Sanhard v Insurance Australia Ltd t/as NRMA Insurance
[2025] NSWPICMP 522
•17 July 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Sanhard v Insurance Australia Ltd t/as NRMA Insurance [2025] NSWPICMP 522 |
CLAIMANT: | Francine Sanhard |
INSURER: | Insurance Australia Ltd t/as NRMA Insurance |
REVIEW PANEL | |
MEMBER: | Jeremy Lum |
MEDICAL ASSESSOR: | Christopher Canaris |
MEDICAL ASSESSOR: | Himanshu Singh |
DATE OF DECISION: | 17 July 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accidents Injuries Act 2017; review of Medical Assessment Certificate (MAC); near head on collision on highway; claimant was front passenger; post-traumatic stress disorder (PTSD) as a result of the motor accident; significant improvement with the effect of treatment (medication); impairment assessed at 6% whole person impairment; Held – Review Panel made the same findings on diagnosis and impairment as the original Medical Assessor; MAC confirmed. |
DETERMINATIONS MADE: | Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017 1. The Review Panel confirms the certificate of Medical Assessor Paul Friend dated |
STATEMENT OF REASONS
INTRODUCTION
Francine Sanhard (the claimant) was involved in a motor accident on 31 May 2021. She was the front seat passenger in a vehicle driven by her husband. They were on a highway and a fast-moving oncoming vehicle crossed onto their side of the road. Her husband managed to reduce the direct impact of the collision by swerving to the left.
Following the accident, the claimant had pain in her head which radiated into her neck. She also alleges that she sustained post-traumatic stress disorder and a depressive episode.
The claimant made a claim for statutory benefits with NRMA (the insurer), the third-party insurer of the vehicle that she 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 20 July 2024, Medical Assessor Paul Friend diagnosed the claimant’s psychological injury to be “post-traumatic stress disorder in partial remission” to be caused by the motor accident. The degree of WPI was assessed at 6% which is not greater than 10%.
The claimant lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Friend’s decision. This was allowed by the President’s delegate (Ms Ashley Payne) and this Panel was convened to conduct the review.
MEDICAL ASSESSMENT UNDER REVIEW
Medical Assessor Friend diagnosed the claimant with post-traumatic stress disorder in partial remission as a result of the motor accident.
The Medical Assessor noted that the claimant had longstanding anxiety and was depressed and anxious after the birth of her first child almost 52 years ago. She also developed panic attacks in her thirties when working in a very stressful job.
It was further noted that the claimant worked in a less stressful job in the last 22 years of her working life and the panic attacks gradually reduced. The claimant was able to continue working full time until she retired despite these symptoms. The Medical Assessor concluded that there was no other cause for the post-traumatic stress disorder other than the motor accident of 31 May 2021.
The Medical Assessor stated that the condition was in partial remission because there was improvement in the claimant’s ability to sit in a motor vehicle and travel in the front seat in her local area, whereas initially she refused to get into a motor vehicle.
The Medical Assessor assessed the claimant under the psychiatric impairment rating scale (PIRS) as having a permanent impairment of 6% WPI (2,2,2,2,2,2). The pre-existing anxiety had no impairment to the claimant’s day-to-day functioning and hence there was no apportionment required.
SUBMISSIONS
Claimant
The claimant’s review application refers to alleged issues pertaining to the claimant’s consistency. The Medical Assessor recorded that the claimant struggled to provide an account of her psychological symptoms and then stated, “she did not appear to realise the importance of providing a more precise account of her symptoms”. It is alleged that the Medical Assessor did not raise these concerns with the claimant and proceeded to assess the claimant’s impairment on the basis of an inaccurate account of her issues.
It is submitted that had the Medical Assessor put these concerns to the claimant, further evidence or argument could have been put before the Medical Assessor that could possibly have affected the outcome of the assessment. Alternatively, the Medical Assessor could have had regard to the histories contained in the medical evidence of Dr Suman or
Dr Siefken so as to obtain more accurate information about the claimant.
The claimant also submits that there are errors with respect to the permanent impairment evaluation done under the PIRS, specifically in the categories of adaptation and concentration, persistence and pace.
Insurer
The insurer disagrees with the claimant arguing that the inconsistency is confined to the claimant not describing she was experiencing nightmares and flashbacks. Notwithstanding this, the Medical Assessor was able to diagnose post-traumatic stress disorder causally related to the motor accident and provide considerable detail regarding the claimant’s current symptoms. The insurer further says the Medical Assessor’s reasons for the findings in the PIRS categories are free from error.
In the insurer’s original reply, it was submitted that the claimant had a long history of psychological symptoms prior to the motor accident. It was observed from the clinical notes that the claimant was prescribed Effexor on 9 January 2021. The claimant was also prescribed Oxazepam multiple times within 2021, the last occasion being on 4 May 2021 which was just before the motor accident.
The insurer also says the histories recorded by Dr Siefken and Dr Suman are inconsistent and do not provide “treating verification of the claimant’s current psychological/psychiatric symptoms following the outcome from the treatment received from the claimant’s psychological and psychiatric health professionals”.
It is submitted that the medical evidence, including the report of Dr Suman, would lead to a permanent impairment of greater than 10% WPI.
REVIEW OF THE EVIDENCE
On 16 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 parties responded with the claimant’s bundle comprising of pages 1-154 and the insurer’s bundle comprising of pages 1-76.
The Panel has read the documentation relied upon by the parties. A summary of the relevant material is provided below.
Reports of Vika Shvachkina, clinical psychology registrar (June – December 2017) – various reports detailing symptoms of anxiety and a depressive episode. Notes conflict with her husband and issues with home life. Self-guided mindfulness techniques provided.
Certificate of capacity / fitness completed by Dr Robert Sheahan dated 24 June 2021 – noted motor accident as a “near death experience” with diagnosis of post-traumatic stress disorder.
Report of Dr Jan Siefken, consultant psychiatrist, dated 2 June 2022 – noted prior history of anxiety and panic throughout her life. Diagnosis is accident-related post-traumatic stress disorder.
IME report of Dr Zbigniew Poplawski, orthopaedic surgeon, dated 25 October 2022 – diagnosed whiplash associated disorder grade 2 and right greater occipital nerve neuritis.
IME report of Dr Aman Suman, forensic psychiatrist, dated 25 May 2023 – diagnosed post-traumatic stress disorder as a result of the motor accident. WPI was assessed at 17% with the additional of 1% for the effects of treatment. A deduction of 1/10 (1.7% rounded to 2%) was made due to pre-existing impairment. Final WPI was 16% (17%-2%+1%).
RE-EXAMINATION REPORT
At the teleconference on 10 June 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessors Canaris and Singh is below.
Date of Examination: 25 June 2025
Year of birth: 1950
Who attended the assessment
The assessment was attended by Ms Sanhard. Ms Sanhard was examined by Medical Assessor Christopher Canaris and Medical Assessor Himanshu Singh. Ms Sanhard was seen over a video conference by both Medical Assessors. She was located at her home and attended the appointment on her own.
HISTORY
Psychosocial history and pre-accident history
Ms Sanhard was born in Sydney. She was adopted at birth. She never saw her birth parents. Her adopted parents died when she was 19 and later another one when she was 21. She grew up with her parents. When her parents passed away, she was already living with her husband to whom she got married. In terms of her childhood, she stated it was not bad. However, her adopted parents were into smoking and alcohol abuse and she noted that it affected their health. She denied any specific trauma or abuse growing up, but stated it would have been happier if they were not into alcohol and smoking.
Ms Sanhard attended school and finished Year 10. Later, she did a secretarial course and started to work at a bank. She has worked at banks since the age of 16 years. She has worked at a lot of other places in secretarial positions. She was in France and worked at the Australian Embassy in Paris. She also worked at Westmead Children's Hospital as a medical secretary for 23 years. Ms Sanhard stated that she retired around 10 years ago. She does not drive and has never driven and does not have a driver’s licence. She denied any previous Workers’ Compensation Claim. She denied any previous motor vehicle accident related physical or psychological injuries. Ms Sanhard stated that she had not had any motor accidents in the past, and this was the first time that she and her husband were in a motor accident.
Ms Sanhard stated that in 1972, at the time of the birth of her first child, she suffered from postnatal depression. She was very depressed at that time. She was in France. She did not know what was happening to her. She saw a psychiatrist for depression and it lasted for few years. She initially saw a psychiatrist in France and started to take antidepressants. She was not able to function due to the depression. It was hard to get dressed and it was a very dark time. She was still working though with some time off. She denied any admissions to the hospital. She denied any self-harm or suicide attempt. She then moved to Australia in 1973. She saw a psychiatrist after she came to Australia. She stated that it was not a good experience as the psychiatrist told her to have shock treatment. However, she did not want to do that and she took the equivalent of the antidepressant medication that she was taking in France. She continued the medication for another year or so and stated that she recovered from her symptoms after two years. She denied any further history of depression. She did not have similar symptoms following the birth of her subsequent two children.
Ms Sanhard developed panic attacks in her 30s while she was working for a French company in Australia. She described her panic attacks as happening every now and then where the feeling was that she would die, her heart beating fast, chest tightness, breathing faster and deeper, feeling that she could not get enough air and that something bad is going to happen. The panic attacks also occurred while travelling on bus or train. Sometimes she needed to get off the bus or train and go to a private place and try to breathe using a paper bag. She stated that there was work stress and the panic attacks would happen every now and then. She worked in very high-powered jobs. The panic attacks may happen once a week, sometimes in the train as well.
She was prescribed medication for panic attack which was mainly Xanax, and she would take it at the time of attack or at times when she would anticipate the attack to happen. She stated that otherwise things in her life were great. She continued work up until 2015 when she retired from work and the panic attacks stopped as well. Following her retirement, very occasionally she required taking Xanax. She has not worked after her retirement. After the retirement, Ms Sanhard along with her husband moved from Sydney to Byron Bay. She stated that she found the relocation quite good. She was not experiencing panic or anxiety attacks. She was social. She had group of friends. She moved. She used to go to the beach, go to the movie and go out.
Ms Sanhard stated that before the accident her personal care was fine. She did not have anxiety in leaving home. She had no issues in travel. She travelled overseas with her husband. Her personal care was fine. She would enjoy knitting and sewing. She would enjoy reading and was a part of French book club, reading both fiction and non-fiction. She was a very happy person without any issues.
Ms Sanhard was diagnosed with pernicious anaemia in her 30s, soon after the onset of her panic attacks, and she developed Hashimoto's thyroiditis around the time that she developed the panic attacks. She has a history of hypertension for the last few years and is controlled with medication. She was diagnosed with psoriasis and later psoriatic arthritis after she relocated to Byron Bay. She has a history of shoulder surgery and foot surgery. She takes medication for hypertension and high cholesterol.
Ms Sanhard does not smoke and has not used illicit substances. She drinks alcohol socially. She denied any dependence on alcohol.
Ms Sanhard does not have a significant forensic history.
Ms Sanhard had retired before the accident and has been on aged pension. She lives with her husband and has three adult children. Her eldest son is 52 and lives in Japan. Her second son is 50 who is single and lives close to them and her daughter is the youngest who is 44 and lives in Brisbane. She has six grandchildren.
History of the motor accident
Ms Sanhard stated that she was involved in a motor vehicle accident on 31 May 2021. She was the passenger in the front seat of their car which was driven by her husband. As mentioned, she has never driven and has never held a driver's licence. She stated that they were on the highway and they were returning from a consultation for her husband with an oncologist in Lismore. He had previously been diagnosed as having prostate cancer. There was a truck in front of them and at the distance, she saw a white vehicle which was incoming and travelling fast. The white vehicle coming from opposite direction was shaking all over the road and they could see it from a distance. The vehicle hit their car and she thought that the other car was nearly on top of them. The other vehicle wiped out the driver's side of their car. They thought that they would both die in the car crash and that was the end. Her husband managed to swerve the car to the left and impacting the barrier at the side of the road and reducing the direct impact of the collision.
She stated that even today, it feels horrible to think about the accident. She stated that it would have been head on, had not her husband turned left. She stated that the other vehicle took the right side of their car. The other driver was sleeping. She stated that they were wearing seatbelts, the airbags were not deployed which still surprises her and it was a relatively new car. It was their Volkswagen Jetta and the car was later written off. She was in a shock for a while. There was no loss of consciousness. She started to experience some pain. They were not physically injured. She had to call the police and a tow truck. The policeman came on a motorbike. They did not go to the hospital as her husband had to start radiation therapy the next day. There was no visible bleeding or cuts and the damage has been psychological to her. She stated that she was in a state of panic and was shaking. Both of them were in a mess. She was crying and very upset.
Ms Sanhard stated that initially she was in shock and later she started to experience pain in the neck and top of the head. The pain is on top of her skull and goes down to the neck.
Ms Sanhard stated that the thought at the time of the accident was that they would have died as they saw the other car wobbling on the road from a distance. Both cars were at around 90 to 100 km/h as it was a highway, and the other driver was asleep. They had to hire a car as they needed to travel to Lismore the next day for radiation treatment. She stated that the other car was not damaged much and the other lady was fine. She does not think that the other driver was charged and she was not given any information about that other driver.
History of symptoms and treatment following the motor accident
Ms Sanhard was in a state of shock. She was panicking, crying and anxious. She continued to experience the pain in the top of the head which radiates to her neck. She saw her GP the next day who told her that she was having PTSD. She had scans. She had an x-ray of her head and was prescribed oxazepam to reduce her anxiety. She had later MRI scan of her head and cervical spine. She stated that the physiotherapy gave her a lot of relief in regards to her pain. She was also referred to an osteopath for treatment of her pain in her head and her neck.
Ms Sanhard stated that she continued to suffer from anxiety when she had to sit in the car, especially in the front seat. She struggled to sit in front seat of the car as a passenger and was constantly watching. She would mostly sit at the back seat of the car, except if it was a very short drive for 5 to 10 minutes to go to the shop. If she had to travel on a highway, she would definitely sit in the back of the car. She would be very nervous before any long trip. She would start having panic attacks, thinking about it, and it would take a while to her to calm down. She stated that her car was a writeoff, though she was lucky that she and her husband survived. She started to have fear of being involved in a further motor vehicle accident and fearful of anything bad happening. She would constantly look in front of the vehicle, and at any vehicle coming at a speed.
Ms Sanhard stated that she started to have nightmares. She would be screaming in her nightmares and that would happen every few weeks. In her nightmares, she would see a white car and her husband had to wake her up when she would start screaming. The white car would be coming towards her and the moment it would hit her, she would start to scream. She also had flashbacks during the day where she was thinking and reliving the accident. She would try hard not to think about it but when she saw her GP, she was prescribed something similar to Xanax, which was oxazepam, which she would take when she had long distance trips. She would still sit at the back seat of the car and would not look in the front. She would try hard not to think about it and started to take a lot more oxazepam straight after the accident.
She was referred to clinical psychologist, Vika Shvachkina and had 6 sessions of therapy. She later saw psychologist Ms Bourchier, Psychologist at Byron Bay whom she saw 3-4 times. However, her psychologist retired during that time. She was referred to psychiatrist, Dr Siefken. She was diagnosed with post-traumatic stress disorder. She was started on Effexor 75 mg and which was increased in last year to 150 mg. She could not take any further psychological or psychiatric treatment as she found it quite expensive.
I have noted Dr Seifken's report dated 2 June 2022 which stated a diagnosis of post-traumatic stress disorder. It recommended to increase the dose of venlafaxine to 150 mg which was double the dose from 75 mg. She was referred for eye movement desensitisation and reprocessing (EMDR) and a trial of medicinal cannabis. She did not go for the EMDR due to financial reasons. However, she increased her medication in the last year only when she was not doing very well. She tried medicinal cannabis in the form of CBD oil but it did not help her much so she stopped it. She also has stopped seeing the osteopath as the consultations were declined by the insurance company. She later changed her GP as well and her new GP has been Dr Matthew Wood.
Details of any relevant injuries or conditions sustained since the motor accident
Ms Sanhard denied any relevant injuries or conditions sustained since the motor accident. She has not suffered any kind of trauma or stressors since the motor accident.
Current Symptoms
Ms Sanhard stated that she continues to experience the pain on top of her skull which goes down to her neck. Her neck is quite sore. She has to go for massages to get relief for the pain. She was going to the osteopath which was helpful but she could not afford the treatment so it stopped.
In terms of her mental health, Ms Sanhard stated that it is not wonderful. She has lot of anxiety. She was initially recommended to increase her Effexor by her psychiatrist. She did not increase it initially but she was not doing good so she increased it the venlafaxine (Effexor) to 150 mg last year. It has helped her with the anxiety. The panic attacks are not as severe. They still happen a day before any travel in the car. She cannot sleep a day before the travel. She feels different. She does not feel the same person. Even if she is not travelling, she still feels anxious. She has not felt the same since the accident. Her condition has not improved, though being on medication and initially receiving psychological treatment. She still has huge anxiety to go in the car. A short distance travel for 5 minutes is fine, but she is in a mess when she has to travel in a highway, as a passenger in the car and she has to sit on the back seat. She is fine to travel in a bus and is able to catch a local bus. She may go for a walk in the town.
Ms Sanhard stated that her life is quiet after the retirement. She spends her time walking the dog. Her sleep is pretty good but it can be disturbed due to nightmares especially when she has to think and plan to travel. Her appetite is fine and her weight has been quite consistent. While in the car, she has to take oxazepam before the travel. She stated that she never had to refuse to travel as the oxazepam helps but she is sitting in the back seat and not looking out.
Ms Sanhard stated that in terms of her mood, it has been an improvement in her mood every day especially since increasing the dose of medication. Before that, she was struggling with anxiety. She is able to do the tasks at home. She is cooking and makes sure that her husband is looked after. Her husband is quite independent and is a strong person, but she looks after the house chores such as cooking, cleaning and laundry. She reported that her motivation is fine and she has the energy to do those tasks. She is able to enjoy things that she does. She denied any self-harm or suicidal thoughts. She never had self-harm or suicidal thoughts even when she was struggling with her mental health.
Ms Sanhard denied any pervasive sadness of mood. Her anxiety is less when she is at home. She is able to connect emotionally with her husband and her children. She denied any issues with her anger.
Current and proposed treatment
Ms Sanhard continues to take treatment for her physical health. She is on iron tablets for her anaemia. She takes candesartan for high blood pressure and Lipitor for cholesterol. She receives vitamin B12 injection every 3 months. She is on levothyroxine in the morning for Hashimoto's thyroiditis. She also takes oxazepam 15 mg half tablet for anxiety and to prevent panic attacks before she has to travel in a car for long distance. She takes Nurofen for her pain and goes for massages when she can. She has increased her Effexor (venlafaxine) and now she is on Effexor (venlafaxine) 150 mg daily which has helped her a lot. She was on CBD oil drops but it did not help much with her anxiety so she stopped it. There is no further proposed treatment for her mental health however she plans to continue her medication.
CLINICAL EXAMINATION
Mental state examination
Ms Sanhard was seen over a video conference on 25 June 2025. She was at her home and attended the appointment by herself. She was casually dressed and appeared clean. She maintained good eye to eye contact and a rapport was established. She was calm and cooperative during the assessment. There were no signs of agitation or retardation. She smiled a few times. She described her mood as improved and denied any depressive symptoms. She reported anxiety in the context of travelling in a car and her effect was mood congruent and reactive with adequate range. She described her energy and motivation as fine. She is able to enjoy the activities in her daily life. Her sleep has been fine and her appetite has been good and there have been no changes in her weight. She reported occasional nightmares before travel in a car and having anxiety and needing to take medication (oxazepam) to help with her anxiety. She has the fear of being in an accident again though she is able to travel and manage her anxiety. 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. She described her attention and concentration as fine. She had a reasonable insight and her judgement was intact.
Current functioning
Ms Sanhard’s self-care is fine. She showers regularly and changes into clean clothes every day. She denied any issues in looking after herself. She can attend to the household chores such as cooking, cleaning and laundry. She can go to shop for the groceries in the local area and prepare meals for herself and her husband. She stated that she is aware that her husband needs to be looked after, however, he is independent in his care and he is determined and a strong person and is recovering from his cancer. In the opinion of the Panel Medical Assessors, Ms Sanhard did not demonstrate any deficits in self-care and personal hygiene.
Comments on consistency
Her presentation was consistent with the history given during the clinical interview, documentation received and mental state examination.
RELEVANT PROVISIONS
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 9.3 of the Guidelines, effective from 6 December 2024, 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 clause 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 ss 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.[2]
[2] Section 7.26(6) of the MAI Act.
The evaluation should only consider the impairment as it is at the time of the assessment.[3]
[3] 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.[4]
[4] Section 7.26(7) of the MAI Act.
The Panel refers to the above re-examination report of Medical Assessors Canaris and Singh and adopts the findings in their entirety. The Panel reconvened on 16 July 2025 and discussed the re-examination report findings before collectively making the below determinations.
Diagnosis and reasons
Ms Sanhard is a 75 years old, married, retired female, currently on aged pension.
Ms Sanhard retired in 2015. Ms Sanhard has adopted parents since birth. She has a previous history of postpartum depression which was treated with anti-depressant medications and she attended complete remission of symptoms after the birth of her first child in 1972. She later started to have panic attacks and anxiety in the context of work-related stress. She continued to work managing her anxiety by taking benzodiazepine (Xanax), to help with her panic attacks. She eventually retired in 2015 and her panic attacks also became occasional and gradually stopped needing occasional use of Xanax.
The Panel did however note the insurer’s submission that the clinical notes indicate the claimant was prescribed Effexor as recent as 9 January 2021 and Oxazepam multiple times within 2021, the last occasion being on 4 May 2021. The Panel felt this was consistent with her history of requiring occasional use of benzodiazepine or anti-depressant medication for her panic attacks.
Ms Sanhard did not indulge in any form of employment after her retirement and moved to a quieter place to live in Byron Bay along with her husband. She was functioning quite well. She was involved in a motor vehicle accident on 31 May 2021 where she was a front seat passenger in the car along with her husband.
In the accident, she did not sustain any major physical injuries, however, it affected her psychologically where she feared for her life and thought she would have died in the accident. Following the accident, she started to develop nightmares and flashbacks with disturbed sleep, often screaming and waking up and seeing the white car approaching her. She developed avoidance of travel and anxiety over sitting in the car. She was able to sit in the car after some time, however would sit in the back seat and needed to take medication to travel. She also reported initially disturbed sleep and being anxious and hypervigilant while in the car.
Ms Sanhard developed symptoms which met the criteria of post-traumatic stress disorder as per the DSM-5;
A. She was exposed to threatened death and serious injury in the motor vehicle accident where she directly experienced the traumatic event.
B. She developed intrusion symptoms associated with the car accident beginning after the accident in the form of recurrent involuntary intrusive distressing memories, recurrent distressing dreams about the motor accident and flashbacks in which she felt as if the accident was reoccurring.
C. She developed persistence avoidance of travelling in the car and being reminded of the motor accident. She would avoid to sit in the front of the car as she would have a distressing memory and thoughts of having the motor accident.
D. She noticed alterations in her cognition and mood associated with the motor accident which began after the motor accident. Her panic attacks became more frequent along with feelings of anxiety. She struggled to experience positive emotions and experienced negative emotional state.
E. She experienced alterations in her arousal and reactivity associated with the motor accident in the form of hypervigilance, exaggerated startle response and sleep disturbance.
F. The duration of symptoms was more than one month.
G. The disturbance caused clinically significant distress or impairment in social, occupational or other important areas of functioning. This was evident though her remaining at home with her husband and not wanting to go anywhere.
Ms Sanhard sustained a psychological/psychiatric injury because of the motor vehicle accident and met the DSM-5 TR criteria of post-traumatic stress disorder. She has received treatment in the form of medications which she still continues. She has been seen by a GP, psychiatrist and psychologist and had therapy sessions in the beginning. She has reported improvement in her symptoms though she still continues to have anxiety with travel and gets panic attacks though these are less in frequency and intensity. Her post-traumatic stress disorder is in partial remission.
Causation and reasons
Ms Sanhard has a diagnosis of post-traumatic stress disorder in partial remission as per the DSM-5 TR. Ms Sanhard has a pre-existing vulnerability due to past history of postpartum depression and panic attacks in the context of work-related stress. However, she was symptom free. She did not report symptoms of anxiety or depression at the time of motor accident and was managing quite well. She did not report any impairments in her functioning at the time of motor vehicle accident. There is a direct temporal relationship between the motor vehicle accident and the onset of a psychiatric/psychological symptoms following the motor vehicle accident. She has reported improvement in her symptoms with the treatment received so far. However, she still continues to be anxious to travel in a car. She anticipates the anxiety and may have a panic attack or a disturbed night sleep and occasional nightmares.
Summary of injuries referred by the parties
The following injuries were caused by the motor accident:
· post-traumatic stress disorder in partial remission.
Permanency of impairment
Ms Sanhard has sustained a psychological/psychiatric injury because of the motor vehicle accident. Ms Sanhard has reached maximum medical improvement. Her impairment is permanent as it has become static or well stabilised with medical treatment and is not likely to remit despite medical treatment. Her impairment is considered to be unlikely to change substantially or by more than 3% in the next year with or without medical treatment.
Permanent impairment is defined in the American Medical Association’s Guides to the Evaluation of Permanent Impairment, fourth edition (AMA4 Guides) (p 315) as follows:
“Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment.
A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment.”
Degree of permanent impairment psychiatric impairment rating scale
The determination as to permanent impairment is made in accordance with the AMA4 Guides and Part 6 of the Motor Accident Guidelines.
| Psychiatric diagnoses | 1. Post-traumatic stress disorder in partial remission. | 2. |
| 3. | 4. | |
| Psychiatric treatment description | Treatment by her GP, psychologist and psychiatrist. Treatment with venlafaxine, CBD oil, and oxazepam prn. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 1 | Ms Sanhard’s self-care is fine. She showers regularly and changes to clean clothes every day. She denied any issues in looking after herself. She can attend to the household chores such as cooking, cleaning and laundry. She can go to shop for the groceries in the local area and prepare meals for herself and her husband. She stated that she is aware that her husband needs to be looked after, however, he is independent in his care and he is determined and a strong person and is recovering from his cancer. In the Panel’s opinion, Ms Sanhard did not demonstrate any deficits in self-care and personal hygiene. |
| 2. Social and Recreational Activities | 2 | Ms Sanhard stated that life has been quiet since retirement. She does not do a lot socially. There was a time after the accident where she did not want to go anywhere and was in the house. However, she has started to go for walks. She attends the book club every month, sometimes every two months. She goes for walks mainly in the daytime. Herself and her husband both started to go to the gym it was good, but they stopped it around nine months ago when she started to feel a bit down. She is thinking of restarting the gym. She and her husband mostly stay at home. However, their friends may visit them every few months and they will visit their daughter. She may visit her daughter every three months. In the Panel’s opinion, she is able to go out socially without needing a support person. |
| 3. Travel | 2 | Ms Sanhard has never driven even before the motor accident and never had a driver's licence. She has relied on her husband to drive or would catch a public transport. She is able to sit in the car as a passenger but has to sit in the back of the car whereas earlier she used to sit in the front. She can walk around the town without a support person. She can catch a bus in the local area by herself. She has been to France as her husband's family lives in France. She had a car trip to Hunter Valley for a wedding around Easter time. She stated that the roads were busy and it caused her anxiety and she sat in the back of the car the whole time. In the Panel’s opinion, she can travel without support person but only in the familiar area such as her local town and the local shops. While acknowledging Dr Suman’s opinion, the Panel was given a history that the claimant can travel to the local shops on her own, by walking or using public transportation. |
| 4. Social Functioning | 1 | Ms Sanhard described her relationship as fine. They have been together for 55 years. She stated that the accident was a big shock for them. She denied any strain in her relationship. She denied any arguments with her husband or her children. She has a good relationship with her children and her husband and her distant family. She has few friends with whom she keeps in contact. In the Panel’s opinion, there is no deficit other than what would be attributable to the normal variation in general population and she does not have difficulty in forming and sustaining relationships. |
| 5. Concentration, Persistence and Pace | 2 | Ms Sanhard stated that she has reported some issues with her focus and concentration. She may at times may not remember things and stated that it is more age-related. She has spoken to others who also have similar issues. She continues to look after the finances at home though she is not as sharp. She is still part of the book club. She denies any issues in reading and enjoys reading and is able to finish book though she may not remember them. She is able to knit and finds it relaxing. She described herself not as sharp as before. She loves music and watches TV and able to enjoy these things. She was able to sustain her attention and focus during an hour and a half of the assessment without any issues. In the Panel’s opinion, she can focus on intellectually demanding tasks for a period of 30 minutes and she has mild impairment in concentration, persistence and pace. As the claimant gave the Panel several examples of hobbies or pursuits not recorded by Dr Suman such as still belonging in a book club and her ability to enjoy knitting, watching tv and music, the Panel felt class 2 was appropriate. |
| 6. Adaptation | 1 | Ms Sanhard had retired at the time of accident. Since the accident, she continues to look after her house and attend the home duties which is similar to someone working in a full-time position. She denied any issues in carrying out the household chores, shopping for groceries and managing her finances. Hence, in the Panel’s opinion, there was no change to Ms Sanhard’s functioning following the motor accident. The Panel noted Dr Suman’s finding of Class 4, premised upon his opinion that the claimant cannot return to a work role. However, as the claimant had retired before the motor accident, her adaptation is assessed through her usual pre-injury role of home duties, as detailed in the preceding paragraph. This is consistent with clause 6.221 of the Guidelines. |
| List classes in ascending order: 1, 1, 1, 2, 2, 2 | ||
| Median Class Value: 1.5=2 | ||
| Aggregate Score: 9 | ||
| % Whole Person Impairment: 4 % | ||
*%WPI = Percentage Whole Person Impairment
Psychiatric Impairment Rating Scale – Pre-existing/subsequent impairment
| Psychiatric diagnoses | 1. Panic disorder. | 2. Postpartum Depression. |
| Psychiatric treatment description | Treatment under the care of GP and psychiatrist. Treatment with antidepressants and benzodiazepines. | |
| Category | Class | Reason for Decision |
| 1. Self-Care and Personal Hygiene | 1 | Nil deficit. |
| 2. Social and Recreational Activities | 1 | Nil deficit. |
| 3. Travel | 1 | Nil deficit. |
| 4. Social Functioning | 1 | Nil deficit. |
| 5. Concentration, Persistence and Pace | 1 | Nil deficit. |
| 6. Adaptation | 1 | Nil deficit. |
| List classes in ascending order: 1 1 1 1 1 1 | ||
| Median Class Value: 1 | ||
| Aggregate Score: 6 | ||
| Pre-existing % Whole Person Impairment: 0 % | ||
*%WPI
Apportionment – pre-existing/subsequent impairment
Ms Sanhard did not have a pre-existing or subsequent impairment in her functioning; hence, the Panel did not make any adjustment for a pre-existing or subsequent impairment.
Effects of treatment
Ms Sanhard has reported significant improvement with the effect of treatment, especially since increasing the dose of her antidepressant in the last year. Hence, the Panel has added 2% for the effects of treatment.
CONCLUSION – PERMANENT IMPAIRMENT
The Panel concludes that the claimant’s injury caused by the motor accident results in a whole person impairment of 6% which is not greater than 10%. The Panel arrived at the same injury diagnosis and impairment percentage as Medical Assessor Paul Friend.
The certificate issued by Medical Assessor Paul Friend dated 20 July 2024 is therefore confirmed.
Ex
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0
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