Wali v Insurance Australia Limited t/as NRMA Insurance
[2025] NSWPICMP 9
•7 January 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Wali v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 9 |
CLAIMANT: | Muhammad Wali |
INSURER: | NRMA |
REVIEW PANEL | |
MEMBER: | Nolan |
MEDICAL ASSESSOR: | Hong |
MEDICAL ASSESSOR: | Smith |
DATE OF DECISION: | 7 January 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; psychological injury; review of Medical Assessment Certificate under section 7.23(1); whether adjustment disorder caused by motor accident resulted in permanent impairment exceeding 10%; claimant involved in a rear-end motor vehicle collision; initial physical injuries reported, with psychological symptoms emerging later, including feelings of frustration, anxiety, and social withdrawal; medical evidence reviewed, including history of familial conflicts and situational stressors; inconsistencies in claimant’s narrative and pre-existing stressors noted but found not to negate causation; Panel determined motor accident made a material contribution to claimant’s psychological injury; claimant’s impairment evaluated under psychiatric impairment rating scale (PIRS); median class value of 2 and aggregate score of 13 corresponded to 7% whole person impairment (WPI) plus 1% for the effects of treatment, being a total of 8% WPI; Held – motor accident caused an adjustment disorder resulting in a permanent impairment below the statutory threshold of 10% WPI. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION 1. The Review Panel revokes the certificate of Medical Assessor Atsumi Fukui dated · adjustment disorder, gives rise to a WHOLE PERSON IMPAIRMENT OF 8% WHICH IS NOT GREATER THAN 10%. |
STATEMENT OF REASONS
INTRODUCTION
On 4 April 2016, the claimant, Muhammad Wali, was involved in a motor vehicle accident (the motor accident) while driving his car with his wife seated in the front passenger seat and his son seated in the rear passenger seat. The incident occurred at a traffic light in Blacktown, New South Wales, where the claimant had come to a complete stop. While stationary, his vehicle was struck from behind by another car, causing a sudden and forceful impact that pushed his vehicle forward. The claimant and all passengers were wearing seatbelts at the time of the collision. The airbags did not deploy.
Following the motor accident, the claimant’s son exited the vehicle to address the situation with the at-fault driver, including documenting the scene with photographs and exchanging details. Subsequently, the son took over driving, and the family continued their journey, collecting the claimant’s daughter before returning home.
The immediate aftermath of the motor accident for the claimant was marked by shock but no apparent physical injuries. However, the claimant claims he began experiencing pain in his lower back, neck, and shoulders the following day. Initially attributing the discomfort to temporary soreness, he says he delayed seeking medical attention for one to two weeks. When the pain persisted, he consulted his general practitioner (GP), who referred him for imaging and physiotherapy. Despite these interventions, the claimant says he continued to experience chronic and debilitating physical symptoms, particularly lower back pain, which impacted his mobility and ability to perform daily activities. The claimant claims that the physical limitations imposed by the motor accident necessitated a transition to a less demanding role at work and reduced his capacity for household and recreational activities, such as sports, which had previously been a central part of his life.
In addition to the physical injuries, the claimant claims he experienced a progressive decline in his psychological well-being. Over the months following the motor accident, he reported feelings of frustration, inadequacy, and social withdrawal. These psychological symptoms were exacerbated by the strain of his physical limitations, the financial pressures resulting from his reduced functional capacity, and the deterioration of his familial relationships. The claimant was eventually diagnosed with adjustment disorder with mixed anxiety and depressed mood, a condition his medical professionals attributed directly to the motor accident and its aftermath.
The claimant lodged his initial claim with the insurer, NRMA, shortly after the motor accident, seeking compensation for both physical and psychological injuries sustained in the motor accident. The claim primarily outlined the claimant’s immediate injuries, including lower back and neck pain, which he claimed were attributed directly to the motor accident. The psychological symptoms, including anxiety, low mood, and social withdrawal, which developed subsequently were not initially part of the primary claim.
The claimant sought a formal assessment of the extent of his permanent impairment. In 2021, he applied to the Personal Injury Commission (Commission) under s 58(1)(d) of the Motor Accidents Compensation Act 1999 (NSW) (the MAC Act), relevantly to determine whether his psychological injuries qualified as a permanent impairment and whether the claimant’s impairment exceeded the statutory threshold of 10% whole person impairment (WPI).
This dispute between the claimant and the insurer under s 58(1)(d) of MAC Act about the degree of permanent impairment arising out of psychological injuries caused by the motor accident was initially referred to a single Medical Assessor to determine the dispute.
MEDICAL ASSESSMENT THE SUBJECT OF THE REVIEW
By certificate and reasons dated 25 July 2022 (the MAC), Medical Assessor Atsumi Fukui (the Medical Assessor), assessed the psychological assessment of the claimant following the motor accident.
Prior to the motor accident, the claimant was a 58-year-old man with a stable psychosocial and medical history. He was born in Pakistan, completed a bachelor’s degree in chemistry, and worked in industrial management before migrating to Australia in 2000. He had been employed at an oil refinery for 21 years, transitioning to a less physically demanding role in operations due to prior workplace injuries. Socially, the claimant was active in sports such as cricket and basketball, and he enjoyed family and community engagements. He had no prior psychiatric history, significant medical conditions, or involvement in previous motor vehicle accidents.
The motor accident occurred when another vehicle rear-ended the claimant’s car while he was stopped at a traffic light. Although airbags did not deploy, he experienced back pain, which initially appeared manageable. However, over time, the physical limitations resulting from the accident significantly affected his psychological well-being. The claimant reported feelings of uselessness, frustration at his inability to fulfill familial and personal responsibilities, and a decline in his sense of self-worth. These changes marked the beginning of a deterioration in his mental health.
The Medical Assessor diagnosed the claimant with adjustment disorder with mixed anxiety and depressed mood, as defined by the DSM-5. Psychological symptoms included persistent low mood, episodes of anxiety, withdrawal from social activities, and strained familial relationships. The claimant reported feeling isolated and less capable, particularly due to his inability to participate in sports and household responsibilities. He described himself as “half dead” and experienced worsening relationships, especially with his daughter, whose decision to move out against his wishes exacerbated his mental distress. Suicidal ideation was documented in 2018, though these symptoms had subsided by the time of the assessment. Despite brief contact with mental health services, the claimant declined prolonged psychological treatment or medication.
Functional impairments were assessed through the Psychiatric Impairment Rating Scale (PIRS), which revealed substantial limitations in several key areas of the claimant’s life. Social and recreational activities were particularly affected, as the claimant experienced persistent feelings of inadequacy, leading to his avoidance of social gatherings and community events. This withdrawal was closely tied to his sense of loss over being unable to participate in sports and other physically engaging activities, which had been central to his identity prior to the accident.
The claimant’s family relationships were also notably impacted. Frequent arguments within the household led to a noticeable deterioration in his familial bonds. This included a significant shift in his role within the family, as he could no longer contribute to household tasks or provide the level of support he had once offered. These changes compounded feelings of inadequacy and strained interactions with family members.
In terms of cognitive functioning, the claimant reported a marked decline in his concentration and decision-making abilities. He struggled to focus on tasks requiring sustained mental effort, such as reading, and found himself unable to complete even moderately complex activities. These cognitive limitations further restricted his capacity to perform responsibilities both at home and in his professional environment.
Despite maintaining full-time employment, the claimant’s professional role had been adapted to accommodate his limitations. His current duties were less demanding, reflecting the combined impact of his physical injuries and psychological constraints. This adjustment, while necessary, underscored the long-term impact of the accident on his capacity to engage in his previous workload or work environment.
The impairments were systematically evaluated across several functional domains, resulting in a median class value of “2” and an aggregate score of 14 under the PIRS methodology. This score corresponded to a WPI of 7%.
The Medical Assessor concluded that the claimant’s psychological condition was directly caused by the motor accident. Before the incident, he had been functioning well without prior psychiatric issues. The physical injuries sustained during the accident triggered a gradual psychological decline, which was further compounded by family conflicts and financial stress. The condition was deemed permanent and static, as it had remained unchanged for six years post-accident and was unlikely to improve substantially in the future, even with treatment.
APPLICATION FOR REVIEW
The claimant sought a review of the MAC, which the insurer opposed.
The claimant contended that the assessment was materially incorrect and failed to provide adequate reasoning, particularly concerning the PIRS category of concentration, persistence, and pace. Specifically, the claimant argued that the Medical Assessor did not sufficiently justify the classification of the impairment as Class 2 (mild impairment). This classification was based on the claimant’s reported difficulties, including a reduced ability to concentrate, an inability to read more than half a page, and the need to maintain employment in a less stressful role. The claimant also argued that the assessor’s reasoning did not align with the standards established in Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43; 252 CLR 480, which require that sufficient reasoning is provided to explain the conclusions reached.
The claimant referred to the Motor Accident Permanent Impairment Guidelines 2018 (the Guidelines) which outline the criteria for various PIRS classifications. Specifically, he referred to the differences between classes 2 and 3. Class 2, denotes mild impairment, applies to individuals who can undertake a basic retraining course or standard course at a slower pace and focus on intellectually demanding tasks for up to 30 minutes before experiencing fatigue or headaches. In contrast, Class 3, which indicates moderate impairment, applies to individuals unable to read more than newspaper articles and who find it difficult to follow complex instructions. The claimant submitted that the Medical Assessor failed to expose the path of reasoning leading to the conclusion that the claimant’s impairment fitted within Class 2 rather than Class 3.
The President’s delegate concluded that the Medical Assessor’s reasoning was insufficient to support the classification of the claimant’s impairment as Class 2. This raised reasonable cause to suspect that the medical assessment was materially incorrect. The decision to accept the application for review was made under s 63 of the MAC Act, and the matter was referred to the Review Panel, presently constituted for re-consideration (the Panel).
REVIEW PROCEDURE
Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the medical assessment the subject of the review was made on or after 1 March 2021, the new review provisions apply.
Section 7.26(5A) of the MAI Act provides that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission. Accordingly, the President’s delegate referred the matter to this Panel to assess.
Section 41(2) of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor.
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. Rule 128 of the PIC Rules provides that a review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.
The review is by way of a new assessment of all matters with which the medical assessment is concerned.
By directions issued on 13 December 2023, the parties were directed to provide the Panel a joint bundle of material on which they relied upon the Review. That direction was complied with. The following is a summary of the relevant material provided.
MATERIAL ON THE REVIEW
The clinical notes from Dr Simon Chua on 13 July 2013 documented the claimant presenting with complaints of right-sided lower back pain, which he described as intermittent over the previous six to seven years. The claimant reported that the pain had been triggered by multiple work-related back injuries involving repetitive bending and heavy lifting during that time. He stated that previous imaging, including X-rays, had been conducted but showed no significant abnormalities. The current episode of back pain occurred after he lifted and carried a television set a week prior to the consultation. The pain radiated from the lower back to the right upper back and the back of the thigh, and despite self-medicating with Voltaren 25 mg intermittently, the pain persisted.
Dr Chua diagnosed the claimant with mechanical pain, likely associated with facet joint arthropathy and potential sciatica. The recommended treatment plan included a prescription for Voltaren 50 mg, to be taken twice daily for five days, and the application of topical heat to alleviate the discomfort.
On 16 March 2018, the claimant underwent a mental health assessment following concerns raised during his initial presentation. He reported feeling worthless and useless since migrating to Australia, expressing dissatisfaction with working below his qualifications and struggling to adapt to Australian culture. He detailed ongoing distress over his youngest daughter’s decision to leave home to live with her boyfriend, which he described as having shaken his family.
He denied a formal diagnosis of depression but admitted to occasional use of Lexotanil (3 mg) over the past 25–30 years to manage emotional difficulties. The mental state examination revealed he was tearful, with a low mood and significant rumination over perceived failures in parenting and cultural conflicts. Although he expressed suicidal ideation, he firmly denied any active plans or intent and emphasised his commitment to his family. The assessment concluded with a diagnosis of a situational crisis, and the claimant was recommended for outpatient mental health follow-up.
Following the mental health review, the claimant was discharged on 20 March 2018 with chronic psychosocial stressors identified as the primary concern. He was advised to engage with outpatient mental health services and continue counselling to address his situational distress and challenges in cultural adjustment. Despite his reported emotional difficulties, he denied any immediate risk of self-harm and was discharged with recommendations for ongoing support to address both his mental health and broader situational concerns.
On 20 March 2018, the claimant consulted with Dr Savithri Rao after collapsing and being taken to hospital due to emotional distress following his daughter’s departure from home. He expressed significant psychological distress, including insomnia, lethargy, and feelings of hopelessness. The claimant was assessed by a psychiatric team, who identified a risk of suicide, and counselling was initiated. Dr Rao prescribed Lexotan 3 mg to manage his sleep disturbances, with a warning about potential addiction. This consultation highlighted the severity of the claimant’s psychological state and the urgent need for intervention.
On 23 March 2018, the claimant presented with continued psychological distress linked to his family issues. His blood pressure was normal at 120/80 mmHg, and his blood sugar level was 4.9 mmol/L. Dr Rao issued a medical certificate permitting the claimant to take leave from 27 March to 28 April 2018, allowing him time to focus on his recovery. She also recommended further diagnostic investigations, including an echocardiogram, to assess other potential underlying symptoms.
On 1 May 2018, the claimant discussed persistent emotional distress during a follow-up with Dr Rao. He reported symptoms such as headaches, tinnitus, and leg cramps, exacerbated by the lack of contact with his daughter. While continuing Lexotan, the claimant expressed significant frustration and sadness over his situation. Counselling was provided to address his emotional state and explore coping mechanisms for his ongoing psychological challenges.
On 19 May 2018, the claimant was brought to the clinic by mental health workers following an overdose of Valium the previous night. Despite refusing to attend the hospital, the claimant sat in the clinic waiting area, visibly distressed and teary. Dr Rao, familiar with his history, conducted an assessment, noting stable vital signs (BP 124/74 and pulse 62). Observations and discussions revealed ongoing feelings of hopelessness and despair, prompting further intervention.
Later, on 19 May 2018, the claimant expressed ongoing emotional distress and feelings of suicidal ideation, stating that he felt it was better to die than to continue suffering. He reported taking 3–4 Valium tablets the night before but denied any active plans of self-harm. Dr Rao ceased Lexotan and prescribed Avanza (Mirtazapine 30 mg) to address his depressive symptoms. The claimant was observed for two hours in the clinic, and mental health services were informed to follow up on his condition.
On 21 May 2018, the claimant reported better sleep since starting Avanza, though he continued to struggle with emotional distress. Dr Rao advised him to continue taking the antidepressant for at least two weeks to assess its effectiveness and scheduled a follow-up appointment. This consultation reflected incremental progress in addressing the claimant’s mental health concerns.
On 5 June 2018, the claimant was discharged after a series of assessments conducted by the mental health team at Nepean Blue Mountains Local Health District. The claimant had initially presented to Access with heightened distress, reporting financial difficulties, relationship problems with his daughter, and experiencing thoughts of self-harm, including contemplating suicide. During his interactions with the Access team, he described feeling overwhelmed by his financial debt and familial conflicts. He expressed a sense of being “trapped” and reported anxiety and panic-like symptoms, particularly at work. However, he consistently denied having immediate plans or intent to harm himself, citing his responsibility to his family as a protective factor.
Further evaluations noted that the claimant had chronic stressors contributing to his decompensated mental state. Despite his refusal to commence medication, he engaged with support services, including financial counselling, which provided some relief and optimism. His mental health trajectory showed a mix of progress and setbacks, with fleeting suicidal thoughts that he acknowledged but without actionable intent. Recommendations included follow-up with his GP, mental health reviews, and ongoing counselling support to address his situational stressors and improve his mental well-being.
On 6 June 2018, the claimant discussed ongoing distress during a follow-up consultation. Although he reported some improvement in mental health and sleep with Avanza, he remained emotionally strained. Dr Rao advised adjusting the timing of his medication based on his shift work schedule to minimise side effects and emphasised the potential interference with driving. Counselling was provided to address his concerns.
On 21 June 2018, the claimant reported feeling mentally better with improved sleep since starting Avanza. However, he expressed financial worries and lingering distress over family matters. Dr Rao provided counselling and discussed strategies to manage stress. The claimant requested a summary of his medical notes for personal purposes, reflecting his engagement in understanding and addressing his health challenges.
On 10 July 2018, the claimant attended with his wife and reported that while his sleep had improved, he continued to experience depression. He expressed frustration with ongoing family and financial issues, including dissatisfaction with previous legal assistance. Dr Rao conducted a prolonged discussion on coping strategies, provided education on available mental health resources, and issued a medical certificate to support his recovery.
On 23 July 2018, the claimant reported knee pain and chronic back problems that impacted his mobility, including difficulty bringing his knees together. He also expressed ongoing distress about his daughter and described confusion and fatigue from prior medications.
Dr Rao prescribed Voltaren Rapid 50 mg for knee pain and provided counselling to support his mental health. Financial and legal challenges were also discussed, further complicating his emotional state.
On 16 October 2018, the claimant consulted Dr Rao regarding chronic back pain linked to his 2016 motor vehicle accident. He also reported right knee pain with tenderness and crepitus. Examination revealed tenderness at L4–L5 and normal reflexes. Dr Rao prescribed Panadeine Forte 500/30 mg for pain relief and referred the claimant for physiotherapy. Counselling was also provided to address his ongoing emotional struggles, reflecting a holistic approach to his care.
On 26 November 2018, the claimant consulted with Dr Savithri Rao regarding improvements in his chronic low back pain following increased physical activity, including walking approximately 2km daily. He reported being able to sit and straighten his back with less discomfort. Previous imaging had shown degenerative changes at the T12 to L5 levels, consistent with chronic pain. Dr Rao encouraged the continuation of walking, swimming, and specific back exercises to support recovery and mobility. The consultation reflected progress in managing the claimant’s symptoms through regular activity and non-invasive interventions.
On 27 December 2018, the claimant consulted with Dr Savithri Rao for ongoing chronic low back pain and right leg pain. He reported persistent symptoms despite using Lyrica and Panadeine Forte, which provided limited relief. Examination revealed tenderness over the sacroiliac joint and restricted extension to 50 degrees. Dr Rao discussed potential interventions, including a cortisone injection, and recommended stretches and targeted back exercises to alleviate discomfort. Additionally, the claimant’s major depression was noted, and counselling was provided to address his psychological state. A General Practice Management Plan (GPMP) was performed, and referrals to physiotherapy and sports therapy were arranged under Medicare for continued care and rehabilitation. This consultation highlighted the interplay of chronic physical pain and psychological distress in the claimant’s condition.
On 26 July 2019, the claimant consulted with Dr Savithri Rao regarding ongoing left-sided sciatica and chronic low back pain. Imaging from a prior CT scan revealed the presence of Tarlov cysts, which were noted not to be caused by trauma. The claimant described persistent pain radiating down his left leg and expressed interest in engaging with an exercise physiologist for symptom management.
During the consultation, the claimant also discussed his continuing psychological distress, particularly related to unresolved family tensions involving his daughter. Despite this, he indicated some stability in his condition. Dr Rao provided counselling and encouraged the claimant to continue with prescribed back exercises and physical activities. A referral for an exercise physiologist was issued to assist in managing his symptoms and improving mobility.
On 28 November 2019, the claimant consulted with Dr Savithri Rao, reporting frequent severe snoring, a blocked nose, and episodes of apparent apnoea during sleep, which his wife had observed. Additionally, he expressed ongoing psychological distress, including occasional suicidal thoughts, though he noted slight emotional improvement after recent interactions with his daughter. On examination, his blood pressure was normal at 120/70 mmHg, and his blood sugar level was 6.2 mmol/L (non-fasting). Respiratory findings were consistent with obstructive sleep apnoea (OSA). Dr Rao referred the claimant to Dr Girish Patel, a specialist, for further assessment of OSA and continued the use of Panadeine Forte for pain relief. Lexotan was prescribed on a limited basis (once every three weeks) to manage anxiety, and counselling was provided to address his emotional distress and support his mental well-being. This consultation reflects ongoing management of both the claimant’s physical and psychological conditions.
Dr Tanveer Ahmed’s medico-legal report dated 8 August 2019 provided an assessment of the claimant, focusing on the psychological impacts arising out of the motor accident. The report was further to an in-person interview conducted on 5 August 2019 and a review of various medical records, including GP notes, orthopaedic evaluations, and other professional reports.
The claimant, a 57-year-old married man residing with his family, described the accident in which his stationary vehicle was struck from behind. He recalled the immediate shock but could not pinpoint acute pain at the time. However, by the following day, he experienced significant discomfort in his shoulder and lower back. Over time, he developed additional symptoms, including leg pain with occasional radiation, neck pain, right shoulder pain, and knee pain. He sought medical attention two weeks after the accident and underwent imaging, physiotherapy, and intermittent use of analgesics. These treatments provided limited improvement.
Dr Ahmed’s report highlighted the claimant’s psychological sequelae, describing a “tired life” marked by difficulty engaging in daily tasks and reduced motivation. The claimant reported a loss of social and recreational activities, particularly his inability to participate in cricket and other sports, which had been a significant aspect of his life. This withdrawal led to diminished social connections and strained relationships within his family. He reported being more irritable at home, less intimate with his wife, and relying heavily on coworkers to manage physical tasks at work, which allowed him to maintain his job despite significant challenges. He also noted disruptions in sleep and appetite, although he denied suicidal ideation.
The claimant was diagnosed with adjustment disorder with mixed anxiety and depressed mood, which Dr Ahmed attributed to the motor accident. Dr Ahmed observed that the claimant had been upbeat, socially engaged, and optimistic before the accident, and his subsequent psychological decline was directly correlated with the incident. The doctor noted that the psychological impact was magnified by the claimant’s love of physical activity, which had been significantly curtailed due to his injuries.
Dr Ahmed concluded that the claimant was receiving appropriate treatment and did not require ongoing psychological input, given his limited response to prior therapy. However, he recommended the consideration of a low-dose antidepressant to assist with sleep. The doctor opined that the motor accident had significantly contributed to the claimant’s psychological decline and noted that the claimant had reached maximum medical improvement three years post-accident. It further acknowledged prior physical injuries but highlighted that the claimant had been psychologically stable before the incident, reinforcing the causal link between the accident and his current condition.
Dr Christopher Rikard-Bell’s psychiatric medico-legal report, dated 11 November 2021, examined the claimant in connection with his motor accident. The evaluation was conducted via video link on 7 September 2021. The purpose of the report was to assess whether the claimant’s psychological injuries met the criteria for a diagnosable psychological condition and impairment directly attributable to the motor accident.
The claimant recounted the details of the accident, describing being stationary in traffic when his vehicle was struck from behind. He reported initial shock and only minor physical discomfort at the time. However, symptoms such as neck pain, lower back pain, right-hand discomfort, and pain in the right lower limb developed the following day. Over time, these physical symptoms expanded to include right shoulder pain and occasional radiation to the legs. The claimant sought medical attention approximately two weeks later, underwent imaging and physiotherapy, and intermittently used analgesics, though these interventions provided limited relief.
In describing the psychological impact of the accident, the claimant expressed frustration and sadness over his reduced physical capabilities, which affected his ability to engage in activities he previously enjoyed, such as cricket. He noted a withdrawal from social and familial interactions, strained relationships within his family, and a loss of intimacy with his wife. However, he also reported that he continued to work full-time by transitioning to a less physically demanding role, which allowed him to maintain employment without prolonged absences. The claimant attributed many of his emotional challenges to longstanding familial conflicts, particularly with his daughter. He acknowledged an overdose on Valium in 2018 during a period of acute familial distress, which he linked to personal stress rather than the motor vehicle accident. He confirmed that he was not undergoing psychological treatment at the time of the assessment.
Dr Rikard-Bell reviewed a broad range of medical records, including GP notes and hospital and mental health team assessments. The GP records documented intermittent emotional distress, occasional use of sedatives such as Lexotan and Valium, and episodic depressive symptoms. The mental health team evaluations noted significant situational stressors, particularly familial conflicts, but did not identify a sustained or severe psychological condition related to the accident.
In the mental state examination, the doctor recorded that the claimant appeared cooperative and articulate, with no observed signs of active depression, anxiety, or post-traumatic stress disorder. His thought processes were coherent, and there was no evidence of psychosis or cognitive impairment. Despite reporting some emotional lows, the claimant denied any active suicidal ideation. His ability to continue full-time work and maintain functional capacity was evident throughout the evaluation.
Dr Rikard-Bell concluded that the claimant did not meet the criteria for a diagnosable psychological condition directly attributable to the motor accident. He found that the claimant’s emotional difficulties were predominantly influenced by familial stressors and pre-existing vulnerabilities rather than the trauma of the accident. Furthermore, he emphasised that the claimant demonstrated no significant restrictions in his occupational or domestic functioning and had not sought recent psychological treatment. The report determined that there was no need for a calculation of WPI.
RECONSIDERATION BY THE PANEL
The Panel determined that a re-examination of the claimant was required.
RE-EXAMINATION
Who attended the assessment
Medical Assessors Hong and Smith were in their Sydney offices.
The claimant was at home, and his daughter Fariza Fatima was present during the assessment to provide support.
The assessment was conducted by MS Teams.
HISTORY
Psychosocial history and pre-accident history
The claimant was born in Pakistan and came to Australia in 2000. He grew up with his parents and was the seventh of nine siblings. His father passed away in 2000 and his siblings are all in Pakistan. He has a nephew and cousins in Australia. He did not experience major sickness or trauma in his childhood.
In terms of general medical history, he confirmed in 2010 he suffered a back injury at work. In 2016 he was leaning on a valve at work and had sustained a back injury, which happened after the subject accident. He has been diagnosed with diabetes for about two years and takes oral hypoglycemics and does not need insulin. He has high cholesterol and has had prostate hypertrophy for about a year, and his urologist prescribed Duodart. The Panel asked him about sleep apnoea as noted in November 2019, and that his wife noticed apnoeic episodes, and he reported that he was referred for a sleep study but did not attend.
In terms of substance history, he does not drink alcohol or use recreational drugs.
He is not aware of a family history of mental illness.
The claimant does not have a confirmed past psychiatric history.
In terms of education and employment history, he completed a Bachelor’s Degree in Chemistry and has worked in industrial management.
History of the motor accident
The Panel confirmed that the claimant only had one car accident in 2016. He has nominated various dates, 6 February, 12 February and 4 April, and it was agreed that 12 February 2016 would be the accurate date of the motor accident.
He was driving and his son was the only passenger, and he said they were going to visit somebody, and this was at either 8.00pm or 10.00pm They took the M7 and were in Blacktown. He remembered having stopped at a red light and he was the first in line. He said he intended to exit on Sunnyholt Road to go to Bella Vista, then he heard a loud bang, and he said he could not conclude what had happened. A few seconds later, his son left the car and helped him get out and that is when they discovered that they were rear-ended while stationary. They decided to go home, and his son drove. His airbags were not deployed, and his vehicle was later repaired. He did not sustain a head injury.
He said that he saw his GP a few days later because he initially thought he was alright, but the agony and the pain were not getting better by then.
He still suffers chronic pain, and the main physical problem is his back. He also reported a right shoulder injury which affects how he performs his work, and he finds it hard to lift his arm above his head. His writing is okay on a desk, but he struggles to write on a whiteboard. He can lift maybe 4 or 5kg of groceries with his left arm, but he does not know what he can carry with the right and said that the doctor told him that if he lifts anything heavy, he will damage his shoulder ligament, so he avoids using his right arm. He is not sure about running and said he cannot walk very fast. He struggles to walk after 16 to 20 minutes due to his back pain and right leg pain, radiating from his back. He has not had surgical treatment since the accident.
History of symptoms and treatment following the motor accident
The claimant said there was no problem immediately after the accident with his mental health, but he started having mental health struggles in 2017 because his physical injury became quite severe. He first sought psychological help in March 2018 when his daughter left home. He said that as “things keep going on”, “there was too much decline physically” and the pain stopped him from doing a lot of things, he could not support his family and he could not play sports or do his work properly, he then started losing support from his family and so his psychological health deteriorated. He further explained that he normally looked after his youngest daughter, but he could not do it after the accident and so she left home.
The Panel clarified what looking after the daughter meant and what she needed, as she was 21 when she left home. The claimant explained his cultural expectations that the children leave home when they get married, and it was a shock that she left home without parental permission. He said that normally, he would take her places, to the university, the train station, to her friends and he was giving her driving lessons but could not do these after the accident, due to his physical injuries and pain. He stated she complained that he was not looking after her and so she left. He also said that his wife had to stop working to look after their daughter. He said he became paranoid and irritable, causing conflict with his family. He said it was a shock that she left, and his mental health problems started at that point; he recalled he did not want to exist, and he had suicidal thoughts.
The Panel tried to clarify with the claimant, whether there were pre-accident problems with the daughter, but it was very hard to obtain a clear answer. He later said that there was no pre-accident relationship problem because they would go out together and do things, and she would swim at home and therefore there was no pre-existing relationship problem. The Panel also clarified whether there were different cultural expectations between Pakistani and Australian cultures, which affected the relationship. Again, it was difficult to clarify the issue, which was noted in his treatment records. He said that he did not want her to be in bad company, go to parties or use drugs. He said he is not sure whether she is using drugs now.
He said he did not want to talk about that issue because this assessment was about the motor accident, and the Panel discussed the Guidelines and requirement to ask about issues that could contribute to his mental health injury, particularly issues that are noted in his files. The Panel discussed the assessment does not involve forceful enquiries, and he should tell the Panel as much as he felt comfortable.
The Panel asked the claimant why his daughter refused to have contact with him after she left home and his response was that, if she wanted to be free then he had no objection. He stated she claimed that he was not supporting her and therefore she left, and when he contacted her, she texted back and said that if he did not stop, she would apply for an Apprehended Violence Order (AVO).
He said that his daughter would drop in and sometimes they would have lunch together and then she would go. He thinks she is working somewhere but is not sure about the details. Sometimes she will come home to eat with his wife, and he will not know about it. The Panel asked about his daughter leaving home to live with her boyfriend, as his file indicated, and he stated she lived with her friends, and he does not know if this was a boyfriend.
The Panel asked about the bankruptcy issue, and he said that he took out a loan in 2008 to invest in a company called Great Southern Timber on a friend’s advice. He made regular repayments over the years; however, he discovered that it was a fake company and a scam and then it went into liquidation. He stopped the payments when he discovered it was a scam in 2012, however, the company sold the loan to Bendigo Bank who then chased him for money. He said it started at $24,000 and then went to about $80,000 due to 11% interest per year over five to six years. They sent him a letter regarding the bankruptcy. He said that because of the car accident, he had suffered a lot of physical problems and pain and decided he could not fight the court case. He borrowed money from a friend and instead of going to court, they settled out of court through the lawyers, and he paid the agreed sums. The Panel asked him about the psychological impact of this, which started before and continued after the accident, and he said, “money comes and goes” and therefore he felt it had no impact.
The Panel asked the claimant about the loss of his driver licence in 2018, and he said that he had double demerit points and a few existing lost points, and so he lost his licence for three months. The Panel tried to clarify whether his daughter drove his car and contributed to the lost points, but it was very difficult to clarify the issue. The Panel discussed in his file, he worried about losing his driver licence and his daughter was the driver. He eventually said that he had paid the fine already and discovered his daughter had been driving, but he did not declare that she was the driver. He reported that she was driving and was caught in a school zone on a camera speeding. After that, he lost more points and therefore lost his licence.
Details of any relevant injuries or conditions sustained since the motor accident
The claimant has not had further car accidents.
He said his mother passed away in July 2021 and not August 2021. The Panel attempted to confirm with him that he received counselling and took psychotropic medications due to his mother passing away and he said maybe, but he could not remember. The Panel noted in his file, his mother passed away in August 2021 and he had counselling, and he was prescribed Lexotan (Bromazepam) by his GP.
Current symptoms
The claimant has variable and amorphous anxiety and depressive symptoms. He is irritable and speaks with “harsh words”, without physical aggression or domestic violence. He described concentration and memory problems and reduced energy levels. He said he lost 1 or 2kg in 2023 and exercises sometimes but not regularly. He had suicidal ideation, and this has ceased. He has never self-harmed or attempted suicide. He reported being withdrawn from people. He sleeps 5 to 6 hours and wakes up in pain, and said his wife witnessed this. The Panel also noted she witnessed his apnoea, and he has not proceeded with the sleep study for obstructive sleep apnoea. He generally eats regularly but skips lunch sometimes. He said he does not shower unless prompted, and his son said he is smelly.
Current and proposed treatment
The claimant takes Lexotan (Bromazepam) as needed for anxiety. The Panel noted Diazepam and Mirtazapine had been prescribed but he no longer takes these medications.
He consulted a female psychiatrist for two sessions a long time ago and does not remember her name. He consulted a psychologist from LikeMind a couple of years ago.
The claimant has never had a psychiatric admission. He presented to Nepean Hospital Emergency Department in March 2019 and the Mental Health Team followed up for a while after the hospital presentation.
CLINICAL EXAMINATION
Mental State examination
The claimant had short greying hair and a full beard. He wore glasses and spoke slowly in a soft tone. He spoke faster at times, but he was easily interruptible. There was no psychomotor slowing or abnormal movements. He was moderately restricted in his affective range and had a bland expression throughout the assessment. He spoke spontaneously. The claimant exhibited good focus and remained attentive throughout the assessment. There was no overt cognitive impairment.
Current functioning
The claimant is 60 years old and living with his wife and an adult son. He has three adult children. His wife was a casual teacher but stopped working three years ago, he said to look after him, and later he also said it was to look after their daughter.
The claimant reported that his driving is generally fine now, but he will not drive long distances, he only drives to the shops and to go to work, and the most he would drive is 27km to go to work, taking the M4. He told the Panel that he does not go anywhere, generally only three or four places and he struggles to go anywhere new, and even in the street behind his house, he will get confused sometimes. The Panel noted this was highly unusual.
He said he avoids socialising because he will respond in a harsh way to people and that he has no friends, although he later said that he will see his friends maybe once a year at special events.
The claimant goes to the mosque every day to pray, and he only talks to the priest when there is an appointment made. He also prays at home. He said that he still goes to social gatherings and community events with his family, maybe once every two months. He said there is no alcohol involved, and he would go and eat, talk to some people that he knows, and then leave with the family. This included last month, when he went to a wedding for a friend’s son. The Panel asked him how he felt about going to the wedding and he said it was okay.
Before the subject accident, the claimant said he played sports, cricket and basketball, but he cannot play now, and explained the bat is too heavy and he cannot run to bowl. He said he normally likes to run and cook, but he does not cook now because the pan is too heavy for him. He does not run and struggles to walk fast.
He helps around the house with tidying up and the laundry sometimes, but said it takes him longer due to the physical restrictions. He said his son does most of the shopping and he might do the shopping 10 to 15% of the time but cannot carry anything heavy. He reads the Koran and prays at home.
He has been working at Cleanaway Refinery for 20 years as a full-time control room operator. After the accident, he estimated he took eight days off work. He returned to full-time preinjury duties.
He said he works in the control room and manages the control panel. The refinery operates 24/7 and he does dayshifts and nightshifts, which are 12 hours overnight with two people. Sometimes they would have to go and check the equipment, but generally the co-worker would go and he occasionally would go, but he finds it hard to do many things physically. He said he trained the other workers and so the other people are happy to go for him whilst he remains in the control room. He checks measurements, makes sure the machines are working properly and ensures there are no mistakes or safety issues.
The Panel confirmed with him that checking the control panel requires constant concentration and that he would need to maintain concentration during the 12-hour shifts. He also told the panel that he cannot focus, for example when he reads the book, after three lines he cannot focus anymore and the Panel discussed with him that this is inconsistent with his ability to work and focus on the computer equipment, which he agreed requires sustained concentration.
Comments of consistency
Many inconsistencies were discussed with the claimant, including his comments about the loss of his licence and his relationship with his daughter and the Panel asked him to discuss as much as he felt comfortable.
The claimant’s responses during the assessment demonstrate several conflicting accounts and inconsistencies, undermining the coherence of his narrative and raising questions about its reliability. When questioned about the loss of his driver’s licence in 2018, the claimant initially attributed the suspension to a combination of double demerit points and pre-existing lost points, leading to a three-month suspension. However, upon further clarification by the Panel, it emerged that his daughter had driven his car, was caught speeding in a school zone, and that this contributed to the loss of points. The claimant admitted to paying the fine without declaring that she was the driver. This sequence of events, including his eventual admission and earlier reluctance to disclose her involvement, reflects inconsistent explanations, particularly given his earlier framing of the suspension as entirely related to his own driving.
The claimant’s account of his mental health struggles similarly revealed significant contradictions. He initially stated that there were no psychological issues immediately after the accident, with challenges beginning in 2017 due to worsening physical pain. Later, he claimed (consistently with the clinical records) that his mental health deteriorated in March 2018 when his youngest daughter left home, which he described as a shocking and destabilising event. He linked this to an escalation of paranoia, irritability, and suicidal thoughts. These timelines and explanations appear inconsistent with earlier assertions that his psychological issues were linked primarily to physical injuries caused by the accident. The conflation of physical and psychological triggers, without a clear or linear progression, raises questions about the reliability of his explanation.
The narrative surrounding his relationship with his daughter further highlights conflicting accounts. While the claimant denied any pre-existing problems with his daughter before the accident, describing their relationship as close and supportive, his responses became vague and evasive when asked whether cultural differences or pre-motor accident issues contributed to tensions. He referred to his cultural values, including expectations that children leave home only after marriage, but was reluctant to engage further when the Panel attempted to explore whether this cultural divide influenced their relationship. Furthermore, the claimant expressed concerns about his daughter potentially being in bad company or using drugs, which appears inconsistent with his earlier claims of a harmonious relationship prior to the accident.
When asked about his daughter’s living situation after leaving home, the claimant’s account conflicted with documentation in his file. While he stated she was living with friends, the file indicated she had moved in with her boyfriend. Upon being questioned directly, the claimant claimed he was uncertain whether she lived with a boyfriend, which further convoluted his account and undermined the credibility of his narrative.
The Panel’s attempts to clarify these issues were met with vague, shifting, and at times contradictory responses from the claimant. His reluctance to address certain topics, combined with discrepancies between his statements and the documented evidence, highlights inconsistencies that undermine the coherence and credibility of his claims. The interplay of these conflicting narratives suggests that caution needs to be exercised when assessing the claimant’s account for its accuracy and reliability.
Review of documentation
Summary of relevant documentation
Commission’s certificate by Medical Assessor Atsumi Fukui, dated
25 July 2022, noted date of injury 4 April 2016. She diagnosed adjustment disorder and 7% WPI. She noted Nepean Hospital Emergency department presentation in March 2018, with psychological symptoms related to his daughter moving out with her boyfriend. He engaged with Mental Health Team in May 2018, related to his daughter and took Mirtazapine two days. No psychologist treatment noted. He can only read half a page at that time. He avoids social events and would go if pushed. She provided a PIRS 232 322, the total WPI was 7%.
Dr Christopher Rikard-Bell IME psychiatrist reported on 11 November 2021, with date of injury 12 February 2016 and the subject accident was on M7 and Sunnyholt Road. After the subject injury, his mother passed away August 2021 and he had some depression and took medication briefly, and counselling for some family issues, and he attended hospital with suicidal ideation 4 May 2018 due to daughter. He reads less and loses concentration after 20 minutes; he can read the Koran and attends to paperwork and emails. He returned to work full-time with no impairment in adaptation. He drives 25 minutes. He is independent in self-care and attends to household chores. There is no problem in relationship or social functioning. He enjoys interaction with friends in the Muslim community, weekly but cannot play sports due to his physical injuries, but he does enjoy socialization. His further report advised there is no psychiatric diagnosis and no requirement to calculate a WPI.
An application to the Commission noted 4 April 2016 as the date of injury and in Blacktown, but in another form, 12 February 2016 and also in Blacktown.
GP records
29 May 2006, vomiting and diarrhoea
20 March 2018, Lexotan (Bromazepam) PRN, daughter left home and he was upset, she is in fear of her safety. In hospital, daughter not called if they are ok. Seen by Psych team and with follow up by counsellor, at risk of suicide, tried Lexotan, counselled against addiction. Given 30 tablets.
One May 2018, Lexotan, very distressed, daughter still no made contact
19 May 2018, mental health worker concerned regarding overdose of Valium yesterday. Patient refused to go to hospital.
19 May 2018 18, Lexotan ceased. Avanza/Mirtazapine 30 mg commenced. Visit daughter, she was upset told patient never to come. He feels better if he dies. Took 3-4 Valium last night.
21 May 2018, antidepressant at least two weeks, better.
16 June 2018, months distressed, Avanza, work night shift.
21 June 2018, better mentally, can sleep with Avanza, financial worries, counselling done.
10 July 2018, depression since March/February this year, hospital twice, sleep improved then triggered by fine for not voting, suicidal ideation better. Medications make him forgetful.
23 July 2018, back problem, try calm his aggression. Loss of licence due to points, from speeding. Mental illness would not help his need to drive. Ask to declare bankruptcy. Attends LikeMind as well, counselling for depression. Went to court. May lose house.
16 October 2018, back pain two years, motor vehicle accident two years ago. There was no psychiatric history recorded.
27 December 2018, back pain, leg pain, major depression.
28 November 2019, Lexotan once in three weeks. Wife witnessed apnoea, OSA (sleep apnoea). Suicidal ideation sometimes, sees daughter a few times, counselling done.
Nepean Hospital discharge summary 18 March 2018, low energy level/ motivation, disappointment regarding daughter, disrespect. The claimant paid daughter’s driving fine from speeding, court case tomorrow and he may lose his driver’s licence. Difficulties adapting to adult children and Australian culture. Thoughts of hanging self. Plan to suicide tomorrow due to stressors. ? acute stress reaction on a background of psycho-social, ?cluster B traits (narcissism) in crisis. Offered voluntary admission. ACCESS follow up.
Discharge summary 5 June 2018, better by 2 June 2018 and follow up with GP. Patient declined further contact with ACCESS.
Dr Tanveer Ahmed, IME psychiatrist, 8 August 2019, noted the February 2016 accident, rear-ended when stationary. No airbags were deployed. Emergency service not needed. His disability included: he cannot engage in sporting activities, intimacy or domestic duties, reduced wide-ranging social connection and family relationship. He can maintain his job as his problems are managed by his co-workers. The subject accident has made some contribution to his psychological health. He diagnosed an adjustment disorder.
Comment
The Panel confirmed he has reduced social interaction and still has regular but fewer social and recreational activities with his community since the accident.
The Panel confirmed he has maintained his job and continues to perform his pre-injury duties. His colleagues perform some physical activities he used to. He predominately works in the control room, with other people or on his own, to ensure the refinery operates safely.
PANEL’S CONCLUSIONS
Diagnosis and reasons
The Panel is satisfied that the claimant developed an adjustment disorder with anxiety and depressive symptoms, as a result of his physical injuries. Accepting his physical injuries are related to the accident, his psychological symptoms arising out of his physical limitations are therefore also related to the accident.
In reference to the DSM-5 TR diagnostic criteria for an adjustment disorder:
(a) Criterion A: He developed emotional and behavioural symptoms in response to identifiable stressors, occurring within 3 months of the onset of the stressor, being the pain arising from the subject accident.
(b) Criterion B: His psychological symptoms are clinically significant, as evidenced by significant impairment in his social and occupational functioning.
(c) Criterion C: This is not merely an exacerbation of an underlying condition and does not meet criterion for another disorder.
(d) Criterion D: His symptoms do not represent normal bereavement reaction
(e) Criterion E: His psychological injury has not resolved as his chronic pain symptoms perpetuated his psychological symptoms.
Causation and reasons
The claimant’s accounts and the supporting evidence present a complex picture, involving conflicting narratives about the cause and extent of his psychological injury. Despite these inconsistencies, the evidence demonstrates that the motor accident did make a material contribution to his psychological condition. Under the legal framework, the motor accident need not be the sole cause of the injury; it is sufficient that it made more than a negligible contribution.
The claimant reported that he had no immediate psychological issues following the motor accident but that his mental health deteriorated over time due to chronic pain and the resulting physical limitations. However, his timeline of events is not entirely consistent. He also attributed the onset of psychological distress to his youngest daughter leaving home in 2018, which he described as a significant and destabilising event. During the assessment, the claimant struggled to reconcile whether pre-existing familial conflicts contributed to this, offering conflicting accounts. On the one hand, he denied any pre-accident issues with his daughter, describing their relationship as close and harmonious. On the other hand, he mentioned concerns about her behaviour and possibly being in bad company, raising questions about whether these issues existed prior to the motor accident.
Further, the claimant’s statements about his daughter’s departure contained inconsistencies. While he initially stated she left to live with friends, records indicated that she may have moved in with a boyfriend. When directly questioned, the claimant expressed uncertainty, claiming not to know whether she was living with a boyfriend. This reluctance to fully engage with certain aspects of his family life added to the difficulties in determining the precise role of familial stressors in his psychological decline.
Despite these contradictions, the claimant consistently linked his psychological struggles to his inability to perform physical activities and maintain his familial and social roles, which he attributed to the injuries caused by the accident. Dr Ahmed’s medico-legal report strongly supports this causal link, noting that the accident had a significant psychological impact on the claimant, magnified by his love of physical activity and social engagement. Dr Ahmed highlighted that the accident caused a shift in the claimant’s life, leading to reduced motivation, withdrawal from social interactions, and a loss of intimacy with his family, all of which contributed to his adjustment disorder with mixed anxiety and depressed mood.
The physical injuries resulting from the accident, including chronic back and neck pain, are well-documented in medical records. These injuries directly limited the claimant’s ability to participate in sports, work effectively, and fulfill familial obligations. The mental health records from Nepean Hospital and Access Mental Health Team further demonstrate that the accident’s physical consequences created a foundation for his subsequent psychological struggles, even if other stressors—such as his daughter’s departure and financial difficulties—compounded these issues.
Dr Rikard-Bell’s diagnosis was, in the Panel’s opinion, overly narrow and failed to properly consider the test of causation. His focus on familial and situational stressors, such as conflicts with the claimant’s daughter and financial difficulties, downplayed the material role of the motor accident in contributing to the claimant’s psychological condition. By dismissing the cascading impact of the motor accident - documented as causing physical injuries, chronic pain, and functional limitations - Dr Rikard-Bell overlooked how these factors disrupted the claimant’s familial roles, social interactions, and self-identity.
While the claimant’s accounts are at times contradictory, the evidence as a whole supports the conclusion that the motor vehicle accident made a material contribution to his psychological injury. The motor accident triggered physical limitations that disrupted his sense of identity and self-worth, leading to a cascade of psychological symptoms. Although familial and situational stressors exacerbated his condition, they do not diminish the role of the motor accident as a material contributing factor. The inconsistencies in the claimant’s narrative underscore the complexity of his situation but do not negate the material contribution of the motor accident to his psychological condition. The evidence satisfies the legal standard that the motor accident made more than a negligible contribution to his injury.
The claimant’s impairment is permanent and entrenched, and unlikely to change substantially and by more than 3% in the next year, with or without medical treatment.
Degree of permanent impairment PIRS
Current PIRS
Category
Class
Reason for Decision
1. Self Care and Personal Hygiene
3
The claimant was rated Class 3 for self-care and personal hygiene because he reported needing prompting to shower regularly, indicating a dependency on others for maintaining hygiene. While he eats regularly and completes some household chores, his reliance on external prompts for basic hygiene elevates his impairment beyond Class 2, which describes occasional lapses in appearance but no need for prompting. This need for regular support aligns with the moderate impairment outlined in Class 3, where assistance is required to ensure hygiene standards are met.
2. Social and Recreational Activities
2
He attends occasional social recreational activities with his family and friends. Overall, this has been less since the onset of his psychological injury. He estimated attending community events once every 2 months, which are enjoyable activities. He can actively engage with other people but less so since the motor accident. He cannot play sports due to his physical injuries, which are not assessable in the PIRS.
The claimant was rated Class 2 for social and recreational activities because he attends occasional social events, such as community gatherings every two months, and actively engages with others, although less frequently than before the onset of his psychological injury. This demonstrates that he can independently participate in social events without requiring a support person, consistent with the mild impairment outlined in Class 2. While his engagement has decreased due to his psychological injury and physical limitations, he remains able to take part in enjoyable activities when he chooses, which distinguishes his impairment from the more severe withdrawal and reliance on support described in Class 3.
3. Travel
2
The claimant is anxious and reported he only drives short distances now unaccompanied.
The claimant was rated Class 2 for travel because, although he reported feeling anxious and now limits his driving to short distances, he is still able to travel unaccompanied within familiar areas. This fits the criteria for mild impairment, where an individual can travel independently but confines themselves to familiar locations. His ability to drive alone and without the need for a support person distinguishes his condition from the moderate impairment described in Class 3, where traveling away from home would require the presence of a support person due to excessive anxiety or cognitive limitations.
4. Social Functioning
3
The claimant was rated Class 3 for social functioning, reflecting the significant strain in his personal relationships, which has been a central feature of his psychological illness. While the claimant’s situation shares some overlap with Class 2—such as experiencing strained relationships and a loss of friendships—his level of impairment goes further, as evidenced by the severe deterioration in his familial relationships, particularly with his daughter, and the ongoing conflict and irritability that have permeated his household.
Key to the Class 3 rating is the evidence of severe relational breakdowns, including his daughter previously raising an AVO, which, while no longer in place, underscores the depth of their conflict. Furthermore, his anxiety, avoidance, and irritability have caused a broader decline in his relationship with his wife and other children, leaving him socially isolated and withdrawn. This exceeds the moderate tension described in Class 2 and aligns with the more severe disruption of relationships described in Class 3, where relational strain becomes the dominant feature of the impairment.
Although the claimant has not reported periods of separation or domestic violence in his marital relationship, the substantial strain on his familial connections—central to his psychological injury—warrants the higher classification. The rating acknowledges that his family dynamics are at the core of his illness and have been significantly impacted by his irritability and withdrawal, placing his social functioning firmly within Class 3 despite elements of overlap with Class 2.
5. Concentration, Persistence and Pace
2
The claimant was rated Class 2 for concentration, persistence, and pace, a decision supported by both objective observations during the assessment and his reported functional capacity. While the claimant described difficulty concentrating, such as only being able to read three lines of a book at a time and feeling mentally fatigued, the evidence gathered demonstrates that his impairment is consistent with a mild level. During the assessment, which lasted more than 90 minutes, the claimant was able to engage fully, maintain focus, and respond coherently to detailed and complex questions. This capacity for sustained intellectual engagement aligns with the description in Class 2, where individuals can perform intellectually demanding tasks for up to 30 minutes or longer before experiencing fatigue.
Further evidence supporting a Class 2 rating comes from the claimant’s work duties. He continues to perform full-time pre-injury duties as a refinery operator, which include monitoring safety equipment and systems, tasks that are intellectually demanding and require sustained focus and attention to detail. The claimant’s ability to carry out these duties independently and safely, without evidence of significant lapses or cognitive errors, strongly contradicts the higher level of impairment described in Class 3. A Class 3 impairment would preclude him from following complex instructions or working effectively in an environment requiring significant attention and decision-making.
While the claimant subjectively reported concentration difficulties, these appear to reflect mild fatigue or psychological distress rather than a moderate cognitive impairment. He can still engage with intellectually challenging tasks, such as safety monitoring and long-format assessments, demonstrating that his functional capacity remains intact. The distinction between Classes 2 and 3 lies in the claimant’s ability to engage meaningfully with complex tasks, and the evidence does not support an inability to follow instructions or focus as described in Class 3. Overall, his impairment is more accurately categorized as mild under Class 2, as it reflects occasional challenges without a loss of functional capacity for sustained intellectual activity.
6. Adaptation
1
The claimant was rated Class 1 for adaptation, as he continues to work full-time in his pre-injury role with duties that are consistent with his education and training. Despite the psychological challenges he reported, including irritability and anxiety, there is no evidence that these issues have impaired his ability to cope with the normal demands of his job. The claimant’s role as a refinery operator requires sustained focus, safety monitoring, and adherence to complex systems, which he continues to perform without evidence of reduced capacity or significant modifications.
A Class 2 rating, which requires the claimant to either work in a different environment or reduce hours due to psychological limitations, is not applicable here. The claimant has demonstrated resilience and the ability to maintain his full-time workload despite his psychological injury. While he has reported difficulties in other areas of his life, such as strained familial relationships and social withdrawal, these issues have not translated into an inability to function effectively in the workplace. His performance aligns with the expectations of Class 1, where there is no measurable deficit beyond normal variation in the general population. The claimant’s continued ability to meet the demands of his role underscores the appropriateness of the Class 1 rating for adaptation.
List classes in ascending order: 122 233
Median Class Value: 2
Aggregate Score: 13
% Whole Person Impairment: 7 %
*%WPI = Percentage Whole Person Impairment
Psychiatric Impairment Rating Scale - Pre-existing/subsequent impairment
The claimant has not sustained a subsequent injury.
He has no past psychiatric history.
Apportionment
Nil.
Effects of treatment
The Panel assessed a 1% contribution from treatment and noted that the claimant uses Lexotan (Bromazepam) as needed for anxiety.
PANEL’S CONCLUSION
The claimant suffered from an Adjustment Disorder caused by the motor accident, which has occasioned a WPI of 8%.
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