Sulusulu v QBE Insurance (Australia) Limited
[2025] NSWPICMP 711
•15 September 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Sulusulu v QBE Insurance (Australia) Limited [2025] NSWPICMP 711 |
CLAIMANT: | Faanoto (Grace) Sulusulu |
INSURER: | QBE Insurance (Australia) Limited |
REVIEW PANEL | |
MEMBER: | Alexander Bolton |
MEDICAL ASSESSOR: | Matthew Jones |
MEDICAL ASSESSOR: | John Baker |
DATE OF DECISION: | 15 September 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Review of decision of Medical Assessor (MA) who assessed the claimant as having 2% whole person impairment (WPI) and diagnosed a post-traumatic stress disorder with a dysthymic disorder; claimant involved in an accident; issue of whether the claimant’s psychiatric disability was affected by a pre-existing psychiatric disorder; the claimant's solicitors lost contact with their client and on failure of the claimant to attend a medical examination by the Review Panel it was only possible for the review of the certificate and reasons of the MA to proceed on the papers; Held – Review Panel assessed the claimant as having a 4% WPI and diagnosed a post-traumatic stress disorder in partial remission and an exacerbation of a persistent depressive disorder; certificate of MA revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Determination 1. The Panel revokes the certificate and reasons of Medical Assessor Ng dated 2. The Panel assesses the claimant as having a Post-Traumatic Stress Disorder in partial remission and an exacerbation of a Persistent Depressive Disorder. 3. The Panel has assessed the claimant’s whole person impairment at 4%. 4. The Panel makes no deduction for any pre-existing psychiatric condition of the claimant. |
STATEMENT OF REASONS
INTRODUCTION
The claimant seeks a review of the Certificate and Reasons including the assessment
of Medical Assessor Bradley Ng (“Medical Assessor”) dated 4 October 2023, on the following grounds:
(a) Ground A: Failure to demonstrate a clear path of reasoning, and
(b) Ground B: Failure to provide transparency and illogical conclusion.
The Medical Assessor diagnosed the claimant with post-traumatic stress disorder as being wholly attributable to the subject motor accident and Dysthymic Disorder which was partially attributable to the motor accident.
The Medical Assessor found a whole person impairment (WPI) of 2% and thereafter deducted 1% due to the Dysthymic Disorder.
The following injuries were referred by the Personal Injury Commission (the Commission) for assessment of WPI:
(a) Psychological Sequelae, and
(b) Major Depressive Disorder.
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 fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned – see WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46]. 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 has come to its own conclusion based on the documented history.
Medical examination of the claimant
The claimant has been legally represented however, her solicitors have lost contact with her and cannot locate her. The Panel had intended to medically examine the claimant but, as she could not be contacted, she was not able to be informed about the timing of a medical examination. Accordingly, the Panel has had to proceed to undertake an assessment on the papers consisting of the parties’ respective bundles of documents.
The accident
The accident occurred on 14 March 2019. The claimant was heading home from work. A car from a side street on the claimant’s left proceeded through a stop sign and crashed into her front left passenger side. The claimant was wearing a seat belt. She believed that there may have been a loss of consciousness for less than a minute. The air bags were activated.
The claimant was treated at Liverpool Hospital overnight. Her car was written off.
The Panel understands that the claimant sustained a fracture of the right index finger and a left wrist injury. These were treated conservatively and the claimant had specialist follow-up. There may also have been a torn left wrist ligament, which was diagnosed on MRI. The claimant had no surgery. She had physiotherapy for about three months, as well as hydrotherapy for her lower back. She was on Panadeine Forte and Panadol Osteo. There was no further treatment for any of those injuries.
The following history of the accident was reported by Alex Wong, physiotherapist, in his initial assessment report to the insurer dated 5 April 2019:
“Ms Sulusulu is a 28-year-old lady who presented with acute injuries of the lower back, right shoulder, right wrist and right 3rd finger. She reported that on 14/3/19 she was driving her car in a straight direction when a car failed to stop at a stop sign from a side street and impacted with the front left side of the vehicle. She stated that she stopped the car but was unable to move from the car, so she had to be extricated by emergency services. She was transported by ambulance to Liverpool Hospital where she stayed overnight and underwent scans of her whole body. They found a fracture of the right 3rd distal phalanx and was placed in a finger splint. She saw a hand specialist, Dr Roland Jiang, and he further diagnosed her with a fracture of the wrist and torn ligament in the right shoulder and she was placed in a wrist splint. She reported that she had been advised to wear it for another 6 weeks but also that she had been removing the splints when showering.
She reported that initially after the injury she had significant limitations with personal care as well as psychological issues including nightmares and flashbacks. She reports that she still has ongoing issues with performing ADLs and managing her personal care due to her injuries and whilst the nightmares have subsided, she still has anxiety when sitting in a car. She has not worked since the accident.”
Claimant’s submissions
Ground A
The claimant submits that after the accident, the following has occurred:
(a) She has resumed psychological treatment.
(b) She blames the motor accident on the breakdown of her relationship with her mother.
(c) She has lost all hope in herself and has felt lifeless.
(d) She has had suicidal ideation but no attempts.
(e) She feels alone and heavy.
(f) She suffers with her thoughts.
(g) She no longer goes out and is no longer exercising.
(h) She is using an increased amount of Marijuana.
(i) She wants to feel numb and normal.
(j) In the past 3 months she also feels alone, lonely and down.
(k) She thinks about her mother, her family and the significant separation she had had from her family.
(l) She is unsure what to do next.
(m) She has no plans for the future.
(n) She still feels numb.
(o) She still alludes to suicidal ideation with no attempts.
(p) She is reckless with substances and its only hurting herself.
(q) She is anxious about her current housing situation and finances.
(r) She is worried about her employment prospects.
(s) She is worried about her relationship with her family.
(t) She has ongoing intrusive memories about the motor accident.
(u) She avoids locations, persons and her family.
(v) She has variable sleep and middle insomnia twice during the night.
(w) She attempted to return to work but she was unable to and is presently not
working.
(x) She has no vehicle but she does occasionally use public transport.
(y) She keeps to herself.
(z) She has had issues with her mother following the motor accident.
The claimant referred to the Medical Assessor who considered an expert report of
Dr Teoh. He diagnosed a Major Depressive Disorder and found a WPI of 15%. The claimant says that the Medical Assessor did not consider the symptoms recorded by Dr Teoh in his report of 28 April 2023 which the claimant says were similar to the symptoms reported to the Medical Assessor.
The claimant confirmed that Dr Teoh found a class three impairment in social and recreational activities due to the claimant’s significant loss of interest in her usual activities and social isolation. The claimant says that the same symptoms were reported to the Medical Assessor and Dr Teoh.
Dr Teoh further found a class three impairment in social functioning, concentration persistence and pace and also adaptation.
The claimant submits that the Medical Assessor has erred by failing to provide a proper reasoning process as to how he found Post-Traumatic Stress Disorder and also Dysthymic Disorder, but then found a class one impairment in self-care and personal hygiene, travel, concentration persistence and pace and adaptation.
The claimant submits that there was ample evidence that the claimant has significant impairment based on the permanent impairment rating scale, as found by Dr Teoh and which has given rise to the diagnoses made correctly by the Medical Assessor.
Ground B
Failure to provide transparency and illogical conclusion.
The claimant says that the Medical Assessor has failed to provide a path of reasoning leading to the conclusion reached by him.
Insurers submissions
The insurer submits that the Medical Assessor appropriately commented on and utilised the medical evidence presented to him, in combination with the outcomes of his own examination to determine and assess the applicant’s WPI as provided for in the Certificate.
Self-Care and Personal Hygiene
The insurer says the Medical Assessor assessed the claimant as class one and considered that she was able to care for herself, do her own shopping, prepare her own meals, and do basic housework. The insurer says that this is as reported by the applicant during the assessment.
The insurer refers to the claimant’s submission that the Medical Assessor erred in placing the applicant in class one, despite diagnosing her with post-traumatic stress disorder. The insurer highlights that the independent medical report of Dr Teoh, on which the claimant relies, also placed her in class one.
Social and Recreational Activities
The insurer says that the claimant was assessed as class two for social and recreational activities. The insurer submits that the Medical Assessor considered she was able to do enjoyable activities but tended to keep to herself and participate in solitary activities. The insurer says that this is consistent with the information reported by the applicant at the assessment.
The insurer noted that Dr Teoh considered the claimant was class three for this psychiatric impairment rating scale(PIRS) classification. The insurer says that the claimant reported to Dr Teoh that she was unable to participate in boot camps, which she used to enjoy. The insurer submits this is not accident related and is due to her unrelated knee injury, for which she required surgery in May 2023.
Travel
The applicant submitted that the Assessor clearly erred in placing the applicant in class one, despite the diagnosis provided.
Class 1 of the (PIRS) is: “[c]an travel to new environments without supervision.”
The insurer says that at the time of the assessment, the claimant did not have a car but reported being able to use public transport. The claimant travelled to the assessment by way of train, bus and taxi. The insurer submits that the claimant became lost and had to tale a taxi to the appointment which the insurer says demonstrated it was a new environment. The insurer says she did so without supervision.
Further, during her work with Crew Services, she was required to travel and work in varying stores, which did not appear to impact her employment. The insurer referred to the claimant’s statement where she said that she left due to unstable hours and no consistent shifts.
Social Functioning
The insurer says makes no submissions with respect to this class. The applicant was assessed as class 4. Dr Teoh assessed the applicant as class 3.
The insurer submits that the reports of the applicant at the time of the assessment show a strained relationship with her family, with a complete breakdown of communication.
The insurer submits that the applicant had previously had family issues prior to the accident. Details of these prior incidents are recorded in the treating medical evidence, which the insurer submits are appropriately taken into account by the Medical Assessor.
Concentration, persistence, and pace
The insurer submits that again, the claimant submitted that the Medical Assessor erred in placing the applicant in class one, despite the diagnosis provided. The insurer notes that this submission does not consider the comments made by the Medical Assessor where he addresses that the claimant has issues outside of the motor vehicle accident.
The insurer says that Dr Teoh placed the claimant in class three, noting:
“She reported chronic pain and physical disability. She has been feeling depressed and worrying about her future and her physical condition. She reported insomnia and social isolation. She has been feeling lethargic and has been experiencing chronic pain.”
The insurer submits that the Medical Assessor had considered the appropriate aspects of the claimant’s reporting and came to an appropriate decision as to class.
The insurer noted that the claimant was able to concentrate on movies, held a
part-time job, and says that the Medical Assessor considered her able to concentrate for the assessment.
With respect to Dr Teoh’s comment regarding insomnia, the insurer noted that the claimant reported that this related to flashbacks when she was younger, and ‘not necessarily the accident.’
The insurer submitted that comments regarding the claimant’s physical condition/disabilities was outside of the area of expertise of Dr Teoh. The insurer noted that the claimant had been assessed for her physical disabilities by the Medical Service at 0% WPI and considered that her physical injures relating to the injury had resolved.
The insurer referred to the claimant noting that she left her employment with Crew Services due to unstable hours and no consistent shifts. The insurer says that at no stage did the claimant report difficulties in concentrating on movies, make any references to issues with concentration, nor comment on this with respect to issues with her employment with Crew Services in this regard.
Adaptation
The insurer submits that the Medical Assessor considered that there were no psychological issues that would prevent the claimant from working full time, or close to full time, in a suitable occupation. Therefore, the insurer says she was assessed as class 1.
The insurer had noted that the claimant had reported the following to the Medical Assessor:
“[the claimant] did obtain work doing merchandising and sales with Crew Services. She was not sure when she started, possibly in 2020 or 2021 and finished with the company by late 2022, possibly in November 2022. She could work from sixteen to thirty hours per week. She was doing shelving and displays at retail stores. The hours were not stable and there were no consistent shifts. Hence, she left that employment. She was not looking for any other work at the moment. There had been no other jobs since the 2019 accident.”
The insurer submits that the claimant admitted being worried about her employment prospects. The insurer says that despite this, she was not looking for any work. Further, the insurer says that the claimant underwent an unrelated knee operation in May 2023, which was determined as beneficial. The insurer says that the reason for the end of employment with Crew Services was not accident related. Further, the insurer submits that the claimant told the Crew Services she had alternative employment when leaving the employment.
The insurer submits that there is no evidence that the claimant stopped working due to the accident, or was unable to continue working due to psychological issues. The reported circumstances regarding the end of her employment with Crew Services is contrary to either of those assertions.
Following in from this, the insurer submits that there was no error in the claimant being assessed at class 1.
Treating Medical Evidence (Psychiatric Impairment) – from the insurer’s submissions
Prior Medical History
A general Practitioner (GP) Mental Health Plan, dated 26 April 2017, signed by
Dr Nguyen, diagnosed the claimant with post-traumatic stress disorder.
The claimant attended Ms Moubarak, psychologist, on 1 May 2017, for treatment focused on anxiety management, self-confidence building, and goal setting.
On 20 June 2017, Ms Moubarak commented that the claimant had attended her fifth session of psychological treatment. She had progressed with her ability to manage stress and effective communication strategies, however, treatment was to continue with a focus on self-confidence building and strengthening her stress management.
On 4 July 2017, the claimant reported issues with work and a strained relationship with her co- workers causing lowered mood and motivation. She described her mother as controlling her and her ability to leave the house. The pressure to complete her chores and meeting appointments took all her time.
On 12 September 2017, Dr Nguyen, records that the claimant has “recurrent thoracic back pain.” It was recorded that this was due to her weight. At that time, she was
161 cm tall and 114 kg.
There are also notations of previous issues with depression and anxiety, with an assessment of “adjustment disorder. PTSD?” on 12 September 2017.
A GP Management Plan was completed on 14 November 2018. The plan detailed that the claimant suffered from asthma, morbid obesity, fatty liver, and neck/back pain. The management plan goals included management of pain, improve mobility, improve knowledge of condition, and improve general health. A physiotherapy initial report completed by Alex Wong, dated 21 November 2018, noted the claimant started to experience left shoulder and lower back pain approximately a month earlier. She stated that her work caused her discomfort, and the claimant believed it began due to work as a general hand lifting school supplies.
Treating Medical Evidence
On 5 April 2019, Alex Wong of Rehab Solutions Australia, assessed the claimant following the motor vehicle accident. In addition to her physical injuries, she noted anxiety sitting in the car, flash backs, nightmares (initially), limitations with personal care.
On 20 March 2020, the claimant cancelled her appointment with Ms Moubarak stating “she was seeing another psychologist.”
However, on 9 April 2020, the claimant was referred to Ms Moubarak for psychological treatment. She presented with heightened ‘stress’ and difficulty managing this. The strategy was to focus on stress and anxiety management and building
self-confidence/resilience.
A rehabilitation report dated 9 April 2020 noted that the claimant’s GP, Dr Nguyen, said that the claimant was fit to work without significant restrictions, although she should avoid any manual handling roles. Despite this she had been unable to secure a job interview or paid employment. On 17 April 2020, her job-seeking file was closed given that she was considered competent enough to find her own employment.
On 22 April 2020, the claimant presented to Ms Moubarak. Clinical notes record issues with her boyfriend due to a lack of care and support, and low self-confidence due to not working and not gaining a position. This was a phone session. The claimant was complaining about medical issues. She was having issues with her boyfriend at the time for not providing any support or care. There was a discussion about relationships. There was no mention of the motor vehicle accident.
The claimant did not attend her appointment with Ms Moubarak on 29 April 2020, and there are no further records of attendance.
On 23 March 2022, the claimant was referred to Dr Dave, surgeon, due to acute anterior cruciate ligament (ACL) associated injuries in her left knee. This was related to an accident whilst on a scooter, post-accident.
On 31 March 2022, a Centrelink Medical Certificate said that the claimant was temporarily unfit for work due to her knee injury. There is no indication of any ongoing injury relating to the motor vehicle accident.
On 11 April 2022, Dr Nguyen prepared a mental health plan diagnosing mixed anxiety and depression, in addition to stress. Goals included returning to her premorbid level of functioning, minimise symptoms of depression, anxiety and stress. She was again referred to Ms Moubarak, psychologist.
On 8 April 2022, Dr Dave stated that the MRI suggested the claimant had an ACL injury, potentially medial collateral ligament (MCL) injury, and a meniscal tear. Dr Dave considered she would require significant rehabilitation, noting her high body mass index.
On 26 May 2022, progress had been made with her MCL injury as scans showed some stability. Dr Dave organised an ACL reconstruction at Fairfield Hospital.
A file note from Crew Services, a prior employer of the claimant, dated
20 January 2023, shows that her employment was terminated based on a message received from the claimant. Her reason for leaving the employment was not due to pain. The note read:
“Not available so you can go ahead and remove me off your database. I’m working for another Merchandise company.”
On 5 May 2023, the claimant underwent a left ACL reconstruction, hamstring autograft, and medial meniscus repair.
Medical evidence
The claimant was assessed by Dr Teoh who provided a report of 28 April 2023.
Dr Teoh diagnosed the claimant with major depressive disorder and assessed her whole person impairment at 15%, categorised as follows:
(a) Selfcare and personal hygiene: category 1
(b) Social and recreational activities: category 3
(c) Travel: category 2
(d) Social functioning: category 3
(e) Concentration, persistence, and pace: category 3
(f) Employability: category 3.
Dr Teoh assessed the claimant as having a Major Depressive Disorder and a WPI assessment of 15%.
Dr Teoh said that the claimant was reactive during the interview. Her speech was coherent, she was not thought disordered. She was cooperative and spontaneous.
She reported chronic pain and physical disability. She has been feeling depressed and
worrying about her future and her physical condition.
Dr Teoh said that the claimant’s condition was caused by the accident which had resulted in physical disability and depressive symptoms. He made no mention of work difficulties, family issues and the scooter incident and physical impact of that.
Medical Assessor Shahzad provided a certificate dated 11 June 2023. He concluded that right middle finger fracture had resolved. A right wrist soft tissue injury had resolved. A lumbar spine strain had resolved. There were injuries not caused by the motor vehicle accident, including cervical spine and left shoulder issues. Medical Assessor Shahzad assessed 0% WPI.
Medical Assessor Ng provided his certificate of 4 October 2023. He noted that in August 2022, the claimant had an accident on an electric scooter and suffered left knee problems. This required an operation in May 2023 which was reported by the claimant as having been beneficial.
The Medical Assessor said that the claimant had some post -traumatic stress disorder symptoms after the motor vehicle accident. She described intrusive memories, flashbacks, sleep disturbance and nightmares. The Medical Assessor said that many of those problems had subsided and the claimant only had residual symptoms of
post- traumatic stress disorder.
The Medical Assessor concluded that:
“Ms Sulusulu also describes long term depression and anxiety, but it is multi-factorial. There are a number of health problems, some of them related to the accident and some not. There appears to be a pre-existing family strain. The general practice record documents conflict with her mother beforehand and this has escalated over the last few years. There appears to be no solid link between the motor vehicle accident and conflict within the family. Ms Sulusulu has left the family home multiple times since 2019. She had a difficult relationship with her mother before 2019. She has now permanently left the family home due to a breakdown in that relationship.
Ms Sulusulu has ongoing symptoms of both Post Traumatic Stress Disorder and a Dysthymic Disorder which is a depression, not quite meeting criteria for a Major Depressive Episode. Both of disorders are according to DSM IV/V criteria.”
The Medical Assessor diagnosed that the claimant had some post-traumatic stress disorder symptoms after the motor vehicle accident. He said that the claimant described intrusive memories, flashbacks, sleep disturbance and nightmares. The Medical Assessor said that many of those problems had subsided and she only had residual symptoms of post-traumatic stress disorder.
The Medical Assessor said that it has been over four years since the motor vehicle accident and during that time, the claimant had psychological treatment. She had experienced major subsequent stressors separate from the accident. The Medical Assessor said that any impact from the accident had stabilised and the psychopathology had stabilised and reached maximum medical impairment.
The Medical Assessor provided the following permanent impairment rating scale.
| Psychiatric diagnoses | 1. Post Traumatic Stress Disorder (wholly attributable to the accident) | 2. Dysthymic Disorder (partially attributable to the accident) |
| Psychiatric treatment description | Psychological therapy | |
| Category | Class | Reason for Decision |
| 1. Self Care and Personal Hygiene | 1 | There is no psychiatric disability preventing Ms Sulusulu from caring for herself, doing her own shopping, preparing her own meals and doing basic housework. |
| 2. Social and Recreational Activities | 2 | Ms Sulusulu can do enjoyable activities, but they tend to be solitary. She tends to keep to herself. There are not a lot of enjoyable activities in her life and that is consistent with mild impairment. |
| 3. Travel | 1 | There are no issues with independent travel and Ms Sulusulu can use public transport. |
| 4. Social Functioning | 4 | There are major problems and I note that Ms Sulusulu is now estranged from her family. She is in contact with one friend. She is able to have a good relationship with other people in her temporary accommodation. |
| 5. Concentration, Persistence and Pace | 1 | There were no objective deficits and Ms Sulusulu was able to focus and concentrate throughout today’s entire assessment. |
| 6. Adaptation | 1 | From a psychiatric point of view, there are no issues and Ms Sulusulu was working part-time until late 2022, up to 30 hours per week. There would be no psychiatric barrier |
| to her working full time or close to full time in any suitable occupation. | ||
| List classes in ascending order: 1, 1, 1, 1, 2, 4 | ||
| Median Class Value: 1 | ||
| Aggregate Score: 10 | ||
| % Whole Person Impairment: 2% | ||
*%WPI = Percentage Whole Person Impairment
Regarding the WPI assessment of 2%, the Medical Assessor said that only the
post- traumatic stress disorder would be completely linked to the motor vehicle accident, while the Dysthymic Disorder was only partially linked to the accident. He said that most of the Dysthymic Disorder was due to other problems, outside of the accident.
The Medical Assessor said that given that the Dysthymic Disorder comprised, on his assessment, most of the psychopathology, greater weight would be given to the Dysthymic Disorder. Because of that, he made a 50% deduction which equated to a final WPI assessment of 1%.
The final WPI assessment of the Medical Assessor was 1%.
The Medical Assessor said that there was no evidence of sustained benefit from treatment. However, earlier in his reasons, he said that the claimant had undergone psychological treatment and that any impact from the accident had stabilised.
Dr Rimmer provided a report for the insurer dated 14 February 2022. This was a report going to the claimant’s physical injuries. He concluded that. as a result of the accident on 14 March 2019, the claimant sustained injuries to four anatomic sites:
a) Right middle finger.
b) Right wrist.
c) Left shoulder.
d) Lumbar spine.
Regarding ongoing disabilities Dr Rimmer did not believe that the claimant had any such disabilities based on what he said was an essentially normal examination of all anatomic sites.
Dr Bodel provided a report for the claimant of 28 January 2022 going to her physical disabilities. Dr Bodel said that treatment was a very difficult issue. From the orthopaedic point of view, she needed exercise and physiotherapy.
From her general health point of view, she needed weight reduction and psychological support. Dr Bodel did not anticipate the need for surgery for any of the claimant’s orthopaedic disabilities.
Medical Examination and adoption of findings
The Panel had made arrangements to medically examine the claimant but as explained earlier, she cannot be located or contacted. Accordingly, the Panel has had to proceed on the basis of an assessment of her psychiatric disabilities on the papers. This has been undertaken by Medical Assessor Jones. His report follows:
“The Panel had previously convened to discuss Ms Sulusulu’s case. An assessment was booked for 28 January 2025 for the Medical Assessors to examine Ms Sulusulu however she failed to attend. The Panel has subsequently convened, and it is apparent that Ms Sulusulu is unable to be contacted by her legal representatives. Generally, this would occur in the context of a withdrawal of a claim. However, the Panel informed the parties, and particularly the claimant’s legal representatives that unless the claimant can be contacted on or before 20 June 2025 and informed that she is required to attend a medical examination, then the Panel would proceed to thereafter provide a review and assessment on the papers. This is an unenviable and challenging task given the intended purpose of a medical assessment is to ascertain the claimant’s mental status and level of impairment at the time of the assessment. Notwithstanding these limitations, the review of Ms Sulusulu’s case on the papers appears below.
All of the documents provided were perused, however relevant documents are reviewed below, and following this, our conclusions will be stated.The PIC Certificate under review is by Dr Bradley Ng and was dated
4 October 2023. Dr Ng assessed that Ms Sulusulu suffered from Post Traumatic Stress Disorder which was wholly attributable to the accident, and Dysthymic Disorder (more formally likely Persistent Depressive Disorder under DSM-5-TR), which was partially attributable to the accident.In Dr Ng’s assessment of Ms Sulusulu, she was born in New Zealand and came to Sydney at the age of five with her brother and mother. She was raised in a single parent household. She finished high school in Year 10 and then completed nursing studies and worked as an Assistant in Nursing for three or four years. This was after working in retail and as a medical receptionist. She found her nursing work emotionally challenging and started working as a pick-packer on a full-time casual basis.
The accident was described as Ms Sulusulu was driving alone, a car from a side-street went through a stop sign and crashed into the front left passenger side of her vehicle. She believed that she had a brief loss of consciousness. The car’s airbags were deployed. The car was written off and she was treated at Liverpool Hospital overnight, suffering a fracture to her right index finger, and a left wrist injury. She was later treated conservatively, had physiotherapy, hydrotherapy, and was on painkillers for a period. There was no further treatment for her physical injuries.
Ms Sulusulu had some ongoing problems with respect to her physical injuries including related to her right index finger and her left wrist. She still had lower back pain at that stage.
Ms Sulusulu re-engaged with a psychologist whom she had previously seen, Charmain Moubarak, at the end of 2019. Ms Sulusulu was having problems with her mother from mid to late 2019, including arguments at home and the relationship deteriorating. Her mother was accusing her of being lazy and not wanting to do anything around the house. Ms Sulusulu was angry at a lot of things and felt that no one understood her. She lost hope in herself and felt lifeless. She had suicidal ideas but no attempts and felt alone and heavy. She was not going out and was no longer exercising and was using increased amounts of marijuana.
Ms Sulusulu saw the psychologist during 2019 and then once or twice in 2020. She did not see anyone during 2021 and 2022. She had attempted to re-engage with her psychologist in 2023, however the psychologist was not available. There were some phone consultations. She had not seen a psychiatrist for treatment and was not on psychiatric medications.
Ms Sulusulu had a subsequent accident in August 2022 involving an electric scooter from she suffered left knee problems. She went to have an operation on this in May 2023, which was described as beneficial. At the time Ms Sulusulu was reportedly having three alcoholic drinks per day and up to a quarter of an ounce of marijuana per day, estimated to be about eight cones per day (Comment: There is approximately a ten-fold difference between these two estimates). Ms Sulusulu told Dr Ng that the marijuana relaxed her thoughts. She denied any other illicit drug use.
Around the time of Dr Ng’s assessment, Ms Sulusulu had been feeling alone, lonely and down, and she had been experiencing a lengthy separation from her mother and family. She was unsure about her future, she felt numb, she had some suicidal ideation but no attempts. She admitted that she had been reckless with substances, and she was hurting herself with this behaviour. She was upset about the death of her dog, and she was anxious about her current housing situation and finances. She was worried about her employment prospects. She was concerned about her relationship with her family.
Ms Sulusulu denied any flashbacks, however at the time had ongoing intrusive memories about the accident. She was also having distressing memories of her current life situation. She was avoiding places where her family might be.
Ms Sulusulu, at the time of Dr Ng’s assessment, admitted to being violent to random members of the public. She described two situations where she had altercations with members of the public because she felt that they were attacking her.
Ms Sulusulu had variable sleep, waking twice during the night and she would sometimes wake spontaneously and be wide awake. She at times had flashbacks of when she was younger, but not necessarily the accident. She had no particular dreams or nightmares that she remembered.
Of note in her mental state examination at the time was that she was anxious about current life stresses and had some anxiety and intrusive memories about the accident. She was appropriately groomed and presented, was able to develop rapport, her speech was normal, her affect (expressed emotion) was congruent with her mood, there was no evidence of psychosis, there were no strong thoughts of harm to herself or others and her cognition, insight and judgment all appeared reasonable. Dr Ng noted no gross inconsistencies.
With respect to her functioning around the time of that assessment, Ms Sulusulu had not returned to work as a pick-packer as her doctor had not given her clearance. She did obtain some work in merchandising and sales, starting in either 2020 or 2021, but finishing up there in late 2022. She was working from 16-30 hours per week, however the hours were not stable, nor were there consistent shifts, so she left the employment. She was not looking for any other work at the time of Dr Ng’s assessment.
Ms Sulusulu described significant problems in her relationship with her family to Dr Ng. Between 2020 and 2022 she described herself as constantly angry whilst living at home. She had left home a few times. There was conflict with her mother about her “attitudes and habits.” She was drinking alcohol, smoking marijuana and “could not be bothered.” She had relationship problems with her brother and left the family home for the final time in January 2023 and was now estranged from her mother and brother. Ms Sulusulu had to euthanise her elderly dog after leaving home, and she was not in a relationship. She had ceased contact with her father, mother or brother and had “blocked them all” for “peace of mind.”
At the time of Dr Ng’s assessment, Ms Sulusulu was in temporary housing and had no formal fixed abode. Her current accommodation, organised through a non-government organisation, had been for one week. She had been in four different temporary accommodations since the January of the year of the assessment. She confirmed that she was doing very little on a day-to-day basis, she sometimes slept through the day, although she was able to do chores and go to the local shops. She was able to cook and do her own laundry. There were eight other people in the accommodation at that time and she tended to keep to herself, but could interact if needed. She was accessing social media, watching videos on her phone, she might smoke marijuana in a local park where she goes for a walk, and she would also go to a hotel to have a few beers. She was in touch with one friend in Australia. She was able to use public transport and did not have a vehicle. On the day of the assessment, she reported that she became lost and had to take a taxi to the correct address. She was therefore late for the appointment.
Dr Ng summarised the relevant documentation including a general practice record of Mediclinic Bankstown. This included a history of Ms Sulusulu having presented on
24 April 2017 with a “nervous breakdown after a fight with a family member.” The possible diagnoses included Adjustment Disorder and PTSD. Counselling was provided. The records following the accident included presentations for orthopaedic injuries and a note on 1 November 2019 that there had been a fight with her mother and she had left home. She was tearful on that occasion. There was a case conference noted on 20 November 2019 recording that Ms Sulusulu was avoiding heavy manual work, but her functional capacity had almost returned to normal. On 11 July 2020, she was noted to be tearful after a break-up with her partner. On 10 September 2020, it was noted her relationship with her mother had improved. In a note on 13 September 2022, Ms Sulusulu presented with insomnia and tiredness. She was sleeping during the day and waking up choking at night. The possibility of obstructive sleep apnoea was entertained.Dr Ng reviewed the clinical notes of Charmain Moubarak, Psychologist. This refers to an entry dated 22 April 2020 which did not mention the motor vehicle accident, Ms Sulusulu was complaining about medical issues and having issues with her boyfriend at the time.
Dr Ng noted Dr Ben Teoh’s psychiatric report dated 28 April 2023. Dr Teoh diagnosed Major Depressive Disorder with a whole person impairment of 15%. Dr Ng also noted the permanent impairment medical assessment from Dr Farhan Shahzad, dated 11 June 2023, indicating 0% whole person impairment and that her physical injuries had resolved.
Dr Ng’s overall opinion was that there had been some Post Traumatic Stress Disorder symptoms, many of which had resolved, and she now had residual symptoms. Dr Ng also noted longstanding depression and anxiety, noting pre-existing family strain and that there is no clear link between the motor vehicle accident and the conflict within the family. Dr Ng noted that the Post Traumatic Stress Disorder symptoms would have been attributable to the subject motor vehicle accident, but they were now minimal, and that the Dysthymic Disorder (Persistent Depressive Disorder) was only partially related to the subject motor vehicle accident.
Dr Ng went on to assess current whole person impairment as 2% with, notably, a score of class 4 for social functioning, noting that she had been estranged from her family. Dr Ng utilised his own reasoning (which seems understandable but not in line with Motor Accident Guidelines) and deducted 50% of the whole person impairment due to the Dysthymic Disorder comprising most of the psychopathy. He opined a final whole person impairment of 1%.
The claimant’s submissions with respect to Application for Review of the assessment of Medical Assessor Bradley Ng, dated 11 October 2023, was noted. This submission was based on a failure to demonstrate a clear path of reasoning and a failure to provide transparency, and illogical conditions. The first ground for the review was based on disagreement with Dr Ng’s clinical assessment of whole person impairment. The second ground rests on the claimant’s solicitors not understanding the reasoning behind the whole person impairment assessment. The submission seems to conflate the issue of the presence of symptoms with the presence of impairment, or an assessment of functioning, as is required with the PIRS. The Panel has reviewed Dr Ng’s PIRS assessment in his certificate and there is reasonable evidence, and reasoning, for his assessment of PIRS as at the time of his assessment of Ms Sulusulu.
General Practitioner records of Mediclinic Bankstown are noted with her height of 161cm, and weight in 2009 of approximately 100kg, 109kg in 2010, 99kg after prescription of Duromine in 2010, 114kg in 2013, 113kg in 2016; a BMI of 50 in 2016. There is a noted presentation on 24 April 2017 indicating a “nervous breakdown” after a fight with her mother with the precipitating factor being a previous relationship problem. Her ex-boyfriend was violent and abusive, and he had threatened to harm himself, or her, in the past. The diagnosis was “Adjustment Disorder, PTSD?”. She was referred to Psychologist, Charmain Moubarak at that stage with a self-reported K-10, psychological distress, score of 34/50. Her weight was 126kg in October 2018 and the motor accident is noted on 18 March 2019. In November 2019 it is noted that her functional capacity had almost returned to normal and, in February 2020, it was indicated that she was performing full duties at home. Her weight is measured in February 2020 as 142kg. The first mention of a presentation for psychological reasons is 16 March 2020 when a Mental Health Care Plan was instigated. There is a note in September 2020 that she was caring for her mother and that her relationship with her mother had improved. There was nevertheless “stress/relationship counselling”. There was a presentation on 13 September 2021 for insomnia with tiredness, sleeping in the day, and waking up choking at night with the general practitioner questioning whether Ms Sulusulu’s morbid obesity was causing obstructive sleep apnoea. The records end in December 2021, with little in the way of presentations for mental health problems.
The Mental Health Plan and Review dated 26 April 2017 is noted with the diagnosis being Post Traumatic Stress Disorder. Her K-10 score at that stage was 36/50.
The first Certificate of Capacity noted regarding the accident had physical diagnoses listed, as did subsequent Certificates of Capacity and Certificates of Fitness.
General Practitioner Mental Health Care Plan dated 16 March 2020 is noted with presenting issues of depressive symptoms, anxiety symptoms and stress. The diagnosis was mixed anxiety and depression, stress.
There is a referral to Ms Charmain Moubarak, Psychologist, dated 16 March 2020, asking for opinion and management with Ms Sulusulu presenting with anxiety, depressive symptoms for further psychological intervention. There is no mention of the motor vehicle accident.
There is a letter from Charmain Moubarak to Ms Sulusulu’s general practitioner, dated 20 June 2017, indicating she had attended five sessions of psychological therapy.
Clinical notes from Ms Charmain Moubarak are noted including for 22 April 2020 with no mention of the motor vehicle accident. There is a note for 20 May 2020 that the appointment was cancelled indicating Ms Sulusulu was seeing another psychologist. There is a note on 13 July 2017, during a previous series of treatment, when Ms Sulusulu cancelled the appointment. There are notes for four preceding sessions in mid-2017 indicating problems at home, problems at work (and some cancellations of appointments and non-attendance).
Psychiatric Report from Dr Ben Teoh dated 28 April 2023. This preceded Dr Ng’s assessment of Ms Sulusulu. This is a somewhat brief report and Dr Teoh diagnoses Major Depressive Disorder and subsequently opines a whole person impairment of 15%. Dr Teoh’s reasoning does not seem to justify his assessment of whole person impairment. For example, a loss of interest or motivation in previous activities does not necessarily justify a Class 3 impairment in Social and Recreational Activities; “she admitted that she has been aggressive and irritable. She reported a marked fluctuation in her mood” does not necessarily relate to Social Functioning descriptors, and if it did it would represent a Class 2; “She reported chronic pain and physical disabilities. She has been feeling depressed and worrying about her future and her physical condition. She reported insomnia and social isolation. She has been feeling lethargic and has been experiencing chronic pain”, does not necessarily relate to Concentration Persistence and Pace descriptors and focusses heavily on physical symptoms, that are excluded under current guidelines, and perhaps representing a Class 2 from a psychiatric perspective, and; “She is fit for suitable duties. Her capacity has been reduced since the motor vehicle accident. She has tried to return to work, unsuccessfully” is not informative with respect to delineating the Class of impairment in the Adaptation category and might represent a Class 2.
There are various physiotherapy and orthopaedic records.
In summary, contained in the claimant’s revised bundle of documents (over 500 pages) there is little to support a highly significant psychiatric injury caused by the motor vehicle accident or a whole person impairment above 10%, nor is there much in the way of information to suggest that the original Medical Assessment Certificate should be challenged.
The insurer’s Review Application bundle of documents numbered approximately 136 pages.
The submissions dated 19 October 2023 (post-assessor Ng’s certificate) are noted.
The insurer’s PIC submissions dated 27 June 2022 are noted. They point out that by that date there had been no application for psychiatric injuries made.
The insurer’s submissions dated 15 August 2023 are noted. They note that the end of Ms Sulusulu’s relationship with Crew Services, a merchandising company, was based on her stating that she was working for another merchandise company.
PIC Certificate from Assessor Farhan Shahzad dated 11 June 2023, although for physical injuries, includes some mention of matters of psychological and psychiatric relevance. It notes that her scootering accident following the subject motor vehicle accident led to a knee injury and the need for knee surgery. There is mention of difficulties with sleeping and fatigue and that her ongoing pain makes her feel “angry and useless.” There is mention that she had gained over 60kg and had developed psychological symptoms of anxiety and depression. She was not taking any antidepressant medication but reported that she had been diagnosed with mental health issues. She reported to Assessor Shahzad that she was seeing Psychologist, Charmain Moubarak because of psychological disturbances following the motor vehicle accident. At that stage her height was 170cm and her weight was 119kg.
Email from Crew Services Group indicating case notes that there was a text message from Ms Sulusulu on 20 January 2023, “Not available so can you go ahead and remove me off your database. I am working for another merchandise company, all the best.”
CONSIDERATIONS
There has been little novel documentation for approximately two years, particularly as relates to Mr Sulusulu’s psychological and psychiatric status. The Panel has the challenge of attempting to make an opinion about Ms Sulusulu’s current psychiatric status, the presence of any diagnosis, her current level of functioning, and make sense of her pre-accident mental health history in a situation where she is uncontactable, unwilling, or unable, to attend Medical Review Panel assessments.
Her history, as at the time Assessor Ng produced his Certificate and whole person impairment assessment with respect to the subject motor vehicle accident was that she had experienced psychological problems prior to the motor vehicle accident, including engaging with a psychologist, albeit only for approximately five sessions in 2017 with a variable attendance. She had a history of problematic relationships in her family, she had had a history of an abusive relationship with her partner, and she had previously drunk alcohol, smoked marijuana and been morbidly obese. She had an occupational history that was varied.
Assessor Ng’s assessment of Ms Sulusulu appears to be the most comprehensive (and in fact the closest to contemporaneous) and the Panel considers her narrative reported to Assessor Ng, and Assessor Ng’s observations of Ms Sulusulu, to be valid.
The claimant’s submissions challenging this Certificate revolved around his reasoning and logic with respect to his assessment of whole person impairment. The claimant’s submissions appear to have confused the presence of symptoms with the presence of impairment and although the Panel does not agree with Assessor Ng’s rationale for making a 50% deduction on whole person impairment based on pre-existing mental health problems (he diagnosed a Dysthymic Disorder, which would now be considered Persistent Depressive Disorder, because of DSM revisions), the information provided in his Certificate and his logic with respect to assessing current whole person impairment is considered by the Panel to be valid in the presence of the information available to him. There is no information available that contradicts his assessment, however the Panel notes that Dr Teoh’s independent medical assessment differed slightly with respect to the diagnosis (Major Depressive Disorder as opposed to ongoing Dysthymic Disorder), and the absence of any Post Traumatic Stress Disorder diagnosis, Dr Teoh differed in his assessment of whole person impairment, although in the Panel’s opinion his reasoning lacked validity because it contained an inherent lack of reasoning with respect to utilising the PIRS. .
With respect to the issue of pre-existing mental health conditions, which likely existed, on the information available, utilising the appropriate Guidelines, an assessment of whole person impairment for a pre-existing impairment should be undertaken. This is an impossible task with respect to the information available, although this could be more properly explored in an in-person Medical Review Panel Assessment, were that to have been a possibility. There are potential areas of possible impairment with respect to her pre-existing mood disorder such as in the areas of social and recreational activities, social functioning or concentration, persistence and pace, and adaptability, however no fair or firm opinion could be made with respect to this, given the information available. As such, it can be assumed that, although Ms Sulusulu may have had a pre-existing psychiatric diagnosis and possibly a pre-existing impairment, an impairment level of 0% is a fair estimate.
Therefore, despite the complexity of the case, Ms Sulusulu’s level of whole person impairment post-accident is low (last assessed as 2% by Assessor Ng) and there is no information available that would alter the Panel’s opinion of this level of impairment by any significant degree. The issue with respect to pre-existing impairment can be considered moot as the Panel accepts that there was likely a 0% whole person impairment. The Panel is not aware of any treatment that Ms Sulusulu is or has been undertaking. At the time of the previous medical assessment, she was not taking antidepressant medication, nor was she actively seeing a psychologist or a psychiatrist. With the information available to the Panel, there is no adjustment for treatment effect.
Therefore, with the inherent significant limitations of an assessment on the papers, and in the absence of any further documents to inform the Panel, in its assessment that Ms Sulusulu’s diagnosis from the motor vehicle accident was a mild Post Traumatic Stress Disorder, in partial remission, and an exacerbation of a mood disorder, namely a Persistent Depressive Disorder of mild severity.
The presence of a Substance Use Disorder is also likely, given Ms Sulusulu had reported daily ingestion of marijuana in an amount somewhere between 8 cones to a ¼ of an ounce a day. There was also daily alcohol ingestion, at the time of the medical assessment. As Ms Sulusulu was both drinking alcohol and smoking marijuana prior to the motor vehicle accident, the Panel is unable to pass any opinion whatsoever on the effect of the motor vehicle accident on any possible Substance Use Disorder.
Again, taking into account the limitations of a paper assessment, not having assessed Ms Sulusulu, and an absence of meaningful recent or probative documentation or information, Ms Sulusulu most likely has a whole person impairment under 10% which is similar to that which was assessed by Assessor Ng, that is, 2%. The Panel assessors have assessed her Whole Person Impairment as 4%. The scores and reasoning is detailed in the table below. This is her final whole person impairment given that there is no adjustment for treatment effect and no way to adjust for pre-existing impairment. The Panel is not aware of any other subsequent events that would contribute to a post-accident impairment, however if these were present, it would reduce her whole person impairment related to the motor vehicle accident.
Both medical assessors agree that the claimant has a 4% whole person impairment.”
Degree Of Permanent Impairment utilising the Psychiatric Impairment Rating Scale
| Psychiatric diagnoses | 1. Post-Traumatic Stress Disorder in partial remission and exacerbation of a Persistent Depressive Disorder (exacerbated by the accident) | 2. |
| 3. | 4. | |
| Psychiatric treatment description | No known current psychological or psychiatric treatment | |
| Category | Class | Reason for Decision |
| 1. Self Care and Personal Hygiene | 1 | Minor deficit attributable to the normal variation in the general population. Dr Ng assessed Ms Sulusulu as having no psychiatric impairment regarding tasks such as caring for herself, doing her own shopping, preparing her own meals and doing basic housework. Dr Teoh reported that she had been lacking motivation to care for herself. The Panel assessors consider there is no evidence to support any other Class here other than 1. |
| 2. Social and Recreational Activities | 2 | Mild impairment. Dr Teoh reported a loss of interest and motivation in usual activities. Dr Ng reported some enjoyment from solitary activities. The Panel assessors consider that there is no evidence available to suggest the presence of impairment higher than a Class 2. |
| 3. Travel | 1 | Minor deficit attributable to the normal variation in the general population. Dr Ng reported there were no issues with respect to independent travel, and the ability to use public transport. Dr Teoh noted Ms Sulusulu was able to drive herself around, but some feelings of anxiety. The Panel assessors considered this to ne consistent with a Class 1 level of impairment. |
| 4. Social Functioning | 2 | Mild impairment. Dr Teoh described that Ms Sulusulu had been aggressive and irritable with mood fluctuations (this is more consistent with Class 2 descriptors). Dr Ng assessed a Class 4 impairment, noting family estrangement, one close friend and getting on with her current housemates/neighbours. Interestingly, Dr Ng was unable to opine a connection between the MVA and the difficulties in the family relationships. Given the pre-existing problems in her family relationships, the Panel assessors considered Ms Sulusulu’s impairment was more consistent with a Class 2, representing strain in her existing relationships, and the ability to maintain at least one long term relationship, and form new ones. |
| 5. Concentration, Persistence and Pace | 1 | Minor deficit attributable to the normal variation in the general population. Ms Sulusulu concentrated well for her assessment with Dr Ng. She reported being able to use her smart phone, use social media and watch movies on her phone. She was not at the time engaging in any particularly cognitively demanding tasks (for example she was not working or studying). Dr Ng assessed there to be no cognitive deficits at assessment. She was smoking considerable quantities of marijuana daily. Dr Teah described pain, physical disability, lethargy, feeling depressed and worried about her future and physical condition, insomnia and social isolation, but did not address impairment in line with descriptors in the Guidelines. The Panel assessors, taking into account the limited available information, considered there was a Class 1 minor deficit present. |
| 6. Adaptation | 2 | Mild impairment. Dr Ng assessed there was no psychiatric deficit to working, noting that Ms Sulusulu was working regular part-time work, up to 30 hours a week, almost 3 years after the accident. She had not been looking for work. It appears she left her penultimate employer for another employer, due to the hours and shifts being unsuitable. The Panel assessors did not have information regarding this. Dr Teoh assessed Ms Sulusulu as being fit for suitable duties, but some impairment in her employment capacity. Taking into account the information available, Ms Sulusulu likely has a Class 2 impairment, consistent with being able to work in her preinjury work, but at reduced hours, or full-time in a lower stress role. |
| List classes in ascending order: 1, 1, 1, 2, 2, 2 | ||
| Median Class Value: 2 | ||
| Aggregate Score: 9 | ||
| % Whole Person Impairment: 4% | ||
The Panel met on 2 September 2025 to discuss the Medical Assessor Jones’ findings and his assessment on the papers. Prior to the Panel meeting on
2 September 2025, both the legal Member and Senior Medical Assessor Baker had the benefit of reading and considering the assessment report of Medical Assessor Jones. On 2 September 2025 the Panel all discussed the examination findings and the issues going to causation and assessment of WPI. It is from this teleconference of the Panel that the Panel has agreed and reached its final conclusion and determination.
The Panel adopts the report of Medical Assessor Jones.
Reasons/causation
The Panel refers to the decision of Mandoukos v Allianz Australia Insurance Limited [2023] NSWSC 1023. The scope of the medical dispute referred to the Commission and the Panel for determination is defined by the parties’ submissions.
This is a hearing de novo and those issues raised before the Medical Assessor and for determination by the Panel now include consideration of
adiagnosis from the motor vehicle accident was a mild post-traumatic stress disorder, in partial remission, and an exacerbation of a mood disorder, namely a Persistent Depressive DisorderThe Medical Assessor assessed 2% WPI before any deduction for a pre-existing condition. Dr Teoh assessed 15% WPI. The finding of Dr Teoh is at best, a difference of opinion to that of the Medical Assessor. The Panel is not aware of any error of assessment by the Medical Assessor in reaching his opinion and conclusion.
The Panel has not “gone looking” for alternative diagnosis when the specific diagnosis of post-traumatic stress disorder had been referred to it. The Panel would normally examine the claimant and perform its assessment on the basis of its discussions with the claimant on the day of assessment. That has not been possible with respect to this assessment as the claimant cannot be located and cannot be examined in any way.
Psychiatric symptoms might evolve overtime and disappear overtime for that matter. In this case, the Panel was satisfied that the claimant had a post-traumatic stress disorder but was satisfied on the basis of the history provided on the papers, that this disorder was in partial remission, with an exacerbation of a mood disorder, namely a Persistent Depressive Disorder
There is little, if any, information available that could influence the Panel’s opinion with respect to Ms Sulusulu’s psychiatric status or level of functioning subsequent to the Medical Assessor’s certificate. So, we are left with her status around that time to make an assessment about her current status, psychiatric diagnosis and level of impairment. This is clearly a challenging task.
Taking into account all of the information available and attempting to be as fair and reasonable with respect to the current situation, on the balance of probabilities, the claimant’s level of whole person impairment is likely to be the same as that assessed by the Medical Assessor (or very similar), that is, below the 10% threshold (the Medical Assessor assessed the claimant’s current WPI as 2%).
Therefore, with the inherent significant limitations of an assessment on the papers, and in the absence of any further documents to inform the Panel, it is the consensus agreement of the Panel that the claimant’s diagnosis from the motor vehicle accident was a mild post-traumatic stress disorder, in partial remission, and an exacerbation of a mood disorder, namely a Persistent Depressive Disorder.
The claimant had well documented psychiatric issues before the accident on 14 March 2019 including a diagnosis of post-traumatic stress disorder by Dr Nguyen. On 15 April 2020, when the claimant attended her psychologist, whom she had been seeing before the accident, she made no mention of the accident. When the claimant left her employment in May 2022 her resignation letter only referred to the fact she was working for another merchandise company. The claimant was working after the accident and suffered a significant injury to her knee in a scooter accident around August 2022 when she injured here anterior cruciate ligament.
The claimant had experienced psychological problems prior to the motor vehicle accident, including engaging with a psychologist. This was only for approximately five sessions in 2017 with a variable attendance. She had a history of problematic relationships in her family, she had had a history of an abusive relationship with her partner, and she had previously drunk alcohol, smoked marijuana and been morbidly obese. She had an occupational history that was varied.
Noting the claimant’s prior psychiatric history, the Panel must consider whether the accident contributed to the claimant’s injuries as referred to it by the Commission, whether the claimant’s condition arises because of contribution by the accident, and whether the accident materially contributed to that condition.
On the balance of probabilities, can it be said that the claimant suffered a recognisable psychiatric injury? For the reasons discussed above in the report of the Medical Assessor Jones, the Panel does find that this can be answered in the affirmative. The claimant did develop a mild post-traumatic stress disorder, which it considers to be in partial remission, as well as exacerbation of a Persistent Depressive Disorder. As the Medical Assessor said, her condition is multifactorial with some problems related to the accident and some not related. The claimant had a pre-existing family strain and this cannot be related to the accident. However, after the accident the claimant did have symptoms of post-traumatic stress disorder.
Would the impairment have occurred, if not for the accident? The Panel is satisfied that the accident and impact has had a more than negligible effect on the claimant’s psychiatric condition suffered by the claimant.
It is possible that the claimant had a Substance Use Disorder as she had reported daily ingestion of marijuana in an amount somewhere between 8 cones to a ¼ of an ounce a day. There was also daily alcohol ingestion, at the time of the assessment by the Medical Assessor. As the claimant was both drinking alcohol and smoking marijuana prior to the motor vehicle accident, the Panel is unable to pass any opinion on the effect of the motor vehicle accident on any possible Substance Use Disorder.
Conclusion
The Panel concludes that the claimant was involved in a motor vehicle accident on
14 March 2019 that did give rise to a psychiatric disorder.
The claimant has suffered a post-traumatic stress disorder in partial remission and an exacerbation of a Persistent Depressive Disorder.
The Panel has assessed the claimant as having WPI of 4%.
The Panel makes no deduction for any pre-existing psychiatric condition as, having only been able to make an assessment on the papers. Such an assessment would only be a matter of speculation.
Determination
The Panel revokes the Certificate and Reasons of Medical Assessor Ng dated
4 October 2023.
The Panel assesses the claimant as having a post-traumatic stress disorder in partial remission and an exacerbation of a Persistent Depressive Disorder.
The Panel has assessed the claimant’s WPI at 4%.
The Panel makes no deduction for any pre-existing psychiatric condition of the claimant.
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