Saco v Insurance Australia Limited t/as NRMA Insurance
[2025] NSWPICMP 775
•8 October 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Saco v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 775 |
CLAIMANT: | Alexander Saeed Saco |
INSURER: | Insurance Australia Limited t/as NRMA |
REVIEW PANEL | |
MEMBER: | Jeremy Lum |
MEDICAL ASSESSOR: | Gerald Chew |
MEDICAL ASSESSOR: | Matthew Jones |
DATE OF DECISION: | 8 October 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant was on a motorcycle when a parked car pulled out in front of him and there was a T-bone collision; psychological injuries assessed by the original Medical Assessor who found post-traumatic stress disorder amounting to 8% whole person impairment (WPI); Review Panel noted pre-accident clinical notes which indicated some anxiety and substance use and that this may have been in part an adjustment to the COVID-19 period; no treatment or psychiatric diagnosis before the motor accident therefore no apportionment required; Held – Review Panel diagnosed persistent depressive disorder and assessment of WPI under the psychiatric impairment rating scale (PIRS) was 7%; treatment of psychiatric medication and seeing a psychiatrist was considered a mild (1%) treatment effect; total psychiatric impairment as a result of the motor accident was 8% WPI; MAC revoked as the Review Panel made a different diagnosis; new certificate issued. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Wayne Mason dated (a) the Review Panel certifies the following injury was caused by the motor accident: (i) persistent depressive disorder, and (b) the Review Panel finds that the above injury results in a whole person impairment of 8% which is not greater than 10%. |
STATEMENT OF REASONS
INTRODUCTION
Alexander Saeed Saco (the claimant) was involved in a motor accident on
17 September 2021. He was riding a motorcycle at 50kmph when a car parked on the left-hand side pulled out in front of him and there was a T-bone collision. The claimant was dislodged from his motorcycle and landed on the other side of the road. He suffered multiple fractures and contusions as well as psychological injuries as a result of the motor accident.
The claimant made an application for personal injury benefits with Insurance Australia Limited t/as NRMA (the insurer), the third-party insurer of the vehicle that he says caused the accident.
A medical dispute arose about whether the degree of the claimant’s whole person impairment (WPI) is greater than 10% WPI. This is important because if there is a dispute about the degree of a claimant’s WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor/s for determination.
[1] See Division 4.3 of the MAI Act.
On 11 July 2024, Medical Assessor Wayne Mason found the claimant’s psychological injury to be caused by the motor accident and his WPI was assessed as 8% which was not greater than 10%.
The claimant lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Mason’s decision. This was allowed by the President’s delegate and this Panel was convened to conduct the review.
MEDICAL ASSESSMENT UNDER REVIEW
Medical Assessor Mason was referred the following injuries for medical assessment:
· psychiatric condition – chronic post-traumatic stress disorder, depressive disorder with anxious distress, hypochondria, and panic disorder.
Medical Assessor Mason reasoned:
“Mr Saco was involved in a frightening motor cycle versus car motor accident which was potentially life threatening and in which he sustained multiple orthopaedic injuries which were also potentially life threatening. He underwent multiple surgical procedures and a protracted rehabilitation programme which has not resulted in a full return to pre-accident physical functioning. I note he was an ambitious, physically oriented young man who was keen to get ahead in life and his ambitions have been thwarted.”
The Medical Assessor determined that the claimant met the DSM-5 criteria for post-traumatic stress disorder, persistent depressive disorder with anxious distress and panic disorder. The motor accident, in the Medical Assessor’s view, was considered serious enough to cause the conditions diagnosed.
For the degree of permanent impairment, this was assessed under the psychiatric impairment rating scale (PIRS). When the values for the areas of function were collated, there was a median Class of 2 and an aggregate score of 12 (1,2,2,2,2,3). This resulted in a permanent impairment of 6% WPI.
The Medical Assessor noted some evidence of improvement in symptoms as a consequence of treatment and therefore allowed a treatment effect of 2% WPI.
Therefore, the total degree of permanent impairment caused by the motor accident was 8% WPI.
ISSUES FOR DETERMINATION
Claimant’s submissions
The claimant’s review submissions assert that the Medical Assessor should have assessed the claimant’s psychological impairment as being greater than 10% WPI.
It is submitted that the class ratings in the following categories under the PIRS should be changed as follows:
· Self-care and personal hygiene: Class 2;
· Social functioning: Class 3;
· Concentration, persistence and pace: Class 3, and
· Adaptation: Class 5.
The insurer says it was open for the Medical Assessor to reach his assessment under the PIRS with the reasoning provided. The insurer also says the Medical Assessor has considered the impairment as it is at the time of the medical assessment[2] which included the consideration of the medicolegal and treating evidence that was before him.[3]
[2] Under cl 6.21 of the Guidelines.
[3] Under cl 6.18 of the Guidelines.
In its supplementary submissions dated 18 June 2025, the insurer says the claimant reported psychological symptoms to various treating medical professionals (general practitioners (GPs), psychologists and naturopath) in the months leading up to the subject motor accident. It was also submitted the documents revealed the claimant taking illicit substances at the time.
REVIEW OF THE EVIDENCE
General observations
On 3 April 2025, the Panel issued a direction to the parties requesting indexed and paginated bundles of the information they relied upon. The Panel advised that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The claimant and the insurer complied with the direction lodging bundles comprising of pages 1-408 and 1-375 respectively.
On 18 June 2025, the insurer lodged an Application to Lodge Additional Documents (ALAD) seeking to admit updated clinical records from Associated Psychology Practice and the insurer’s supplementary submissions. The Application was made on the basis of a Directions to Produce which was previously issued by the Commission and with the insurer obtaining access to the clinical records on 16 June 2025. The Panel allowed the ALAD on 19 June 2025 and the clinical records are before the Panel.
The Panel has read the documentation relied upon by the parties. The Panel will only specifically refer to material that is relevant to the determination of the permanent impairment dispute and the issues in dispute.
Summary of relevant documents
Application for personal injury benefits dated 13 October 2021
– Motor accident on
17 September 2021. Accident described as motorcyclist colliding with a driver performing an illegal U-turn. Multiple fractures with abdominal internal bleeding. Psychological sequelae with anxiety severely aggravated post injury. Claimant was self-employed business operator of Kingz Supplements. Has not returned to work since the accident. Discharged from Westmead Hospital on 7 October 2021.
Clinical records – records of Eastbrooke Blacktown GP Super Clinic; Family Medical Practice Mount Druitt; Associated Psychology Practice; Australian Access Clinics, and Medimind – GP records mainly concern physical injuries with Certificates of Capacity / Fitness issued. Dr Sandra Rahme: mental health consult April 2022. Symptoms of post-traumatic stress disorder, panic attacks, flashbacks of motor vehicle accident when sees motorbikes. Saw psychologist initially but not keen to see again despite GP recommendation to do so. Declined psychiatrist referral. Mertazapine prescribed. Mental health care plan dated 15 June 2022 – completion of six sessions of psychological treatment. Dr Richa Rastogi, consultant psychiatrist, August 2023 – diagnosis of post-traumatic stress disorder with anxiety attacks. Provided psychoeducation regarding the illness. Ms Jessica Stanford, treating psychologist notes presentation of “depression, PTSD and panic attacks”.
Report of Dr Peter Klug, forensic psychiatrist, dated 28 February 2024 – Noted no prior psychiatric history. Diagnosed chronic post-traumatic stress disorder in partial remission, persistent depressive disorder with anxious distress and panic disorder. WPI assessment of 13% with 2% treatment effect. Total 15%.
Report of A/Professor Michael Robertson, consultant psychiatrist, dated 25 June 2024, supplementary report dated 14 July 2024 – Diagnosed chronic post-traumatic stress disorder. Agreed with Dr Klug assessment of 13% but treatment effect allowed at 1% given resolution of depressive symptoms.
RE-EXAMINATION REPORT
At the initial teleconference on 20 June 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessors Chew and Jones is below:
“ALEXANDER SAEED SACO
Year of birth: 1997
THE MEDICAL REVIEW PANEL EXAMINATION
The Panel examination was conducted via audio-visual link through the MS Teams platform organised by PIC. Present were Medical Assessors Gerald Chew and Matthew Jones and the claimant, Mr Saco.
The usual cautions with respect to confidentiality, impartiality, and that the interaction was for assessment and not treatment purposes were delivered. Mr Saco indicated that he understood the limits of confidentiality and the purpose of the examination.
INTRODUCTION
Mr Saco is a twenty-seven-year-old man currently living at his mother and father’s home in Erskine Park, in Western Sydney. He has lived there for approximately two years. His parents and his twin brother live in the main house and Mr Saco, his partner, Bianca, and their one-year-old son live in the granny-flat. It is a separate space.
Mr Saco reported he is not currently formally working and said he last worked about two years ago. He reported he had had his own business previously, however he is helping his brother out at a pizza shop. He said he is going once or twice a week, but being paid full-time by his brother. With respect to his own business, Mr Saco reported that he was ‘big into the gym.’ He said that body building was his passion. He said he had never wanted to work for someone and was previously working in security and buying and selling cars. He bought a supplements shop that he would previously frequent and renovated it. He said that he and his family members were well known from the gym. He reported that the supplements business was ‘successful from the start’ and he said he was ‘smashing it straight out the door.’ He said that he would provide meal plans and workout plans and he loved this work.
Mr Saco reported that after the subject accident (17 September 2021) he had his brother take over the business and his brother was ‘not as hungry.’ His brother did not want to work six days a week and his brother hired someone else to help with the business and ‘everyone started fucking around.’ Mr Saco said at the time he, himself, was ‘so busy trying to get better.’ He said he did not like going to the store because it reminded him of who he was and who he is now. He sold the business to a friend who had his own supplement chain. He sold the business for about $100,000.
After this, Mr Saco, with a friend, set-up a mobile carwash business. Mr Saco acquired the ABN and he would pay the friend $1200 a week to do the work and then the two of them would split any profits above that, fifty-fifty. Mr Saco said that around that time he had ‘told the insurance company to fuck off’ and he said of himself that he ‘didn’t know [he] wasn’t functioning mentally.’ He could physically stand and sell things, however mentally he ‘wasn’t there.’ His friend ended up not being very passionate about the business and Mr Saco would only make $500 a month. He said that he lost $5000 all up with that venture and after that he, ‘went downhill from there.’ The carwash business went for about a year and it has been two years since the carwash stopped. Mr Saco reported he has only been with his brother at the pizza shop for about two months.
Mr Saco reported he has not received Centrelink benefits since the accident.
Mr Saco reported that Bianca is currently working and is ‘an office girl.’ He said that since the accident he had eaten through his savings. He said that Bianca works from home, part-time, three to four days a week.
Mr Saco is the sixth of six children born to his parents and he has three brothers and two sisters. He spoke of having friendships with ‘the boys’, and he was referring to his cousins. He said he only has two other mates currently. He reported his father is about seventy, does security work and also sometimes helps with the pizza shop. His mother is around sixty years old and is a stay-at-home mother.
CURRENT FUNCTIONING
The Panel asked Mr Saco how he spent his days, and he said that he has his ‘ups and downs.’ He said that lately he had been struggling and that he wakes up and goes for a walk. He said his brother tries to keep him busy. Mr Saco plays videogames and has some commitments, for example a weekly youth group, however he commented that he hardly goes. He said he is close with his faith. He said he is religious in the Mandaean faith, and he attends church and does not mind going by himself. He said that he tends to get anxious and insecure about who he is and that the things people do upset him. He said he got upset when someone at the youth group was playing around and said that they would box him. Mr Saco previously did a lot of boxing.
Mr Saco reported that he has chronic pain and that he can stand and move, but people cannot see his pain. He said this is the worse part.
The Panel asked Mr Saco about getting to the gym. He said that he used to train a lot after the accident and ‘started from the bottom.’ He would work with his physiotherapist but he had lots of pain and he would push through it. He said the insurance company suggested he go to a pain clinic, and he continued to ‘push through the pain.’ He said he was getting ‘good numbers in the gym’, referring to lifting heavy weights. He remembers waking up sore the next day. He said he then started getting nerve and back pain, a little over a year before the current assessment, and then he stopped training. He then found an osteopath who ‘really cared’ about him and suggested he stop training and to loosen up his muscles. He said what he was experiencing was that his muscle fascias were dehydrated.
Mr Saco reported he recently received approval for exercise physiology and an exercise program was developed. He said he is meant to go four times a week to the gym, but he only goes twice a week as he does not like being there and he does not do the exercises. He said he will do twenty minutes of the forty minutes planned exercises and he feels weak. Mr Saco reported he sees his osteopath every week.
With respect to current treatment, Mr Saco takes an antidepressant, Desvenlafaxine, at a dose of 100mg. (He was previously on 200mg.) He also takes Quetiapine (a mood stabilising antipsychotic), 100mg at night, to help him with sleep. He reported he also sees a psychiatrist, Dr Rastogi, whom he sees every three to four months. Mr Saco also reported he sees a psychologist regularly, Hannah, whom he has seen for a little over a year. He said he used to see a different psychologist, however they moved to Coffs Harbour. The first psychologist he saw was about one year after the accident. He first saw Dr Rastogi about six months after the first psychologist. He said initially his general practitioner put him on a different antidepressant, Lexapro (escitalopram), however this was not helping.
The Panel asked Mr Saco what symptoms he was experiencing back then, and he said he was severely depressed and anxious and was having panic attacks. He said he was struggling with his mental health. He said he did not know how to talk about it, and he did not want to be here, indicating that he was feeling suicidal. He said he has only recently been able to talk about it, and he finds it hard to talk about his mental health. He said he, ‘just wanted to get better.’
Mr Saco reported the medications have helped his mood, however he finds himself emotionless and numb. He said his mood ‘has its seasons.’ He said sometimes he feels okay and normal and then he gets a feeling of fear, which he knows will not last. He said there are ‘seasons’ when he goes down and feels like he is drowning and has no hope about fixing or facing his mental problems. He said the bad times last about six months and the good times last one or two months, if nothing bad happens, for example if his pain stays constant.
Mr Saco reported that the accident occurred in September, and he subsequently does not like Christmas. He has not liked Christmas since then. He said he also tends to like winter.
Mr Saco reported he bought another motorbike. This was despite being triggered by motorbikes (and also ambulances). He said he had exposure therapy which helped and allowed him to talk about the accident. He said he was able to ride again, but he did not like it or enjoy it, so he sold the bike. With respect to driving, he said he was not bad with places that he knows, but he likes people being with him. He tends to “autopilot” when he drives. He reported that in standstill traffic he still gets a bit anxious and commented again that ambulances trigger him. Mr Saco reported he does not catch public transport and referred to not being able to protect himself. He commented that he had always been a protector and had always ‘picked on the bullies.’ He feels physically unable to protect himself now.
With respect to self-care and personal hygiene, Mr Saco receives no assistance with respect to the physical tasks. He commented that his partner helps him with waking-up because he tends not to be bothered. He said his partner makes him go to things, for example appointments. He said for his son’s birthday, his brothers made him get a haircut but otherwise he would let it grow. He joked about how his brothers call him ISIS because of his dark hair and facial hair.
Mr Saco reported he tries to spend time with his son but remembers that he struggled when he was first born. He feels he lacks empathy towards his son and towards others. He also struggles with carrying his son and he pushes through, however it hurts.
Mr Saco reported his current weight is around 78 or 80kg. He said he had been up to 95kg ‘shredded.’ His height is 180cm. (His current Body Mass Index is about 24 which is at the upper end of normal.)
Mr Saco described his appetite as ‘up and down’ and ‘seasonal.’ He tends to never eat a lot and sometimes eats bad quality food and does not care. He said he eats one to two meals a day. His partner cooks him lunch and dinner.
Mr Saco reported his brothers are trying to help him and he said, ‘God bless them all.’ He said that they try and fix him, and he tells them that he is fine. He said that he is kind of good now and tells them to leave him alone. He reported he struggles with envy and jealousy. This is particularly relevant because he has a twin brother who is competent at Brazilian Jujitsu. He said his brother has always been a little smaller than him. Mr Saco previously did boxing.
Mr Saco reported that he will take a Valium tablet (up to one or two per week) if he ‘wig[s] out’, referring to feeling anxious. He said his brother also comforts him.
The Panel asked Mr Saco about pastimes, and he said that he plays videogames to keep his mind active, for example Black Ops. He said he used to watch television a lot. He said he is also on his phone a lot, looking at Instagram. He has a walking routine where twice a day he walks for fifteen minutes. He said if he is not at the gym he does twenty minutes of stretching exercises at home.
Mr Saco reported that he likes to take his partner and son out, for example into the City, to go to midday mass and have lunch. He said he does this every week. He goes to church on Sundays. He also goes to youth group on Tuesdays, where he has a role like a mentor.
The Panel asked Mr Saco about work options, and he said that he has looked for work because he needed the money. His friend has a business which supplies glass vials, beakers and needles and he had wanted a worker. The friend wanted him to work 10.00am to 4.00pm, five days a week, however Mr Saco got nervous about this. He said that there are some nights he does not sleep, so he did not think he could be reliable.
The Panel asked Mr Saco about future work, and he said that he sits and thinks most days and he does not know what he will do. He said he would love to be a personal trainer, but he asks himself what he can do. He has thought about being a real estate agent, however his psychologist and brother suggested that was very stressful. He thinks about what he will do if he gets money from the insurance company but then his “brain tricks [him] out of it.” He does not think he would have the confidence to give advice to people. He then rather obliquely said that he does not wear a shirt anymore. He said he does not know what to do with his life.
Mr Saco reported that his relationship with Bianca is close, and he said that she is his best friend and his ‘rock.’ He said he has always looked after her and they have been together for ten years. He said, however, they have had their ups and downs previously and that they would separate at times and he would ‘do [his] own thing.’ He commented that he used to party before the accident, however he ‘didn’t respect it.’ He went on to say that he was ‘so social’ and said ‘we all made good money and partied.’ He said he was always very social, but not on weekdays.
HISTORY OF THE MOTOR VEHICLE ACCIDENTMr Saco confirmed the date of accident as 17 September 2021 (approximately four years before the assessment). He said the accident occurred two minutes from his home. At the time, he was living with his partner in Penrith and the accident occurred on the road across from the train station. He said a lady driver performed a U-turn from a parking spot in front of him and he said it was ‘like slow-mo.’ He said in his head he thought, ‘fuck, I’m finished.’ Mr Saco was riding a motorcycle at the time. He hit the A pillar of the vehicle, summersaulted and then landed on the ground. He remembers thinking, ‘Shit, I’m gone.’ He said he faceplanted on the road, tried to get up, and then dragged himself to the gutter. He tried to turn over and then there was ‘some random girl’ who was telling him to stop moving. He remembers that he wanted his phone so that he could tell his brothers goodbye. He said his bike caught on fire and he felt blood because his abdomen had been cut open. He said the whole situation, “took forever.” He remembers feeling the heat of the fire from the bike. He said the emergency services arrived and he remembers hearing a helicopter overhead. He remembers the police and the helicopter coming and then he started passing out. He said that he had landed without his helmet because it had flown off.
Mr Saco remembers that he next woke-up in hospital and felt very foggy. He can remember clearly from only about the third day after the accident. He was transported to Westmead Hospital and around that time it was peak COVID period. He had a four-week hospital stay and had morphine and ketamine drips, and also received two blood transfusions.
After hospital, Mr Saco had four weeks bedrest at home. He said Bianca performed the role of nurse. He remembers also a nurse would visit to attend to his dressings.
After this time, Mr Saco started rehabilitation in Penrith and remembered visiting there two to three times a week. He did this for a year, and it was “fully intense.” He said after that he had pain management treatment. He said the insurance company then stopped paying for this. He remembers using a lot of painkillers and he considers that they ruined his gut health.
The Panel asked about current painkiller use and he said that his doctor gave him some Cannabis CBD and he takes the pure oil because he does not like the high feeling. He does however smoke some THC flower at night occasionally. He said the medical cannabis was prescribed for pain.
Mr Saco reported that a psychologist was brought to him in hospital. He said that he did not know how serious his psychological injuries were.
Mr Saco reported that he had never had mental health issues previously and had ‘thought more of [him]self.’ He said however when his training (exercising) stopped working, his mental health went bad. He said this was about the one-year mark after the accident. He struggled with the acceptance part. He accepted that he was lucky to be alive, however previously had ‘the best life.’ He was twenty-four when the accident happened and ‘not at [his] peak yet.’ He referred to himself as having ‘had the body and the money.’ He said after the accident he just ‘wanted it back.’ He added that for the last four years, he had been in pain.
PRE-ACCIDENT HISTORY
From a medical perspective, Mr Saco denied any medical history or any childhood illnesses, any hospitalisations, any taking of medications, or any surgery previously. He did unusually comment that he had once had spots detected in his bladder or kidneys because he would hold his urine whilst playing videogames at home. He said that if he left to go to the toilet, he would lose his turn.
With respect to his psychiatric history, Mr Saco denied any significant history of anxiety, depression, taking psychiatric medications, going to a psychiatric hospital, or having seen a psychologist. He said on reflection that he thinks he did have some anxiety previously but since the accident he cannot remember this anxiety and he ‘can’t picture it.’ He said he ‘can only remember the best life,’ which he described as ‘amazing.’ With respect to family history, he said his older sister has some depression and that his parents had come from a war-torn country. Within his family, his parents do not believe in mental health problems.
Mr Saco reported that he has no history of self-harm. He said he sometimes thinks about the worst case scenario of his physical condition and wonders, for example, if he has a neurological disorder.
The Panel asked Mr Saco about childhood issues that were referred to in the documents and he firmly declared that they were ‘not relevant.’
The Panel cross-checked with Mr Saco some details from the documents including in April and July 2021 him seeing his general practitioner for assistance and that he went to see Headspace. He said that he was seeing his general practitioner, wanting help with his drug and alcohol problems, and that he went to Headspace. The assessors pointed out that this was just before the accident. He said that COVID was around at the time, he had just opened his business, and he was stressed out about this. He said he got stressed, but it was nothing compared to currently. He said that prior to April 2021, there were no mental health problems. He said he never went to see anyone about any of his childhood problems.
The Panel discussed with Mr Saco his recreational drug use before the accident and he said that he used to party with friends. He would not take drugs every weekend, but perhaps every second weekend. He would go out, have eight or more drinks, and ‘have a laugh.’ He said when he partied, he would have a couple of lines of cocaine and perhaps two caps of ecstasy. Mr Saco said as an aside that for six months to a year before the accident, he was ‘making money and looking good.’ The Panel discussed with Mr Saco the concerns around his drug use with respect to the relationship and he said that he spoke to Hannah about it and Hannah said it was ‘more of a relationship problem’ than a substance problem. He said after the accident when he was seeing two women at once, he 'missed the old [him].’ He said ‘wanted that life again’ and that is when he started ‘getting big and training.’ He said he started, ‘chasing that feeling’, using drugs and seeing the girls. However, ‘it didn’t feel as good.’
The Panel asked Mr Saco about steroid use, and he said that about one year prior to the accident he did cycles of steroids under a doctor’s supervision. He said he got back on steroids after the accident when he was doing recovery training. He used growth hormone and another steroid for about twelve weeks, and this was prescribed by ‘the gear doctor.’
FORENSIC HISTORY
Mr Saco denied any criminal history or any history of work-related injury or worker’s compensation. He had never been involved in any other motor vehicle accidents, nor any other compensation or litigation processes.
SUBSTANCE USE HISTORY
Mr Saco reported he does not smoke tobacco. He ‘used to drink and party’ however after the accident and after he sold the business and had some money, he wanted to spend the money. He said he would drink and take drugs to keep his mind busy and he ‘wanted to send it’ and have ‘one big hurrah.’ He said he tends to like partying. He said the sad thing was that he was doing this while Bianca was looking after him. He commented that he ‘really cared about looking better.’ He said he was entertaining another girl a lot, taking her out to clubs and partying. He said that seeing this girl was in fact the reason that he did not kill himself. He said he ‘got busy with her.’ He said between this girl and Bianca, it ‘helped [him] through the darkness.’ He said he spent about a year or so with this woman and then Bianca and this woman found out about each other. He said it was ‘an ugly time.’ He said it is not who he is morally. He said his family also found out.
MENTAL STATE EXAMINATION
Mr Saco was a well looking man of Middle Eastern appearance. He wore a black ‘Fear of God’ hoodie. There were tattoos visible on his wrists, he had a hearty beard and a neat, faded haircut. He freely gesticulated throughout the assessment. He was polite, cooperative and attentive and displayed no abnormal movements. His speech was normal in rate, tone and volume and there was no evidence of formal thought disorder or delusional thought processes. He was freely and spontaneously speaking. He denied any thoughts of self-harm or thoughts of harm to others, ‘not this month.’
When asked about his mood, he said he feels ‘shit, to be honest.’ He said his anxiety was not that bad, but with respect to his depression he has ‘bad thoughts’ and gets ‘annoyed’. He said he does not know ‘who this person is,’ referring to not feeling like himself. His affect (expressed emotion) was very reactive, congruent and appropriate. There was no evidence of perceptual abnormalities consistent with psychosis. His cognition, insight and judgement appeared intact in the context of the assessment. Rapport was very good. Mr Saco concentrated and focused very well through the assessment, which had a duration of ninety minutes.
Mr Saco was focused on his physical functioning and form. He said he had ‘muscle dysfunction’ and he is operating in a musculoskeletal ‘compensation pattern.’ He said that he tends to like symmetry and focuses on ‘the muscle mind connection.’ He said a year and a half before the assessment he was feeling better and moving better. He exclaimed that he had been physiotherapists for three years, however he had ‘uneven hips from day one’.”
RELEVANT LEGISLATION
Permanent impairment
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 (Guidelines).
Version 10 of the Guidelines, effective from 15 September 2025, applies to the review.
The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.
Permanent impairment is assessed in accordance with Chapter 6 of the Guidelines. Specifically, the assessment of psychiatric impairment draws from the chapter “Mental and behavioural disorders” which commence at cl 6.201 of the Guidelines.
Causation of injury
It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition.
Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:
“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.”
Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and 5E.
DETERMINATIONS
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.[4]
[4] Section 7.26(6) of the MAI Act.
The evaluation should only consider the impairment as it is at the time of the assessment.[5]
[5] Clause 6.21 of the Guidelines.
The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[6]
[6] Section 7.26(7) of the MAI Act.
The Panel refers to the above re-examination report of Medical Assessors Chew and Jones. The Panel reconvened on 17 September 2025 and discussed the re-examination report findings before collectively making the below determinations.
Causation and diagnosis
Mr Saco was ejected from his motorcycle following a motor accident collision which left him with multiple fractures and internal bleeding. He spent some three weeks in Westmead Hospital. While initial treatment focused on his significant physical injuries, he also had psychological symptoms of post-traumatic stress disorder as recorded in the clinical notes of his psychologist, Ms Jessica Stanford, about six months following his discharge from hospital. The Panel was satisfied that the claimant sustained psychiatric injury as a result of the motor accident.
The Panel considered that Mr Saco had some substance use and some experience of anxiety prior to the motor vehicle accident and that these psychological issues may have been in part an adjustment to the COVID-19 period. The updated clinical records of Associated Psychology Practice confirm this. On consideration of all the documents provided, and Mr Saco’s reported history, the Panel did not consider that there was any established treatment or psychiatric diagnosis prior to the motor vehicle accident. There was likely no psychiatric impairment at the time of the motor vehicle accident.
With respect to currently, the Panel considered there was likely a mild psychiatric illness that best fit the DSM-5 diagnosis of persistent depressive disorder. Mr Saco’s reported history was consistent with having depressed mood for most of the day, for more days than not, for at least two years (criterion A). When depressed, Mr Saco reported variable appetite, including periods of poor appetite, sleep difficulties, and feelings of hopelessness (criterion B). It would appear that Mr Saco has never been without these symptoms for more than two months at a time (criterion C) and his symptoms were not better accounted for by major depressive disorder (criterion D). There had never been a manic episode, a mixed episode, a hypomanic episode, nor the presence of cyclothymia (criterion E). There was no evidence of chronic psychotic disorder (criterion F), his symptoms were not due to the direct physiological effects of a substance or a general medical condition (criterion G) and his symptoms caused clinically significant distress and impairment in important areas of functioning (criterion H).
The Panel considered that Mr Saco’s persistent depressive disorder was mild to moderate in severity as he has maintained his family relationships (in fact his primary relationship seems to have improved) and some friendships. He also is independent with respect to his self-care and he maintains some employment capacity. From Mr Saco’s report, he has stabilised in his psychiatric status, and the Panel considers that he has a permanent psychiatric impairment. He is undergoing ongoing psychological therapy and is taking psychiatric medications, although the treatment effect appears only to be mild.
Permanent impairment
The claimant’s impairment is considered permanent. It has been four years since the accident and the claimant has had treatment by his psychologist and psychiatrist. He is also taking prescribed antidepressant and mood stabilising antipsychotic medication. Despite having had treatment which is ongoing, the claimant’s symptoms have not remitted. The medical members of the Panel were satisfied that the claimant’s condition has become well stabilised and unlikely to change substantially and by not more than 3% in the next year with or without medical treatment.[7]
[7] Permanency of impairment, AMA 4 Guides, page 315.
Degree Of Permanent Impairment – Psychiatric Impairment Rating Scale
| Psychiatric diagnoses | 1. Persistent Depressive Disorder | 2. |
| 3. | 4. | |
| Psychiatric treatment Description | Psychological therapy and psychiatric medications. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 2 | Mild impairment Although Mr Saco would be able to live independently, and is able to maintain his functioning from a personal hygiene perspective, he cares about his appearance, but he is paying less attention to it and appears to have irregular eating habits. Although at the lower end of this class, utilising clinical judgement, the Panel considered that he has a class 2, mild impairment. |
| 2. Social and Recreational Activities | 2 | Mild impairment Mr Saco reported that he maintains some regular activities including playing videogames, going for regular walks, having regular outings with his partner and infant child, and attending church, including as a mentor at a youth group, albeit not regularly. He also attends the gym regularly for rebuilding exercises, although he is less regular than prior to the motor vehicle accident, when gym was one of his passions. There is some impairment in this category, which is consistent, utilising clinical judgement, with a class 2 mild impairment. |
| 3. Travel | 2 | Mild impairment Mr Saco is able to drive independently and venture outside of his home by himself. Mr Saco got back to motorcycle riding, however was not enjoying it so sold his replacement motorcycle. Utilising clinical judgement, although at the lower end of the class, he has a class 2, mild impairment. |
| 4. Social Functioning | 2 | Mild impairment While Mr Saco’s relationship with his partner Bianca was previously strained, he currently reports getting along well with Bianca who is supportive. He is also getting along well with his family and maintains a couple of close friends. There has been some reduction in his social network, which is, utilising clinical judgement, consistent with a class 2 mild impairment. |
| 5. Concentration, Persistence and Pace | 2 | Mild impairment Mr Saco reported consistent pain and physical limitation which interfere with his concentration, persistence and pace, however these were not taken into account in this assessment. He reported he enjoys playing videogames and he concentrated very well for the ninety-minute assessment. The difficulties with concentration reported by Drs Klug and Rastogi were not evident at the Panel’s assessment. Utilising clinical judgement, there is no more than a class 2, mild impairment in this category. |
| 6. Adaptation | 3 | Moderate impairment Mr Saco has some employment capacity and is currently working irregularly and part-time in his uncle’s pizza business. He was offered work with a friend but balked at the regular thirty hour per week requirements. Taking into account all factors, the Panel considered that Mr Saco would have an employment capacity of up to twenty hours per week, performing suitable/modified duties, which is consistent with a class 3, moderate impairment. |
| List classes in ascending order: 2 2 2 2 2 3 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 13 | ||
| Whole Person Impairment: 7% | ||
*%WPI = Percentage Whole Person Impairment
Apportionment
There is insufficient evidence for any apportionment for pre-existing or subsequent impairment.
Effects of treatment
Mr Saco is taking psychiatric medication and seeing a psychologist. He indicated that these have had some, but not a substantial, therapeutic benefit which the Panel considered was consistent with a 1% mild treatment effect.
CONCLUSION
The Panel concludes that the claimant’s injury caused by the motor accident results in a WPI of 8% which is not greater than 10%. While the Panel’s total impairment finding is the same as that found by Medical Assessor Mason, the psychiatric diagnoses differ.
The certificate issued by Medical Assessor Mason dated 11 July 2024 is therefore revoked. A new certificate is issued at the front of this determination.
Ex
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