Siladji v Insurance Australia Ltd t/as NRMA Insurance

DETERMINATION OF REVIEW PANEL
CITATION:	Siladji v Insurance Australia Ltd t/as NRMA Insurance [2023] NSWPICMP 308
CLAIMANT:	Danny-Marinko Siladji
INSURER:	NRMA
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Matthew Jones
MEDICAL ASSESSOR:	Michael Hong
DATE OF DECISION:	30 June 2023
CATCHWORDS:	MOTOR ACCIDENTS – Review of certificate of Medical Assessor (MA) Paisley dated 9 August 2021 who found the claimant was suffering a major depressive disorder and a panic disorder with an assessment of whole person impairment (WPI) of 8%; claimant involved in a high speed rear end collision on 5 December 2015; claimant disputed the categories of psychiatric impairment rating scale (PIRS) classifications determined by the MA and submitted that a WPI with treatment effect and amounting in total to 16% was reasonable; insurer submitted that generally the claimant did not satisfy a higher rating as he was not severely and totally incapacitated; following examination of the claimant the panel concluded that the claimant was experiencing ongoing psychological symptoms; Held – the claimants had a DSM-5 diagnosis of persistent depressive disorder with anxious distress and had a WPI assessment of 8% together with an allowance for treatment effect of 1% giving a total WPI of 9%.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The Panel revokes the certificate of Medical Assessor Paisley dated 9 August 2021. 2. The claimant has suffered psychiatric disability of a persistent depressive disorder with anxious distress with a whole person impairment assessment of 8%. 3. An allowance is made of 1% for mild treatment affect giving a total whole person impairment of 9%. 4. The following injuries and treatment caused by the accident gave rise to a permanent impairment of 9% and IS NOT GREATER THAN 10%: • persistent depressive disorder with anxious distress. 5. The claimant’s total whole person impairment is 9%.

STATEMENT OF REASONS

INTRODUCTION

This is an application by the claimant to review the decision of Medical Assessor Paisley (the Medical Assessor) in his certificate dated 9 August 2021.
The Medical Assessor found that;
“The following injuries caused by the accident gave rise to a permanent impairment of 8% and IS NOT GREATER THAN 10%:
• Major Depressive Disorder
• Panic Disorder”

The accident

The accident occurred on 5 December 2015. The claimant was stopped at traffic lights when a car collided with the rear of his vehicle. The claimant has reported that he lost consciousness for a split second after the impact. He had also reported that he remembered people knocking on the car window after he regained consciousness. Ambulance and police attended the scene but he did not go to hospital. The claimant’s car was written off. He sustained some bruising to his chest from the seatbelt but did not have any fractures.

SUBMISSIONS

The claimant’s submissions

The claimant submits that the Medical Assessor was in error in his assessment of the psychiatric impairment rating scale (PIRS) rating system and in particular the Medical Assessor’s assessment and reasoning in respect of both social functioning as well as social and recreational activities of the claimant which were assessed at Class 2 and 3 respectively.
The claimant says that the Motor Accident Permanent Impairment Guidelines (the Guidelines) provide, at cl 1.220, that an assessor “Should obtain a history of the injured person’s lifestyle, activities and habits and then assess the extent to which these have changed as a result of the psychiatric injury”.
With regard to social functioning, the claimant says that the Medical Assessor assessed the claimant’s Social Functioning as a Class 3 impairment saying that he is “Separated from his wife and has lost friends”.
The claimant notes that the Medical Assessor in assessing the claimant’s pre-existing functioning in this domain, noted it as “Maintained a relationship with his wife and socialised regularly”.
In the report, the claimant says that the Medical Assessor took a history of the claimant’s pre accident psychosocial history as;
“He had a very busy lifestyle and would often make up to 100 phone calls per day. He was happily married and owned several investment properties. He was working up to seven days per week. He trained other real estate agents. He enjoyed holidays, reading and racing his car at a racetrack monthly.”
The claimant says that the assessment of current functioning does not entirely accord with the history recorded earlier by the Medical Assessor (section 8) that “Mr Siladji said that he lost his business wife and house after the accident. He had conflict with his son and does not speak to him much anymore”.
The claimant submits that when one combines the complete loss of the claimant’s relationship with his wife as well as not talking very much at all with his son, then this falls within category 4 as opposed to category 3 of the PIRS classifications . The claimant says that this considers the fact that the claimant still has some assistance from his daughters around the house and that Class 4 assessment is appropriate when those factors are considered.
The claimant therefore submits that there is an error on the face of the record in the application of the Guidelines specifically the PIRS rating system for psychological injury.
Regarding social and recreational activities, the claimant says that a more significant error has been made by the Medical Assessor in his assessment of social and recreational activities as a Class 2 impairment instead of a Class 3 impairment. The claimant says that the Medical Assessor made the observation that the claimant was a Class 2 impairment in this domain by saying;
“Socially withdrawn. Prefers to stay at home. Will go for a drive for a day out.”
The claimant says that the example given for Class 2 in the Guidelines reads:
“Mild impairment. Able to occasionally go out to social events without needing a support person, but does not become actively involved; for example, in dancing, cheering favourite team.”
The claimant then refers to the example given for Class 3 in the guidelines which reads;
“Moderate impairment. Rarely goes to social events, and mostly when prompted by family or close friend. Unable to go out without a support person. Not actively involved, remains quiet and withdrawn.”
The claimant says that the social activity referred to “in that terse statement from the assessor” is going for a drive. The claimant says that one must consider what going for a drive really is. It is sitting in a car either by oneself or with others. The claimant says that there is nothing to suggest that the claimant is going for a drive with anyone else, just that it is done for a day out.
The claimant submits that in all the circumstances, he should have been assessed as a Class 3 impairment for Social and Recreational Activities as was done by
Dr Klug in his assessment of whole person impairment (WPI).
The claimant says that change alone would be sufficient to take the claimant from 8% WPI to 14% WPI as the median score would be rounded up to Class 3 and the aggregate score would amount to 13% WPI with an allowance for a mild treatment effect.
The claimant says that if he was assessed in accordance with his submissions, then the scores for each class would be (in ascending order) 1, 1, 2, 3, 4, 4. That would have a median score of 3 (clause 1.225.1, 1.226) an aggregate score of 15 (clause 1.225.2, 1.227) and a WPI of 15% under the PIRS rating (clause 1.225.3, 1.228 and Table 17). The claimant says that would then be increased by 1% for the treatment effect leading to a total WPI of 16%.

Insurer’s submissions

In reply, the insurer highlights cl 1.220 of the Guidelines which it says stipulates that the PIRS class descriptions are intended to be illustrative rather than literal criteria.
Further, the insurer says that cl 1.218 of the Guidelines states that the Medical Assessor's clinical judgment and clinical experience are the most important tools in the application of the scale. The insurer says that the Medical Assessor has exercised his clinical judgment and has provided a clear path of reasoning as to why he assessed the claimant at the stated level of impairments.
The insurer says that whilst the claimant is dissatisfied with the Medical Assessor's determination, this does not indicate there is a material error.
With regard to social functioning, the insurer refers to the claimant’s submission that Medical Assessor Paisley erred in his assessment of the claimant at Class 3 impairment rating for Social Functioning.
The insurer submits that Medical Assessor Paisley made no errors, due to the following:
(a)   the claimant's separation from his wife fits the description of Class 3, that is, it satisfies that there has been domestic separation;
(b)   whilst not explicitly mentioned by Medical Assessor Paisley in the PIRS table, the claimant's relationship with his son also fits the description of Class 3, noting that the relationship is severely strained;
(c)   there is no indication from the interview conducted by Medical Assessor Paisley or the treating/expert medical evidence that the claimant would fit the Class 4 category. The insurer says that the claimant has failed to outline how the claimant would satisfy Class 4. Specifically, the insurer says that the claimant has not completely lost his relationship with his son. The insurer says that it was reported to Medical Assessor Paisley that the relationship was strained and therefore, the insurer submits that Medical Assessor Paisley appropriately assigned Class 3, and
(d)
the insurer says that in any event, there is some element of questionability surrounding the circumstances of the claimant's separation with his wife. The insurer says that in January 2019, over three years after the accident, the claimant told Dr George, psychiatrist that he did not wish to discuss the circumstances surrounding his separation. The insurer says that it is unclear why the claimant did not wish to speak about the separation to

Dr George if the separation was indeed related to the accident, as was alleged to Assessor Paisley. The insurer says that Assessor Paisley was privy to a report of Dr George and therefore it was appropriate to assign Class 3.
The insurer has referred to the claimant’s submission that Medical Assessor Paisley erred in his assessment of the claimant at Class 2 impairment rating for Social and Recreational Activities. The insurer submits that the claimant does not fit the Class 3 impairment or above ratings because:
(a) the claimant did not tell Medical Assessor Paisley that he rarely went to events, which does not necessarily mean that he withdraws from social events altogether. The insurer says that the mere suggestion that the claimant ''prefers" to be at home does not mean that he fits Class 3. The insurer says that it is simply not the case that each individual who prefers to be at home is significantly impaired. It is also a lifestyle choice, and
(b) the functioning described to Medical Assessor Paisley in no way satisfies the Class 3 rating of moderate impairment. The claimant did not tell Medical Assessor Paisley, nor has he told any of the other experts, that he required a support person when leaving the house. The insurer says that it is clear that the claimant can leave the house independently, given that he is able to go on drives for long day trips by himself. The insurer says that the claimant's submissions cannot be accepted, as they do not adhere to the PIRS criteria.
For the reasons above, the insurer submits that the claimant did not satisfy a higher rating than Class 3, that is, severely and totally incapacitated.

Medical evidence

A psychiatric report from Dr George dated 29 January 2019 was provided by the insurer. The diagnosis was a chronic adjustment disorder with mixed anxiety and depressed mood. The report did not note any psychiatric history preceding the accident.
A psychiatric report from Dr Klug dated 10 August 2020 was provided by the claimant. He diagnosed him with chronic post-traumatic stress disorder in partial remission, a panic disorder with agoraphobia and a chronic adjustment disorder with depressed mood. His WPI was rated at 15%. There was no consideration of his pre-existing psychiatric history or any assessment of pre-accident impairment.
A report from psychologist Mr Clancy dated 4 December 2018 was provided by the claimant. He diagnosed him with post-traumatic stress disorder.
A report by an occupational physician Dr Davis dated 5 December 2019 noted that he had a “significant adjustment to injury disorder with anxiety and depression”.
A general practitioner (GP) Mental Health Treatment Plan dated 11 May 2016 noted that the claimant had “anxiety problem since January 2016, panic attack”.
Psychologist, Mr Gomes provided a letter dated 23 June 2018 in which he noted that the claimant had “reported a history of panic attacks, associated with a MVA in December 2015”.
The claimant has also provided a medico legal report from Dr Maniam dated
23 October 2018. Dr Maniam is an orthopaedic surgeon and his report does not address the claimant’s psychiatric disabilities.
A discharge summary from St George Hospital dated 19 September 2020 noted the claimant’s presentation with delirium secondary to excessive opiates and benzodiazepine consumption.
Medical Assessor Paisley provided the following PIRS;

Psychiatric diagnoses

1. Major Depressive Disorder

2. Panic Disorder

Psychiatric treatment description

Antidepressant medication.

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	1	Mr Siladji lives independently, showers daily, and prepares meals for himself.
2. Social and Recreational Activities	2	Socially withdrawn. Prefers to stay at home. Will go for a drive for a day out.
3. Travel	1	Can drive to unfamiliar areas without a support person.
4. Social Functioning	3	Separated from his wife and has lost friends.
5. Concentration, Persistence and Pace	2	Subjective complaints of concentration impairment. No objective cognitive impairment noted during the interview.
6. Adaptation	4	No longer able to work full-time in his usual occupation. Able to work less than 20 hours per fortnight but is unreliable and unproductive.
List classes in ascending order: 1,1,2,2,3,4
Median Class Value: 2
Aggregate Score: 13
% Whole Person Impairment: 7%

The Medical Assessor also said that the claimant reported modest benefits from treatment, and therefore 1% was calculated for the effects of treatment. Thereafter, WPI was assessed at 7% plus 1% for the effects of treatment resulting in 8% WPI.
The Medical Assessor said that the claimant’s symptoms satisfied the diagnostic manual of mental disorders (DSM-5) criteria for a diagnosis of major depressive disorder in the following ways:
(a)    the claimant was experiencing a depressed mood most of the time;
(b)   an inability to experience pleasure and loss of interest in activities;
(c)   insomnia;
(d)   fatigue;
(e)   feelings of worthlessness;
(f)    suicidal thoughts;
(g)   prominent anxiety and impaired concentration and these symptoms have lasted for more than two weeks (Criterion A);
(h)   the symptoms have caused clinically significant distress and impairment in social and occupational functioning (Criterion B), and
(i)    the episode is not attributable to the physiological effects of a substance or another condition (Criterion C).
The Medical Assessor said that the claimant’s symptoms also met the DSM-5 criteria for a diagnosis of panic disorder in the following ways:
(a)   he experiences recurrent unexpected panic attacks characterised by palpitations, shortness of breath, sweating and shaking (Criterion A);
(b)   the attacks are associated with a persistent worry and fear of having further panic attacks and avoidance of situations which may trigger panic attacks such as crowded places and shopping centres (Criterion B);
(c)   the disturbance is not attributable to the physiological effects of a substance or another medical condition (Criterion C), and
(d)   the disturbance was not better explained by another mental disorder (Criterion D).

Medical examination

The claimant was examined by Medical Assessor Jones and Medical Assessor Hong by audio visual link. Their report follows;
“Mr Siladji is a sixty-three -year-old man who was assessed via audio-visual link through the MS Teams platform, organised by PIC.
The Panel assessors consisted of Dr Michael Hong and Dr Matthew Jones.
Mr Siladji understood the limits of confidentiality with respect to this medico-legal assessment and consented to continue.
Mr Siladji lives at home near Liverpool, where he has lived for two years or so. He lives there by himself. He is not currently working and his income, via Centrelink, he believes is the Disability Support Pension. He last engaged in paid employment approximately four to five years ago and said he worked in real estate for thirty-two years. He said he has tried to work but he ‘can’t think or stay still for long.’ Mr Siladji had his own business covering various areas of real estate. The businesses closed a year ago and he reported to the Panel he ‘just can’t go and can’t explain it.’ The Panel noted his psychological health was one of the factors leading to the business being closed.
Mr Siladji is not currently in a relationship and thinks he may have separated from his wife in 2017. He reported his memory had been bad for approximately a year and a half. They were married for twenty-six years and he has had no contact with her for approximately a year.
HISTORY OF THE MOTOR ACCIDENT
The date of accident was 2 September 2015, approximately seven and a half years ago. Mr Siladji described that there were ten to fifteen cars in front of him on the M5 and a lady drifted into his lane and hit the back of his Porsche. He said she used ‘no brakes, no nothing’ and it was ‘a huge impact.’ Mr Siladji was alone in the car and remembers feeling ‘massive heat and electrics into the head, spine, into the legs and feet’. This lasted for about two or three minutes.
Police and ambulance arrived, however Mr Siladji did not go straight away to hospital and said he was ‘in shock.’ He went to see his general practitioner and said it was ‘no big deal.’ After a month or so things started to happen. He lamented that the accident changed his life. He also commented that the car was written-off.
For treatment, Mr Siladji was given inflammation tablets, pain tablets and sleeping tablets. He also reported being prescribed “massive depression tablets.” He said he ‘couldn’t handle it anymore.’
Mr Siladji confirmed he had no surgery, injections or physical treatments for his injuries and he sustained no fractures.
With respect to Mr Siladji’s mental health following the motor vehicle accident, he reported that in the beginning he could think logically but after about two years he lost interest in his job, his marriage, his grandchildren and himself. He said he feels that he was ‘always flatline.’ He reported that he experienced “heavy duty depression for about a year” and then “things went to a new level”. He said over the last year and a half he had been losing important memory. His doctor recommended he see a psychiatrist and he saw three last year. The first one he saw in February asked if he had ever considered electric shock therapy, another one in May suggested that he was unable to help him and the third doctor suggested Attention deficit hyperactivity disorder medication which took some of his depression away and it also helped with anxiety. He would take it in the morning and it would last twelve to fourteen hours. He did however feel on edge. He also reported having panic attacks in the middle of the night and horrible nightmares and that this happens “all the time” and usually between 2.00 and 4.00am. He gets sweaty when this occurs. In the beginning he said it was because of the car accident, feeling shocked and about people trying to get him out of the car. He went on to say it had progressed ‘year on year’ but then said it was ‘still like that now.’
Mr Siladji described his mental health going downhill and he ‘couldn’t dig [him]self out of it.’ He was ‘chewing over the accident.’ He went on to say it put him ‘out of action’ and ‘out of life.’
The Panel asked Mr Siladji how long it was between the accident and seeing a psychologist or psychiatrist and he said it was about three years. He delayed access because of “the stigma.” He did see a psychologist in Kogarah through Medicare, which he found ‘traumatic’ and he thinks he went every two weeks. He now sees Dr Said, a psychiatrist, in Bondi every three to six months. He reported his children pay for it. He does not see a psychologist and said that he had tried talking but it ‘made things worse.’ He has seen two previous psychiatrists; one in Homebush for one visit and another described him as having ‘anhedonia.’ Mr Siladji reported that he knows he should do things, but he cannot get himself to do them. He reported feeling ‘dead inside’ and ‘not excited for a long time.’
PSYCHIATRIC HISTORY
Mr Siladji firmly denied any psychiatric history including a history of depression, anxiety or panic. He said he had ‘told everyone the same.’ He had never seen a psychologist, a psychiatrist, nor taken psychiatric medications prior to the accident. There was no family history of serious mental health problems.
MEDICAL HISTORY
Mr Siladji has undergone a neck operation and hip operation. He also has arthritis. He takes no regular medications and has no medication allergies. There were no other significant medical problems noted.
Mr Siladji reported not having drunk alcohol since the age of nineteen and has had no recreational drug or alcohol issues throughout his life.
Mr Siladji did report that he has ingested CBD gummies to assist him with sleep. He also reported he had been given Vyvanse, for ADHD, from his psychiatrist.
Mr Siladji denied being involved in any other compensation processes. He had previous motor vehicle accidents; one when his vehicle was written-off from hail damage and another when he hit an oil slick and from which there were no injuries.
FUNCTIONING PRIOR TO THE SUBJECT MOTOR VEHICLE ACCIDENT
With respect to his marriage, Mr Siladji reported that he had spent time during the relationship ‘broken-up, but never divorced.’ He said it was never a perfect marriage from day one and there was always a little bit of distance. He said he cannot remember exactly the date when they decided to be apart. Mr Siladji, although he seemed vague on the details, suggested that he started sleeping separately from his wife, but ‘not before the accident.’ He said it may have been a few weeks afterwards.
With respect to hobbies and interests prior to the motor vehicle accident, Mr Siladji liked racing cars, Porsche’s and fixing motorbikes. He has liked this since the age of fifteen. He also added that he liked reading. Mr Siladji added that he now has ‘no money, no will, no interest, no drive.’
MENTAL STATE EXAMINATION
Mental State Examination took place via audio-visual link. Mr Siladji had neat, white hair and was clean-shaven. His appearance was consistent with his age and he wore a blue and white gingham shirt and leather bracelets. He was polite, cooperative and attentive and displayed no abnormal movements. His speech was normal and there was no evidence of formal thought disorder or delusional thought processes. He described his mood as feeling difficult to sit still and difficult to get up and do things. He reported feeling flat inside. He feels low inside and has good and bad days and said nights are worse. Mr Siladji’s affect was reactive, congruent and appropriate. He appeared somewhat teary at times and irritable at others. There were no perceptual abnormalities and no thoughts of self-harm or harm to others. His cognition, insight and judgement appeared intact in the context of the interview. Mr Siladji complained of memory problems, but there were no gross deficits at assessment. Rapport was fair and facilitated the assessment.
RECENT SYMPTOMS
Mr Siladji experiences fear, like he needs to run, and he can feel really good at times and then feel bad for days. He said he uses earphones and meditates to deal with this. He said he has felt weird since he moved to his place and does not know why.
With respect to sleep, Mr Siladji stays up late and falls asleep late. He generally falls asleep in front of the television, and he likes the noise. He sleeps for a few hours and then wakes up between 2.00 and 4.00am. He described feeling worried and not trusting himself. He said he is eating food and added that his daughter makes sure that he does. He reported having lost weight for the last one or two years and is not currently sure of his weight.
Mr Siladji described that he does not have interest in things. He reported feeling a constant panic and noted that all of his colleagues are still working and ‘have beautiful things.’ Mr Siladji has lost his house, his wife and ‘lost two of [his] children’. There appeared to be no deficits in Mr Siladji’s ability to concentrate, recall details and focus during the assessment.
RECENT FUNCTIONING
Mr Siladji lives alone and reported his daughter brings him food every week or so because he finds it difficult to go shopping. He has a driver’s licence, a car, and drives locally.
Mr Siladji requires no assistance with self-care and personal hygiene and has no nursing or domestic assistance at home, but did say his daughter “helps with everything.” He said he has told Centrelink about this and receives no assistance.
Mr Siladji reported he tries to cook but it depends on his mood. He tries to keep himself tidy and his surroundings respectful and does what he can with respect to housework.
Mr Siladji has three children: two daughters and a son and he bought a house with his son. He said he does not see one of his daughters much.
Mr Siladji also has two younger brothers in South Australia; one he rings often and one with whom he has not much contact.
With respect to friendships, Mr Siladji reported he has ‘not any now.’ He said his friends are all in real estate and he does not see them much because he is embarrassed.
When asked what he does to pass time, Mr Siladji reported he listens to audiobooks, because it keeps his mind occupied, and he reads if he can. He lives in a granny-flat and has plenty of time available to him.
Mr Siladji is not currently in a relationship. When asked about any previous marital problems, Mr Siladji reported that he and his wife had previously broken-up but were never divorced and this is still the case now. He has had no contact with her for approximately a year.
SUMMARY
Mr Siladji is a sixty-three-year-old man who reported he was experiencing a number of ongoing psychological symptoms, consistent with a DSM-5 diagnosis of Persistent Depressive Disorder, with anxious distress.
Although it has been seven and a half years since the accident, and there have been a number of life events since, some of which may have been related to the impacts from the accident, the absence of any evidence of a pre-existing significant psychiatric problem, and the nature of some of Mr Siladji’s symptoms (for example nightmares and panic associated with memories of the car accident), the accident was, in the Panel’s opinion, a more than negligible cause of the psychiatric condition.
Mr Siladji sought mental health assistance approximately three years after the accident, found psychological therapy unsuccessful, and has seen psychiatrists and now sees one periodically. In the Panel’s opinion, the injuries have stabilised and there is a permanent psychiatric impairment.
WHOLE PERSON IMPAIRMENT

Degree of Permanent Impairment

Category	Class	Reason for Decision
1. Self-Care and Personal Hygiene	2	Mild Impairment Mr Siladji lives independently and attends to his own self-care. There were no gross signs of neglect at assessment. The Panel noted family members help him regularly with providing food and other chores. Utilising clinical judgment this is a mild impairment.
2. Social and Recreational Activities	3	Moderate impairment Mr Siladji reported little in the way of social or recreational activities. In particular, he passed time and enjoys having interaction with his extended family. He reported he had withdrawn from friends because he felt embarrassed. He reported he lacked drive and motivation to do things. Although likely at the lower end of the category, a class 3 moderate impairment is appropriate.
3. Travel	2	Mild impairment Mr Siladji has a driver’s licence and remains able to drive, however reported he does not drive far and still experiences anxiety.
4. Social Functioning	2	Mild impairment Mr Siladji reported an imperfect marriage “from day one.” He reported working long hours and that he and his wife had had previous periods of separation but never divorced. He implied commencing sleeping in separate beds only a few weeks after the accident, which would suggest significant underlying difficulties, and not a psychiatric impairment. They are still not divorced. Mr Siladji reported withdrawing from his social friendships but maintaining contact with some family relationships. He has a supportive ongoing relationship with his daughter. Utilising clinical judgment, there is a class 2 mild impairment here.
5. Concentration, Persistence and Pace	2	Mild impairment Mr Siladji concentrated well for the assessment, and he appeared to be able to focus and remember appropriate details. He appeared cognitively intact. He did report that his psychiatrist had prescribed a medication for ADHD (a condition unrelated to the car accident) that has assisted Mr Siladji with his concentration throughout the day. Mr Siladji reported he was able to listen to audiobooks and also read when he felt able. Utilising clinical judgment, there is a class 2, mild impairment here.
6. Adaptation	4	Severe impairment Although there was some lack of clarity with respect to Mr Siladji’s employment capacity, for example his business closed only one year ago. Mr Siladji reported that he is just unable to work anymore and he is unable to explain it. He was also not certain if he was on the Disability Support Pension. Taking into account all factors, within the framework of the PIRS, the Panel’s opinion is that Mr Siladji would have some work capacity, albeit at a low level, infrequent, and unreliable pace, consistent with a class 4, severe impairment.
List classes in ascending order: 2 2 2 2 3 4
Median Class Value: 2
Aggregate Score: 15
% Whole Person Impairment: 8%

*8%WPI ^{= Percentage Whole Person Impairment}

Apportionment
Pre-existing/subsequent impairment
There is insufficient evidence of any pre-existing impairment or post-accident impairment.
Effects of Treatment
Mr Siladji reported that the medication prescribed by his psychiatrist helps him with his depression and anxiety, which is consistent with a 1% mild treatment effect, in the Panel’s opinion.
Therefore, final whole person impairment: 9%”

The Panel adopts the findings of Medical Assessors Jones and Hong.

Causation

Taking the claimant’s version of events into account, and applying its clinical judgment, the Panel is satisfied that the claimant has a DSM-5 diagnosis of persistent depressive disorder, with anxious distress. Given the nature of the accident which was a high impact incident, with little warning and little time for the claimant to take any evasive action, it was an incident which might reasonably be considered to be shocking in its effect. The Panel is satisfied that the claimant has suffered a psychiatric injury directly attributable to the motor vehicle accident of 2 December 2015.
As the Panel has previously remarked, it has been seven and a half years since the accident, and there have been a number of life events since, some of which may have been related to the impacts from the accident. However, the absence of any evidence of a pre-existing significant psychiatric problem, and the nature of some of the claimant’s symptoms such as nightmares and panic associated with memories of the car accident, then the accident was, in the Panel’s opinion, causally related to the psychiatric condition.

CONCLUSION

The claimant has suffered psychiatric disability of a persistent depressive disorder with anxious distress with a WPI assessment of 8%.
An allowance is made of 1% for mild treatment affect giving a total WPI of 9%.
The claimant’s total WPI is 9%.

DETERMINATION

The Panel revokes the certificate of Medical Assessor Paisley dated 9 August 2021.
The claimant has suffered psychiatric disability of a persistent depressive disorder with anxious distress with a WPI assessment of 8%.
An allowance is made of 1% for mild treatment affect giving a total WPI of 9%.
The following injuries and treatment caused by the accident gave rise to a permanent impairment of 9% and is not greater than 10%:
• persistent depressive disorder with anxious distress.
The claimant’s total WPI is 9%.

Actions

Download as PDF Download as Word Document

Citations

Siladji v Insurance Australia Ltd t/as NRMA Insurance [2023] NSWPICMP 308

Cases Citing This Decision

0

Cases Cited

0

Statutory Material Cited

0

[2023] NSWPICMP 308

30 June 2023