Sims v Insurance Australia Limited t/as NRMA Insurance

DETERMINATION OF REVIEW PANEL
CITATION:	Sims v Insurance Australia Limited t/as NRMA Insurance [2024] NSWPICMP 657
CLAIMANT:	Kieran Sims
INSURER:	Insurance Australia Limited t/as NRMA Insurance
REVIEW PANEL
MEMBER:	Alexander Bolton
MEDICAL ASSESSOR:	Michael Hong
MEDICAL ASSESSOR:	Christopher Canaris
DATE OF DECISION:	17 September 2024
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC) which found that the claimant’s acute stress disorder was a threshold injury; claimant was driving several disabled passengers one of whom did not survive the accident; significant psychiatric history pre-accident; suffered from major depressive disorder and generalised anxiety disorder (GAD) which waxed and waned; following the accident the claimant developed post-traumatic stress disorder; Lynch v AAI Ltd applied; AAI Ltd v Hoblos, and Todev v AAI Limited t/as GIO considered; Held – Medical Review Panel found that the claimant had pre-existing GAD and was receiving benzodiazepine treatment and psychological treatment or counselling not long before the subject accident; the Medical Review Panel was satisfied that after the accident the claimant suffered an aggravation of his GAD and had suffered a non-threshold injury; MAC revoked.
DETERMINATIONS MADE:	CERTIFICATE OF DETERMINATION 1. The certificate of Medical Assessor Sidorov is revoked. 2. The Panel finds that the claimant suffered a temporary aggravation of a generalised anxiety disorder and that aggravation is now in remission. 3. The claimant suffered a non-threshold injury, now in remission.

STATEMENT OF REASONS

INTRODUCTION

This is an application by the claimant for a review of a certificate and reasons of Medical Assessor Sidorov (the Medical Assessor) dated 25 January 2023.
The Medical Assessor found that the following injury caused by the accident, an acute stress disorder, was a minor injury (now a threshold injury) for the purposes of the Motor Accident Injuries Act2017 (the Act).
There is a dispute between the claimant and the insurer about: whether the injury caused by the accident is a threshold injury under Schedule 2, s 2(e) of the Act.
The claimant seeks a review of the medical assessment of the Medical Assessor under s 7.26(2) of the Act. The claimant asserts that the Medical Assessor’s assessment was incorrect in a material respect.
The following injuries were referred by the Personal Injury Commission (Commission) for assessment:
· psychiatric condition – post-traumatic stress disorder, depression and anxiety.

Bundles of documents

The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
The Panel is not required to “analyse every piece of information from every opinion contained in a document with which he [it] was provided” – see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel is to come to its own conclusion and to take its own history.

The accident

The accident occurred on 4 January 2018, at approximately 10:00am. The claimant was transporting patients in a Hyundai passenger van.
One of the occupants in the vehicle being driven by the claimant did not survive the collision.

LEGISLATIVE BACKGROUND

Jurisdiction

The claimant’s claim is governed by the provisions of the Act. This legislation provides a scheme for the compulsory third-party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2023 with various amendments commencing on 1 April 2023. From
1 April 2023 the MAI Amendment Act provided that a “minor injury” is to be known as a “threshold injury” and “minor injuries” are to be known as “threshold injuries”.
The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
The original Medical Assessment was issued when the relevant term was “minor injury” which, because of the amendment, is now described as a threshold injury. The original medical assessment was written at a time when the term was “minor injury”.
For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks.
Accordingly, an injury which does not fall within the definition of a threshold injury (a non-threshold injury) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26 week or 52-week limitation period. This accident however, occurred before that time of 1 April 2023.
While almost all injured persons are entitled to some statutory benefits in accordance with Part 3 of the Act, there are some disentitling provisions and limits to the amount and extent of benefits available. One of these disentitling provisions is that, under ss 3.11(1) and 3.28(1) of the Act, statutory benefits cease 52 weeks (or 26 weeks as the time of the accident dictates) after the motor accident if the only injuries sustained by the injured person are “threshold” injuries.
It should also be noted that in a common law damages claim, no damages are recoverable if the claimant’s injuries are “threshold” injuries.
Pursuant to Schedule 2, cl 2 of the Act, various matters are declared to be a medical assessment matters, including (e) “whether the injury caused by the motor accident is a threshold injury for the purposes of the Act”.

Threshold injury

Regarding a psychological or psychiatric injury, a threshold injury is defined in s 1.6 of the Act as “a psychological or psychiatric injury that is not a recognised psychiatric illness”.
In summary, if a person injured in a car accident does not have a recognised psychiatric illness, then the injured person’s statutory benefits cease in accordance with ss 3.11 and 3.28 of the Act. If a person injured in a car accident does have a recognised psychiatric injury then that injury will be a non-threshold injury.
Section 1.6(4) provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) further defines threshold injury to include an acute stress disorder and an adjustment disorder in terms of psychiatric or psychological injuries.
Section 1.6(5) says that the Motor Accident Guidelines (the Guidelines) may provide for the assessment of whether or not an injury is a threshold injury. Relevantly to the matters in issue in the claimant’s claim, cls 5.10 to 5.12 of the Guidelines are headed “Threshold psychological or psychiatric injury assessment” and provide:
“5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5- TR), published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”

Claimant’s submissions

It is the claimant’s assertion that the Medical Assessor failed to consider relevant evidence before him when coming to his conclusion in respect of the claimant’s injuries. Further, the claimant says that the Medical Assessor failed to provide adequate reasoning for his opinion.

Failure to consider relevant evidence

The claimant says that on page 5 of his certificate, the Medical Assessor detailed the relevant documentation he had considered in coming to his conclusion. The claimant says that it should be noted that the accident occurred more than five years prior to the assessment with the Medical Assessor and as such, the clinical evidence available is paramount to the determination of the claimant’s diagnosis and whether he sustained a threshold injury. The claimant says that the Medical Assessor has failed to consider the numerous diagnoses of post-traumatic stress disorder from various treating health practitioners since the claimant’s accident.
The claimant relies on the following entries contained within the clinical notes of Dr Bezic, relevant to the claimant’s motor vehicle accident and the injuries sustained:
(a)    Page 122 of the insurer’s reply – entry of 22 January 2018:
“On 4/1/18 involved in a MVA – driving clients – 3 in car. One passed away in hospital – an orphan. Did a eulogy at funeral. Known her for 5½ years… seen psychologist at work… still flashbacks, not sleeping, reduced appetite. PDX PTSD now.”
(b)    Page 140 of insurer’s reply – entry of 22 February 2019:
“IMP: flare up PTSD – last few months… for time of work now. I don’t think that he will be able to return to this work. Too emotionally draining for him following PTSD.”
(c)    Page 181 and 182 of insurer’s reply – entry of 14 August 2020:
“Still OCC – flashbacks of MVA, mainly when going to sleep or when first wakes up… PTSD seems to be in remission on the whole, ongoing anxiety symptoms.”
At page 209 of the insurer’s reply, Dr Bezic completes a mental health plan in which he states, “increasing anxiety over the last 2 months on a background of resolving PTSD – from MVA in January 2018 which involved a fatality.”
The claimant submits that given the historical nature of this claim, the clinical entries, and reports in respect of the claimant’s symptoms and diagnosis are crucial in the Medical Assessor arriving at his conclusion. The claimant says that the frequency of such reports and consultations, and the span of time over which they occur are also relevant in assessing the claimant’s injuries. The claimant asserts that the Medical Assessor has failed to consider, in any detail, the clinical records of the claimant’s treating general practitioner.
The claimant says that on page 5 of his certificate, the Medical Assessor considers these clinical records, however, the claimant says that he primarily refers to incidents and entries within the clinical records, unrelated to the accident.
The claimant also refers to the report of Thomas O’Neill dated 11 November 2021. The claimant says that Mr O’Neill states that “If there was a post-traumatic stress disorder, it is now in remission.” The claimant says that the Medical Assessor failed to consider this opinion.
The claimant refers to the report of Dr Barrett, psychiatrist, of 10 September 2019. Dr Barrett provided this report to Employers Mutual Limited for the claimant’s worker’s compensation claim. At page 7 of her report Dr Barrett provides the following opinion:
“In my view he likely developed generalised anxiety disorder in 2014, after his mother had a cardiac arrest threatening her life. There were less significant contributors at the time, including a change in work and the trial of acting in the Team Leader role, but in my view, were it not for his mother’s condition at the time this would not have resulted in significant anxiety.
As expected in generalised anxiety disorder, his anxiety has waxed and waned since. He has had a relapse in 2016 or 2017 in the context of a number of external stresses, relationship break ups and losses of his pet, extended family members and a former close friend, as well as the death of a client whom he had cared for. These work issues and non work issues caused an exacerbation of his pre-existing generalised anxiety disorder.
Then in January 2018, he developed PTSD as a consequence of the January 2018 accident, further increasing his anxiety overall, and then became dependent upon Benzodiazepine.
His condition has been complicated by chronic pain, the development of opioid analgesic dependence.”
The claimant says that Dr Barrett goes on to state the following at page 8 of her report;
“In the last few days, his PTSD symptoms have increased as a result of a minor accident a week earlier. I consider that were it not for the onset of PTSD in January 2018 and persisting symptoms, this minor accident would not have caused such symptoms. However, I expect that the exacerbation will settle in the near future as he continues to drive and therefore is undergoing an informal exposure program.
I consider that the January 2018 onset of PTSD has further exacerbated his pre-existing generalised anxiety disorder. His symptoms have fluctuated but persisted and overall, the combination of these issues have resulted in reduced resilience to manage usual workplace stress and an inability to continue to work despite an attempt at graded return to work after the accident.”
The claimant submits that Dr Barrett provided an assessment of the claimant approximately 18 months after the accident. She provided a detailed history in respect of the claimant’s pre-existing factors and further, provided a conclusive and reasoned basis for her diagnosis.
The claimant says that the Medical Assessor has failed to consider the report of Dr Barrett in coming to his conclusion.
The claimant submits that the opinion of Dr Barrett ought to have been considered by the Medical Assessor in coming to his conclusion.
The claimant also refers to the report of Dr Kohler, consultant clinical psychologist, dated

16 November 2020. The claimant says that on page 5 of his report, Dr Kohler states the following:
“Mr Sims has a history of suffering from PTSD, a major depressive disorder, and a generalised anxiety disorder. Mr Sims has reported benefit from his psychological treatment and management, with improvement in the measured symptoms.
In my opinion, while there are residual symptoms of PTSD, depression and anxiety, these symptoms do not require ongoing reasonably necessary psychological treatment and management.”
The claimant asserts that when the Medical Assessor considered the relevant clinical evidence, he chose to refer only to those documents that do not support the claimant’s diagnosis of post-traumatic stress disorder or a recognised psychological condition. Further, the claimant says that the Medical Assessor has entirely failed to consider much of the relevant evidence. The claimant reiterated that in a claim of a historic nature, the extensive clinical evidence requires review, for the Medical Assessor to form his opinion.
The claimant submits that the Medical Assessor ought to have made reference to the clinical evidence referred to and should have provided a reasoned basis for his diagnosis and conclusion. The claimant submits that the Medical Assessor has failed to adequately undertake this task.
The claimant submits that the Medical Assessor has failed to provide adequate reasoning for his diagnosis.
The claimant says that the Medical Assessor’s opinion is inconsistent with the extensive clinical evidence presented in this matter. The claimant submits that he continued to consult multiple medical practitioners following the subject accident with frequent diagnosis of and reference to post-traumatic stress disorder. The claimant says that it is plain on the medical evidence that his symptoms did not improve within a few weeks and gradually resolve. The claimant says that he continued to undergo psychological treatment and to date.
The claimant refers to the Medical Assessor stating that the multiple other stressors experienced by him would not account for his trauma related symptoms. However, in light of this, the claimant says the Medical Assessor failed to explain the extensive treatment undertaken by the claimant for his psychological injury.
The claimant submits that based on the clinical evidence, he suffered post-traumatic stress disorder or a recognised psychiatric injury as a result of the motor vehicle accident.
The claimant submits that the Medical Assessor does not engage with any of the medical evidence.

Insurer’s submissions

The insurer referred to the claimant relying on only the medico-legal report of Dr Gertler, psychiatrist, dated 22 January 2022 who made the following diagnosis;
“Following the motor vehicle accident of the 4 January 2018 Mr Sims appears to have developed symptoms consistent with an acute traumatic reaction. The symptoms included nightmares and flashbacks to the accident as well as anxiety when driving. Those symptoms have for the most part resolved and the post traumatic stress disorder must be considered to be in remission.
As well, Mr Sims developed symptoms of an adjustment disorder with depressed mood. This was related to the ongoing physical sequelae of the motor vehicle accident and the fact that he was suffering chronic pain, disability, and finally an inability to function in his work as a disability support worker.”
The insurer says that pursuant to s 1.6(3) of the Act and Regulation 4 of the Regulations, acute traumatic reaction and adjustment disorder are not recognised psychiatric illnesses and are a minor psychiatric/psychological injury.
The insurer says that given the similar findings made by the insurer’s qualified psychiatrist, Dr Chow and the claimant’s qualified psychiatrist, Dr Gertler, a Medical Assessor ought to also make a threshold injury determination for the claimant’s psychiatric injuries.
The insurer says that Mr O’Neill (clinical psychologist), assessed the claimant on

10 November 2021 for a workers compensation insurer.
Mr O’Neill noted the following history:
(a)    the claimant entered into a relationship with a vulnerable young person when he was 13 years old;
(b)    he was significantly bullied in primary school and bashed at the age of 16 in high school. This led him to develop anxiety being outdoors, in particular when using public transport which he still avoids;
(c)    a maternal cousin suicided by gunshot when he was 15 or 16 years old. His sister has a history of panic disorder and agoraphobia and was diagnosed with autism spectrum disorder in her teens. He has a maternal aunt with schizophrenia and bipolar disorder who later developed dementia. His mother also had a drug induced psychosis in her teenage years;
(d)    he said he was robbed on a number of occasions and learned about the fight or flight response. He surrendered to the situation by handing over his wallet. He denied ever sustaining any serious physical injuries;
(e)    he is prone to becoming panicky, stressed, and having difficulties thinking clearly when he is overwhelmed. This is often associated with intermittent insomnia. He had significant anxiety which was triggered in 2014 when his mother had a cardiac arrest and required CPR. There were also stressors associated with moving to a new group home and functioning as a team leader, and
(f)    he had a client with an illness in either 2016 or 2017 who eventually died. He required Diazepam and was quite upset at the time. He also had significant anxiety following the breakup of a relationship in April 2017 which he blames on his pet being around. He also had an uncle and aunt who died in 2017 and at the same time found out that a former childhood friend had died.
The insurer said that Mr O’Neill found no evidence on clinical interview and psychometric testing of the presence of a post-traumatic stress disorder, major depressive disorder, generalised anxiety disorder, or any other specific condition that is related to the accident on 4 January 2018.

The insurer noted that Mr O’Neill concluded that the claimant’s injury was considered resolved with significant complex family of origin issues, marked stressors unrelated to work, underlying anxiety vulnerability, and past history of social anxiety as well as generalised anxiety disorder.
Mr O’Neill said that the predominant features accounting for vulnerability are psychosocial stress and a vulnerable individual. He said that the claimant was likely to experience spikes in anxiety during times of stress when he felt overwhelmed. He was not manifesting signs of generalised anxiety disorder.
Despite the nature of the accident in 2018, Mr O’Neill found no evidence of marked intrusive symptoms, avoidance, marked alterations to cognition or mood, or marked hypervigilance as a result of the accident.
The following was also noted by Mr O’Neill:
(a)    if there was a post-traumatic stress disorder, it was in remission;
(b)    the treatment provided had been evidence based, however, the support being provided is to address problem solving around non-work-related issues, including significant family, health, car er, and other responsibility, and
(c)    treatment has likely maximised benefits in terms of wellbeing and increase in work capacity. He was a fulltime carer at the time of assessment for his grandmother and had been there and available for multiple crises and marked health issues.
There was significant stress associated with non-work-related factors - grandfather’s illness, the passing away of his grandfather in February 2021 with associated grief, and the added burden of needing to provide 24-hour care to his grandmother who lives in the house in front of his granny flat. At the time of assessment, he was negotiating with his family to secure additional support;
(a) there was no evidence of depression, anhedonia, or loss of interest in activity. His sleep was erratic but always had been. He had reasonable energy throughout the day.
The insurer submitted that on the balance, having regard to the reports of Dr Mitchell,

Dr Chow, Dr Gertler, Mr O’Neill and various clinical records, it would be accepted that any injuries sustained by the claimant were minor within the meaning of the Act.

Medical evidence

The claimant informed the Medical Assessor that he continued to experience other stressors, including his grandparents’ illness and deaths in the family. The Medical Assessor said that there was no current evidence of trauma related symptoms and no presence of pervasive low mood. There was also no evidence of mania or psychosis and no thoughts of self-harm, suicidal ideations or thoughts of harm to others.
The Medical Assessor concluded the claimant did not meet the diagnostic criteria for a psychiatric disorder, as per the DSM-5. He likely met the criteria for an acute stress disorder subsequent to the subject accident that was characterised by intrusion symptoms, including intrusive distressing memories of the subject accident, as well as nightmares and flashbacks related to the accident, a persistent inability to experience positive emotions, avoidance of many external reminders and memories relating to the subject accident and arousal symptoms, including sleep disturbance, increased irritability, hypervigilance, difficulties with concentration and exaggerated startle response. However, it was reported that the claimant’s symptoms improved within a few weeks of the accident and gradually resolved. Of note, the Medical Assessor said that the claimant had experienced multiple other stressors in his life, unrelated to the subject accident, including deaths of clients and family members that had caused temporary psychological exacerbation of his symptoms, but there was no evidence of a persistent deterioration in his mental state in relation to these events.
The Medical Assessor said that the claimant’s acute stress disorder was caused by the accident. Even though the claimant experienced multiple other stressors, the Medical Assessor said that there was no other identifiable cause around the time of the subject accident to account for his trauma related symptoms.
The Medical Assessor also concluded that the claimant’s acute stress disorder had resolved.
The Medical Assessor discussed a threshold injury and noting s 1.6(3) of the Act which says:
“A minor psychological or psychiatric injury (subject to this section) is a psychological or psychiatric injury that is not a recognised psychiatric illness.”
Part 1 cl 4 (2) of the Motor Accident Regulations also says:
“2) Each of the following injuries is included as a minor psychological or psychiatric injury for the purposes of the Act;
a) acute stress disorder
b) adjustment disorder
3) In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5)”
The Medical Assessor said that the claimant’s acute stress disorder was a threshold injury.
Dr Chow, consultant psychiatrist, provided a report dated 5 July 2021. He said that “It appears Mr Sims had suffered a period of Adjustment Disorder from the car accident. Physically and psychologically, he has been improving, but he has been affected by other psychosocial issues in the last six months.” Dr Chow assessed a whole person impairment score of 0%.
Dr Gertler provided a report dated 27 January 2022. Dr Gertler said that;
“Following the motor vehicle accident of 4 January 2018, Mr Sims appears to have developed symptoms consistent with an acute traumatic reaction. The symptoms included nightmares and flashbacks to the accident, as well as anxiety when driving. Those symptoms have for the most part resolved and the post-traumatic stress disorder must be considered to be in remission.”
Dr Gertler also said that “Mr Sims developed symptoms of an Adjustment Disorder with Depressed Mood”.
A report of Dr Anand dated 2 December 2019 noted that the claimant continued to have ongoing psychological stressors due to multiple life events. Dr Anand however is a rheumatologist and was treating the claimant for other issues.
Clinical records of Ms Dearlove show entries from 2018 and 2019 and recording mood and anxiety symptoms, secondary to multiple life stressors. The first entry, dated 9 May 2018, describes “panic attacks, trouble sleeping, flashbacks, unexplainable anger, lots of family stress”. There was no clear evidence however, that Mr Sims met the diagnostic criteria for a post-traumatic stress disorder.
Clinical records of Sylvania Family Medical Centre record of a history of insomnia from February 2016 and symptoms of stress and anxiety in a context of a high workload and the claimant’s mother being in hospital, also in 2016. There is a record of treatment with Diazepam, as well as a history of a relationship breakup, having to put down his dog and unexpected family deaths in May 2017, as well as the death of a friend from an overdose. A clinical entry, dated 2 February 2018, records a diagnosis of an acute stress disorder, experiencing flashbacks and feeling uptight, being unable to relax and disturbed sleep. A clinical entry, dated 16 February 2018, recorded an improvement in mental state, with less nightmares and flashbacks and driving well.
A response to questions by Theodore Simos, dated 29 July 2020, provided a description of the claimant’s trauma related, as well as anxiety and mood, symptoms.
There are Allied Health Recovery Requests for a psychologist of various dates. These note a diagnosis of a post-traumatic stress disorder, a major depressive disorder and a generalised anxiety disorder.
The following entries in the clinical notes of Dr Bezic are of note; .
“Entry of 22 January 2018 (previously referred to in the claimant’s submissions).
On 4/1/18 involved in a MVA – driving clients – 3 in car.
One passed away in hospital – an orphan. Did a eulogy at funeral. Known her for 5½
years… seen psychologist at work… still flashbacks, not sleeping, reduced appetite.
PDX PTSD now.
Entry of 22 February 2019.
IMP: flare up PTSD – last few months… for time of work now. I don’t think that ill be able to return to this work. Too emotionally draining for him following PTSD.
Entry of 14 August 2020.
Still OCC – flashbacks of MVA, mainly when going to sleep or when first wakes up… PTSD seems to be in remission on the whole, ongoing anxiety symptoms.”
Dr Bezic completed a mental health plan in which he stated, “increasing anxiety over the last 2 months on a background of resolving PTSD from MVA in January 2018 which involved a fatality”.
Dr Chow provided a report dated 5 July 2021. He said:
“He said over time his physical injuries have improved but he continues to have some
ongoing psychological difficulties.
It appears Ms Sims had suffered a period of adjustment disorder from the car accident.
Physically and psychologically he has been improving but he has been affected by other
psychosocial issues in the last 6 months.
The diagnosis is adjustment disorder. He needs ongoing psychological support.
Prognosis of his condition is likely to remain ongoing.
…It is in my opinion his current psychosocial stressors are contributing 50% to his
condition and his disability rather than his injury from the subject motor vehicle accident as he said physically he is much improved.”
Dr Chow provided a Psychiatric Impairment Rating Scale (PIRS) as follows;

Category

Class

Reason for Decision

Self-Care & Personal Hygiene

Class 1

No impairment. Mr Sims is showering regularly. He is doing household chores. He is his grandmother’s carer at night.

Social & Recreational Activities

Class 1

No impairment. He has resumed engaging in some hobbies and he is seeing his family and visited by friends regularly.

Travel

Class 1

No impairment. He can drive around by himself locally.

Social Functioning

Class 1

No impairment. He said his friends have been coming over to visit. He has regular contact with his grandmother, aunty, mother and sisters.

Concentration, Persistence & Pace

Class 1

No impairment. He did not report concentration difficulties.

Adaptation / Employability

Class 1

He is fit for full time employment.

List classes in ascending order:

1

1

1

1

1

1

Median Class Value: Aggregate Score:

Whole Person Impairment:

Dr Barrett provided a report of 10 September 2019. She reported;
“Mr Sims has generalised anxiety disorder, probably since 2014.
In addition he developed posttraumatic stress disorder from January 2018, although this had attenuated up until the most recent minor accident which exacerbated his symptoms.
He also has a benzodiazepine dependence, now using 15 mg of diazepam daily since February 2018 with evidence of withdrawal symptoms on cessation.
…
It is also likely that he is dependent upon opioid analgesics and I note there is a chronic pain condition.
In the last few days his PTSD symptoms have increased as a result of a minor accident a week earlier. I consider that were it not for the onset of PTSD in January 2018 and persisting symptoms, this minor accident would not have caused such symptoms. However, I expect that the exacerbation will settle in the near future as he continues to drive and therefore is undergoing an informal exposure program.
I consider that the January 2018 onset of PTSD has further exacerbated his pre- existing generalised anxiety disorder. His symptoms have fluctuated but persisted and overall the combination of these issues have resulted in reduced resilience to manage usual workplace stress and an inability to continue work despite an attempt at graded return to work after the accident.”
Dr Gertler provided a report of 27 January 2022. He said:
“Mr Sims developed symptoms of an adjustment disorder with depressed mood. This was related to the ongoing physical sequelae of the motor vehicle accident and the fact that he was suffering chronic pain, disability, and finally an inability to function in his work as a disability support worker.
The symptoms of the depression persist and are characterized by a general lack of motivation, recurrent rumination about the death of the client in the motor vehicle accident, which had been aggravated by the death of another client 6 months following the accident. Several months prior to the motor vehicle accident Mr Sims had developed psychological symptomatology following the death of another patient and had at that time sought counselling. By the time of the motor vehicle accident of January 2018 however, he had resolved those feelings and was essentially asymptomatic.”
Dr Gertler provided a PIRS assessment as follows;
“Self-Care and Personal Hygiene – Class 1
No impairment. Was slightly dishevelled at the time of assessment but is otherwise attending to his self-care and the needs not only of himself but also of his elderly grandmother.
Social and Recreational Activities - Class 2
Is socially somewhat withdrawn but is beginning to have friends visit.
Travel - Class 1
No impairment. Is able to drive without difficulty.
Social Functioning - Class 2
Remains close to his immediate family but has lost some contact with friends.
Concentration Persistence and Pace - Class 1
Denied difficulties in this area.
Employability - Class 3
Capable of up to 20 hours of employment per week but in an area other than disability.
Median Class Score:
1,1,1,2,2,3 = 1.5 = 2
Aggregate: 10”
Dr Gertler assessed whole person impairment: at 5%.
Dr Kohler, psychologist, provided a report of 16 November 2020. He said;
“Mr Sims has a history of suffering from PTSD, a Major Depressive Disorder and a Generalised Anxiety Disorder. Mr Sims has reported benefit from his psychological treatment and management, with improvement in the measured symptoms.
In my opinion, while there are residual symptoms of PTSD, depression and anxiety, these symptoms do not require ongoing reasonably necessary psychological treatment and management.”
Mr O’Neill, psychologist, provided a progress report of 11 November 2021. He said that ongoing psychological treatment was not considered reasonably necessary. The claimed injury had resolved. Mr O’Neill said that there were significant complex family of origin issues, marked stressors unrelated to work, underlying anxiety vulnerability, and history of social anxiety as well as generalised anxiety disorder.
Mr O’Neill concluded by saying;
“There is significant stress associated with non work-related factors. These relate to a host of lifetime traumatic events identified by Dr Barrett, in more recent years his grandfather’s illness, the passing away of his grandfather in February 2021 with associated grief, and the added burden of needing to provide 24-hour care to his grandmother who lives in the house in front of his granny flat. He is currently negotiating with his family to secure additional support.”
The claimant provided a statement dated 17 February 2022. In this statement, he listed his disabilities as;
(a)    pain, stiffness and discomfort in the lower back;
(b)    reduced sitting tolerance;
(c)    inability to twist and bend;
(d)    reduced ability to bend, reach or stretch;
(e)    reduced ability to squat, kneel and crawl;
(f)    reduced ability to lift, hold or carry;
(g)    reduced lifting capacity;
(h)    social isolation;
(i)    reduced driving tolerance;
(j)    depression;
(k)    post-traumatic stress disorder;
(l)    nightmares;
(m)     flashbacks;
(n)    anxiety;
(o)    stress;
(p)    persistent low mood;
(q)    feelings of melancholy;
(r)    feelings of hopelessness;
(s)    reliance on analgesics;
(t)    addiction to opioids, and
(u)    addiction to analgesics.

Medical examination

The claimant was medically examined by Medical Assessor Hong and Medical Assessor Canaris on behalf of the Panel on 13 August 2024. Their report follows:
“Video assessment.
Mr Sims was at home alone.
Drs Canaris and Hong were in their Sydney offices.
History
Psychosocial history and pre-accident history
Mr Sims was born in Australia and grew up with his parents and has a younger sister.
He confirmed being subjected to bullying at school. He said that school was not really for him and he left after Year 9. He did part-time waiter work and then returned to TAFE and later completed his HSC.
He confirmed being assaulted when he was 16 at a train station and said there was a group of bullies that targeted him. Every time he ran into them, they would say either to fight them or to give his possessions to them. He remembered for about one or two years he wouldn’t leave home as a result of this, but he did not seek psychiatric care at the time.
Mr Sims first had psychological treatment in his mid-20s and said that he didn’t suffer Post-traumatic stress disorder, but he had suffered an anxiety disorder and recalled he was generally anxious.
His recollection was that the only psychiatric medication he had ever taken before the subject accident, had been 3 or 4 courses of Valium. The Panel discussed with him there were more than 3 or 4 courses of Valium in his file, particularly in the two years before the accident, there were regular entries related to benzodiazepine. He recalled he consulted Stuart Perritt, Psychologist, and then had a counsellor through an Employee Assistance Program. He confirmed his mother had a cardiac arrest and he saw a psychologist, Stuart Perritt, a few times around that time.
He said that in the two years before the accident, he worked in Civic Disability as a full-time disability support worker, and found working in the group home stressful, and therefore sought psychiatric treatment.
Mr Sims recalled there was a particular patient who was new to the service and was in and out of hospital. He became close to that resident, and they were working on a 1:4 staff to client ratio. The client started having seizures and Mr Sims went to the hospital with the client, who later died in 2017, which led to him seeking psychiatric care. He recalled he had grief symptoms and found it tough to be at work, because it was the first time that he had experienced a client’s death. He said he felt supported by work. He was referred for EAP for ten sessions but said he did not use the full ten sessions.
In terms of general medical history, he does not have cardiac, thyroid or liver disease.
In terms of substance history, he used cannabis in his teenage years and still uses it occasionally at parties, including early in 2024. He denied other substance use and does not abuse alcohol.
In terms of family history, the Panel confirmed an aunt has Bipolar disorder/Schizophrenia and his sister has Asperger syndrome. Autoimmune disorder runs in the family.
He does not have a forensic history.
History of the motor accident
The subject accident happened on 4 January 2018. Mr Sims was working as a disability support worker and remembered he was running late that day. He drove the work van and took four residents and dropped off a client at a day program in Sutherland, and they were on the way back. It was around 9.00am and he drove through the intersection between Princes Highway and Rawson Parade. He then looked to the right and saw there was a car and realised it would not stop in time. He accelerated to try and get out of the way but in the ensuing collision, the right rear of the van was struck. The van spun and became airborne.
After the collision, Mr Sims exited and said he had to kick the door open. He switched off the engine and tried to assess the damages, and discovered the back wheel was at a 90-degree angle. He recalled he clutched his head because he could not believe the accident helped. He checked to make sure everybody was okay, and then called his supervisor. He said he became a first responder and helped everybody. He checked on the female driver from the other car in the collision. He then called 000 and spoke to the operator about the female driver's injury. He recalled he was screaming at the bystanders to not touch any of the residents - some of the passersby seemed to want to move the residents and he knew that after a collision they should not be moved, as they could suffer more injuries.
The ambulance and police came and took the three clients to the hospital. He said he felt okay at the time so he did not go to the hospital.
The paramedics eventually realised that Mr Sims was also in the collision and then checked him. He recalled the area manager arrived at the location of the accident and then took him to a local general practitioner.
Mr Sims said that physically he suffered whiplash and the next day was very sore all over his body. He said a T9/10 torn disc was only diagnosed about a year later.
He recalled the accident happened on a Thursday and after the weekend, he received the news that a resident who was taken to hospital had passed away.
History of symptoms and treatment following the motor accident
Mr Sims said after the accident he was waking up at 2am with flashbacks and would cry uncontrollably. He has anxiety and depressive symptoms.
Once he stopped working after the subject accident, he commenced treatment with Tania Helpert, Psychologist, and he said he asked for more Valium from his GP. He confirmed the doctor discussed Lexapro (SSRI, antidepressant) in February 2018 but he did not take it. He said he has never taken an antidepressant.
He did not stop driving and confirmed the GP entry that he was driving in February 2018 and drove past the location of the accident.
He said he did not go to work for about two months and then returned to work in Blair Athol House, which is a different house from where the client had passed away, and over the next few months he then upgraded to full-time pre-injury duties and by June 2018 he was working full-time on unrestricted duties. With psychological/psychiatric treatment, his psychological symptoms improved, and he returned to his pre-accident functioning and returned to work full-time in his pre-injury duties. The Panel concluded the aggravation from the subject accident had by then resolved and his psychological injury from the subject accident entered remission.
Details of any relevant injuries or conditions sustained since the motor accident
Mr Sims confirmed there was another car accident, which he said happened on 29 August 2019. He had gone to the GP and was in Miranda and then stopped at a traffic light when a P-plater caused a minor collision to the side of his car and broke the side mirror. He remembered this was close to the fire station. The other driver then claimed that Mr Sims was at fault. Mr Sims said he did not suffer any injuries from that accident as it was a minor accident but he said that just in case, he had lodged a PIC compensation claim for it.
He recalled after the subject accident he returned to work and there was another client that passed away and he saw the client only four hours before he died. He has worked as a disability support worker for Civic Disability and done it for around eight years, and in February 2019, he resigned. He recalled there was a new program at Wattle Grove but he suffered a breakdown and was crying, and decided that he did not want to do this work anymore and that he could not cope anymore. He said he was good at the job and was happy with the job but encountered several clients’ deaths over time.
He also reported that he has been having more physical problems and increased pain over time and was starting to take more Endone and that an annular tear disc injury was only picked up after a while.
He reported that his back injury has healed now. He did not work for a while after he stopped working at Civic. In 2023, he worked in a factory for flyscreens. He worked for less than one year and said that during that time he had another minor accident.
He reported that he had a girlfriend in 2018, the relationship ended in 2019, he explained because physically it hurt to do anything, which also affected intimacy.
He reported there had been other stressors, for example during the COVID pandemic his grandfather passed away and they were living together.
He was caring for his grandmother in 2022.
Current symptoms
He has anxiety symptoms, periods of low moods, sleep problems, concentration difficulties and sleep problems at times. He does not have suicidal ideation or psychotic symptoms. He does not have pervasive depression or loss of enjoyment.
Current and proposed treatment
Mr Sims is currently taking:
·    Diazepam 2.5 tablets (5 mg tablet) daily.
·    Targin
·    Endone
Mr Sims’ GP had discussed an antidepressant medication, and he has never taken it.
His current psychologist is Theodore Simos.
He has not had a psychiatric admission.
The Panel discussed with Mr Sims that his GP had warned him regarding benzodiazepine dependence. He said that he thinks that if he does not take it every day now, he would have a problem with withdrawal symptoms.
Clinical Examination
Mental State examination
Mr Sims had curly hair and a full goatee beard. He smiled and laughed appropriately. He engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. He was not restricted in his affect range and reactivity. He spoke spontaneously. He has a complex history, he was not thought disordered and the provided history was easy to follow. There was no overt cognitive impairment.
Current functioning
Mr Sims is 38 and living with his father in an apartment; he has no dependents.
He predominantly has one friend now. He said that sometimes he skips a shower. He feels that his weight has increased over time. He has some concentration difficulties and intermittent problems with sleeping. He is currently looking for work. He also helps his mother when he can.
Comments of consistency

There was no inconsistency identified.
Review of Documentation
Summary of relevant documentation
Personal Injury Commission certificate related to Mr Sims’ physical injuries by Medical Assessor Dr David McGrath, 6 April 2023, concluded his lumbo-thoracic injuries are threshold injuries.
Dr Frank Chow, IME psychiatrist’s report dated 5 July 2021, noted Mr Sims had flashbacks, nightmares, depression and anxiety. He is doing household chores and showering regularly. He drives around by himself, has resumed activities such as turntable and mixing music but mainly focuses on caring for his grandmother. In terms of past history, he said in 2015 or 2016 he had nine weeks off work due to burnout from work and saw a psychologist and six months prior to the accident, he had his first death of a client and also losses including a dog, an uncle, an aunty and a friend that passed away. He diagnosed an adjustment disorder and said he did not report impact from the subsequent accident of 23 August 2019 and assessed WPI at 0%.
Dr Melissa Barrett, IME psychiatrist provided a report dated 10 September 2019, noted various stressors since at least 2014, including when his mother had a cardiac arrest and he saw a psychologist, Stuart Perritt, a few times. His anxiety subsided but returned in 2016 or 2017. He then had an accident (the subject accident) and a graded return to work to full-time capacity. He saw Dr Wilkins, Psychiatrist, for one session, who diagnosed PTSD. He advised that he had Generalized Anxiety Disorder, probably since 2014 and developed PTSD from January 2018, which had been attenuated until the most recent minor accident and he had become dependent on benzodiazepines.
Dr Robert Gertler, IME psychiatrist reported on 27 January 2022, noted the subject accident. He became depressed and suffered anxiety and is hypervigilant when driving. He was taking Valium 5mg three times a day and is currently weaning off opioids. He diagnosed PTSD and this is in remission, but also an Adjustment Disorder due to the physical sequelae from the accident.
There were many reports from Mr Sims’ physicians and pain specialists.
The pain specialist, Dr Raj Anand had repeatedly discussed the need to monitor

Mr Sims’ benzodiazepine and the letters of April 2023 noted ongoing life stressors, including working on the family home and work. He was averaging about 2 ½ tablets of Valium a day and had been a on mirtazapine which was recently stopped.
Dr Anand’s last report appears to be 1 March 2021. He was still on Valium 15 mg a day.
Dr Terry Kohler, Independent Psychologist, provided several reports. 12 November 2020 noted a discussion with the psychologist treating him and noted the history of GAD, PTSD, major depressive disorder.
Lauren Dearlove, Psychologist, record has been noted. Appointment 19 May 2018 noted multiple trauma throughout life and some suicidal thoughts last year and having flashbacks. There was some childhood trauma, including being sick at three and again at eight, having nightmares about the family becoming sick and health-anxiety. There were stressors about clients, including one he worked with for seven years that died last week in the session of 13 May 2021.
Certificates of capacity noted he had a T-bone collision.
Allied health recovery request form noted PTSD and whiplash with consideration for somatic symptom disorder completed by Theodore Simos, psychologist 23 December 2019.
Dr Robyn Mitchell, Occupational Physician, on 18 June 2021 noted Mr Sims’ physical injury and also that he was assaulted at a train station at 16 and has suffered reactive depression to his mother’s illness. In 2017 he had an episode of anxiety and stress when a client passed away in July 2017. He was on Valium 15mg a day. He was diagnosed with PTSD by his treating doctors.
Independent Psychologist, Thomas O’Neill’s report, 11 November 2021 advised that PTSD was now in remission.
The GP records have been noted and some entries discussed with Mr Sims during the Panel’s assessment.
GP records predominantly from Dr Robert Bezic:
·    23 February 2016, try Restavit for sleep, insomnia, taking Normison (benzodiazepine).
·    8 March 2016 – temazepam (benzodiazepine) didn’t help. Looking for another job. Discussed antidepressants but is not keen.
·    4 November 2016 stress and anxious ++ and very heavy workload. Wants Ativan 1 mg (benzodiazepine). The next entry noted visual hallucinations with Ativan, still very anxious and given prn.
·    22 November 2016 – taking 1.5 Valium (Diazepam, benzodiazepine) twice a day, most days, consider SSRI. Seeing a counsellor but not a psychologist. Discuss try online CBT and mood gym.
·    29 May 2017 – lots of stress with mum. Broke up with girlfriend. Put down the dog. Some anxiety, sleep on and off, requested Valium. Seeing Stuart again, not suicidal. Mildly depressed. Mental Health Care Plan.
·    15 June 2017 cannot afford psychologist but sees a counsellor. Uses Valium and wants more Valium. Warned about the risk of addiction. Given Valium up to three times a day prn.
·    21 July 2017 – friend accidentally overdosed and a client passed away. Cannot concentrate. Meeting with EAP. 2
·    8 July 2017 - took Valium. Saw EAP. Has ten free visits. Consider SSRI.
·    22 January 2018, this is following the subject accident. Provisional diagnosis of PTSD. Valium prn. Started seeing Tania, Psychologist, and has seen her twice. Using Valium up to 15mg a day and is seeing Dr Greg Wilkins, Psychiatrist, soon.
·    2 February 2018 – given a PTSD diagnosis by Dr Wilkins, with flashbacks. Returned to work on restricted duties.
·    Further entry noted 16 March 2018, includes stress, anxiety about family gathering. Past trauma mentioned, including being assaulted at 16 at the train station, using Serepax. Strongly advised SSRI but not willing.
·    Regular Valium scripts from GP.
·    4 May 2018 requested Valium due to extra work stress. Client in hospital.
·    10 May 2018 – started at new house, low-care resident, a lot less stress. Some increased anxiety. Using Valium and wants Serepax (benzodiazepine).
·    28 June 2018 lost another client that he had known for seven years from lung cancer. There was no specific mention about the car accident but there was mention of flashbacks.
·    23 August 2018 less flashbacks but anxious when hearing sirens. Doing all normal duties by this stage but taking Serepax regularly. Having second-weekly psychologist. Subsequently Endone opioid was increased.
AHRR 4 dated 28 April 2021 diagnosed PTSD, GAD, major depressive disorder with a previous history of seeing a psychologist for anxiety, 2016 and 2017 from Mr Simos.
Determinations
Diagnosis and reasons
Mr Sims has a complicated psychiatric history and reported early life trauma and has suffered from longstanding anxiety symptoms and generalized anxieties, particularly since 2014, consistent with a Generalized Anxiety Disorder. There was evidence of psychological instability in the two years before the accident due to stressors at home with the family but also work stress and a client's death, and regular prescription of benzodiazepine and referral to have psychological treatment.
After the subject accident, Mr Sims described increased anxiety and did not work for two months. He then returned to work and within about five to six months had returned to work full-time and in his pre-injury, unrestricted duties.
About a year after the accident, he stopped working at Civic Disability, and the Panel confirmed there have been other stressors in his personal life and further clients' deaths that led to that decision. The Panel noted there have been subsequent stressors, including other personal losses, additional work stress, loss of clients and another minor accident.
The overall evidence and Mr Sims’ history is consistent with the subject accident having caused an aggravation of Mr Sims’ pre-existing GAD, which lasted for around 4-6 months and has since entered remission, as the pattern of symptoms and behaviour have returned to the pre-accident pattern. He does not have a psychological injury related to the subject accident now.
Whilst he still suffers from psychological symptoms and regular benzodiazepine use, these are not related to the subject accident, and he was having regular benzodiazepine and had anxieties and depressive symptoms, in the years before the accident.
He does not have PTSD, because the relatively minor nature of the accident and his described psychological and behavioural responses, are not consistent with the PTSD criterion A description. While there have been posttraumatic features, these do not suffice for a diagnosis of post-traumatic stress disorder.
In reference to Generalized Anxiety Disorder DSM-5-TR criteria, Mr Sims confirmed having:
Criterion A: Mr Sims described excessive anxiety and worrying thoughts about several events or daily activities, occurring most of the time, and more than half the days in the week for longer than 6 months before the accident, and his symptoms increased and caused functional impairment after the accident, then returned to the pre-MVA level.
Criterion B: He has difficulty controlling his worrying thoughts and associated emotions
Criterion C: He described symptoms lasting longer than 6 months as it started before the accident:
Feeling restless and on edge.
·    Generalised anxieties
·    Concentration difficulties and periods of time off work
·    Sleep disturbance treated with sleeping pill
Criterion D: This condition causes clinically significant distress.
Criterion D: This condition causes clinically significant impairment in his ability to function.
Criterion E: It is not caused directly by a general medical condition or substance/medication/drugs.
Criterion F: Mr Sims’ generalized anxiety symptoms do not occur only during a mood disorder, psychotic disorder, posttraumatic stress disorder or pervasive developmental disorder.
Causation and reasons

Mr Sims has pre-existing generalized anxiety disorder and was receiving benzodiazepine treatment and having psychological treatment or counselling not long before the subject accident. At the time of the accident, he was not asymptomatic. After the subject accident, he developed increased symptoms and psychiatric impairment from his pre-existing generalised anxiety disorder, and this aggravation is caused by the subject accident and is a non-threshold injury, as generalised anxiety disorder is a non-threshold injury. The aggravation then entered remission sometime between four to six months after the accident, and he no longer has a psychological injury from the subject accident now. The Panel adopts the report of Medical Assessor Hong and Medical Assessor Canaris.

Reasons

Because of the accident, the claimant suffered an aggravation of his pre-existing generalised anxiety disorder. This aggravation was temporary in duration and lasting four to six months only. Since that time, any psychiatric condition of the claimant cannot be attributed to the accident.
A generalised anxiety disorder is a non-threshold injury only and does meet the assessment criteria for a recognised psychiatric illness.
As discussed by the Medical Assessors, after the accident the claimant suffered a temporary aggravation of increased symptoms and psychiatric impairment from his pre-existing generalised anxiety disorder. At the time of examination by the Medical Assessors, the claimant was not suffering generalised anxiety disorder. However, a psychological condition caused by the accident can be present at any time to establish that a psychological injury is not a threshold injury for the purposes of the Act. See Lynch v AAI Ltd [2022] NSWPICMP 6 at [70]-[73]. The Panel adopts the reasoning in Lynch.
As the Medical Assessors concluded in their report, the claimant, after the subject accident, developed increased symptoms and psychiatric impairment from his pre-existing generalised anxiety disorder. This aggravation was caused by the subject accident and is a non-threshold injury. The aggravation then entered remission sometime between four to six months after the accident, and the claimant now, no longer has a psychological injury from the subject accident.
If there is evidence before the Panel that establishes at any time after the accident the claimant sustained a non-threshold injury caused by the accident, there must be a finding of non-threshold injury regardless of whether the injury has healed, the claimant has recovered, or the condition is in remission at the time of the Review.
The Panel also refers to the reasoning in AAI Ltd v Hoblos [2023] NSWPICMP 210 at [141]-[181]. There it was said that the psychological condition is evaluated by determining whether the motor accident caused or materially contributed to a psychiatric condition, albeit by way of aggravation.
The Panel notes that since the reasons were published in Hoblos, the Supreme Court has held that a psychological injury was established if the motor accident aggravated, accelerated or exacerbated a psychological condition – see Todev v AAI Limited t/as GIO [2023] NSWSC 836 at [50]-[53]. An exacerbation of a psychological condition does not have to be ongoing, to satisfy the meaning of an injury. The Panel notes that a common psychiatric diagnosis under DSM-5 TR is that the condition is “in remission”. That obviously means that the psychiatric injury has occurred, but its symptoms have subsided.
The Medical Assessors reported that the claimant still suffers from psychological symptoms and regular benzodiazepine use. However, these are not related to the subject accident, as the claimant was having regular benzodiazepine and had anxieties and depressive symptoms, in the years before and up to the time of the accident.
While the claimant described increased anxiety after the accident and did not work for two months, he then returned to work in a part-time capacity. Within about five to six months the claimant had returned to work full-time and in his pre-injury occupation, working unrestricted duties.

CONCLUSION

The claimant suffered, as a result of an accident occurring on 4 January 2018, a temporary aggravation of a generalised anxiety disorder.
The aggravation of the generalised anxiety disorder lasted 4-6 months and was thereafter in remission.
The claimant has suffered a non-threshold injury as a result of the accident on4 January 2018.

DETERMINATION

The certificate of Medical Assessor Sidorov is revoked.
The Panel finds that the claimant suffered a temporary aggravation of a generalised anxiety disorder and that aggravation is now in remission.
The claimant suffered a non-threshold injury.

Category	Class	Reason for Decision
Self-Care & Personal Hygiene	Class 1	No impairment. Mr Sims is showering regularly. He is doing household chores. He is his grandmother’s carer at night.
Social & Recreational Activities	Class 1	No impairment. He has resumed engaging in some hobbies and he is seeing his family and visited by friends regularly.

Travel	Class 1	No impairment. He can drive around by himself locally.
Social Functioning	Class 1	No impairment. He said his friends have been coming over to visit. He has regular contact with his grandmother, aunty, mother and sisters.
Concentration, Persistence & Pace	Class 1	No impairment. He did not report concentration difficulties.
Adaptation / Employability	Class 1	He is fit for full time employment.

[2024] NSWPICMP 657

17 September 2024