a friend who takes him to his home and cooks for him. He has started going to the mosque and is “trying to make it as routine” though “it doesn’t work all the time and every time I skip a week or two, I would try again”. He manages to get to early morning prayers which is a quiet setting as opposed to Friday prayers. He does not do anything else socially saying, “I didn’t go out at night at all – I used to like in the past to go out to bars and clubs or to the casino – I haven’t done that since the accident”. At the second interview, he provided the following history: He reiterated that he does not go out socially at all but would go out with one friend saying, “I don’t feel the need to see anyone – I don’t like crowded places – noisy places…”. We asked him about attendances at a café in Lakemba and restaurants in Lakemba. He said he would have eaten in that restaurant though he would not be comfortable going there and eating saying he would get takeaway. He was pushed on this point and said, “I need to eat”. He again referred to being on the new medication and that his appetite was better and he gained weight. He could not recall the name of the medication although it could be Lyrica saying he had stated on 75 mg and now 150 mg daily. but said he had been hungrier on his new medication which he had been taking “more the one year” and that he was more relaxed, calmer and not as anxious. The Panel finds a moderate impairment. The Panel notes that clause 6.220 of the Guidelines requires an assessment of the extent to which the claimant’s pre-accident lifestyle, activities and habits have changed as a result of the injury. The claimant does not go to social events, unless prompted to do so by his friend and he no longer goes to bars and clubs as he did pre-injury. The claimant does not like crowded places and when he has eaten at restaurants, he has not felt comfortable, and he prefers to purchase takeaway. He is not actively involved and remains quiet and withdrawn. He no longer goes camping, sailing or surfing. Whilst the claimant has on occasion ventured out alone it is apparent from the evidence of Mr Choukair, who referred to the claimant disappearing for months, and. the surveillance evidence where only 4.5 hours of footage was obtained notwithstanding surveillance over 331 hours that the claimant spends large periods of time at home out of sight. |
| 3. Travel | 1 | At the first interview, the claimant reported he had travelled to Syria to see his father. Friends accompanied him. He does drive and can manage a 3 to 4 km maximum distance “but if I don’t feel safe on the road, I park my car and I get someone to pick me up… when I take the medication and I feel my vision is blurry, I don’t drive”. He does not like being a passenger although he would sit next to his fiend when he takes him to the city (“I don’t like the feeling – what if he crashed…”). At the second interview, the claimant confirmed he had travelled to Germany and when it got too much for his sister he travelled to Sao Paulo in Brazil to stay with his other sister. The claimant confirmed he travelled to Damascus to see his father who had been diagnosed with cancer, even though it is a dangerous place. When asked about his travel in Sydney and its environs he confirmed he travelled to Potts Point to attend his GP and therapist. He has a friend Firaz who checks on him and takes him out to drink coffee about once a month. Asked about his trips to Macquarie Fields and Glenmore Park he said he probably went there with a friend. He said he went to Gosford with his friend who was working there. He could not recall travelling to Glenmore Park. He said he would drive “only when it’s necessary”. He admitted he had been to Bondi Junction which was near Bronte where his psychiatrist was located. The Panel finds no deficit where the claimant has demonstrated the capacity to travel independently overseas on a number of occasions as well as the capacity to travel to areas in Sydney on his own. |
| 4. Social Functioning | 2 | He is not in a relationship and has not been in a relationship for a considerable time. However, he has maintained a consistent relationship with at least two friends and with his uncle and with family overseas. The Panel finds a mild impairment where there has been the loss of some friendships and the inability to form new relationships. |
| 5. Concentration, Persistence and Pace | 3 | At the first interview, the claimant provided the following history: He lacks energy. His concentration is poor. He used to love reading but can’t focus and “I’m discovering when I’m praying that I forget what I’m praying – did I say this line or do this action – like this appointment if my lawyer didn’t remind me, I would have forgotten”. He would watch some TV when he goes to his friend’s home but does not watch TV at home. He says he can watch for “a really short time” such as “maybe 5 minutes and then I lose interest and then I go back again”. At the second interview, the claimant provided the following history: His memory is “OK for certain things – like if you ask me something, I can process your question and I can answer”. He said, “I haven’t tested myself without medication. He feels he is better than he was, and he is happy with his progress and “I deserve to get better”. He would “try to read every once in a while, before I would read and forget what I was reading – now I can focus – before the accident, it was better – then it was getting worse and worse – now I’m on the right track”. He listens to audiobooks and has recently downloaded a book called “Alpha” and has listened to the first 3 chapters several times, but he has not been able to understand it. The book was meant to “help a man act like a man – not to get laughed at…”. He liked audiobooks saying, “Especially when you’re outside, you can have your headphones on and not overthink…”. He would have listened to about 6 audiobooks, and he mentioned Jordan Peterson. The Panel noted his capacity to provide precise recall of times when he believed he was under surveillance. It also noted his capacity at the first interview to provide a precise account of the medication he took including doses and variations in his regime from day to day although at the most recent interview, he was not able to identify the new medication he had been taking for over a year. The Assessors noted his capacity to maintain reasonable focus over 2 interviews of 1.5 hours and 1 hour and 40 minutes duration. The Panel assesses a moderate impairment. The Assessors formed the view the claimant did not have the capacity to follow complex instructions. Mr Choukair said that any work undertaken by the claimant on his vehicles had to redone. The claimant outlined the difficulty he experienced in preparing and lodging his own taxation return. He struggled to read and whilst he now attempts to listens to audiobooks, he has still found it necessary to listen to chapters several times. He can only watch TV for a short period of time before losing interest. The Panel notes the claimant had previously completed a Diploma in Film Production, but even though he subsequently enquired about a Bachelor of Business Course he did not complete the paperwork. |
| 6. Adaptation | 4 | At the first interview, the Panel elicited the following history: He said his friend who owned a car repair shop came and took him to his shop and “started to force me to fix my cars”. He said he is “better than last year”. He did this last year for four weeks – he had some classic cars which he could not look after and had left at a friend’s shop. He made some repairs and then stored them with someone else. He did not think he had done any work on his cars this year. He said he just did not have the energy to do anything. He is not working saying, “It’s just hard for me to control myself and leave the house – I can do it for a couple of days and then I can’t – I just stop – I have no continuity with my actions…”. At the subsequent interview, the panel elicited the following history: He had not done any work even as a volunteer “and I don’t think anyone would get me employed”. We asked about his work on his cars. He replied, “I was forced to… I had a friend – he had my cars – he said he wants me to get the cars out of the shop…”. He said it was nice when he went to this store saying, “He is nice – he talks to me – it was a good vibe”. He added, “It was one of my biggest joys working on my cars – it’s not a joy anymore”. His friend painted his van after he “removed some rubber – and windows…”. He reiterated, “It’s good to leave the house”. The Panel finds there is evidence of a residual capacity for work consistent with Class 4. |
| List classes in ascending order: 1, 2, 3, 3, 3, 4 | ||
| Median Class Value: 3 | ||
| Aggregate Score: 16 | ||
| % Whole Person Impairment: 17% | ||
*%WPI = Percentage Whole Person Impairment
Pre-existing/subsequent impairment
The Panel noted evidence of pre-existing symptoms but could not find evidence in the documentation indicative of impairment.
Apportionment – pre-existing/subsequent impairment
There was therefore no apportionment.
Effects of treatment
There is evidence of treatment effects manifesting in reported recent improvement equating to a 1% uplift.
CONCLUSION
The Panel revokes the certificate of Medical Assessor Atsumi Fukui dated
19 December 2023 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a WPI of 18%:· post-traumatic stress disorder, and
· persistent depressive disorder (dysthymia).
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