Saba v Insurance Australia Limited t/as NRMA Insurance

DETERMINATION OF REVIEW PANEL
CITATION:	Saba v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 612
CLAIMANT:	Sandra Rita Saba
INSURER:	Insurance Australia Limited trading as NRMA Insurance
REVIEW PANEL
SENIOR MEMBER:	Susan McTegg
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Himanshu Singh
DATE OF DECISION:	14 August 2025
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; assessment of threshold injury under section 1.6(3); claimant suffered injury in a motor vehicle accident; Medical Assessor (MA) found the claimant sustained an adjustment disorder with anxiety caused by the accident; a threshold injury; claimant sought review; Held – claimant had sustained an adjustment disorder with mixed anxiety and depressed mood of chronic nature caused by the accident; certificate of MA revoked; adjustment disorder with mixed anxiety and depressed mood of chronic nature is a threshold injury.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION Assessment of Threshold Injury Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Fukui dated 1 June 2023 and certifies that the following injury caused by the accident was a threshold injury: · adjustment disorder with mixed anxiety and depressed mood of chronic nature.

STATEMENT OF REASONS

INTRODUCTION

Ms Sandra Rita Saba (the claimant) sustained injury in a motor vehicle accident on
24 January 2023 when her vehicle was rear ended by the at fault vehicle and pushed onto the median strip (the accident).
Ms Saba lodged an Application for personal injury benefits dated 17 April 2023 in relation to injury allegedly sustained in the accident.
Insurance Australia Limited trading as NRMA Insurance is the relevant insurer with liability to pay statutory benefits to Ms Saba under the Motor Accident Injuries Act 2017 (the MAI Act).
Ms Saba’s claim is governed by the provisions of the MAI Act. At the time of the accident statutory benefits for treatment and care under the MAI Act ceased after 26 weeks if the person’s only injuries resulting from the accident were threshold injuries.
On 25 July 2023 the insurer issued a Liability Notice - Benefits after 26 Weeks declining the claim for statutory benefits on the basis the injury sustained by the claimant was a minor (threshold) injury for the purposes of the MAI Act.
On 27 July 2023 the claimant requested an internal review of the minor (threshold) injury decision.
The insurer issued a Certificate of Determination – Internal Review dated 21 August 2023 affirming the decision that the injuries met the definition of minor (threshold) injury for the purposes of the MAI Act.[1]
[1] Insurer’s bundle p 312.
The claimant filed an application with the Personal Injury Commission (Commission) seeking a medical assessment to resolve the minor (threshold) injury dispute between the parties.
Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be medical assessment matters, including “whether the injury caused by the motor accident is a threshold injury for the purposes of the Act”.
A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[2]
[2] Section 7.20 of the MAI Act.
The dispute as to threshold injury in respect of the psychological injury was referred by the Commission to Medical Assessor Fukui.
The claimant has sought a review of the certificate of Medical Assessor Fukui.

DOCUMENTS BEFORE THE REVIEW PANEL

On 26 March 2025 in response to a direction from the Panel the claimant uploaded to the portal a bundle of documents indexed and paginated from pages 1 to 126 (claimant’s documents).
On 12 July 2024 the insurer uploaded to the portal a bundle of documents indexed and paginated from pages 1 to 50 (insurer’s documents). On 10 April 2025 in response to a direction from the Panel the insurer confirmed those records comprised the entirety of the records relied upon by the insurer.

THRESHOLD INJURY- STATUTORY PROVISIONS

The Motor Accident Injuries Amendment Act 2022 (the MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From
1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.
The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
Any reference in these reasons to “minor injury” is a reference to a “threshold injury” and any reference to the word “minor” referring to the injury alleged to have occurred in the accident is a reference to “threshold”.
A threshold injury is defined in s 1.6 of the MAI Act. Section 1.6(1)(a) of the MAI Act defines a “threshold psychological injury” as:
“A psychological or psychiatric injury that is not a recognised psychiatric illness.”
Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a threshold psychological or psychiatric injury.
Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) provides the following:
“Each of the following injuries is included as a threshold injury for the purposes of the Act:
(a)acute stress disorder,
(b)adjustment disorder.”
Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the MAI Act. Version 9.1 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:
“5.3   The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.4    Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. Diagnostic imaging is not considered necessary to assess threshold injury.
5.5    A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6      The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
In respect of threshold psychological or psychiatric injury the Guidelines also provide:
“5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”

ASSESSMENT UNDER REVIEW

In a certificate dated 22 May 2024 Medical Assessor Fukui certified the following injury caused by the accident was a threshold injury for the purposes of the MAI Act:
· adjustment disorder with anxiety.[3]
[3] Claimant’s documents p 9.
The injuries referred for assessment were:
· post-traumatic stress disorder, depression, shock, insomnia and panic attacks.
Medical Assessor Fukui noted the claimant was a 20-year-old woman who lived at home with her mother and three brothers. She worked as a legal secretary.
Medical Assessor Fukui reported following the accident the claimant had disrupted sleep with initial insomnia, flashbacks of the accident and anxiety symptoms. She avoided driving for a few months although she was fine as a passenger. The claimant denied nightmares. She reported less interest in socialising.
Medical Assessor Fukui found the claimant experienced symptoms of anxiety and insomnia and reported experiencing “shock” but her symptoms did meet the full diagnostic criteria for post-traumatic stress disorder. She noted there was not any significant impairment in her occupational or psychosocial functioning.
Medical Assessor Fukui also concluded the nature of the accident did not meet Criterion A for a DSM-5 diagnosis of post-traumatic stress disorder. Medical Assessor Fukui diagnosed an adjustment disorder with anxiety.

REVIEW PROCEDURE

The claimant lodged an application for review of the medical assessment of Medical Assessor Fukui on 20 June 2024 within 28 days of the date on which her certificate was made available to the parties.
On 26 July 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Panel.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[4]
[4] 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 27 May 2025 the Panel agreed an examination was required.

EVIDENCE BEFORE THE REVIEW PANEL
Police report

The police report noted it was a minor crash, although it was also noted that the claimant’s vehicle was towed away.

Application for personal injury benefits

In the application dated 17 April 2023 the claimant described her injuries as follows:
·post-traumatic stress disorder, and
·back and neck pain.

Treating medical evidence

The claimant consulted Dr Gallardo, general practitioner (GP) on 16 April 2023 when she reported the claimant was involved in a car accident when she was hit from behind when driving on 24 January 2023.[5] Dr Gallardo reported post-traumatic flashbacks, anxiety while driving, always cautious of getting hit from behind. She noted the claimant previously attended Headspace when her parents divorced. In a Certificate of capacity/certificate of fitness dated 16 April 2023 Dr Gallardo diagnosed post-traumatic stress disorder due to vehicular accident.[6]
[5] Insurer’s documents p 36.
[6] Claimant’s documents p 22.
The clinical notes of Edge Medical Centre Prospect as of 5 April 2024 commence on
20 September 2023. Attendances on 20 September 2023, 21 September 2023,
28 September 2023, 5 October 2023, 9 October 2023, 16 October 2023, 16 October 2023, and 7 November 2023 do not reference either the accident or psychological symptoms.
On 22 November 2023 Dr Xu reported the claimant had seen a well-being coach through her work and it was suggested she seek referral to a psychologist. The claimant reported she found relatively simpler tasks very stressful and overwhelming. She also admitted that her mood was down at times.
On 30 November 2023 Dr Xu obtained a history of the accident.[7] He reported the claimant had attended psychology sessions through Friendship Centre Counselling and was also seeing another psychologist arranged through her work. The claimant referenced flashbacks, a lot initially but less now, she was avoidant of cars, gets anxious when cars pull up behind, was anxious about work, finds herself getting overwhelmed, doesn’t enjoy going out as much now, cancels plans, sometimes gets acutely distressed, for example in the car, struggles with sleep but still enjoys the gym and walks. Dr Xu diagnosed post-traumatic stress disorder.
[7] Claimant’s documents p 34.
Clinical notes of SANE document counselling conducted by telephone on 22 November 2024, 25 November 2024, 9 December 2024, 23 December 2024, 6 January 2025, and
[8] Claimant’s documents p 104.
20 January 2025.[8] Themes discussed included the claimants involvement in the accident, her fear of driving, the fear and anxiety she experiences when she sees another car coming, her preference for public transport, her social withdrawal, and her lack of interest in seeing friends.

Certificate of Medical Assessor Alan Home

In a certificate dated 30 April 2024 Medical Assessor Home certified the following injuries caused by the accident were threshold injuries for the purposes of the MAI Act:
·        cervical spine - soft tissue injury;
·        thoracic spine - soft tissue injury resolved, and
·        lumbar spine - soft tissue injury.[9]

SUBMISSIONS

[9] Insurer’s documents p 8.

Claimant’s submissions

The claimant provided submissions dated 20 June 2024 in support of the application for review. [10]
[10] Claimant’s documents p 1.
The claimant submits Medical Assessor Fukui failed to provide reasons as to why the nature of the accident was not one which meets Criterion A and why the claimant’s symptoms which it was accepted related to the accident did not meet the DSM-5 diagnostic criteria for post-traumatic stress disorder.

Insurer’s submissions

The insurer provided submissions dated 12 July 2024 in response to the application for review.[11]
[11] Insurer’s documents p 2.
The insurer submits that a failure for the claimant’s psychological symptoms to meet any or particular criteria for post-traumatic stress disorder, would fail to meet a diagnosis of post-traumatic stress disorder even if all the other criteria are or would be satisfied.
The insurer submits in concluding that the accident did not satisfy Criterion A for post-traumatic stress disorder Medical Assessor Fukui took into account the mechanism of the accident and the claimant’s reported perception of same. The insurer submits “[h]ow the matter is taken into account is a matter for the decision maker. It may be dismissed, given little weight, or decisive weight.”[12]
[12] QBE Insurance (Australia) Limited v Alawia [2016] NSWSC 1875, [61].
The insurer submits once the Medical Assessor has determined the subject accident did not meet Criterion A, the claimant could not have developed post-traumatic stress disorder at any stage leading up to and including the assessment.
The insurer submits when read as a whole the Medical Assessor provided sufficient reasons for a diagnosis of adjustment disorder with anxiety:
“A. The claimant was involved in a motor vehicle accident where she experienced shock and physical injuries within 3 months of the subject accident.
B. (1) The claimant has experienced marked distress with ‘initial insomnia, and reported flashbacks of the accident and anxiety symptoms’, ‘hypervigilant in a car and had lost confidence in driving’, ‘overthinking’.
(2) ‘She socialised less because she avoided driving but maintained her occupational functioning’.
C. The claimant did not have a pre-existing psychological condition, and the condition did not meet the diagnostic criteria for post-traumatic stress disorder.
D. The ‘symptoms do not represent normal bereavement’ or ‘prolonged grief disorder’.
E. The stressors have not ceased due to ongoing exposure to vehicles and ongoing physical complaints.”

THE MEDICAL EXAMINATION

Who attended the assessment

The assessment was attended by the claimant, Ms Saba, who was located at her home and attended the appointment by herself. She was examined by Medical Assessors Baker and Singh, who were located in their respective offices and conducted an assessment via a Microsoft Teams meeting.

History

Psychosocial history and pre-accident history

Ms Saba stated that she was raised in Sydney, in the Mount Druitt area. She had two older brothers and a younger brother growing up. Her parents divorced when she was around age five to seven. She later lived with her mother and her three brothers. She still spoke to her father every day and saw him every weekend. Her father was her best friend. She had been very close to her brothers, and they have a common close friendship group. Her younger brother is five years younger than her, and she has a good relationship with him as well.
Ms Saba stated that she was upset about the divorce of her parents, but it did not affect her mental health. She denied any previous mental health issues. She denied any history of childhood trauma or abuse.
She finished Year 12 and then attended a business college, where she completed a one-year diploma in business studies. She started working at the age of 14 as a waitress. She worked as a sales representative at City Cave, which is a wellness centre and a pizza shop. She later joined a law firm. This was her first full-time job. She initially started as a trainee legal assistant, a position she held for nine months. She was later promoted to a legal assistant, working with a team of lawyers and partners. She started a new job on
30 January 2023.
Ms Saba denied any previous history of Workers’ Compensation claims and any previous history of personal injuries related to motor vehicle accidents. The accident was the first time she was involved in a motor vehicle accident.
Ms Saba denied any family history of mental illness.
Ms Saba denied any significant drug and alcohol history.
Ms Saba stated before the accident, she was in a “really good state”. She was about to start a new job on 30 January 2023 and was excited about it. She was working in the City Cave and at the pizza shop. She loved her high school, although she didn’t pursue an ATAR. She had a very good social life. She was the first in her friend group to get a driver's licence, and she used to often drive around with her friends.
Ms Saba stated that there is no family history of mental illness. She was born with thalassemia and asthma, although she is not on any medication.

History of the accident

Ms Saba said the accident was on 14 January 2023. However, when she was informed of the date recorded on the documents furnished by the parties, she agreed her accident was on 24 January 2023. She stated she started her new job on 30 January 2023, which makes sense as she commenced her employment with the legal firm about one week after the accident.
Ms Saba was driving her Kia Sedan from Blacktown to Mount Druitt. She stopped at a red light, waiting for the light to turn green. She was sitting in her car wearing her seatbelt. There were a few cars in front of her. She saw in her rearview mirror a car speeding behind her and approaching her car. The other car was a Toyota Kluger; it didn’t stop and hit her. Due to the collision, her car went on the grass island between the roads. She did not experience any immediate injury, but she developed back pain following the accident. The airbags were not deployed.
There was no police or ambulance at the site of the accident. Ms Saba was in shock and was crying and called her father. She stated it was ‘pretty traumatic’. It was a big hit. She did not get back into her car. The tow truck arrived, and her car was towed away. The whole back of her car was pushed in; it was pretty bad. She did not hit the car in the front, and her car ended up on the grass island in the middle of the road. She was in shock. She was surprised as she did not expect it. She felt anxious and unsettled. She thought the other driver would stop before the collision. She spoke to the other driver and exchanged details. She was unsure what to do when her brother and uncle arrived to pick her up. They took her home.

History of symptoms and treatment following the accident

Ms Saba stated she initially thought her back pain was normal following the accident. She did not want to go to the doctor for a while. She saw her GP around three months after the accident. She never wanted to put in a claim. She needed help. She wanted anything that would help with her mental health and wanted to be fit for her new job. She did not wish to feel anxious, and the main feeling has been of anxiety.
Ms Saba stated that few weeks later she saw a GP, but she cannot remember the name. It was at Mount Druitt Westfield which is not her usual medical centre. She had started her new job and was working Monday to Friday from 9.00am to 5.00pm so it was not possible to see her usual GP during those hours. She did not do anything for her back pain. She saw a physiotherapist privately by herself and attended massages.
Ms Saba stated a few months after the accident, her GP diagnosed her with “PTSD”. She said she was having dreams of the accident. She struggled to sleep and was very fearful. It affected her social life. She was scared to drive, and she did not drive for a while. She did not buy a replacement car. She stopped going out and stopped talking to her friends. She experienced a fear of driving. She preferred to stay home and cancelled social interactions.
Ms Saba stated she got flashbacks while she was at work or at home. She had flashbacks of a car coming behind her, hitting her car, and she not being able to avoid the accident. She would replay the accident in her head. She would see the car in her rearview mirror while driving and would replay that in her head. She started to catch a train to go to work and avoided driving her car. She did not drive for few months. Later she slowly started to drive which she found difficult due to anxiety and flashbacks when she was in the car. She also got flashbacks if someone else was driving.
Ms Saba continued to work in her full-time position, working 9.00am to 5.00pm from Monday to Friday. She caught a train and did not drive to work. She experienced anxiety and flashbacks at work but managed to get through her work. She had a lot of anxiety, more like a generalised anxiety, sometimes with panic attacks. She found she would hyperventilate, and her anxiety would get bad.
After seeing her GP, Ms Saba started having psychology sessions with Szanthiah from the Friendship Centre. The psychologist told her to breathe in and out and to hold her breath. It worked for her. Initially, she had sessions more often; however, they became spaced out as time progressed. She has not been on any psychotropic medications, and she was never referred to a psychiatrist.
Ms Saba stated she saw her GP when it took a toll on her mental health. The sessions continued from the beginning for almost two years, every two weeks. She was still not feeling better, although she regularly attended work. She drove when necessary but mostly travelled as a passenger. She did not go out. She stopped socialising and lost her friends. She had no partner. Her previous relationship had ended before the accident.

Details of any relevant injuries or conditions sustained since the accident

Ms Saba had work related issues. She stated there was bullying at work and she developed depression and lot of anxiety following the bullying. It made her situation worse, and she struggled with low self-worth. She has not worked for the last four months since ceasing work in April 2025. She worked as a legal assistant for almost three years in a law firm known as Corrs Chambers Westgarth and has now put in a psychological injury claim due to ongoing bullying in the workplace. She also put in a claim for carpal tunnel injury. She is not currently engaged in study. She is not getting paid but is getting treatment for her mental health through the Workers’ Compensation Scheme.
Ms Saba stated she continues to regularly see her GP. She has seen a psychiatrist at Mega Health, but she did not remember the name. She visited psychologist Samantha at Edge Medical Centre in Prospect. She was not aware of specific therapy that she has attended but she is having ongoing conversations with her psychologist and talking with her about her psychological problems.
Ms Saba has also been on the antidepressant Mirtazapine 30 mg for the last two months.

Current symptoms

Ms Saba stated her mental health is very bad. She experiences depression, anxiety and feels worthless. She has worked for the last four months and that makes her feel worse, makes her feel that she wants to kill herself. Her sleep is up and down. She may oversleep or under sleep. She struggles to fall asleep and has a very broken sleep pattern. She wakes up a few times in the night and gets a light sleep for around four to five hours. The antidepressant has helped a bit with sleep. At times she may sleep in the day at around 11.00am. Her appetite has also changed. She wants to eat everything in front of her. She has been binge eating and has gained about 20kg. She is now 80kg and she used to be 60kg. She has also gained weight after her work injury claim of around 5kg in the last four months. She eats to help with her anxiety. The dreams about the accident have stopped. The flashbacks in the car have continued. She denied any self-harm or suicidal thoughts. She denied any self-harm or suicide attempts. She stated that she has thought about not being here many times, but she does not know how to do it.

Current and proposed treatment

Ms Saba continues to see a psychiatrist at Mega Health and a psychologist Samantha with whom she has ongoing conversations. She stated that treatment started after she went off work and put in her work injury claim. She also continues to take the anti-depressant Mirtazapine, which she has been taking for the last two months.

Clinical examination

Mental state examination

Ms Saba was seen over a video conference. She was dressed appropriately and was well groomed.
There were no signs of agitation or retardation. She made good eye-to-eye contact, and a rapport was established. She had a spontaneous speech with normal rate, tone and volume. She described her mood as anxious, especially being in the car or around driving, and her effect was reactive. She described her sleep as disturbed and an increase in her appetite and weight gain. She described low levels of self-confidence and self-esteem, following her bullying at work.
She described flashbacks of a motor accident when she is in the car. She denied any nightmares. She can drive; however, she experiences some anxiety and drives only if necessary.
She denied having any active or passive suicidal thoughts, intents or plans, and there were no thoughts of harming others. She did not describe any grandiosity, racing thoughts or increased energy levels. There was no evidence of formal thought disorder, no delusional pattern of thinking and no perceptual abnormalities. There was no cognitive dysfunction. She was orientated, had an intact judgement and had good insight into her issues and was help-seeking.

Current functioning

Ms Saba is currently not working. She was working full-time and resigned from her job four months ago following work related psychological and physical injury. She denied any issues with her self-care and grooming. She drives if necessary. She reported decrease in her social interactions. She does not go out as much as she used to do. She is currently living with her mother and her brother and described a good relationship with her family. Her two older brothers have moved out and the youngest one lives at home.

Comments on consistency

Her presentation was consistent with the history given during the clinical interview, documentation received and mental state examination.

Review of documentation

On being asked about her visits to Headspace when her parents separated, Ms Saba stated it was not traumatic, though she hated the fact that her parents got divorced. She does not have memory of her parents being together. The sessions were good. She used all her eight sessions. She went to Headspace a year before the accident as well when she was in college and she was seeing someone. She wanted to talk about maintaining her relationship, however, most of the session was around her parents.
On being asked about her EAP (Employee Assistance Programme) sessions, Ms Saba stated her workload kept picking up; she had anxiety, so she saw a wellness coach/psychologist through work. She used as many sessions as she could, and she spoke to the coach like a friend. She felt she had found someone to talk to, to support her with the challenges at work.
On being asked about her sessions with SANE Australia, Ms Saba stated it is a free online service. She approached SANE when the insurance company did not approve her psychology appointment. It was good to talk about the car accident and the sessions were over the telephone. She mainly spoke about her fear of driving and the fear and anxiety she experienced when she saw a car coming.
On being asked about her treatment with the Friendship Centre Counselling, Ms Saba stated this again was a free service with sessions over Zoom. She saw Szanthiah about her anxiety every time she went on the road or got a headache and discussed with her how she avoided being on the road.

DETERMINATION

Diagnosis

Ms Saba is a 21-year-old female currently living with her mother. She has not worked for the last four months and has submitted a workers compensation claim for psychological and physical injuries sustained at work. She denied any drug and alcohol history. There was no family history. She had a previous history of psychological issues, following the separation of her parents and following difficulty in her relationship. However, she denied any prior diagnosis of anxiety or depressive illness.
Ms Saba reported nil issues with her mental health at the time of the accident and denied any impairments in her functioning. She was involved in the accident on 24 January 2023 where she was rear-ended by another car while she was stationary. She developed psychological/psychiatric symptoms and back pain following the motor vehicle accident.
Ms Saba developed a psychological injury which was caused by the accident. The Panel finds Ms Saba has sustained an adjustment disorder with mixed anxiety and depressed mood as per the DSM-5-TR. Her psychological injury has become chronic, and the symptoms have continued. She received some treatment from a psychologist following the accident.
She meets the following criteria for a diagnosis of an adjustment disorder as per the DSM-5-TR:
“A.     The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).
B.     These symptoms or behaviours are clinically significant, as evidenced by one or both of the following:
1.Marked distress that is out of proportion to the severity or intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
2.Significant impairment in social, occupational, or other important areas of functioning.
C.     The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.
The symptoms do not represent normal bereavement.
D.     Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.”
Ms Saba currently meets the DSM-5-TR criteria of adjustment disorder with mixed anxiety and depressed mood of chronic nature.
The panel has noted that in criteria B, the symptoms or behaviours are clinically significant as evidenced by Ms Saba meeting criteria B.1 for adjustment disorder.
The symptoms reported by Ms Saba were not better explained by another mental disorder or pre-existing mental disorder, and her symptoms do not represent normal bereavement.
In criteria E, the symptoms of adjustment disorder do not commonly persist for more than an additional six months; however, in some cases, even if the stressors are terminated, the symptoms may persist for more than six months, because the consequences of the accident have not fully resolved. When this occurs, the adjustment disorder is defined as chronic.
The Panel finds that Ms Saba does not meet the criteria for post-traumatic stress disorder because:
·        Ms Saba does not meet criteria A as she was not exposed to actual or threatened death or serious injury in the motor vehicle accident. She did not seek immediate medical attention. She was surprised and in shock after the motor vehicle accident. She was able to speak to the other driver and exchange details and did not report fear from the driver of the other car. There was a delay in seeking psychological treatment following the accident. Her family who came to pick her up, took her home and did not take her to the hospital which again is in line with her injury not being serious. The police report noted it was a minor accident. Taking these factors into account, the Panel is of the opinion that the severity and nature of the motor accident does not meet the minimum necessary level of severity to be classified as a criteria A stressor.
·        Ms Saba reported some distressing memories of the accident and dreams and flashbacks. She did not report any psychological distress when exposed to cues that symbolised or resembled the traumatic event. She was able to drive though the area where the accident happened a few months after the accident.
·        Ms Saba was able to drive after the accident hence there was no complete avoidance of the situation where she is driving or sitting as a passenger in a car.
·        Ms Saba was able to remember the important aspects when asked details about the accident. She did not report any persistent and exaggerated negative beliefs or expectations about herself. She did not report a negative emotional state such as anger, guilt or shame and she did not report diminished interest in or participation in significant activities. She has not reported feelings of detachment or estrangement of others and is able to experience positive emotions such as happiness and satisfaction.
·        Ms Saba did not report irritable behaviour and anger outbursts or reckless or self-destructive behaviour. She is hypervigilant but she did not report any exaggerated startled response. There is no problem with concentration. There has been sleep disturbance currently aggravated by her work-related psychological/psychiatric injury.
·        The psychological injury had not caused disturbance by way of clinically significant distress or impairment in her social relationship. Ms Saba had already ended the relationship with her boyfriend before the accident. She continued to work after the accident for more than three years and she recently stopped working due to a work-related psychological/psychiatric injury. The Medical Assessors noted a reduction in social outings, but she has maintained good social relationships with her family members.
·        She has returned to driving as required, although with less socialisation and due to her dislike of being on the road, her range of driving is reduced.
The Panel did not find any evidence of a depressive disorder as there was no pervasive sadness or mood, no pervasive issues with motivation or energy, no reported depressive thoughts such as hopelessness or helplessness and no suicidal thoughts. Her affect was reactive and congruent with the content of her speech during the re-examination. The Panel finds that her mental state examination findings were not supportive of a diagnosis of a significant primary mood disorder such as a depressive disorder.

Causation

Ms Saba has sustained a psychological/psychiatric injury because of the accident on
24 January 2023. There is a direct temporal relationship between the onset of her psychological symptoms and her psychological symptoms. The Panel finds those symptoms are causally related to the accident. Ms Saba currently meets the DSM-5-TR criteria of adjustment disorder with mixed anxiety and depressed mood of chronic nature.

Threshold injury

Section 1.6(1) of the Act provides:
“For the purposes of this Act, a threshold injury is, subject to this section, one or more of the following—
(a) a soft tissue injury,
(b) a psychological or psychiatric injury that is not a recognised psychiatric illness.”
Part 1, cl 4 (2) and (3) of the Motor Accident Injuries Regulation 2017 states:
“(2) Each of the following injuries is included as a threshold psychological or psychiatric injury for the purposes of the Act
(a) acute stress disorder
(b) adjustment disorder
(3) In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5)”
The following injury is a threshold injury:
· adjustment disorder with mixed anxiety and depressed mood of chronic nature.

CONCLUSION

The Panel revokes the certificate of Medical Assessor Fukui dated 1 June 2023 and certifies that the following injury caused by the accident was a threshold injury:
· adjustment disorder with mixed anxiety and depressed mood of chronic nature.

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Citations

Saba v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 612

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Statutory Material Cited

0

QBE Insurance (Australia) Limited v Alawia [2016] NSWSC 1875

[2025] NSWPICMP 612

14 August 2025