Zjalic v AAI Limited t/as GIO
[2024] NSWPICMP 8
•8 January 2024
| DETERMINATION OF REVIEW PANEL | |
| CITATION: | Zjalic v AAI Limited t/as GIO [2024] NSWPICMP 8 |
| CLAIMANT: | Slobodan Zjalic |
| INSURER: | GIO |
| REVIEW PANEL | |
| MEMBER: | Gary Victor Patterson |
| MEDICAL ASSESSOR: | Glen Smith |
| MEDICAL ASSESSOR: | Michael Hong |
| DATE OF DECISION: | 8 January 2024 |
| CATCHWORDS: | MOTOR ACCIDENTS – The claimant suffered injury in a motor vehicle accident on 6 October 2019 in Wollongong; the dispute related to the assessment of permanent impairment arising from psychological injuries; claimant re-examined; Panel required to form its own opinion on diagnosis and assessment; Insurance Australia Limited v Marsh applied; claimant diagnosed with an adjustment disorder and mild driving phobia; assessments made in accordance with Psychiatric Impairment Rating Scale categories; Held – claimant assessed at 6% permanent impairment for the psychological injury; original assessment revoked. |
| DETERMINATIONS MADE: | CERTIFICATE Certificate is issued under s 7.26(7) of the Motor Accident Injuries Act2017
The following injuries caused by the motor accident give rise to a permanent impairment of 6% AND IS NOT GREATER THAN 10%: · adjustment disorder with a mild driving phobia. |
STATEMENT OF REASONS
BACKGROUND
Slobodan Zjalic (the claimant) is a single man aged 34 years of Croatian extraction. He grew up in Australia. On 6 October 2019, the claimant was driving his Nissan Pulsar on Darling Street in Wollongong. He was slowing to turn right into a petrol station. His vehicle was struck in the rear by the insured vehicle (the accident). The forcefulness of the impact is a matter in issue. The claimant’s vehicle was drivable after the accident. Neither ambulance nor Police Officers were required to attend. The claimant subsequently attended the emergency department of his local hospital as he experienced lower back pain. The claimant has been treated by a psychologist and physiotherapist. He developed symptoms of psychological disturbance following the accident.
GIO (the insurer) insured the owner and/or the driver of the vehicle at fault for liability to pay to the claimant any damages and/or statutory compensation entitlements under the Motor Accident Injuries Act2017 (the MAI Act).
As there is a dispute between the claimant and the insurer about the degree of permanent impairment arising from psychological/psychiatric injury caused by the accident under s 4.12 of the MAI Act, the claimant was referred for assessment by Medical Assessor Doron Samuell, who certified as follows:
“The following injuries caused by the motor accident have resolved and do not result in permanent impairment:
·Adjustment disorder and specific phobia
An assessment of the degree of permanent impairment arising from these injuries is therefore not required.”
Medical Assessor Samuell also found that a Somatic Symptoms Disorder was not caused by the accident.
THE REVIEW
The claimant sought a review of Medical Assessor Samuell’s certificate on the basis that the assessment was incorrect in a material respect within the meaning of s 7.26 of the MAI Act.
The claimant submitted that Medical Assessor Samuell decided that the accident was of a low speed, contrary to the claimant’s contention, without putting that alleged inconsistency to the claimant. Medical Assessor Samuell stated that the subject accident was unlikely to have been directly psychologically impactful as it was of low speed.
It was submitted by the claimant that Medical Assessor Samuell also took into account an irrelevant consideration, that there were only soft tissue injuries in the absence of structural physical changes, which is not relevant to whole person impairment arising from a psychological condition.
Medical Assessor Samuell made reference to the following documentation:
(a) photographic evidence of the claimant’s vehicle.
(b) A report dated 23 July 2021 by Dr James Powell.
(c) Certificate and Reasons of Medical Assessor Thomas Rosenthal in relation to physical injuries.
(d) Certificate and Reasons of Medical Assessor Melissa Barrett in relation to an Adjustment Disorder with Mixed Anxiety and Depression as well as a specific phobia.
(e) A report dated 31 March 2021 by Dr Mastroianni.
(f) A report dated 19 May 2021 by Dr Rastogi.
(g) A report by Dr Herald who diagnosed a Post-Traumatic Stress Disorder.
(h) A report dated 19 November 2021 by Dr Graham Vickery who diagnosed a Somatoform Chronic Pain Disorder.
(i) MJM report.
(j) Records of Dr Olga Lavalle, psychologist.
(k) Report of Dr Andrew McIntosh, biomechanical engineer.
None of that material initially was made available to the Panel.
The claimant’s application for review was opposed by the insurer on the basis that the particulars provided by the claimant do not reveal material errors. The insurer noted that the evidence of Dr McIntosh was not disputed by the claimant. It was submitted that any inconsistency identified by Medical Assessor Samuell during his assessment was put to the claimant. It was submitted that Medical Assessor Samuell’s consideration of the claimant’s physical injuries was not an irrelevant consideration and was not a material error.
President’s delegate Rachel Brittliff issued a Determination of an Application for Review of a Medical Assessment on 13 February 2023 which stated the satisfaction of the President’s delegate that there is a reasonable cause to suspect that Medical Assessor Samuell’s assessment was incorrect in a material respect. The basis of that decision was stated to be that consideration of the nature of the claimant’s physical injuries, when determining that the accident could not have been psychologically impactful, was in irrelevant consideration.
OTHER MEDICAL ASSESSMENTS
Medical Assessor Melissa Barrett assessed the claimant on 2 November 2020 and subsequently certified as follows:
“The following injury caused by the motor accident:
·Adjustment disorder with mixed anxiety and depression
is a MINOR INJURY for the purposes of the Act.
The following injury caused by the motor accident:·Specific phobia of car travel
is not a MINOR INJURY for the purposes of the Act.”
Those finding were not challenged by either party. Assessor Barrett opined that, given the chronicity of the stressors and his failure to respond to treatment, the claimant would be considered at risk of developing a persistent depressive disorder.
Medical Assessor Rosenthal certified on 12 November 2020 as follows:
“The following injury caused by the motor accident:
·Neck – soft tissue injury
·Back – soft tissue injury
is a MINOR INJURY for the purposes of the Act.
The following injuries referred to me for assessment have been assessed and determined to be not caused by the motor accident:·Injury to hips
·Injury to shoulders
A decision as to whether these injuries are a minor or non-minor injury is not required for the purposes of the Act.”
Those findings were not challenged by either party.
Medical Assessor Alan Home certified on 21 March 2022 as follows:
“The following injuries caused by the motor accident give rise to a permanent impairment of 10% and IS NOT GREATER THAN 10%:
·Cervical spine – soft tissue injury
·Lumbar spine – soft tissue injury
·Right shoulder – restricted motion secondary to neck pain (Nguyen case principle)
·Left shoulder – restricted motion secondary to neck pain (Nguyen case principle)
The following injuries caused by the motor accident give rise to a permanent impairment of 10% and IS NOT GREATER THAN 10%:
·Cervical spine – soft tissue injury
·Lumbar spine – soft tissue injury
·Right shoulder – restricted motion secondary to neck pain (Nguyen case principle)
·Left shoulder – restricted motion secondary to neck pain (Nguyen case principle).”
Medical Assessor Home found 5% whole person impairment for the cervical spine, 3% whole person impairment for the right shoulder and 2% whole person impairment for the left shoulder. It is not known if those findings are the subject of a separate review application. In any event, that is not relevant to the Panel’s deliberations.
STATUTORY PROVISIONS/GUIDELINES
Section 4.4 of the MAI Act provides that no damages may be awarded to an injured person if the person’s only injuries resulting from the motor accident were minor (now threshold), injuries. Where it is accepted by the parties, or a Medical Assessor has certified, that any of the injuries caused by the motor accident are non-minor (now non-threshold) it is necessary to assess whole person impairment arising from all injuries caused by the motor accident, in determining whether or not the statutory threshold of more than 10% is satisfied.
MATERIAL BEFORE THE REVIEW PANEL
The Panel requested and were provided with separate bundles of documents provided by the parties. The additional documents listed in paragraph 10 of the Review Panel Report and Directions issued on 1 August last were included in the insurer’s bundle. That material is outlined in the Medical Assessors’ report. The parties’ submissions have been outlined. Medical material relating to the claimant’s physical injuries, disabilities and impairments is not described, as it does not relate to the dispute before the Panel. The claimant concedes that his injuries were of a soft tissue nature and relevantly were minor (now “threshold”) injuries for the purposes of the MAI Act. The Panel accepts that the presence of only soft tissue injuries is not necessarily of direct relevance to the psychological effects of the motor accident, as was submitted for the claimant.
The claimant relied upon his statement dated 27 September 2022 in which he disputes that the collision was of low velocity and minimal impact. He gives a detailed description of what occurred at the accident scene and its aftermath. The claimant describes the damage to his vehicle. It seems to the Panel that the claimant’s statement has the ring of truth about it.
The claimant relies upon a report dated 30 August 2023 by Dr Anthony Greenberg, general and gastrointestinal surgeon. Dr Greenberg opines that the claimant has:
·Gastro-oesophageal Reflux disease;
·Probable analgesic gastropathy, and
·Medication induced gastrointestinal motility disorder
which he relates to the motor accident. Dr Greenberg further opines that the claimant’s orthopaedic injuries are now compounded by his gastrointestinal symptoms which arise from the medication he ingests for pain relief. Dr Greenberg assesses a combined 6% whole person impairment arising from the claimant’s gastrointestinal disorder. Dr Greenberg’s assessment was made after the claimant’s physical injuries were assessed by Medical Assessors Rosenthal and Home. They do not appear to have been the subject of a separate Personal Injury Commission medical assessment.
The insurer adopted Medical Assessor Barrett’s findings of an adjustment disorder with mixed anxiety and depressed mood. It also adopted Medical Assessor Samuell’s finding that the claimant had recovered from his adjustment disorder. The insurer relies upon Dr Vickery in declining a diagnosis of post-traumatic stress disorder on the basis that the motor vehicle accident was minor and did not satisfy the DSM-5 criteria for such a condition. Dr Vickery was of the opinion that the claimant is suffering a Somatoform Chronic Pain Disorder which is not the direct result of the motor accident.
The insurer submitted that it was difficult to accept a diagnosis of psychiatric injury, that relied on the presence of physical pain, in the absence of ongoing physical injury. It relies upon Dr Powell in that respect. The Panel notes that the views expressed by Dr Powell and Medical Assessors Home and Rosenthal are somewhat discordant. It is not necessary for the Panel to deal with any such discrepancy in the circumstances of this case.
The insurer relied upon a report dated 11 May 2022 by Dr Andrew McIntosh, biomechanical engineer. Dr McIntosh opines that the biomechanical forces involved in the accident were not consistent with the claimant sustaining long-term physical injuries and are consistent with a whiplash associated disorder/soft tissue injury for a closed period of short duration. Dr McIntosh does not consider whether the biomechanical forces involved in the accident were consistent with the claimant’s sustaining a psychiatric injury or recognised psychiatric illness. That may be because Dr McIntosh is not qualified to proffer such an opinion.
RE-EXAMINATION
The assessment was conducted remotely. Medical Assessors Hong and Smith were in their Sydney rooms. The claimant was at home alone.
“History
1. Psychosocial history and pre-accident history
Mr Zjalic was born in Croatia and went to Serbia, and then came to Australia in 2000 as a refugee when he was 11. He grew up with his parents and was the youngest of five siblings. He reported that he had no first-hand exposure to trauma, and had a good family. His father passed away about two months after the subject accident from cancer. One of his sisters is overseas and the other three are in Australia. He is not aware of a family history of mental illness.
In terms of general medical history, he does not have cardiac, thyroid or liver disease.
Initially, he did not remember having used cannabis, and with prompting from his file, he later said he used it a couple of times, maybe when he was 20. There is no alcohol problem and he does not use other recreational drugs.
Mr Zjalic does not have a past psychiatric history.After Year 12, he did a training program as a fitter and turner for two years and then worked as a carpenter for nine years.
In terms of employment history, 12 months before the accident, he started work as a truck driver and would deliver and unload plastering products. He worked full-time, however, after the accident, he could not return to any work at all and explained that his work was too physically demanding.
2. History of the motor accident
On 6 October 2019, Mr Zjalic was driving on his own and going to Wollongong Hospital to visit his father. He was across the road from the hospital and about to turn into the petrol station, and he recalled his car was suddenly hit hard from behind. He reported being in shock and he suffered severe pain from whiplash. Mr Zjalic remembered he moved about to make sure nothing was broken, and then exited to check the car. He asked the other female driver if she was okay. His airbag was not deployed.
They parked in the petrol station to exchange IDs. He walked across the road to the emergency department and had x-rays, and stayed there for about one hour. He then drove his car home. The insurer deemed it was not worth repairing and therefore it was written off. He has since purchased a Commodore and still drives the same car now.
He reported that physically, he has chronic pain with constant low back pain being the most severe pain. Back pain radiates to both legs. He also has neck pain which travels down both arms. He has abdominal pain, he said from medication side-effects and reflux, and sometimes he has blood in the stool, he thinks this is from medication side effects.3. History of symptoms and treatment following the motor accident
Mr Zjalic reported suffering depression and anxiety symptoms, maybe a month or two after the accident. He said by then, he realised that he could not return to work and he could not hang out with his friends because of severe back pain. He normally likes to play soccer, basketball, go out for coffee with friends, but he could not do any of these activities anymore.
He reported that he has become ‘paranoid’ driving since the accident and explained it is difficult for him to turn his neck and back, to check for cars around him. If he hears a loud noise or people speeding around him, he cannot turn quickly to look for signs of danger. He said that sometimes he suffers a panic attack or flashback on the road, he becomes scared because he has constant neck pain when driving. He can drive short distances and avoids places with too many cars. He said he can only drive 15 or 20 minutes before his back pain becomes significant. He said he had not driven beyond Wollongong since the subject accident.4. Details of any relevant injuries or conditions sustained since the motor accident
Mr Zjalic has not had further car accidents or sustained other psychological injuries.
5. Current symptoms
Mr Zjalic initially stated he was 90kg before the subject accident, and gained weight after and was 120kg in 2022, and now he is 130kg. The Panel discussed his GP wrote he was 122kg, 1 month after the subject accident. He said he eats too much when bored and cannot exercise, even though he wants to, and therefore he gained weight since the accident.
He reported that his memory and concentration have become very bad because he cannot sleep due to severe pain. He rarely has good sleep, and if he has good sleep, his concentration and energy are better the next day.
We discussed his ‘mood swings’ and he clarified that this means that sometimes he is okay, and sometimes he will crash into a severe depression. He has never had elevated moods or symptoms suggestive of Bipolar disorder, or psychotic symptoms.
He said he has depressed mood ‘all the time’ now.He has reduced motivation.
He has intermittent suicidal ideation but he has never made an attempt.
He reported having chronic sleep difficulties, with initial insomnia and middle insomnia, and random nightmares.
He has memories related to the accident.
He said he has panic attacks.
He reported having a low tolerance for frustration, without anger problems.6. Current and proposed treatment
Mr Zjalic is currently taking:
·Mirtazapine 45 mg and this was commenced in early 2020.
·Panadeine forte intermittently, usually for 2-3 days in a row.
·Temazepam, 3-4 times per week.
·Gastric reflux medication.
·He is no longer taking Tramal.
He consulted Janelle Gallagher but did not find treatment helpful. He ceased after 5 sessions and has not consulted another psychologist, he stated because the COVID pandemic started. He has not consulted a psychiatrist yet, and attributed this to the COVID pandemic. He has made an appointment with Dr Blagoje Kuljic, psychiatrist on 28/11/2023.
He has not had surgical treatment since the subject accident. He has physiotherapy intermittently now.
He said he has not felt significantly improved with treatment yet.Clinical Examination
7. Mental State examination
Mr Zjalic had a full beard and his hair was tied back. He engaged well with the assessment process. There was no psychomotor slowing. He was not restricted in his affect. He was bright and appropriately reactive, and laughed regularly. He spoke spontaneously and fluently. Mr Zjalic gave a cogent history and provided clarification. He was consistently focused throughout the assessment. He maintained a steady pace. There was no evident cognitive impairment.
8. Current functioning
Mr Zjalic is 34 and living with his mother. His partner lives with her parents and they have a 2-and-a-half-year-old daughter, who lives full-time with his partner. He said that his partner and daughter visit almost daily, or sometimes he will go to visit them, and they have a good relationship.
He finds it hard to walk or to sit for long - he can probably sit for about half an hour or an hour at the most. He cannot run at all. He struggles to put on his socks because of his back injury.
He reported that he has an eBay account and will sell some of his old tools, which may be about $50 every few months, and he has never operated an online store.
Mr Zjalic reported that he learnt about computers at school and before the accident, he was following a YouTube video to make a game called Jet Pacman. He said it was a very simple app, you press a button and the character jumps. It is a bit like the ‘Flappy Bird’ game. He finished it after the accident. Mr Zjalic said that once he uploaded it, he did not do anything else with it. It is on the Google Play Store now but he lost the login and he said maybe only five or 10 users had downloaded it in the last few years. He said that he was working on it for maybe five or 10 minutes and maybe 50 minutes in a week, until he finished it.
The panel asked Mr Zjalic whether he could do a similar type of computer-based work, given that he could sit down for about half an hour, but he does not believe that he could because he could not sit at a computer for long enough to be doing any productive tasks.
He said he lies down on a mattress, watching YouTube all day, or he will play computer games on his phone. He watches shows about food and travel. In the past, he used to cook, but said he now cannot because he cannot bend down or stand up for too long and his mother does all the cooking now.
Mr Zjalic does not do any household chores. His three sisters are married and regularly visit him. He said he might have contact with a friend maybe once a month, but they do not go out to do anything because he cannot tolerate it physically.
He has been with his partner for 13 years and they have never lived together. He said they plan to live together, but because of his injury, they cannot afford their own place so now they rely on their parents. He said that they have always had a good relationship.9. Comments of consistency
Mr Zjalic's recollection of his cannabis and weight was different to his GP records but he later confirmed the history in his GP records.
Review of Documentation10. Summary of relevant documentation
Allied health recovery request form dated 6/1/20, written by Janelle Gallagher, psychologist noted Mr Zjalic was rammed by the car behind, developed sleep problems and low moods, difficulties in concentration, symptoms indicative of depressed mood and PTSD following the subject accident. PTSD Checklist for DSM-5 (PCL-5) score has been noted, with ongoing nightmares, anxiety driving, flashes of memory. Pre-existing factor ‘nil identified’.
Treating team's records on 4/12/19, depressed mood, under stress, nightmares, decreased concentration, by Dr Milena Vukoe.
GP letter, referred Mr Zjalic to a psychologist for CBT.
Janelle Gallagher, Psychologist letter to the GP, 7/1/20, the first appointment was 10/12/19, noted Mr Zjalic's sleep problems, hypervigilant, mood and motivation problems, chronic pain symptoms and anxiety, hopelessness from a lack of improvement, worries about his future work, socially isolated. He met criteria for PTSD. PCL-5 has been noted.
Ms Gallagher’s psychologist entry:·3/2/20, using breathing exercise, cyclical mood, up for a few days then crash
·25/2/20, same, sleep problems, online gaming before bed, bored.
·6/4/20, sleep improving
Personal Injury Commission certificate by Medical Assessor Doron Samuell, 27/9/22, diagnosed Adjustment disorder and specific phobia and concluded this resulted in no impairment, although Mr Zjalic feels paranoid when driving.
The claimant's statement noted he came to Australia in 2000 as a refugee. He described the circumstance of the subject accident, he was going to see his father at Wollongong hospital. He stated the insurer considers his accident a low-speed accident but the impact was heavy. He started treatment with Olga Lavalle's practice, seeing a psychologist in late 2019. He takes Mirtazapine at that time. He has significant driving problem. Relationship with his partner gone backwards and remained together, they have been together for 6 years. She no longer spends 5 days per week at his place. They have a 1-year-old daughter but he cannot spend long periods of time with her due to his physical and psychological difficulties. He has not worked since the subject accident. He has a hobby, develop a game Jet Pacman, a computer game to kill time. Now he can only do it for 5-10 minutes a day and not made money from it. He has always performed physical job and cannot work now. His psychological condition also affects his work capacity.
Police report noted there were two vehicles involved in the accident and the police assessed the subject accident as a major traffic crash.
Dr Richa Rastogi, IME psychiatrist reported on 19/5/21, noted Mr Zjalic has significant pain, triggering his symptoms, anxiety driving, lost confidence and does not drive long distances anymore. He has sleep problems and flashbacks and vivid dreams, irritable, struggles connecting with his daughter, poor concentration and memory, overwhelmed. She wrote there is no past psychiatric history, she diagnosed PTSD and Adjustment disorder and provided a PIRS, 232 234, the WPI was 17%. Adaptation 4: Severe impairment as he has an erratic pace with decreased ability to do things independently, needing assistance , reduced attention span and anxiety interfering with functioning
Dr Rastogi 22/2/23, provided and updated PIRS, 232 235, 17%. Adaptation 5, Severe impairment as he has an erratic pace with decreased ability to do things independently, needing assistance, reduced attention span and anxiety interfering with functioning. He has not worked since 2021 and has progressively deteriorated in function and is unlikely to have retraining capacity.
Comment:
This is a mis-calculation and should be 19% as she increased the rating in adaptation from 4 to 5 in her second report. Alternatively, she could have misrecorded it as a 5, as her explanation, severe impairment is a class 4 rating.
The Panel noted Dr Rastogi’s explanation for adaptation is also consistent with 2, which is how the Panel has rated.
The Panel rated 2 in social and recreational activities, and noted Dr Rastogi rated 3 and her explanation is also consistent with 2 according to the Guides, which is the Panel's preferred rating.
The Panel also found him less impaired in concentration, persistence and pace, and noted additional history related to his ability to build an app (with breaks) in the past. The Panel also considered that he would focus on video for hours now and his mental state on the day of assessment, was not consistent with 3.
Dispute Resolution Service certificate by Assessor Melissa Barrett, 16/11/20, concluded Mr Zjalic has an Adjustment disorder and specific phobia of driving. At that time, she noted his changed functioning before and after the subject accident.
Dispute Resolution Service certificate by Assessor Thomas Rosenthal, 12/11/20, concluded he has neck and back soft tissue injuries. His hip and shoulders’ injuries are not caused by the subject accident.
GP prescription history, Diazepam 16/10/19, Temazepam 17/12/19, Mirtazapine script 3/3/20, with repeats including 29/6/22.
GP records:·Entry 13/1/11 noted a little cannabis, counselled. Comment: Mr Zjalic said he has never smoked cannabis. The Panel discussed this and he does not remember it. He later stated he did try cannabis around 20 years old, may be a couple of times and not for a long time before the subject accident. He said he never used it regularly.
·11/10/19, noted the circumstance of the accident, under stress, shocked, ceased work after the subject accident as truck driver and labourer. Car has been written-off by the insurer.
·29/11/19, mood swings, nightmares, anxiety and depressive symptoms, 122kg, no suicidal ideation. Comment: the Panel discussed he was not 90kg before the subject accident, as he recalled.
·Regular entries noted sleep problems, mood and nightmares symptoms.
·Temazepam and later Mirtazapine was prescribed.
·14/12/20, anxiety and depressive symptoms, stress, sleep problems, flashbacks and nightmares, back pain.
The Panel noted the photographs on file.
Allied health recovery request form noted the subject accident, low moods and sleep problems, PTSD.
MJM assessment report and photo noted. There were two vehicles involved in the accident, 20 kph was the pre-crash speed, vehicle not towed and the airbag was not deployed. No witness. Police did not attend.
Biomedical assessment report by Dr Andrew McIntosh, 11/5/22, he stated the force involved from the subject accident was not consistent with Mr Zjalic's account of sustaining physical injuries.
Dr Graham Vickery IME psychiatrist reported on 19/11/21, he said there is no past psychiatric history. His recreational activities and daily tasks are significantly restricted due to his pain. There is no drug or alcohol misuse history. He diagnosed Somatic symptom disorder. He does not play soccer, basketball and was very active before the subject accident, now talk to his friends or they visit him but he cannot play sports, he goes online.
Dr Vickery 31/1/22, file review and discussed MJM report 6/5/21, regarding his online and game development. His Somatic symptom disorder is not directly related to the accident and there is no WPI.
Comment:
The Panel confirmed he has Adjustment disorder and driving phobia, and this is consistent with other Medical assessor’s opinion.
Dr Vickery 1/6/22, does not change his opinion.
Vocational assessment report, 6/6/22, noted before the subject accident, he enjoyed goes to the gym and sports, doing ebay work and making games. Now spends time on the computer in ½ hour bursts then take a break due to his concentration and pain symptoms. He has severe anxiety driving. Written by John Raue, psychologist.Determinations
11. Diagnosis and reasons
Mr Zjalic came to Australia as a refugee and had no prior psychiatric problems. As a result of the accident, he developed chronic pain and his back pain is the most severe. The panel also noted that his hip and shoulder injuries were deemed not caused by the accident.
He described being in shock from the accident and developed chronic depression and anxiety symptoms. Overall, there is evidence that the accident had caused driving anxiety and some impairment, and his psychiatric injury has not completely resolved and this is consistent with an Adjustment disorder and a mild driving phobia.
Mr Zjalic does not have PTSD as the subject accident and his described psychological response, did not fulfil the DSM-5 PTSD criterion A event description.
Mr Zjalic's psychological injury has stabilized and MMI has been reached.12.Causation and reasons
Mr Zjalic came to Australia as a refugee and had no prior psychiatric problems. He described being in shock from the accident and developed chronic depression and anxiety symptoms as a direct result of shock. There are no other major life events or contributing factors identified, therefore the accident has caused his current psychiatric injury.
WPI
Category Class Reason for Decision 1. Self Care and Personal Hygiene 2 Mr Zjalic has 2 or 3 meals a day and eats regularly. He gained weight from inactivity over-eating. He only showers once a week due to having less motivation.
His physical injuries and pain are not assessable in the PIRS.
2. Social and Recreational Activities 2 His physical injuries and pain are not assessable in the PIRS.
He can engage in alternative regular recreational activities, such as playing games on his phone and he enjoys regular social visits from his siblings and family. He actively engages and does not need a support person or prompting.3. Travel
2 Mr Zjalic is anxious when he leaves home and has not driven outside of Wollongong. 4. Social Functioning
2 Mr Zjalic's relationship with his partner and daughter is good.
He is anxious and socially avoidant, and ceased contact with most of his friends.
The relationship with his general family is good and they are close.
5. Concentration, Persistence and Pace 2 Mr Zjalic reported having reduced concentration.
He can perform intellectually demanding tasks e.g. building an app.
He watches YouTube videos and can focus for hours.
His mental state examination is consistent with 1 or 2.6. Adaptation
2 From a psychological perspective, he can perform a full-time role but will need more time off than a typical employee. List classes in ascending order: 222222 Median Class Value: 2 Aggregate Score: 12 % Whole Person Impairment: 6 %”
FINDINGS
The Panel conducts a new assessment of all the matters with which the medical assessment is concerned (s 7.26(6) of the MAI Act). The Panel adopts the extensive reasons of the joint examination findings of the two Medical Assessors.
The Panel is not required to choose between competing medical opinions and is require to form its own opinion. See Insurance Australia Group Ltd v Keen [2021] NSWCA 287 and Insurance Australia Limited v March [2022] NSWCA 31. The Medical Assessors have explained the basis for their assessments which are different from those provided by other specialists in some respects. Further, the medical assessment of permanent impairment is taken at the time of the examination. In that respect, the previous assessments are somewhat outdated and do not reflect current symptomatology.
CONCLUSION
The new certificate is attached at the commencement of these reasons.
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