Webb v Insurance Australia Limited t/as NRMA Insurance
[2025] NSWPICMP 642
•26 August 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Webb v Insurance Australia Limited t/as NRMA Insurance [2025] NSWPICMP 642 |
CLAIMANT: | Melinda Webb |
INSURER: | IAG Limited trading as NRMA Insurance |
REVIEW PANEL | |
MEMBER: | Alexander Bolton |
MEDICAL ASSESSOR: | Paul Friend |
MEDICAL ASSESSOR: | Alan Doris |
DATE OF DECISION: | 26 August 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; whether the claimant’s psychiatric injuries arising out of a motor accident were threshold injuries; review of certificate and reasons of Medical Assessor (MA); MA diagnosed the claimant as having a threshold injury of an adjustment disorder with anxiety and depressed mood after being referred assessment of post-traumatic stress disorder; the Review Panel considered several possible diagnoses and a submission by the insurer that the claimant had not made submissions alleging a specific phobia; Held – the Review Panel concluded that it must examine the claimant and while a diagnosis of post-traumatic stress disorder had been referred it determined that the claimant had suffered a specific phobia of driving which was evidenced in clinical notes and other medical assessments which is a non-threshold injury; certificate and reasons of the MA revoked. |
DETERMINATIONS MADE: | CERTIFICATE OF DETERMINATION Issued under Division 7.5 of the Motor Accident Injuries Act 2017 The Review Panel: 1. revokes the certificate of Medical Assessor Canaris dated 4 June 2024;’ 2. has examined the claimant and determined that she has a Specific Phobia to Driving, and 3. determines a diagnosis of a Specific Phobia to driving is a non-threshold injury |
STATEMENT OF REASONS
INTRODUCTION
This is an application by the claimant for review of a certificate and reasons of Medical Assessor Canaris (the Medical Assessor) dated 4 June 2024.
The following injuries were referred by the Personal Injury Commission (the Commission) for assessment:
(a) Post-Traumatic Stress Disorder.
The Medical Assessor found that the following injury caused by the motor accident:
(a) Adjustment disorder with anxiety and depressed mood
was a threshold injury for the purposes of the Motor Accident Injuries Act 2017 (the Act).
In his certificate, the Medical Assessor also determined that certain treatment and care related to the injury and was caused by the accident. The claimant has limited her review application only to the determination of a threshold injury.
Amendment to legislation
The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2023 with various amendments commencing on 1 April 2023. From 1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”.
The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks. The accident the subject of this claim occurred on 28 June 2022.
Accordingly, an injury which does not fall within the definition of a threshold injury (“a non-threshold injury”) means that a claimant has an entitlement to claim damages and, subject to other exclusions, receive statutory entitlements beyond either the 26 week or 52-week limitation period.
LEGISLATIVE BACKGROUND
Jurisdiction
Threshold injury
A threshold injury is defined in s 1.6 of the Act which says:
“1.6 Meaning of "threshold injury"
(1) For the purposes of this Act, a "threshold injury"is, subject to this section, one or more of the following--
(a) a soft tissue injury,
(b) a psychological or psychiatric injury that is not a recognised psychiatric illness.”
In summary, if a person injured in a car accident does not have a recognised psychiatric injury, then the injured person’s statutory benefits cease in accordance with ss 3.11 and 3.28 of the Act. If a person injured in a car accident has a recognised psychiatric injury then that injury will be a non-threshold injury.
Section 1.6(4) provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) further defines threshold injury to include “an injury to the spinal nerve root that manifests in neurological signs (other than radiculopathy)” and an acute stress disorder and an adjustment disorder (in terms of psychiatric or psychological injuries).
Section 1.6(5) says that the Motor Accident Guidelines (the Guidelines) may provide for the assessment of whether or not an injury is a threshold injury. Relevantly to the matters in issue in the claimant’s claim, cls 5.10 to 5.12 of the Guidelines are headed “threshold psychological or psychiatric injury assessment and provides:
“5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.
5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5- TR), published by the American Psychiatric Association.
5.12 Where the symptoms associated with the injured person’s psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury.”
Method of assessment
Part 5 of the Guidelines contain the procedure for assessing whether an injury resulting from the motor accident is a “threshold injury” for the purposes of the Act. In respect of the medical assessment of whether an injury is a threshold injury or not, the Guidelines relevantly provide:
“5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.
5.5 Diagnostic imaging is not considered necessary to assess threshold injury.
5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.
5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:
(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions
(b) a review of all relevant records available at the assessment
(c) a comprehensive description of the injured person’s current symptoms
(d) a careful and thorough physical and/or psychological examination
(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.”
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 and has taken its own history.
The accident
The accident occurred on 12 December 2021. The claimant was driving her car and came to a stop when the driver of the insured car failed to stop and collided with her car. The impact of the collision forced the claimant's car forward into a stationary car in front of her.
Claimant’s submissions
The claimant submits the accepted approach to determining a threshold injury dispute is that even in circumstances where a claimant does not meet the criteria of a non-threshold diagnosis at the time of assessment, the claimant can still be determined to have sustained more than a threshold injury, if it is accepted that they previously suffered from a diagnosis that is not a threshold injury and that diagnosis was causally related to the subject accident.
It is submitted by the claimant that the Medical Assessor should consider previous diagnoses made by treating doctors and any relevant medicolegal experts and to what extent those diagnoses were accurate at the relevant time. It is submitted that regard should be had to the qualifications and experience of those making the previous diagnoses.
The claimant submits this is the approach consistently adopted by the Commission as set out in David v Allianz Australia Insurance Ltd [2021] NSWPICMP 227 and Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6.
The claimant refers to Allied Health Recovery Request (AHRR) 1, dated 9 June 2022, approximately six months after the accident, when the claimant was diagnosed with
post-traumatic stress disorder by her treating psychologist, Mr Goonniah. Reference was made to an aggravation in February 2023 when the claimant heard a car crash whilst at Wentworthville Pools.
Mr Goonniah confirmed the diagnosis of post-traumatic stress disorder in his report dated
9 May 2023. The claimant says that Mr Goonniah set out in detail his opinion as to how the claimant met the diagnosis of post-traumatic stress disorder in the report.
The claimant says that she was also examined by Dr Rastogi on 30 June 2023. At the time of that assessment, Dr Rastogi made a diagnosis of mild post-traumatic stress disorder in partial recovery.
The claimant submits that it is clear that the Medical Assessor's opinion was that the diagnosis of post-traumatic stress disorder was not present at the time of the assessment The claimant submits though that it is not clear whether he accepted the claimant had previously suffered from post-traumatic stress disorder as a result of the accident but recovered.
The claimant submits that the Medical Assessor did not indicate whether he accepted the diagnoses made in the past. The claimant submits that if he did accept those diagnoses, then the correct decision would have been to determine the claimant sustained a non-threshold injury.
The claimant submits that the Medical Assessor did not indicate whether he accepted the diagnoses made in the past. The claimant submits that if he did accept those diagnoses, then the correct decision would have been to determine the claimant sustained a non-threshold injury.
Insurer’s submissions
The insurer submits the Medical Assessor has considered the possibility of diagnosis of
post-traumatic stress disorder and using his clinical skill and judgment, the Medical Assessor has correctly concluded that the subject accident does not meet Criterion A of
Post-Traumatic Stress Disorder. Therefore, the insurer says that the claimant does not meet the diagnosis of Post-Traumatic Stress Disorder in accordance with DSM-5-TR.
The insurer referred to the claimant’s submission that the Medical Assessor failed to consider the differential diagnosis, in particular, the diagnosis of Specific Phobia. The insurer does not agree. The insurer says that the claimant referred post-traumatic stress disorder to the Commission for assessment.
The insurer referred to the decision of Mandoukos v Allianz Australia Insurance Limited [2023] NSWSC 1023. At [118], Chen J stated:
“[…] It is not, in my view, the function of the Medical Assessor to somehow divine a case, particularly of the kind that is covered by this ground, and it is certainly not for this Court – adopting the words of Bromwich J in COE17 v Minister of Immigration, Citizenship and Multicultural Affairs [2023 FAC 669 at [9] – to “ferret around to construct a claim where none has been made. On no view could it reasonably be suggested that this was a case that clearly arose on the material before the Medical Assessor.”
That decision was upheld in the Court of Appeal. In Mandoukos v Allianz Australia Insurance Limited [2024] NSWCA 71, at [73] it was determined:
“[…] The phrase “about a medical assessment matter” in s 7.17 does not mean that the medical dispute necessarily encompasses the whole of the medical assessment matter. Rather, a dispute between a claimant and an insurer about a medial assessment matter, is s 7.17, is a reference to the dispute which has in fact arisen between a claimant and an insurer, albeit that, to fall within the definition of “medical dispute” in s 7.17, that dispute must relate to the subject matter of a medical assessment matter. […]”.
The insurer submits that is, the scope of the medical dispute referred to the Commission for determination is not defined by law, but by the parties’ submissions.
The insurer submits the issue before the Medical Assessor was whether the claimant had a diagnosis of post-traumatic stress disorder as a result of the subject accident. The insurer says the claimant did not put before the Medical Assessor submissions alleging a differential diagnosis of Specific Phobia.
The insurer also submits there is no medical evidence or reports from treating doctors/treatment provider to support this diagnosis. The insurer says that it appears the claimant came to “the idea of this diagnosis” due to the reported symptoms related to anxiety with driving and in cars.
The insurer submits that the Medical Assessor already considered other possible differentials based on the claimant’s symptoms and clinical examination. The insurer submits that it is obvious that claimant’s clinical examination is not enough to warrant the diagnosis of Specific Phobia.
The insurer says that the claimant failed to provide any evidence to support the diagnosis of Specific Phobia other than her own opinion.
The insurer submits the Medical Assessor has used his clinical experience and judgment and provided a clear path of reasoning on how he arrived at the diagnosis of Adjustment Disorder with anxiety and depressed mood and has provided clear and detailed explanation why the claimant does not meet other diagnosis of DSM-5-TR, in particular, post-traumatic stress disorder.
The insurer noted the prior general practitioner (GP) Mental Health Plan dated 28 August 2019 which listed depression. The insurer also noted that there was evidence of prior anxiety and accident from 2017.
The insurer submits there is insufficient evidence or clinical signs or symptoms to indicate that the claimant sustained a psychological condition to meet a diagnosis for a recognised psychiatric illness as outlined in the DSM-V criteria.
The insurer submits that the psychological/psychiatric injury is a minor injury for the purposes of the Act.
Medical Evidence
The Medical Assessor provided a certificate dated 4 June 2024.
The claimant reported to the Medical Assessor that she had had a previous motor vehicle accident in 2017. She had two rotator cuff surgeries as well as surgery on her wrist. She had numerous cortisone injections to her shoulder. She struggled to shower and could not brush her hair. She was on Palexia. She was off work for four years
Following this first accident, the claimant reported that she felt depressed. She found herself anxious driving afterwards “but I got over it”. She was on an antidepressant and saw a psychologist. The Medical Assessor reported:
“She has become a very anxious driver and “I have to plan my routes” and avoids main roads because she does not like traffic and when in traffic is “very jumpy” and on the lookout for danger. She is an equally anxious passenger saying she is always gripping on to something” and finds she would struggle to do a longer trip which she cannot manage on her own because of her accident.”
The Medical Assessor referred to photographs of one of the cars involved in the collision. No photographs have been produced to the Panel
The claimant’s application for personal injury benefits dated 17 March 2022 listed injuries to her back and neck with headaches as well as “shock” and “anxiety”.
The Medical Assessor said:
“I considered a diagnosis of posttraumatic stress disorder. however, the accident as described was not an “A Criterion” event as described by DSM-5-TR. I also considered a diagnosis of persistent depressive disorder (dysthymia) with anxious distress but her overall functioning in a range of aspects of her life is not consistent with the diagnosis. Her principal symptom which admittedly is a source of significant distress to her is her anxiety driving and in cars which is associated with some insomnia and with some difficulties in concentration. Her overall presentation is more consistent with a diagnosis of adjustment disorder with anxiety and depressed mood. In terms of DSM-5-TR, I note the onset of emotional and behavioural symptoms in response to an identifiable stressor, ie, the subject motor vehicle accident (Criterion A) which are arguably out of proportion to the severity of the stressor (the claimant might not agree with this assessment), and which cause definite impairment in her social functioning (Criterion B). Her stress related disturbance does not meet criteria for another mental disorder nor is it merely the exacerbation of a pre-existing condition (Criterion C), does not represent normal bereavement (Criterion D) and has persisted well beyond six months largely because the consequences of the stressor (her pain) continue to be present (Criterion E)”.
The Medical Assessor diagnosed the claimant as suffering an Adjustment Disorder with anxiety and depressed mood, replacing post-traumatic stress disorder. This is a threshold injury.
Dr Rastogi prepared a report dated 30 June 2023 for the claimant. Dr Rastogi concluded the claimant had mild partial post-traumatic stress disorder in partial recovery. She said:
“Ms Webb presents with PTSD presenting with intrusive memories, vigilance and arousal, sense of impending doom, decreased confidence , triggers with driving and avoidance behaviours and catastrophic thoughts of having an accident This was her second accident and she had just recuperated from her first accident from 2017 and was resuming her functioning. This has set her backwards with fears, catastrophic thoughts, immense fear and avoidance of driving. She has become stress intolerant and now living in fear of having another accident. There are triggers with driving and seeing and listening about accidents. She is making an effort but anxiety and avoidance is causing limitations”.
There are clinical notes forming the claimant’s bundle of documents which are only partly legible and handwritten. These include references to nightmares and avoidance of driving as well as to images and thoughts of an accident and of being the victim. There are also references to poor concentration and weight loss.
An undated clinical note referred to anxiety when driving and as a passenger with ongoing anxiety that she would have an accident with encouragement of exposure and discussion of eye movement desensitisation and reprocessing (EMDR).
There is a letter from the claimant’s psychologist to her GP dated 14 March 2020 noting that she is receiving cognitive behaviour therapy and suggesting a trial of an antidepressant such as Lexapro or Endep.
A clinical note dated 18 August 2020 referred to the claimant having aggravation of her shoulder, being upset by a possible third surgery, and feeling triggered and interrogated and as if she was lying in an independent medical examination.
There is a letter from the claimant’s psychologist to her GP noting that she had symptoms consistent with an adjustment disorder and posttraumatic stress disorder and recommending a trial of antidepressant medication
Medical Assessor Home gave a certificate dated 8 March 2024 stating the claimant’s physical injuries to her cervical spine, lumbar spine, and right shoulder were soft tissues injuries These were declared threshold injuries.
Medical Assessor Home in his certificate dated 8 March 2024 found that an Allied Health Recovery Request (AHRR) #5 related to the injury and this was caused by the accident but the treatment requested was not reasonable and necessary in the circumstances.
The claimant’s treating psychologist, Mr Goonniah provided a report, not addressed to anyone, of 9 May 2023. He said the claimant satisfied criteria for post-traumatic stress disorder and was suffering from a “non-minor injury”.
Mr Goonniah had provided an earlier letter dated 19 August 2020 when he said the claimant had symptoms consistent with an Adjustment Disorder relating to her injury and pain. She said that the claimant’s anxiety and depressive symptoms are worsening “albeit I am pleased Ms Webb is trying”. He did not elaborate about what he was “trying” and what treatment she was engaged in.
Within the claimant’s bundle there is a letter from Dr McKay, colorectal surgeon, dated
2 September 2020. Dr McKay commented on physical problems of the claimant, unrelated to the accident. He noted that the claimant was being treated by her psychologist, Mr Goonniah, who has given her some meditation and relaxation techniques to help deal with the stress in her life. Dr McKay referred to the claimant as being a single mother, and at the time living alone with her 20 year old son who did not do a lot of the house chores for her due to her right shoulder and wrist injury.
Medical Examination
The claimant was examined by Medical Assessor Friend and Medical Assessor Doris on
24 July 2025. Their report follows:
1. Who attended the assessment
Ms Webb was examined by video teleconference by Medical Assessor Paul Friend and Medical Assessor Alan Doris. Ms Webb was sitting in her vehicle outside the Castle Hill Shopping Centre. She was alone at the time.
HISTORY
2. Psychosocial history and pre-accident history
Ms Webb lives in Northmead. She has a son who lives in Queensland and has no other children.
Ms Webb grew up with her mother. Her father died when she was very young. She has no memories of him.
She was born in Liverpool in southwest Sydney and lived in Canley Vale until relocating with her mother at about the beginning of Year 7 to Westmead where she completed school.
Ms Webb’s mother formed a new relationship from when Ms Webb was about age 15 years. She initially found it difficult to adjust to have another person in their lives. Ms Webb’s stepfather “accepted” her and she accepted him as part of the family. Her stepfather remained in the relationship with Ms Webb’s mother until she died in 2015.
Ms Webb after completing Year 12 worked for about 12 months with the State Rail Authority at Chullora doing customer service.
She next worked as a nursing assistant in a nursing home on and off for 8-10 years and during that time studied beauty therapy.
She subsequently worked in retail locations for 8-10 years in department stores doing makeup demonstrations. She was an account manager for the Clarins brand of cosmetic at the Myer store in Carlingford for 18 months. She later sold perfumes and fragrances at Myer until 2002.
Thereafter she transferred to Myer at Castle Hill where she worked in ladies’ fashions until 2008.
She worked from 2008 to 2015 as a receptionist at Evolve Housing which was a community housing organisation in Parramatta.
Her mother died in 2015. She had about a year away from work and then commenced studying for a Diploma of Travel and Tourism and later a Diploma in Events at TAFE.
Previous medical history
Ms Webb’s first motor accident was in 2017. This was a rearend collision when she was stationery at red traffic lights. She had several corticosteroid injections into the right shoulder and subsequently had surgery on the rotator cuff of the right shoulder in 2018 and 2019.
She later had surgery on her right wrist.
She had physiotherapy before the first surgery on the right shoulder and after the second surgery for 1- 1½ years. Ms Webb did not work during that time but did continue with her studies, completing them in 2019.
Ms Webb was mentally shocked after the motor accident. She felt very nervous about driving and repeatedly looked in the rearview mirror when she resumed driving.
She gradually improved. She was able to drive locally but not into the city. She avoided driving alone outside of Sydney. She always drove with someone, even to Wollongong or Gosford.
The insurance claim for the first motor accident was settled early in 2021 prior to the subject motor accident.
Ms Webb had surgery on a duodenal ulcer at age 19 years. She had gastroesophageal reflux postoperatively and took Somac and later Nexium.
She developed asthma at about age 23 years.
She has had recurrent migraine headaches for about the past 10 years. She takes Maxalt when required. She has occasionally needed to attend the Emergency Department of a hospital for injection for the headache, most recently in 2019.
She has had several presentations to hospital with an acute asthma attack usually she has had a “bad” influenza infection which last occurred in 2020 or 2021. She was treated overnight in the emergency department and discharged the next day.
Ms Webb prior to the first motor accident weighed 65-67kg and was a dress size 12. She felt comfortable with this weight. She gained weight after the first motor accident.
Prior to the first motor accident she attended the gym regularly and did boxing and Zumba. She had to cease these activities and do a modified form of yoga because of the injury to her right shoulder. She continued to walk on a treadmill and use hand weights.
Ms Webb was in a relationship for 13-14 years during which she was engaged.
During this time her son was born who is now aged 25 years.
The relationship ended when her son was aged 3-4 years.
She has subsequently had several relationships but has not cohabited. She was not in a relationship at the time of the subject motor accident.
Substance Use
Ms Webb is a non-smoker.
She consumes 1-2 glasses of wine every couple of weeks at social events.
She has never used illegal substances.
She drinks about two cups of tea each day and a bottle of zero sugar cola drink about once each week.
3. History of the motor accident
The motor accident occurred when Ms Webb was returning home from driving her elderly neighbour to a hardware store in Blacktown.
The vehicle in front stopped. She stopped and the vehicle behind hit her vehicle, forcing her vehicle into the vehicle in front.
She was driving a new motor vehicle which was purchased about one month previously.
She was thrown forward and back. She sat in her vehicle feeling shocked and “frozen”. She had a headache, felt nauseated, was concerned about her right shoulder and had soreness or pain in her neck.
An ambulance arrived. The ambulance officer persuaded her to get out of the vehicle and recommended that she be taken to hospital, but she declined because her neighbour was elderly and she was wanted to get him home.
4. History of symptoms and treatment following the motor accident
Ms Webb felt very scared and fearful of being involved in another motor accident whilst driving home.
She felt “very sore” across her whole body, had bad headaches and nausea, by the time she arrived home.
Her friend drove her to Auburn Hospital the same day. The accident occurred during the COVID-19 pandemic restrictions. She had to register outside the hospital. She was told that she would have to wait for 5-7 hours outside the hospital before she could be seen.
She instead returned home, took Panadol and consulted her doctor at Wentworthville Medical Centre the following day.
She believes that she subsequently had an MRI scan of her neck and possibly her right shoulder. She was told that the scans showed that she had some inflammation but no significant damage to her right shoulder.
She had actually been planning to drive to the Gold Coast, Queensland to visit her son, later in December. Her vehicle was safe to drive after the motor accident.
She travelled to the Gold Coast, in her vehicle. She had a girlfriend drive most of the way. She drove when there was little traffic on the road. She felt very nervous during the trip particularly when driving near trucks or buses. The trip lasted from 7.00am to 9.00pm because Ms Webb needed to take breaks because of her nervousness. She did not drive after dark.
Ms Webb remained living with her son on the Gold Coast for six weeks.
She remained very anxious and scared when driving or travelling as a passenger, particularly on the main highway thought the Gold Coast. She was fearful of a further motor accident and repeatedly looked in the rearview mirror.
Her friend returned to Sydney in early January.
Ms Webb’s ex-partner flew up and drove her vehicle back to Sydney.
She remembers she was very nervous during the trip, even though her ex-partner was not a fast driver. She repeatedly told him to slow down, to not speed and to be careful and not get too close to
other vehicles.
Her vehicle was repaired when she returned to Sydney.
Ms Webb subsequently continued to drive in the local area but was very anxious and fearful of a further motor accident in doing so.
She recontacted the psychologist, Navin Gooniah, who treated her after the first motor accident. She had consultations by telephone but on a few occasions he persuaded her to drive to Penrith to his office.
Ms Webb continued to feel very nervous when driving, was very nervous when travelling as a passenger and avoided driving on busy roads or main roads. She always took back roads even though the trip may take much longer.
Ms Webb also had some pain and soreness in the right shoulder and had physiotherapy and sometimes had physiotherapy on her neck. She occasionally has had lower back pain.
Ms Webb was determined to try to get on with her life, not wanting to have her life on hold for years as it had occurred after the first motor accident.
She took herbal or natural sleeping tablets, if she was tense and had pain, to help her relax and get to sleep.
She did not take any analgesic or antidepressant medication.
She had taken antidepressant medication after the first motor accident and her weight had increased to 89kg.
5. Details of any relevant injuries or conditions sustained since the motor accident
Ms Webb has subsequently been able to lose weight and currently weighs about 71kg. This has been in part by watching her food intake but she also had injections of Wegovy from October 2024 until about a month ago.
She trialled taking Duromine, prior to having injections of Wegovy. It was initially effective, but lost its effectiveness over time.
She would like to weigh 60-67kg.
Ms Webb developed glaucoma in both eyes and had laser surgery in either 2022 or 2023.
Ms Webb developed hypertension about a year and a half ago and was taking medication which she has been able to cease with the weight loss.
Ms Webb has continued to take Nexium every day, Maxalt when required for headaches and Seretide daily as prophylaxis for asthma. She takes a Ventolin inhaler when she is required to do so.
Ms Webb had an intrauterine Mirena inserted in 2020 because of fibroids and endometriosis. It remains in situ, but needs to be replaced.
6. Current symptoms
Ms Webb continues to have the same symptoms when driving. She always feels nervous and anxious and fearful of a further motor accident, particularly a rearend collision. She always avoids driving on main roads and sometimes this means it takes her far longer to travel to a specific location.
She drives herself in the local area. She tries to get someone else to drive, if she needs to drive further afield, but this is not always possible. She recently attended a birthday party in Ashfield and it took her two hours to drive from Northmead to Ashfield because she avoided all the main roads.
7. Current and proposed treatment
Ms Webb continues to take the same medications.
CLINICAL EXAMINATION
8. Mental state examination
Ms Webb was examined by video teleconference. She was alert, orientated, on time and cooperative with the assessment.
She described ongoing anxiety and fear of a further motor accident every time she drove.
She avoided driving wherever possible and avoided if possible, driving outside the local area, and if she did so it was only if necessary and it always provoked intense anxiety.
She has avoided driving outside of Sydney.
She has travelled several times up to visit her son on the Gold Coast, but has always been driven by another person to and from the Gold Coast.
She remains very nervous, anxious and fearful of a further motor accident if she travels as a passenger.
9. Current functioning
Ms Webb can undertake her personal care without difficulty. Sometimes she has pain in her right shoulder and needs to use her left arm more to wipe down benchtops or vacuum.
Her neighbour carries her groceries inside for her. It can be difficult to hang bedsheets on the clothesline and her neighbour will help.
Her right shoulder does not have full range of motion after the rotator cuff surgery.
Ms Webb has always been a very social person, enjoyed meeting other people, going out dancing, walking, exploring and previously travelling. She enjoys going shopping and previously enjoyed going to the gym but had to cease going to the gym about a year ago because it felt “too much” after work. She was reduced to doing treadmill and hand weights which she enjoyed, prior to ceasing attending the gym.
Ms Webb can drive locally to the local shopping centre about ten minutes travel and to work which is about twenty minutes travel.
She can drive as far as Thornleigh along Pennant Hills Road but feels very tense, anxious and fearful of a further motor accident. She drives into the Birkenhead Shopping Centre in Drummoyne, but drives early in the morning and gets home as quickly as possible.
She avoids driving in the rain.
She has travelled three times to the Gold Coast, Queensland to visit her son, but was always driven by another person.
Ms Webb completely ceased driving for a few weeks after returning from Queensland at the end of January 2022. She was motivated to resume driving because she did not want to have to use public transport.
Ms Webb has good relationships with all her friends, with people at work and with her neighbours and her son.
Ms Webb reported that her ability to think and concentrate are generally good. Occasionally she is a bit forgetful.
Ms Webb resumed work at the Winnings Appliances shop in Westmead which she could walk to and from in 2022.
She was made redundant and was unemployed for a month until she obtained employment in March 2023 in the Witchery clothing in Myer at Castle Hill.
She is the manager and has one part time employee to manage. She works full time. Her roles include keeping track of stock, hanging clothes, making the area presentable, tidying and serving customers. She enjoys this activity because it gives her a reason to get up in the morning and she can interact with customers which she enjoys.
10. Comments of consistency
Ms Webb’s account was consistent throughout.
She forgot some details of her earlier medical history until she was prompted, but then readily provided the history above.
Her description of her symptoms was inconsistent with the account of the reports of Navin Gooniah who diagnosed Posttraumatic Stress Disorder and Adjustment Disorder.
Her account was also inconsistent with the diagnosis of Dr Rastogi who made a diagnosis of Post-traumatic Stress Disorder in partial recovery.
Her account was generally consistent with the report of Assessor Canaris, except that she described more symptoms related to driving.
REVIEW OF DOCUMENTATION
11. Summary of relevant documentation
The Personal Injury Commission Certificate by Assessor Christopher Canaris dated 4 June 2024, makes a diagnosis of Adjustment Disorder with Anxiety and Depressed Mood, which is a threshold injury for the purposes of the Act.
It states the following treatment Allied Health Recovery Request Number 2 for Psychology relates to the injury caused by the motor accident and is reasonable and necessary in the circumstances.
There was a previous motor accident, 2017. She had two rotator cuff surgeries, as well as surgery on her wrist, and numerous cortisone injections into her shoulder.
She was off work for four years and receiving Centrelink benefits with financial help from her son.
She lived off the payout after the 2017 claim was settled.
Prior to 2017, she worked for P&O Cruises.
She felt depressed and was anxious driving, but states she got over it. She was treated with antidepressant medication and a psychologist.
She stated by December 2021, she decided to look for work again.
The subject motor accident occurred when she was driving and stationary behind another vehicle. She suffered a rear end collision which pushed her into the vehicle in front.
She is very anxious as a driver and has to plan her routes, avoids main roads and does not like traffic.
She is very jumpy in traffic and on the lookout for danger.
She is very anxious as a passenger, always gripping onto something. She struggles to do longer trips which she cannot manage since the accident.
She freaks out if she sees an accident on television.
She saw an accident at Wentworthville which caused her to cry.
She says, “Every day I think I'm going to get hit”.
She is trying to get a transfer to Parramatta because all she has to do is catch a bus.
She has difficulty falling asleep.
She had two dreams in which she had been in an accident and has also had dreams about going to be in an accident or an accident has happened.
She wakes two to three times each week with a start. She overthinks and gets anxious and nervous if she has to go somewhere the next day.
She gets depressed but keeps it in.
She is always on edge. This is usually in regard to driving. She feels she' would be fine if she could just walk everywhere.
She was depressed for a few months after the second accident, which she saw as a big setback.
Current functioning states that she cares for herself, showers and changes her clothes daily and her weight is stable.
She goes out once a fortnight, which is less than prior to the motor accident.
She has symptoms with regard to driving.
She was not in a relationship and gets on well with her son who is in Queensland and her friends.
Her concentration is not too bad.
She says, “I am a manager and I have to be focused. If there are things not to do with work, I get distracted watching television and I’m overthinking even with a book”.
She is coping well with her current job which she's been doing for 12 months.
The report by Dr Richa Rastogi, dated 30 June 2023, states she was off work at the time of the accident and had been not working since 2017.
She commenced work in September 2022 as a sales assistant on a part-time basis at Castle Hill where she works 29 hours each week.
Since the time of the motor accident, she has a fear of driving, is scared to get back to driving and has lost confidence about driving.
She feels anxious and nervous and has commenced psychological counselling.
This has affected her driving to Queensland to see her son.
She goes to Queensland with a friend or family member and always drives on the highway with a companion.
She is afraid she is going to be hit from the back and slows down and drives on the left lane.
She has been abused for driving slowly, especially in heavy traffic where she gets overwhelmed and very anxious.
She is disappointed in herself and how the anxiety is controlling her.
She is restricted socially and relies on a friend or family and does not volunteer to drive.
She avoids the site of the motor accident.
She is triggered by hearing about an accident and witnessing an accident brought back memories of the accident in which she visualised herself being seriously hurt.
She is vigilant and aroused in an intersection and always fearful that something sinister will happen.
She relives the accident at night, going through vivid images of being in an accident.
She finds it difficult to drive and anxiety provoking, such as exhausting.
She describes herself as rigid and almost hyper-focused on the road.
She has been consulting a psychologist, Navin Gooniah who diagnosed PTSD and an adjustment disorder.
Dr Rastogi makes a diagnosis of mild PTSD in partial recovery.
The application for personal injury benefits regarding the motor accident on 12 December 2021, state she suffered injuries of back, neck, headaches, shock and anxiety.
The Allied health recovery request by Navin Gooniah psychologist, dated 9 June 2022, lists the symptoms as rumination about motor accident, flashbacks, nightmares, significant anxiety when driving or as a passenger when driving, avoidance of driving, depressive symptoms and difficulty sleeping. The diagnosis is Post-traumatic stress disorder.
The Allied Health Recovery Request by Navin Gooniah, dated 10 April 2023, lists the same symptoms and diagnosis.
The report by Navin Gooniah, psychologist, dated 27 February 2023, states Ms. Webb has symptoms consistent with an adjustment disorder and post-traumatic stress disorder.
Her anxiety symptoms have been aggravated by having a severe car accident in Wentworthville and observing the wreckage.
The report by Navin Gooniah, psychologist, dated 9 May 2023, states Ms Webb first attended on 6 June 2022, and the last appointment was on 23 March 2021.
At the time of the accident she was going well and had purchased a property in Queensland and a new vehicle.
Following the accident 2021 she was unable to exit the vehicle. She experienced pain in the neck and lower back and anxiety about a shoulder.
She developed symptoms consistent with post-traumatic stress disorder.
It states during the course of the sessions she was making progress. She informed me in the session of 27 February 2023, she was at the pool in Wentworthville, when she heard a motor vehicle crash. She exited the pool and observed the wreckage, which triggered anxiety, as she questioned, "what if it was me?"
She was improving until the session on 27 February 2023.
There are no restrictions on her capacity to work, short of not working in a role related to motor accidents. She has a diagnosis of post-traumatic stress disorder.
The clinical notes of Navin Gooniah, only some of which are dated, contains a typed entry which is undated, states she's still working at Winning Appliances. She is working part-time. She has anxiety in regard to driving and does not drive too far. She won a steam oven. It is not a stressful job. She has ongoing anxiety about having an accident.
The handwritten clinical notes dated 28 February 2019, apparently of Navin Gooniah, states she was involved in a motor accident two years ago. She was doing a Certificate III in travel and was doing job interviews.
She had a rear end accident with a lower back injury and increased pain.
She had right rotator cuff bursitis and no improvement with physiotherapy. She had tears on an MRI scan.
She had tendonitis with right muscle right hand symptoms.
She is unemployed and a single mother. She has an 18-year-old son.
She has a frozen right shoulder with chronic pain, which impacts on her daily functioning.
She has depressive symptoms and anxiety.
The report of Dr. Gary McKay Colorectal surgeon, dated 2 September 2020, states her irritable bowel symptoms have been exacerbated by stress since a motor accident in May 2017, when she sustained a rotator cuff injury and wrist injury. She has been off work for some time.
She has reflux symptoms which are worse.
It was recommended she stop the Somac and try Nexium.
She had a normal gastroscopy and colonoscopy on 15 March 2019.
She has five to seven loose bowel motions each day, which is usually triggered by stressful events.
She's gained weight from 65 to 82 kg in the last 10 years. She has been trying to lose weight with taking Optifast.
She has had two episodes of urge incontinence last year.
There is no evidence of progressive weakening of the anal sphincter or rapid deterioration.
The report by Navin Gooniah dated 14 March 2020, states Ms. Webb has diagnoses consistent with an adjustment disorder. She has anxiety and depressive symptoms.
The GP mental health treatment plan by Dr Zaid Ali dated 28 August 2019, states she has depression.
The insurer's reply submissions state the assessor considered the previous diagnosis. The assessor determined the claimant did not reach criteria for a diagnosis of pos-ttraumatic stress disorder.
The GP mental health treatment plan by Dr Zaid Ali, dated 14 February 2022, makes a diagnosis of Generalised Anxiety and Adjustment Disorder.
The clinical notes from the Wentworthville Medical Centre from 26 May 2022 to 21 July 2023 include the following.
The entry dated 26 May 2022 by the physiotherapist CY Ernest Kwan states she was rear-ended by another vehicle. Her vehicle hit the vehicle in front. She is unemployed and had been travelling to Queensland as her son has moved there. She can currently drives for 20-30 minutes, whereas pre-injury could drive for 60 minutes.
She has neck pain with headache, lower back pain, right shoulder pain, and secondary left shoulder pain due to overuse post-motor accident.
There is a past history of right cuff and biceps repair by Dr Gupta from a previous motor accident, 2017, and De Dequervains release by Dr Simon Chan. She had a cortisone injection in December 2021 to relieve the pain from this motor accident.
She has been approved for physiotherapy and psychology sessions and may also get cleaners too as she lives alone.
The entry dated 20 June 2022 states she has been doing physiotherapy. She is taking Nexium 20mg in the morning, and Duromine 30mg in the morning.
The entry dated 18 July 2022 states she is continued her physiotherapy and has consulted the psychologist. She uses Duromine every third day or so, but has not lost weight.
Her weight is 74.5 kg.
The entry dated 7 August 2022 states she is feeling better and has nearly finished the oral antibiotics. She is travelling to Queensland tomorrow.
The entry dated 30 August 2022 states she has recently returned from Queensland and is willing to start a new sales job, which she will trial next week.
The entry dated 9 October 2022 states her new job requires tasting food to sell appliances and she has gained weight.
The entry dated 25 October 2022 states she has increasing pain in the right shoulder, which is very stiff and she has shoulder capsulitis. She was referred for an ultrasound, plus or minus cortisone injection.
The entry dated 1 January 2023 is a telehealth appointment. She has laryngitis and is in Queensland. She has cough and asthma and sore throat. She was prescribed Augmentin Duo Forte and prednisolone 25mg if required.
The entry dated 9 January 2023 states she has returned from Queensland and there are a few issues. The sore throat and cough are worse.
The entry dated 6 March 2023 states she has tried swimming to help with her shoulder. She is having physiotherapy. She has attended the Sydney Eye Hospital regarding glaucoma.
Navin Gooniah states she has some anxiety issues with flashbacks of the car accident December 2021 after she came across another car accident. She became nervous and had some difficulty.
The entry dated 25 June 2023, which is the last medical entry, states the right hand ultrasound showed tendinitis with thickening. It states she may need to see a hand physiotherapist
DETERMINATIONS
12. Diagnosis and reasons
The Review Panel considered all the available evidence including the information provided by Ms Webb and in the supplied documents. The Review Panel determined that Ms Webb had a diagnosis of a specific phobia of driving.
She reaches criterion as follows.
Category A
She has a marked fear and anxiety about the specific object or situation which is driving.
Category B
The object provokes immediate fear or anxiety.
Category C
The phobic situation is actively avoided or induces intense fear or anxiety.
Category D
The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation.
Category E
The fear or anxiety and avoidance is persistent and has lasted more than six months.
Category F
The fear or anxiety and avoidance causes significant distress and impairment into social and day to day functioning, particularly travel.
Category G
The disturbance is not better explained by the symptoms of another mental disorder and is not associated with avoidance for panic because of panic like symptoms. She does not have agoraphobia or obsessive compulsive disorder.
Ms Webb mostly described symptoms specific to driving which are outside the criteria for an Adjustment Disorder with mixed Anxiety and Depressed Mood.
Ms Webb did not describe sufficient symptoms to reach criterion for a diagnosis of Posttraumatic Stress Disorder.
13. Causation and reasons
The Review Panel determine that the condition of a Specific Phobia of Driving arises from the injuries sustained in the motor accident.
The Review Panel noted that Ms Webb had some symptoms in regard to driving but was able to drive in Sydney but not into the City but required someone to accompany her if she drove outside of the city such as to Gosford or Wollongong
She did not have the intense fear or anxiety when driving prior to the subject motor accident.
The Review Panel considered that she had a pre-existing Adjustment Disorder and Anxiety.
Summary of injuries referred by the parties
14. The following injuries WERE caused by the motor accident:
·Specific Phobia of Driving.
The condition of a Specific Phobia of Driving is not an acute stress disorder and is not an adjustment disorder so it is not a threshold injury.
The assessment of whether the injury is a ‘threshold injury’ is not a direct measure of symptoms or disability. A finding that the injury is a ‘threshold injury’ indicates that there was an injury caused by the motor accident and that there may be continuing symptoms, however the injury satisfies the definition of a threshold injury under the Act and the Regulation.
CONCLUSION – THRESHOLD INJURY
The following injuries are not threshold injuries:
· Specific Phobia of Driving.
The Panel met on 21 August 2025 to discuss the Medical Assessors findings on examination. The legal Member of this Panel did not participate in the medical examination but prior to the Panel meeting on 21 August 2025, the legal Member has had the benefit of reading and considering the Medical Assessors examination report. On 21 August 2025 the Panel met and all discussed the examination findings and the issues going to causation. It is from this teleconference of the Panel that the Panel has agreed and reached its final conclusion and determination.
The Panel adopts the examination report of Medical Assessor Friend and Medical Assessor Doris.
Causation/Reasons
Whilst the claimant has coping strategies regarding the driving of car, it is apparent from the by the history provided by her that she has continued to drive on a regular basis but in a considerably restricted form.
However, the Panel is satisfied that the accident has caused a specific situation phobia to driving because following the accident, she informed her physiotherapist, Mr Kwan, that she could drive for 20 to 30 minutes but pre-injury she could drive for 60 minutes. Mr Goonniah noted some anxiety issues with flashbacks of the car accident when in December 2021 she came across another car accident. She also informed Mr Goonniah as noted in his AHRR of 9 June 2022 that she had significant anxiety when driving or as a passenger when driving and avoidance of driving. The clinical notes of Mr Goonniah also record that she had anxiety in regard to driving and she does not drive too far. She has consistently reported this anxiety to other practitioners and not just to the Panel.
It is apparent from the reasons of the Medical Assessor that at the time of his examination of the claimant, she did not demonstrate to him a driving phobia. However, the Panel is satisfied that at other points in time, the claimant has suffered this phobia and at the time of examination by the Panel, the claimant clearly demonstrated a specific situation phobia to driving.
The Panel is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen and Insurance Australia Ltd v Marsh [2021] NSWCA 287.
The claimant informed the Medical Assessors that she actively avoids driving or situations involving driving. She has stopped driving because of his distress experienced and has further anxiety whilst having to travel a long distance to visit her son in Queensland.
The claimant’s fear, anxiety, or avoidance is persistent, having lasted for six months or more. The onset of the claimant’s specific situational phobia to driving was at the time of the motor accident on 28 June 2022. The claimant remained impaired by this psychological injury at the time of her examination on 24 July 2025.
The Panel adopts the reasoning in Lynch v AAI Ltd [2022] NSWPICMP 6 (Lynch) that the psychological condition can be present at any time to establish that the injury is not threshold for the purposes of the Act. However, in this claim, the Panel is satisfied that a driving phobia was demonstrated at the time of examination by the Panel Medical Assessors, in any event.
The Panel also adopts the reasoning in Lynch that the claimant bears the onus of proof in establishing that any injury is not a threshold injury for the purposes of the Act. The Panel is satisfied, following examination of the claimant, that this onus has been satisfied.
The Panel must also ask itself in considering whether the accident contributed to the claimant’s injuries as referred to it by the Commission, whether the claimant’s condition was caused by or materially contributed to by the accident. The Panel is satisfied that this can be answered affirmatively. She has had to change her driving arrangements and routes of travel and is reliant on assistance to get from one point to another.
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 Assessors, the Panel does find that this can be answered in the affirmative.
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. This is because up to and at the time of the accident his driving activities were not restricted and caused her no distress. Prior to the accident the claimant was driving without restriction and without anxiety. Following the accident though, her driving was curtailed due to her anxieties arising from this such that she was not able to drive all the time and had to plan her route of travel, endeavour to avoid the accident site, and to try to avoid traffic, amongst other things.
The insurer has relied on the decision of Mandoukos v Allianz Australia Insurance Limited [2023] NSWSC 1023. The insurer says that the scope of the medical dispute referred to the Commission for determination is not defined by law but by the parties submissions. The insurer says that the claimant did not put before the Medical Assessor submissions alleging a differential diagnosis of specific phobia. That may be the case but this is a hearing de novo and those very issues raised before the Medical Assessor and for determination by the Panel now include consideration of a differential diagnosis of specific phobia.
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 must examine the claimant and perform its assessment on the basis of its discussions with the claimant on the day of assessment. A psychiatric symptom might evolve over time and disappear over time for that matter. In this case, the Panel was not satisfied that the claimant had a post-traumatic stress disorder but was satisfied on the basis of the history provided by the claimant, and the clinical assessment of the Medical Assessors, that she was suffering a psychiatric disability of a specific situation phobia to driving.
Conclusion
The Panel is satisfied that consequent upon the motor accident which occurred on 28 June 2022, the claimant developed a psychiatric disability of a Specific Phobia of driving. This is a non-threshold injury
Determination
The Review Panel:
(a) revokes the certificate of Medical Assessor Canaris dated 4 June 2024;
(b) has examined the claimant and determined that she has a Specific Phobia to Driving, and
(c) determines a diagnosis of a Specific Phobia to driving is a non-threshold injury
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