Zervos v Allianz Australia Insurance Ltd
[2025] NSWPICMP 498
•10 July 2025
| DETERMINATION OF REVIEW PANEL | |
CITATION: | Zervos v Allianz Australia Insurance Ltd [2025] NSWPICMP 498 |
CLAIMANT: | Chris Zervos |
INSURER: | Allianz Australia Insurance Ltd |
REVIEW PANEL | |
MEMBER: | Member Hugh Macken |
MEDICAL ASSESSOR: | Thomas Newlyn |
MEDICAL ASSESSOR: | Paul Friend |
DATE OF DECISION: | 10 July 2025 |
CATCHWORDS: | MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); depressive disorder with alcohol use disorder; post-traumatic stress disorder (PTSD); depression and anxiety; remedial assessments; changing demeanour; chemical dependence history; relevant psychiatric history; post-accident symptom; excessive alcohol consumption; ongoing psychiatric treatment; specific phobias; consistence in history; Held – MAC revoked; new MAC issued with 19% whole person impairment (WPI). |
DETERMINATIONS MADE: | Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017 1. The Review Panel revokes the certificate of Medical Assessor Matthew Jones dated 11 January 2024. · persistent depressive disorder with alcohol use disorder is a non-threshold injury for the purposes of the Act. 2. The psychiatric injuries caused by the motor accident give rise to a permanent impairment of 19% which is greater than 10%. |
STATEMENT OF REASONS
BACKGROUND
Chris Zervos (the claimant) is a 37-year-old man who was involved in a motor vehicle accident on 28 February 2020. The vehicle he was driving was hit from behind by the insured’s vehicle. The claimant lodged an Application for Personal Injury Benefits and thereafter sought a concession from the insurer that he had sustained a non-threshold injury. Following a review the insurer confirmed its determination that the claimant had sustained a threshold injury. The claimant then lodged an assessment of threshold injury and was examined by Medical Assessor Matthew Jones on 11 December 2024 in respect to the allegation that he sustained post-traumatic stress disorder, depression and anxiety, major depressive disorder as a threshold injury and further that the claimant sustained a major depressive disorder and whole person impairment above 10%.
Medical Assessor Matthew Jones determined that the claimant had sustained a chronic adjustment disorder with depressed mood and mixed anxiety which is a threshold injury for the purpose of the Motor Accidents Compensation Act 1999 (MAC Act). He further determined that the injuries caused by the motor vehicle accident gave rise to a whole person impairment of 9%.
The claimant sought a review of this determination, and in a certificate dated 6 May 2024 the President’s delegate Melinda Drew determined that she was satisfied that there was a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The matter was then referred to this Medical Panel.
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 the 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.
The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (the Commission).
Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure 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. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
STATUTORY PROVISIONS/GUIDELINES
Section 57 of the MAC Act defines a “medical dispute” as a disagreement or issue to which Part 3.4 of the MAC Act applies.
Section 58 and s 60 of the MAC Act together with clauses 1.5-1.7 of the Guidelines set out the procedures for referral to one or more medical assessors and the principles to be applied at such assessments.
ASSESSMENT
The claimant is a 37-year-old man. He attended unaccompanied, with his wife and baby daughter at home. He said that his wife knows more about their baby daughter, born in April 2025, but did not elaborate on why. He commented that his wife had to assist with the connection on the day of the appointment, and expressed frustration, saying he did not know why he could not connect and that everything seemed to go wrong. He called on his wife to disconnect when the interview ended three hours and five minutes later.
The assessment was conducted via MS Teams videoconferencing. He was at home in Gymea Bay. He confirmed he had not consumed alcohol for 12 hours before the assessment.
The original scheduled re-examination, on 9 April 2025 was cancelled after about 20 minutes when Mr Zervos admitted that he had consumed at least three glasses of Vodka.
HISTORY
The claimant said he was six feet tall (183cm).
He did not know his current weight. He estimated it to be approximately 134kg, noting that it was a wild guess. He was then asked if he was overweight before the 28 February 2020 motor vehicle accident. After a long pause, he said, “I was fit before. I was not overweight.” He appeared distressed by the use of the word “overweight” and was not challenged further due to his level of distress, although his general practitioner (GP) had written in 2019 that he was obese.
The claimant is right-handed.
The claimant said he saw a doctor about his left hip before the motor vehicle accident. Dr Solomon noted there was some discomfort at the time. Following the motor vehicle accident, he described the pain as excruciating. He said that he was able to work before the accident but now cannot work due to the pain.
The claimant had an ingrown hair just above his tailbone, for which he had surgery. He said that he had never heard the term “pilonidal sinus”.
The claimant reported no allergies to medicines.
EDUCATION HISTORY
The claimant gained a Higher School Certificate.
The claimant completed an Advanced Diploma in Building Studies at the University of Sydney after completing secondary school. He later completed a Diploma in Management at the University of Sydney through his employer, Buildcorp.
EMPLOYMENT HISTORY
When asked about work, the claimant paused for a moment before saying:
“After I finished school, I went into remedial building with KBS Australia in design and estimating. I was a cadet involved in pre-contract design, learning how to design solutions. I stayed with KBS until the director became sick and passed away—I can’t remember exactly when that was
After that, I worked for Buildcorp for a couple of years in estimating and design. It was a great company, and I was there on a contract. I also worked with my dad on a block of units for two years. During that time, I was also a contractor with Intermain.
Before that, I had worked with Eptec at KBS, and later I returned to Eptec for a few years to do remedial work. Initially, it was a great company, but things changed when it grew larger. I had problems with the new ownership, especially around shifting KPI targets. I was part of the national management, development, and estimating team.
My boss was dealing with depression, and there was a lot of pressure, but I managed to cope with it. Eptec is very successful and did address some of my concerns. I stopped working there when the company was sold. Not long after the sale—maybe a month or two later—I was offered a better position with Crawford. I can’t remember exactly, but it could have been in 2018. My memory isn’t the best.
Before the accident, things were going well at Crawford. There was a safety issue in my team, but it was less serious than others made it out to be. After the accident, Mark said I wouldn’t receive a bonus because I didn’t have billable hours, and my salary changed from that point.
Aside from the safety issue, which multiple people raised, Mark treated me poorly after the accident, like I was a broken toy to be put aside. Dr Panos documented that in September 2020 at Leura, I had gone to assess damage at a house that turned out to be a drug lab. There were syringes and marijuana, and I felt dizzy from being there. I can’t go into high-risk environments like confined spaces anymore. I had already been exposed to asbestos and had the Leura incident before the accident. I’ve always done remedial assessments, which are high-risk. Now I have a fear of physical harm and feel like I’m deteriorating.
After the accident, I stopped going on site.
After the accident, they issued a breach notice to get rid of me, but it was never resolved. The insurer stepped in, and Crawford complained, which led to the appointment of a new claims manager. The new claims manager was terrible. She told me my whole team was affected and that I was affected because of the car accident. I still think about my manager’s actions and inactions. I was the only one handling complex matters. The breach of company policy was nonsense. I was told to focus on my recovery.
In November 2021, I received a letter that my wife read, saying there was no longer a position for me
Recently, I started working for Martin. It was part of a treatment program and not a clean-cut job. I worked different hours. Martin now says it’s not profitable. My wife helps me. I have no income from the insurer. Martin gave me 12 months to improve, but he is retiring now and says I’m not profitable.
Tasks that should take one hour now take me ten. My memory is poor, and I’m not integrating information well. Martin has tried to support me, but he can’t invest more time. He sympathises with me because he was the other expert at the meeting after the accident. I’ve known him since my time at Buildcorp.”
PSYCHOSOCIAL HISTORY
Family History
The claimant said:
“My parents are of Greek heritage. I have one sister and two brothers. My wife and I have been moving between my place and my parents' house. My parents call me every day and visit as much as they can; usually three to four times a week. We talk, but I can’t tell them how I feel. I couldn’t tell them about the accident or the pain I’m in. Building the house hasn’t stopped, but I’m just trying to survive.”
When asked about walking up the stairs in 2022 he said Dr Panos and Anna gave him the task. “I could walk up and down the stairs, though in pain. Now, I’m not doing as well.”
When asked why he stays in his room, he replied:
“I don’t want to stay in the room, but I don’t trust anyone. I don’t have hope or wishful thinking anymore. I think a lot, and I feel safer in this room. I can’t be injured here. No one tells me how well they’re doing.
I don’t think my demeanour has changed, but I was homeless in 2022. Why change? I don’t know why I’m worse now. I think I’ve given up. I used to see Anna and had weekly physiotherapy. I just don’t feel safe or comfortable, and I know I’ve gotten worse.
I can’t accept that I was once recovered enough to carry four coffees. That’s what I was told to do. No one understands. I freeze. I’m in pain all the time. I couldn’t sleep last night because of the pain.
I think people have false perceptions of me. I feel overwhelmed, and my wife says we have to start thinking about ‘Plan C.’ Things are getting worse. I’m being pushed beyond my limit. I’m in a spare room now. The room I work in is downstairs.
Work used to be a distraction and gave me hope, but the feedback hasn’t been good. Rewriting an email five times isn’t a good sign. This is not a situation I can mask anymore. I’m just putting a band-aid over my problems.
I love my brothers and sister, but I can’t relate to them. I only see them at family events. I haven’t done Easter.
I’ve been to my parents’ birthdays, and they visit me more than I go to them.”
DEVELOPMENT HISTORY
Childhood sexual or physical trauma.
RELATIONSHIP HISTORY
When asked how long he had been married, he replied, holding his head, “I can’t remember the date.” He estimated that it had been about eight years. He said his wife has been understanding since the accident, but she has told him she can’t keep going and that his condition has affected her life.
They have been sleeping separately for several months due to his disrupted sleep. He wakes during the night and struggles to get back to sleep. He said his wife suggested he move to another bedroom, as she needed a break from him. He still considers that the marriage is intact.
They have two daughters. Penelope was born in May 2021. He mentioned that she checks in on him when he is in a "black spot." Each time he looks at her, he says he feels sorry for her, describing himself as “a mess.” They also have an infant daughter, born in April 2025.
CHEMICAL DEPENDENCY HISTORY
He did not exceed the Australian Government Department of Health and Aged Care guidelines for alcohol use before the motor vehicle accident. See the section “History of Symptoms Following the Motor Accident” for details on alcohol use after the accident. No use of street drugs was reported. No use of cigarettes was reported.
FORENSIC HISTORY
The claimant reports current difficulties with anger management. He said, “I get angry with anyone and everything. I don’t throw things, but I hit myself sometimes. I was angry with you guys about my ability to communicate.”
He reported filing a complaint with SafeWork Australia in 2020, after which his then manager was let go. He said the insurer provided instructions by email on what he was to do.
He referenced a Supreme Court matter in 2020 where his employer wanted him to represent the company.
He said the insurer advised that the company was breaching policy, and he wrote a letter to the court with the insurer’s assistance, but ultimately did not go to court.
He does not have a gambling problem.
He had not made any compensation claims before the motor vehicle accident.
PSYCHIATRIC HISTORY BEFORE THE MOTOR ACCIDENT
The claimant denied having any psychiatric history before the 28 February 2020 motor vehicle accident.
His GP’s records noted anxiety in 2014 and depression in 2018, with the 2018 entry related to reports of bullying and harassment at Eptec.
The claimant said, “I don’t believe I was anxious in 2014. I have always been involved in high-risk projects.”
Regarding 2018, he acknowledged having concerns about Eptec and described himself as stressed rather than depressed. He said he did not need or have treatment.
PRE-ACCIDENT FUNCTIONING
The claimant reported that he loved cooking.
He described himself as being very hygienic. He regularly used wet wipes and hand sanitiser, showered after the gym, and sometimes trained twice daily.
He reflected on his previous social life: “Every Friday was date night. I was social on Saturdays.”
Before the accident, he spoke with friends daily and went out weekly or even more often. He attended industry events regularly.
He drove wherever he needed to go.
He described no issues in his marriage or with his parents.
He described no issues in his ability to focus and functioning well in his job at Crawford.
HISTORY OF THE MOTOR ACCIDENT – 28 February 2020
On 9 April 2025, the claimant said:
“I remember being stopped at the lights. I was eager to get to a job site. I had been there the day before, so it was fresh in my mind. I was on St Thomas Crescent when someone behind me smashed into my car. I was in shock. I didn’t expect it to be so bad. It was enough to shake me. I talked to the guy. We exchanged details. His bumper had fallen off, and honestly, I don’t remember it being properly attached in the first place. I don’t believe it. My whole tow bar had to be replaced—it was bent. There must have been some serious force to bend something like that.”
On 19 May 2025, the claimant said:
“I was driving to work. I was going to a meeting with an old colleague [Martin]. I was stopped at a red light and was the first car there when someone hit me from behind. I had a lot of strange sensations—hot and cold feelings, and my legs felt jelly-like. I had an appointment to meet a client. It was supposed to be a joint meeting with her husband. I wasn’t feeling well, but I still went (to the building site)
When I got there, I started feeling worse. Both the client and my colleague said I didn’t look well.
I went to the office, and my manager told me I should go to the doctor.
The doctor monitored me over the weekend. He arranged scans because my condition got worse. Since then, it’s been like taking one step forward and one step back. I get sick all the time.
My psychologist and doctor both say my immune system isn’t strong.
I’ve had physiotherapy, injections, hydrotherapy, dry needling, and used a TENS machine.
I haven’t had any miraculous surgery. I might need hip surgery in the future. I already had a problem with my left hip before the accident, and I believe the accident made it worse.
I fall often now, and I’ve injured my left Achilles tendon. I’ve even broken ribs in some of the falls. My whole left side is weaker, and I get shooting pains on the right side. I experience pins and needles in my left arm, weakness, and shooting pain in my neck. The pins and needles are also in my left arm, which is weaker than my right.
My doctors said the issues in my neck are causing the pain and the pins and needles.
The pain from my hip radiates past my knee and down to my foot. When I went to the hospital last week, my hip felt like it popped out.”
HISTORY OF SYMPTOMS FOLLOWING THE MOTOR ACCIDENT
The claimant said:
"At the time of the accident, I felt I had to get to the meeting and get it done. I was focused on making it there, but when I started feeling pain at the meeting, I realised it was worse than I initially thought. My wife noticed that I seemed down when my manager began discriminating against me because of my injury. It happened straight away—everyone downplayed it. I feel like I’m discriminated against every day.
That’s when things really started falling apart. We had to sell the house because I couldn’t manage the physical maintenance. I think we sold it two or three years ago, maybe in 2022. We had spent a lot of time designing and building that house. We ended up selling it well under what it was worth. We were looking for a fresh start, a new page to move on from everything.
The same year as the car accident, a severe storm damaged our house.
Let me explain how my manager breached my privacy. The house was water damaged. I was insured with NRMA, and my workplace also worked with NRMA.
My manager was downplaying my injury and went directly to the insurer to say I wasn’t seriously injured. The situation was eventually addressed by removing him from his position.
The insurer took me off work due to the discrimination. I tried returning to light duties, but they interfered. I went back and was taken off again by the insurer. I believe that happened the same year as the accident.
My manager didn’t acknowledge the seriousness of what had happened. I couldn’t drive for three hours, but they claimed a trip to Gosford counted as light duties.
They didn’t accept how serious the accident was.
I couldn’t sleep and started having flashbacks. These weren’t just dreams—they were vivid nightmares. In them, I get hit from behind and everything turns into a mess. I still have them. I wake up hot, cold, panicked, and completely overwhelmed.
I have good days and bad days. I shut down, and my daughter and wife have to bring me back. My whole life experience has changed since the accident. I can’t relate to anyone. I can’t connect. I feel like I’m here but not really present. Time just slips away from me. Everything feels like it happened so long ago.
Regarding the house renovation, we were looking for the cheapest house we could find. We picked it without knowing there were termites. We knew there were 50 stairs, but we planned to install a lift. My brother-in-law and my dad were there helping every day.
Now, I struggle to go to job sites. I struggle with taking risks. I even struggle at red lights.
I don’t want another accident.Both my psychologist and psychiatrist suggested I help my dad with work, but I was followed by people from the insurer for months.
I’ve been told to try living my life. But every time I take one step forward, it feels like I get knocked ten steps back."
On 9 April 2025, he described his alcohol use as:
“I drink until I’m out. I’ll drink anything. I think it was scotch or bourbon recently. This morning, I drank vodka with sparkling water. It was just a little bit. I think I could still drive. Without the alcohol, I wouldn’t survive. It takes the edge off. I think about everything that’s happened. I think it was three or four drinks. I can’t not drink. I can’t do without it.”
When asked by the Review Panel about his alcohol use on 19 May 2025, the claimant said:
“I don’t like alcohol, but it helps me take the edge off. Valium helps too, but it makes it harder to function. Alcohol makes me feel worse the next day and I get worried about what I’ve done.
Even though I don't enjoy it, I drink whatever I can find. We have a storage area with alcohol that people give to us. My wife likes wine, so I’ll drink whatever is around. The other day, I drank from an open bottle of wine.
I usually drink until it’s gone. My wife has found me on the floor a few times. I started drinking when I gave up on everything with the hope of getting better. That was months ago, maybe last year or the year before.
My psychologist once said I should try to engage more with my wife and maybe share a glass of wine with her. Bec and I sleep in separate beds now, but at the time, that suggestion was meant to help us reconnect. I drink alone. I don’t like being around people.
Dr Jacobs has given me Valium to help with the drinking, but it hasn’t been effective.”
I’ve given up. Alcohol is the only thing that feels good anymore. I try to enjoy time with my wife and daughters, but I can’t connect.”
When asked whether he felt life was worth living, he turned away, visibly emotionally distraught. He said, “I just want to be left alone, away from everyone. I think it would be better to be dead. I’d rather be on an island by myself. My wife and kids don’t deserve this. I feel like I’m a burden.”
He added:
“I can’t relate to my friends anymore. I’m not successful. I have friends, but I can’t talk to them. I haven’t spoken to them for a while. I can’t say when—maybe last week when I was in the hospital. A friend’s daughter was in the hospital too, and I spoke to him, but I didn’t really feel like it.”
At 9.59am, the claimant sought a short break, complained of a migraine and took Panadol.
HISTORY OF TREATMENT FOLLOWING THE MOTOR ACCIDENT
The claimant reported seeing his GP, Dr George Panos, every two to three weeks.
When asked about his current prescribed medications, he referred to a list on his phone and provided this information:
Efexor [the serotonin and noradrenaline reuptake inhibiting antidepressant medication venlafaxine] 225mg – taken in the morning.
Valium [the long half-life benzodiazepine medication diazepam] – taken in the morning and at night.
Lamictal [the mood stabilising anticonvulsant lamotrigine] 100mg – three tablets daily (two at dinner, one in the morning). He reported that it helps with racing thoughts, nightmares, and persistent thoughts about the accident and feelings that the insurer still follows him.
Lyrica [the pain modulating anticonvulsant pregabalin] 75mg – taken twice daily to manage migraines and shooting pain.
Celebrex [the non-steroidal anti-inflammatory medication celecoxib] 100mg – taken at lunch.
Endep [the tricyclic antidepressant medicine amitriptyline] 100mg nocte – taken at night for migraines and to assist with sleep.
Inderal [the beta blocker antihypertensive medicine propranolol] 10mg – taken twice daily for migraines.
Diabex [the oral blood glucose-lowering medicine metformin] 500mg – he said this was recommended due to weight gain, but the insurer stopped paying for it.
Somac [the proton pump inhibiting medicine pantoprazole used for gastro-oesophageal reflux disease] 40mg – taken for reflux. He noted that coffee used to help but no longer does. He experiences abdominal pain and has had scans which revealed no significant findings.
Ostelin [ergocalciferol is a form of Vitamin D] – taken daily; provided by his wife as the insurer does not cover it.
Panadol – he reported taking four to six 500mg doses daily, with two tablets each dose and sometimes three “to be sure.” He acknowledged being told he takes too much and has taken up to 12 tablets in a single day (the recommended maximum is eight 500mg tablets).
The claimant reported that he has been under psychiatric care since the accident. He saw Dr Selwyn Smith until he died. He now sees Dr George Jacobs every three to four weeks, depending on availability.
He also reported seeing a psychologist, Ms Anna Bradshaw, regularly after the accident; weekly at first, then fortnightly. He said he stopped seeing her a few months ago, explaining, “I’m not with her train of thought anymore. She tries to help me think positively, but everything is going wrong, and for me, it’s always a real tiger, not a fake one. I feel like I’m at loggerheads with her. I’m living in a disaster right now.”
He added that she still checks in with messages and calls and had recently spoken to him about starting counselling again, but he said, “I’m not there yet.”
Physiotherapy, hydrotherapy, and exercise programs were prescribed.
He recalled that “exercise physiology rings a bell,” but wasn’t sure if he had participated. He reported that the insurer stopped funding physiotherapy some time ago and no longer pays the chemist regularly for medicines.
He also expressed feelings of being followed by the insurer, stating: “I feel like I’m followed every day.”
DETAILS OF ANY RELEVANT INJURIES OR CONDITIONS SUSTAINED SINCE THE MOTOR ACCIDENT
The claimant reported experiencing multiple falls since the accident.
He said:
“I’ve had many falls. I fell and broke ribs. I’ve fallen on my left shoulder a few times but didn’t need surgery, but it was painful. I also dropped onto my knee in the shower and injured it, though I can’t remember if I had an X-ray at the time. I was undergoing physiotherapy and hydrotherapy then.”
He recalled a specific incident on Christmas Day 2024, when his left Achilles tendon gave way while walking up the driveway. “That night, I couldn’t walk. We had to hire crutches from the chemist. The whole left side of my body is weak.” He was advised to consider surgery or platelet-eich plasma (PRP) treatment for his Achilles injury but said he could not afford it. Instead, he manages the condition by strapping it, resting, using a TENS unit, and wearing a moon boot when walking.
He noted that he does not have a lift in his home and that he must navigate 50 stairs.
He also reported a recent hospital visit. “I was in hospital a week ago—in Emergency—with fevers. I was really unwell. My teeth were chattering up and down. The ambulance couldn’t take me—it was a two-hour wait.” He added, “I thought I was dying.”
CURRENT SYMPTOMS
The claimant said, “I think it’s worse now. I feel sick all the time. I have nothing going for me. I hoped I would be better by now. Even my kids need more from me, and I find it hard to give them what they need.”
He explained that their home remains incomplete and described it as “a disaster.” They have been unable to afford to install the lift he needs. “My parents can’t afford it either,” he added.
He reported feeling disconnected from his brothers and friends, saying, “I can’t relate to them anymore. I can’t enjoy their company and prefer to be alone.”
He said that Crawford could not offer him light duties following the accident, and that marked the end of his employment there. He believes his job was formally terminated.
He noted that Martin, now 81 years old, has given him some casual work, though not much. “Last year he helped me a lot,” he said. “My wife set me up with AI technology so I could help as an assistant. I can’t go into an office, so he sent me things to read.”
He completed some tasks with reading assistance but needed to read material multiple times for comprehension. He said, “AI helps, but sometimes it gets things wrong”.
Martin has since told him he can no longer afford to continue supporting him and that the arrangement is not working out.
CURRENT AND PROPOSED TREATMENT
He is prescribed medication as previously listed.
He sees Dr Panos fortnightly or every three weeks and sees Dr Jacobs every three to four weeks.
He is not consulting Ms Bradshaw.
The only surgery that has been recommended is for his Achilles tendon, but he said that he cannot afford it now.
He added, “I struggle and hope for a lift.”
He is currently awaiting a medical opinion regarding his neck to determine what to do if the condition worsens, and noted, “I’m terrified about that.”
There are no physiotherapy or exercise programs currently in progress.
The claimant did not anticipate any changes to his current treatment.
The medical material confirms the claimant to have been in receipt of ongoing psychiatric care following the motor vehicle accident. Additionally, the material supports the claimant's ongoing complaints of significant psychiatric disturbances albeit with some variation as to it precise diagnosis. The claimant’s general practitioner, Dr Panas, referred him to a psychiatrist on 2 September 2020.
The claimant’s treating GP, Dr Paz, wrote on 25 March 2020, about one-month post-accident, that he was suffering flashbacks of the accident, more obsessive, anxiety and arousal with a queried post-traumatic stress disorder. The claimant has reported ongoing psychiatric symptomology consistently since this time. This was also borne out by the examination of the claimant.
MENTAL STATE EXAMINATION
Appearance: appearance consistent with age.
Grooming: neatly groomed, with longish hair and a bushy, trimmed beard.
Attire: appropriate for age and social context. He wore a T-shirt and track pants during the April assessment, and a hoodie with pyjama pants during the May assessment.
Activity: behaviourally within normal limits. He did not display pain behaviours.
Psychomotor: no retardation or agitation observed.
Movements: no tics or vocalisations reported.
Aggression: no aggressive acts towards others or property reported.
Impulse Control: average. He was not accident-prone.
Interaction: cooperative throughout the interview, although he frequently became oppositional when asked to elaborate on his answers. He appeared irritated at times by the Review Panel’s line of questioning. He was distraught at 10.50am and 12.03pm.
Facial expression: appropriate to verbal content, with frequent tearful episodes.
Eye contact: generally good, though he turned away when tearful.
Affect: anxious and distressed at times. Consistent with thought content. Affective reactions were appropriately modulated. No evidence of cyclic mood changes. Suicidal ideation was absent.
Language:Rate: appropriate, though occasionally rapid with long pauses before answering.
Volume: average.
Coherence: he frequently strayed from the question asked, needing redirection to focus on specific queries. His answers often expressed feelings of powerlessness and being misunderstood.
Phobias: none reported.
Obsessions: none observed or reported.
Dissociation: no dissociative behaviours observed.
Preoccupations: preoccupied with the belief that he is surveilled. No patterns of recurrent self-injurious behaviour were noted.
Perceptions: no perceptual anomalies were reported.
Hallucinations: none were reported.
Delusions: none were reported.
Sensorium: clear.
Memory: no deficits in short-term or long-term memory were noted.
Concentration: impaired, based on clinical observation. He could attend to tasks, though with some difficulty. He requested a one-minute break at 10.59am. He stated that a one-hour task took him 10 hours to complete. He needed to read emails five times.
Comprehension: no difficulty understanding verbal instructions.
Abstraction: he demonstrated the ability to use abstract concepts.
Knowledge and digital literacy: he needed assistance from his wife to log on and log off Teams during both the April and May 2025 assessments.
CURRENT FUNCTIONING
The claimant lives with his wife and their two daughters in a house located in Gymea Bay.
The claimant said, “My wife gives me something to do, but I feel like I’m looking in from the outside. It’s like I’m in the corner of the room watching.”
Previously, Ms Bradshaw had given him a structured list of daily tasks to follow, which helped him maintain a routine. Without the list he could not initiate activities.
“Now,” he said:
“I’m comfortable staying in bed all day. When I do get up, I stay in my pyjamas unless I’m going out.
I’ll put on a jumper if Martin sees me on the phone.
I don’t get bored lying in bed all day, the feelings and pain are enough.”
The claimant noted that Anna’s list had previously motivated him to shower and get dressed.
The claimant’s wife sometimes trims his beard and takes him to the barber for a haircut.
“Now I don’t like company, and I don’t trust humanity.”
The claimant does not remember the last time he went out socially, and when he does go out, it’s not his decision. “We went to the doctor. I remember the negative things, but not the positive ones. I’ve been to the doctor and hospital. I avoid going to the office.”
Since the accident, the claimant said, “I don’t clean myself anymore. I haven’t cut my nails. I only shower when my wife tells me to, and even then, I have no sense of time or awareness. I don’t feel like I need to be presentable.”
The claimant reported that getting out of bed in the morning is difficult, particularly because of his alcohol use. He cannot drink coffee to wake up due to stomach issues, which he suspects might be irritable bowel syndrome (IBS) or related to his current condition. He finds it hard to wake up after taking Valium. He said his daughter often comes in to ask him to get up.
“There have been complaints that I don’t go to industry events anymore. Friends message us all the time, but I haven’t spoken to people. I might have been in contact when they checked on me in hospital, but I avoid it now.”
The claimant reported that he drove his car to pick up his daughter Penelope from day care. “When we go somewhere, Bec forces me to drive. I don’t want to drive. I go with Bec to the shops, and I’ll help her. She gives me things to do around the house.”
The claimant avoids television and the news.
“I was worried about the election. I see it as five years of a failed system. I hoped for a change. I can’t look at the TV without thinking about what I’ve been through.
The future feels uncertain. I zone in and out when my daughter and wife are talking to me.
People try to give me small tasks like taking out the nappies or feeding the cat. I struggle to read emails—my wife helps me with tools and writing. I have assistive tools on my phone.”
The claimant does not use social media. “I post things with my wife and share them with my parents. I only check chats with friends when Bec tells me to.”
The claimant said, “I’m certain that I’m done. There’s no work for me. I’m semi-retired now. I don’t see any work ahead of me.”
“I used to be a devout Christian. I used to go to church at Easter and occasionally at other times. Easter was my most important time, but I haven’t been since the accident.”
COMMENT ON CONSISTENCY
The Review Panel raised consistency issues with the claimant, who insisted that the motor vehicle accident wholly caused his mental health problems. When asked about the video surveillance that showed him walking along a street in the city, walking up the stairs at the house in Gymea Bay and interacting with others at the building site he stated that he had been attempting to follow and comply with the activities suggested by Ms Bradshaw. He denied working at the building site.
He was an inconsistent historian who repeatedly strayed from answering a question posed to report on perceived grievances. He could not provide clear, concise answers, resulting in a three-hour assessment.
The claimant receives treatment from Dr Jacobs, Dr Panos, and Ms Bradshaw. He previously saw Dr Selwyn Smith. He has been evaluated by Professor Kaplan, Mr Cipriani, Dr Hong and Dr Teoh.
Dr Jacobs does not comment on consistency in his 2024 report but saw the claimant’s prognosis as guarded and that his diagnosis was Major Depressive Disorder and post-traumatic stress disorder caused by the motor vehicle accident.
Dr Panos diagnosed anxiety in 2014 and depression in 2018, but the claimant disputes the accuracy of the GP entries.
Dr Smith did not comment on consistency in his 2020 report with a focus on treating Adjustment Disorder mental health symptoms.
Ms Bradshaw attributed the claimant’s mental health symptoms to the motor vehicle accident and subsequent bullying, and this is congruent with the claimant’s history.
Professor Kaplan wrote that employment, not the motor vehicle accident, was not the cause of mental health symptoms and that the claimant had also developed a pain disorder because of the motor vehicle accident. The claimant disputed that employment was the sole cause of his mental health symptoms.
Mr Cipriani wrote that the claimant had a Somatic Symptom Disorder and had adopted a sick role.
Dr Hong was unable to assess the claimant because of his overuse of Valium, a precursor to the Review Panel’s difficulties on 9 April with Mr Zervos being intoxicated with alcohol.
Dr Teoh diagnosed a Major Depressive Disorder caused by the motor vehicle accident but did not comment on consistency.
Medical Assessor Jones’ certificate has six paragraphs related to consistency. Compared to the Review Panel’s consistency check, the claimant focused on his claim that the surveillance showed him in a helper role but not a primary work role.
The claimant downplayed any work problems before the motor vehicle accident with Medical Assessor Jones and with the Review Ranel.
With Medical Assessor Jones and the Review Panel, the claimant asserted the motor vehicle accident was a significant crash despite his being able to drive to the worksite afterwards.
PSYCHIATRIC DIAGNOSIS AND REASONS
| F10.20 Alcohol Use Disorder, Severe | |
Criteria: | A. Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others, for at least 2 years (the MVA occurred over 5 years ago). B. Presence, while depressed, of the following: Poor appetite. Insomnia. Low energy and fatigue. Low self-esteem. Poor concentration or difficulty making decisions. Feelings of hopelessness. C. During the 5-year period of the disturbance, the individual has never been without the symptoms in Criteria A and B for more than 2 months at a time. D. Criteria for a Major Depressive Disorder may be continuously present for 2 years. E. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. F. The disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder. G. The symptoms are not attributable to the physiological effects of a substance or another medical condition. H. The symptoms cause clinically significant distress with impairment in social and occupational. Specify if: Late onset: If onset is at age 21 years or older. With intermittent major depressive episodes, with the current episode: Specify current severity: Severe |
| DSM-5-TR Diagnostic Criteria for Alcohol Use Disorder A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by the following, occurring within a 12-month period: Alcohol is often taken in larger amounts or over a longer period than was intended. There are unsuccessful efforts to cut down or control alcohol use. A strong desire or urge to use alcohol. Recurrent alcohol use resulting in a failure to fulfil major role obligations at work or home. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. Important occupational activities are reduced because of alcohol use. Recurrent alcohol use in situations in which it is physically hazardous. | |
Comment: | Although his treating psychiatrist diagnosed PTSD, the panel did not diagnose this disorder, noting that despite the claimant’s belief that this was a severe MVA, the physical circumstances were not those of an MVA that threatened death or serious injury. |
| The severity of his depressive symptoms were such he did not meet criteria for the diagnosis of an Adjustment Disorder with Mixed Anxiety and Depressed Mood with persistent mood and lack of enjoyment being present most of the day, nearly every day | |
CAUSATION AND REASONS
Causation: | The claimant denied mental health disorders before the 28 February 2020 MVA disputing the GP entries on Dr Panos. There were no documented mental health symptoms at the time of the accident. After the MVA he developed depressive and pain symptoms. These symptoms resulted in Alcohol Use Disorder. |
Comment: | There are two previous PIRS assessments in the provided documents. In 2021, Dr Teoh assessed a 15% WPI, noting no impairment in self-care, mild impairment in travel, and a moderate impairment in the other four categories. In January 2024, Dr Jones assessed a 7% WPI, noting no impairment in self-care, a moderate impairment in social and recreational activities and adaptation, and mild impairments in the other three categories. |
The degree of whole person permanent impairment of the injuries caused by the MVA was calculated as follows:
CURRENT PERMANENT IMPAIRMENT
Psychiatric diagnoses
Persistent depressive disorder
Psychiatric treatment described
Psychiatric consultation
Psychological counselling has ended
The prescription of psychotropic medicine.
Category
Class
Reason for decision
Self-care and personal hygiene
3
Moderate impairment. He could not describe his showering routine except to say that he showered when his wife asked him. He described some personal neglect of his fingernails. His wife arranges for him to have his hair and beard trimmed at a barber. He may help prepare meals but no longer cooks. His description of his abilities means that he could not live alone without support.
Social and recreational activities
3
Moderate impairment. He only attends social events when prompted by his wife or to celebrate his parents’ birthdays. He does not enjoy these events and is not actively involved.
Travel
2
Mild impairment. He can travel alone and may collect his older daughter from preschool. He is an anxious driver who prefers that his wife drive.
Social functioning
2
Mild impairment. He sees himself as married but has begun sleeping alone because his disturbed sleep has affected his wife. There have been no separations. He has reduced contact with his parents and siblings. He no longer has face-to-face contact with friends, but he does hear from them via text and phone messages.
Concentration, persistence and pace
3
Moderate impairment. He reported taking ten hours to complete a job that he usually would take one hour to do. He could read work-related instructions with the help of artificial intelligence. He did not read otherwise. He did not focus on television. He responded on social media at his wife's direction. He did not persist with tasks unless directed to do so. His pace of work was slow.
Adaptation
4
Severe impairment. His social withdrawal and anxiety in social settings would preclude him from working in his former professional role. His fear of high-risk settings would result in a significant reduction in his ability to work. From his description, he could not work more than one or two days at a time and less than twenty hours a fortnight. His adaptive functioning outside the workplace was diminished significantly.
17
* %WPI = percentage whole person impairment
List classes in ascending order
Median Class Value
2
2
3
3
3
4
3
Aggregate score
Total
%WPI
+
+
+
+
+
=
17
19%
Current % whole person impairment 19%
APPORTIONMENT
No mental health condition was present before the motor vehicle accident.
STABILISATION
The claimant meets the criteria for the diagnosis of Persistent Depressive Disorder with Comorbid Alcohol Use Disorder. These two disorders are not threshold injuries.
ADJUSTMENT FOR THE EFFECTS OF TREATMENT
No adjustment is required, as there has been no measurable treatment effect from psychiatric consultations or using psychotropic medication. The claimant is no longer receiving psychological counselling.
Determination regarding the degree of whole person impairment of the claimant because of the injuries caused by the motor accident
The total percentage whole person permanent impairment for assessed psychiatric injuries caused by the motor accident is 19%. Therefore, permanent impairment is greater than 10%.
CONCLUSION
The Review Panel notes that the claimant suffers from a persistent depression disorder with alcohol disorder caused by the motor accident which is a non-threshold injury. The Review Panel notes that the injuries give rise to a permeant impairment of 19%.
0
0
0