Russell v Allianz Australia Insurance Limited
[2024] NSWPICMP 720
•17 October 2024
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Russell v Allianz Australia Insurance Limited [2024] NSWPICMP 720 |
CLAIMANT: | Tayler Russell |
INSURER: | Allianz Australia Insurance Limited |
REVIEW PANEL | |
MEMBER: | Elizabeth Medland |
MEDICAL ASSESSOR: | Christopher Rikard-Bell |
MEDICAL ASSESSOR: | Doron Samuell |
DATE OF DECISION: | 17 October 2024 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017 (MAI Act); medical review of medical assessment; whether psychological injury is a threshold injury for the purposes of the MAI Act; claimant has a background of psychological symptoms; original medical assessor found the claimant suffered from pre-existing psychological disorders and the motor accident did not cause a psychological injury; Medical Review Panel found that the diagnostic criteria for posttraumatic stress disorder is not met; diagnosis of adjustment disorder caused by the motor accident, which is a threshold injury for the purposes of the MAI Act; original certificate revoked and new certificate issued. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act2017 The Review Panel:
|
STATEMENT OF REASONS
INTRODUCTION
Ms Tayler Russell (the claimant) alleges injury from a motor accident occurring on
19 August 2019. She was the passenger on a bus when the driver allegedly braked hard causing her to go forward into the seat in front.
She subsequently lodged a claim upon Allianz Australia Insurance Limited, the insurer of the bus considered at fault (the insurer). The claimant seeks payments of statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act).
A dispute has arisen between the parties as to whether the claimant has suffered a psychological injury caused by the motor accident and whether any such injury is a “threshold” injury (previously known as “minor” injury) for the purposes of the MAI Act.
An additional dispute between the parties is the level of whole person impairment.
A threshold injury determination is an important one in terms of an injured person’s entitlements under the MAI Act. If a determination finds that the motor accident has caused a non-threshold injury then the gateway to ongoing statutory benefits and an entitlement to claim damages is opened.
An application was lodged with the Personal Injury Commission (Commission) seeking a determination of the dispute.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether “the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor.
The dispute about whether the injury caused by the motor accident is a threshold injury, is a medical dispute, as defined by s 7.17 of the MAI Act, and a medical assessment matter: Schedule 2, cl 2(e) of the MAI Act.
Medical Assessor Matthew Jones issued a certificate and reasons dated 28 May 2023, which certified that the injury referred for assessment (depression and anxiety) was not caused by the motor accident, and therefore a decision as to whether these injuries are a threshold injury is not required for the purposes of MAI Act.
THE REVIEW
The claimant sought a review of the medical assessment in accordance with s 7.26 of the MAI Act. On 11 August 2023 the President’s delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel).
Section 7.26(5A) of the MAI Act provides that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission.
The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act.
Rules 127 and 130 of the Personal Injury Commission Rules 2021 (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: Rule 128 of the Rules.
The Panel met via video conference on 5 July 2024 and determined that a re-examination of the claimant was required. A medical examination was arranged to take place on
26 July 2024 with Medical Assessor Rikard-Bell and Medical Assessor Samuell via Microsoft Teams. The examination took place as scheduled.
The Panel reconvened via videolink for a second teleconference on 30 August 2024.
RELEVANT STATUTORY PROVISIONS
The term “threshold injury” is defined in s 1.6 of the MAI Act. It provides that a threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness: s 1.6(1)(b).
Section 1.6 also provides that the regulations may exclude or include a specified injury from being a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (Regulation) further defines threshold psychological or psychiatric injury to include acute stress disorder and adjustment disorder. For the purposes of cl 4 ‘acute stress disorder’ and ‘adjustment disorder’ have the same meanings as in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013: cl 4(3) of the Regulation.
Part 5 of the Motor Accidents Guidelines (Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by a motor accident is a threshold injury for the purposes of the MAI Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:
“General provisions for assessment
5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4 Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the assessment of threshold psychological or psychiatric injury. These clauses provide:
“Threshold psychological or psychiatric injury assessment
5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”
ASSESSMENT UNDER REVIEW
Medical Assessor Jones documented a history from the claimant including a prior psychiatric history. This includes a diagnosis of agoraphobia. She has been on antidepressants, on and off since her teenage years.
The claimant was reported to be taking two antidepressant medications, and not seeing a psychologist or psychiatrist.
Medical Assessor Jones noted the claimant to be a forthright and open interviewee with no inconsistencies noted.
The Medical Assessor noted that the claimant’s narrative and presentation at assessment was consistent with psychological and emotional symptoms that are proportional to, and consistent with, her reported level of pain and dysfunction. He noted the claimant displaying resilience, with a return to full-time employment.
He went on to state:
“There is a background of psychological and emotional problems, including symptoms of anxiety and depression, that have been longstanding and variable and are indeed consistent with a probable diagnosis of Borderline Personality Disorder, or likely more correctly Complex Posttraumatic Stress Disorder, related to her earlier life experiences. There has been some exacerbation of symptoms associated with this, due to her injury from the motor vehicle accident and her subsequent recovery, however these have stabilised somewhat. Her current clinical situation is not consistent with an active psychiatric diagnosis or disorder related to the motor vehicle accident, mainly because of her return to reasonable functioning in key areas of her daily life…”
Accordingly, the Medical Assessor stated that a decision as to whether the injuries are a threshold injury is not required. A 0% whole person impairment assessment was given.
SUBMISSIONS
Claimant’s submissions dated 28 June 2023
These submissions were lodged in support of the application for review.
It is submitted that the Medical Assessor gave the incorrect diagnosis pursuant to the DSM 5. It is submitted that a diagnosis of persistent depressive disorder (PDD) ought to have been made. After noting the history recorded by Medical Assessor Jones, it is submitted that the symptoms fit the diagnosis of PDD.
It is also submitted that the Medical Assessor’s description of symptoms does not include an opinion as to whether they are due to the accident, secondary to a physical injury, or attributable to a prior psychological injury.
The claimant submits that the conclusions of Medical Assessor Jones are inconsistent in that it is said that there is no psychological injury caused by the accident but later states that there has been an exacerbation of a pre-existing psychological condition. It is noted that an aggravation of a pre-existing injury is enough to satisfy that a claimant has suffered a non-threshold injury.
It is further submitted in the alternative, that the claimant was not afforded procedural fairness. In this regard, it is alleged the claimant was not given the opportunity to respond to the inconsistencies between the Medical Assessor’s findings and the contemporaneous evidence. In this regard it is said that the claimant has received a diagnosis of post-traumatic stress disorder from other doctors and she was not asked if she continued to experience relevant symptoms, such as recurrent recollections or dreams of the motor accident.
It is stated:
“The claimant submits that there is a plethora of both treating and independent evidence suggestive of a diagnosis of PTSD caused by the subject accident. Accordingly the inconsistencies between the GP’s diagnosis of PTSD and Assessor’s Jones’ observations have not been put to the claimant, as the claimant was not required to respond to the above criteria, which is used to diagnose (and consequently eliminate a diagnosis of) PTSD. Accordingly, Assessor Jones has not afforded the claimant procedural fairness.”
Insurer’s submissions dated 21 July 2023
The insurer submits that the claimant’s allegations of errors in the Medical Assessor’s medical assessment are not errors and are instead manifestations of the claimant’s disagreement with the Medical Assessor’s clinical findings.
The insurer argues that there is no requirement for the Medical Assessor to address each and every report which offers a different opinion and explain why their opinion differed (Dunbar v Allianz Australia Insurance Limited [2015] NSWSC 119).
DOCUMENTATION
Medico legal evidence
The claimant relies on a report of orthopaedic surgeon, Dr Dixon, dated 16 August 2021.
Dr Dixon made a number of diagnoses centred around the claimant’s right lower limb.
A report of Dr Kwong, rheumatologist, dated 8 November 2021 is included in the claimant’s bundle. He considered the claimant to have a joint effusion and anterior cruciate ligament strain and has developed a complex regional pain syndrome. He assessed a 32% whole person impairment.
Medical evidence
Treating surgeon, Dr Herald, noted in a report dated 8 July 2020 that bone scans confirmed features of chronic regional pain syndrome.
The clinical file of “My Doctors Medical Centre” at Macquarie Fields is included in the material.
The file includes a consultation of 9 October 2018 that notes the claimant having moved recently from Townsville where the claimant was seeing a psychiatrist. She had also seen a psychiatrist in Campbelltown three times the previous year. It is noted the claimant wanted “fixing” and had seen “many psychologists but they always move interstate.” She is noted to have been on 7-9 different medications over the last two years but could “never tolerate” them. Self-harm by way of cutting is noted. Her mood was self-reported as mostly depressed. An impression of possible borderline traits/depression/bipolar is noted.
A visit on 5 December 2018 includes notes the claimant not feeling well, with complaints of pain all over and a “dramatic description of symptoms”.
The claimant is noted to have presented on the day of the accident with a painful right knee following “trauma”.
On 21 October 2019 the claimant is noted to have anxiety and depression and wanted to see a psychologist. On 3 February 2020 the claimant was given a referral to psychiatrist,
Dr Nagesh.
A file of Workers Doctors, includes a diagnosis from a psychologist on 29 July 2021 of “PTSD – Adjustment Disorder”. She was noted to be ok but tired. She had been sleeping a lot, had a low mood. She walked her dog in the morning and was going to book a consultation with a psychologist.
An earlier entry of 5 July 2021 noted a past psychological history with aggravating factors. I diagnosis in respect of the accident was given of “PTSD” with symptoms such as intrusive thoughts, unwanted memories, avoidance behaviours and catastrophising.
On 1 July 2021 the claimant was noted to have difficulty adjusting since the accident, she had a lower mood, difficulty sleeping and was more anxious.
Notes of a telehealth consultation of 22 June 2021, noted a struggle to overcome “PTSD” and return to normal functioning. She was noted to have poor sleep hygiene, and unhealthy standard of living, chronic pain and personality factors. There was mention of suicide ideation and self-harm, but no imminent risk. The claimant’s post-traumatic stress disorder was noted to be quite severe.
A report of Angela Parasher dated 12 February 2021 notes a history of the motor accident. A diagnosis of PTSD/Depression Anxiety/Panic Disorder symptoms (DSM-5) is noted with a plan to introduce cognitive behavioural therapy. She was noted to have suicide ideations on and off.
Dr Nagesh provided a report dated 25 February 2020. He notes a history of the motor accident. The claimant reported being in constant pain with difficulty walking. She complained of low mood and had ceased an anti-depressant due to it causing suicidal thoughts. However, there were no current suicidal ideations. She complained of feeling anxious all the time and having mood swings. She was noted to have taken multiple overdoses in the past.
Dr Nagesh noted past diagnoses of anxiety, depression and generalised anxiety disorder.
Dr Nagesh opined that the claimant “…continues to exhibit depressive and anxiety symptoms, she also suffers from Borderline personality disorder.”
The claimant was not keen on commencing an antidepressant. Cognitive behaviour therapy for her depressive and anxiety symptoms. In respect of borderline personality issues
Dr Nagesh suggested that claimant do the “dialectical behavioural programme” with long term psychotherapy for her borderline personality symptoms.
A report dated 3 September 2022 of Dr Jeffrey Baron Levi, psychologist, was obtained by the insurer’s legal representatives.
The claimant stated that she often had thoughts of dying, especially when in pain. She stated that she was unable to do normal things due to body changes. Dr Levi, concluded that the claimant satisfied the DSM criteria for a diagnosis of borderline personality disorder. With the diagnosis consistent with her life history. He stated: “I am of the view that because of her borderline personality Ms Russell had been catastrophising her reported pain from the bus accident and that her post-accident level of anxiety was the result of an exacerbation of her premorbid level of mood.” He disagreed with the diagnosis of post-traumatic stress disorder. He concluded that the claimant had unstable self-image and body image as evident in her teenage years and following the subject accident. He provided a whole person impairment assessment of 0%.
A discharge summary from Macarthur Aged & Mental Health Care documents the claimant self presenting to Canterbury Emergency Department on 3 February 2021 with reports self-harm ideation in the context of a life stressor. A history of anxiety, depression, borderline personality disorder ad relationship trauma is noted. She left the hospital before the mental health team saw her. She then visited the centre on 5 February 2021 and was discharged on 9 February 2021.
The summary states the claimant reported the subject accident with her suffering from chronic regional pain syndrome. She stated that as a result she was suffering from ongoing low mood, poor sleeps, poor appetite and ongoing anxiety. She apparently self-harmed four days prior. A long history of auditory hallucination was noted. There is a note that the claimant reported a deterioration in her mental state since the motor accident and her pain syndrome.
The various GP notes document ongoing knee pain and symptoms following the accident. On 21 October 2019 the claimant attended a Dr Rassam and wanted a referral to a psychologist with complaints of anxiety and depression. On 12 November 2019 a Dr Gabriel records the claimant battling depression and a prescription for Zoloft was given.
The claimant’s school records were noted that document various incidents involving conflicts with other students. They also document the claimant recounting difficulties with her mother including mental and physical abuse.
RE-EXAMINATION
Identification data
Ms Tayler Russell is a 25-year-old woman who resides in Campbelltown with her partner Keiran, aged 26, who works in logistics. Ms Russell is currently unemployed.
Personal history
Ms Russell is one of two siblings and had a good relationship with both parents, however, her mother had Multiple Sclerosis (MS). Nevertheless, Ms Russell was forced to grow up quickly and mature as she was required to assist her mother. Her parents separated when she was 11 years old and she coped reasonably well with the separation although her brother found it more difficult. Ms Russell is close with her brother, who is 24 years old and works for the Council, although there are some disputes. She is close to her father and he works as a welder. Ms Russell decided to live with her father at the age of 15. She denied any traumatic experiences as a child or adolescent. Ms Russell attended St Andrew’s Public School where she managed adequately, however, she said she was a nasty child at times and said “I was a bitch. I had attitude.”She attended Robert Townsend High School and completed Year 12. There were difficulties interacting with friends and constant bickering which made life at school stressful. After the HSC, Ms Russell remained at home for four months before relocating to Townsville, where she worked in retail at Jay Jay's for one and a half to two years. She returned to Sydney to help her father who became unwell and worked in several positions before starting at Supre in March 2019 on a part-time basis. She was progressing well until the motor vehicle accident.
Mental state examination
Ms Russell presented as a pleasant woman of stated age with blonde hair in a bob wearing a long-sleeved warm top. There were tattoos visible on her fingers and forearms and she wore neat earrings. She was pleasant, cooperative and engaged well with the interview process. She appeared quite confident and assertive at times and questioned whether certain parts of her life history were relevant, but she was able to be persuaded to answer a range of questions. Her speech was normal in tone and volume. There was no abnormality of perception. Ms Russell’s affect was reactive and she seemed quite happy and chirpy at times, even though she was describing how pain could be quite disabling. She smiled throughout the interview and there was no evidence of any distress. Her cognitive function appeared normal and her thoughts were logical. There was no evidence of thought disorder. Ms Russell believed she was suffering from a pain disorder from the injury to her right knee and this was having an impact on functioning and causing significant issues with pain.
Ms Russell wishes the accident never occurred and that her leg was fixed so that she could return to work and that she was pain free.
History of motor vehicle accident
On 19 August 2019 Ms Russell was involved in a motor vehicle accident as she was travelling to work on a bus. The bus driver was driving erratically and was jerking the bus. He suddenly stopped and applied the brakes causing passengers to lurch forward.
Ms Russell was injured and she recalls how the accident “changed my life.”At the time, she was listening to a song which she recalls and the chair she was sitting on moved forward breaking off the mounts. She stated the accident was “like an explosion and everyone was screaming.”The bus driver asked if anyone had been hurt and Ms Russell stated she did not notice any initial pain but she rubbed her right knee. Another passenger who was quadriplegic required water and another passenger hit her face on the window. The driver asked if an ambulance should be called and no one responded. At the next stop, “all the passengers got off.” There was a piece of paper to record the names of passengers in case of later injuries. Ms Russell was late for work nevertheless she wrote her name down and then caught an Uber to work.
Symptoms and treatment after the accident
Once at work, as Ms Russell was opening the store that morning, she was required to bend and open the roller door. Although she was late, she was still able to go to work and “toughed it out.” Ms Russell stated she was unable to stand easily and she said she felt a “pop” in her knee which occurs regularly and she believes is part of the damage to her knee. She said, “It really hurt” and the pain radiates down her leg. She cries when she is in pain and there is pain radiating to her foot and lower back. Ms Russell stated her whole body aches particularly on the right side. There was treatment with physiotherapy which ceased and there was another two months of physiotherapy in an attempt to break the pain cycle due to restrictions with her right knee. Ms Russell used a crutch until 2023 to prevent falling and she has a wheelchair should she need to walk long distances. She finds it difficult to sit for extended periods as she experiences pins and needles in her right knee and there is pain around her hips. On standing there is pain in her knee and it will “flare up.”She can walk with her partner who is often required to support her. Ms Russell can go to the shops, however after 20 minutes her right hip will start to ache. She consulted Dr Herald, orthopaedic surgeon, who recommended various exercises and she consulted with several pain specialists including Dr Hou and Dr Mino two months ago who suggested she may require surgery on her knee or back. Ms Russell is able to do the grocery shopping for three hours on a Saturday, however, she will be exhausted on Sunday and said, “Sundays I’m dead.” In addition, she is able to clean the house on Saturday and is “dead” for the rest of the day.
Past medical history
There is no history of serious illnesses, injuries or conditions. She had her wisdom teeth removed in 2022 and she had significant nerve issues, however, there are no ongoing dental problems. The current medication is Valdoxan 25 mg, Lexapro 20 mg, Topiramate 100 mg and pain medication. There is a family history of depression but no admissions to hospital for mental illness. Her father has diabetes and her mother has MS. There are no drug or alcohol problems.
Past psychiatric history
Ms Russell stated she had had some anxiety as a 16-year-old with agoraphobia for about four months after the HSC and there were anxiety and panic attack symptoms which then resolved. There was no particular anxiety in primary school, although she said she was not particularly happy. There was no excessive bullying or marginalisation, however, she commented she was a difficult child and felt that she was better than other students. We asked about high school and initially Ms Russell declined to answer questions as she felt this was not relevant to the assessment and the motor vehicle accident and we addressed this later in the interview.
Past forensic history
There is no history of motor vehicle accidents, Workers’ Compensation claims, insurance claims or legal issues.
Current symptoms
Ms Russell is taking medication to help with sleep, however sleep is interrupted by pain. Her appetite is the same but her weight has increased by 18kg and she has tried taking Duramine for weight loss. Ms Russell’s mood fluctuates but she is able to enjoy herself at times although she is worried about work in the future. There are panic attacks and anxiety occasionally and she feels hopeless at times. She denied suicidal feelings currently but there have been suicidal thoughts as a teenager.
Current routine
Ms Russell goes to bed at 11.00pm and wakes up at 3.000am as her lower back aches. Her partner leaves for work at 6.00am and Ms Russell will lie in bed then get up and start cleaning. She may eat lunch and she attends to her dogs. She does not walk the dogs currently due to pain and she wears a brace around her hips. She said when the dogs were smaller, she could walk them, however they are now too big and boisterous. In the evening, Ms Russell will cook dinner and then watch television with her partner. On Saturday they do a “big shop” together and clean the house then on Sunday they rest.
Current functioning
Ms Russell is able to dress, feed and wash herself, however, she will only shower every third day, particularly during winter as her knee aches in the colder weather. In addition, she has slipped in the shower and she lacks confidence often needing assistance from her partner. Therefore, there is no impairment of self-care and personal hygiene from a psychological perspective.
In terms of social functioning, the relationship with her partner is good and there is no impairment of social functioning.
In terms of concentration, Ms Russell is quite creative and can make things and she showed some craft times she had made. Therefore, there is no impairment of concentration, persistence and pace.
In terms of socialisation, although Ms Russell is not particularly social, she has a good friend in Townsville and other friends she will meet for coffee. She will go out on birthdays and she interacts with others positively. Therefore, there is no impairment of social and recreational activities.
In terms of travel, Ms Russell is unable to drive on her own as she is on her L-plates, however, she does worry about her knee. Therefore, there is possibly mild impairment of travel.
In terms of adaptation, Ms Russell ceased work due to the requirement for mental arithmetic and mathematics which she said, “isn’t my thing” and is currently seeking a more appropriate role. Therefore, there is no impairment of adaptation from a psychological perspective.
DIAGNOSIS AND CAUSATION
Ms Tayler Russell is a 25-year-old woman who is currently unemployed and resides with her partner Kieran who works in logistics. There are two Staffordshire Terriers at home.
Ms Russell may have had anxiety issues as a teenager, however, there was no formal diagnosis, although she was unable to leave the home for four months after she completed the HSC. Therefore, there were vulnerabilities noted to developing anxiety.
Whilst there were pre-existing vulnerabilities to developing anxiety and she volunteered that she was a difficult child who truanted and was non-compliant, Ms Russell was never excluded or suspended from school. After school, she worked in various capacities before the accident. Ms Russell was in a stable relationship with her partner and there are no drug or alcohol issues. There have been no legal issues, and no substance use issues. There is a previous history of deliberate self-harm as a coping strategy but no evidence suggesting being a victim of domestic violence. Ms Russell has been able to work in various capacities although she is currently not working. There was no reported early history of trauma. It was the panel’s view despite some reported self-harm behaviours as a cooping strategy that she did not reach the criteria for complex trauma or borderline personality disorder as according to DSM-5 such as exaggerated fear of abandonment, relationship instability, identity disturbance, emotional dysregulation, extreme impulsivity and recklessness, substance use, anger or paranoia.
On 19 August 2019 Ms Russell was involved in a motor vehicle accident whilst travelling on a bus and she sustained an injury to her right knee. On 30 November 2022, Medical Assessor Ho found soft tissue injuries to the right knee and lumbar spine. There has been chronic pain emanating from her right knee which now involves the right leg and hips. There is a diagnosis of complex regional pain syndrome from Dr Herald. She allegedly self-harmed four days prior presenting to Canterbury Hospital on 3 February 2021 and she reported a deterioration in her mental state since the motor accident and her pain syndrome, which is consistent with an adjustment disorder.
The panel diagnosed an adjustment disorder with anxiety and depression (DSM 5 TR 309.28 (F43.23)) caused by the injury according to DSM 5 criteria: Criterion A there was the accident causing injury to her knee and ongoing pain; Criterion B there was clinically significant distress with anxiety impacting on her social and occupational functioning; Criterion C there was no other mental disorder; Criterion D there was no bereavement; Criterion E the stressor has continued as there is ongoing pain perpetuating the condition.
Therefore, the Panel concluded there was an adjustment disorder injury attributable to the subject motor vehicle accident.
Pursuant to cl 5.12 of the Guidelines, an adjustment disorder is deemed a threshold injury for the purposes of the MAI Act.
CONCLUSION
The diagnosis of the Panel differs from the conclusions of Medical Assessor Jones. Accordingly, the medical certificate is revoked and new certificate is issued at the beginning of these reasons.
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