1. The Panel revokes the certificate of Medical Assessor Sidorov dated 10 October 2024.
2. The Panel determines that consequent upon the motor accident which occurred on 25 May 2022, the claimant developed an aggravation of a psychiatric disability of somatic symptom disorder with persistent and predominant pain (somatic symptom disorder). This is a non-threshold injury.

1. This is an application by the insurer for review of a certificate and reasons of Medical Assessor Sidorov (the Medical Assessor) dated 10 October 2024.
2. There is a dispute between the claimant and the insurer about whether the injury is a threshold injury under Schedule 2, s 2(e) of the Motor Accident Injuries Act 2017 (the Act).
3. The following injuries were referred by the Personal Injury Commission (Commission) for assessment:

(a) psychiatric condition -post-traumatic stress disorder.

1. The Medical Assessor diagnosed the claimant as having a post-traumatic stress disorder which is a non-threshold injury.

1. 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.
2. 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.
3. The Panel notes the High Court judgment in Gamestar Pty Ltd v Lockhart [1993] HCA 79. The Court observed in the absence of submissions referring to specific documents that a tribunal is not required to search for references within documents where the submissions do not specifically address the materials. The Panel also notes the comments of Bellew J in Bevan v Bingham [2023] NSWSC 19 concerning the obligation of legal practitioners to place only the necessary evidence before the decision-maker.

1. 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". 2. The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury. 3. The original Medical Assessment was issued when the relevant term was "minor injury" which, because of the amendment, is now described as a threshold injury. The submissions and original medical assessment were written at a time when the term was "minor injury". 4. 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. 5. 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.

1. A threshold injury is defined in s 1.6 of the Act which says:

(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."

1. 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.
2. 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).
3. 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."

1. 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 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."

1. The subject accident (the accident) occurred on 25 May 2022. The claimant was a front-seat passenger, wearing her seatbelt. The claimant's car was stationary at a red light and, at that time, was rear-ended by the insured car. The force of the collision pushed the claimant's car forward. Emergency services did not attend the accident scene.

1. The insurer submits that while the Medical Assessor reported that the claimant met the diagnostic criteria for post-traumatic stress disorder, the Medical Assessor failed to comply with cl 5.11 of the Guidelines.
2. The insurer says the Medical Assessor listed generic symptoms that were not supplemented with examples and were not explicitly categorised against criteria A to H for post-traumatic stress disorder.
3. The insurer submits that it remains ambiguous how the claimant has met criteria D, F, G and H under the DSM-5-TR.

1. The claimant submits that the insurer has failed to identify any errors within the certificate of the Medical Assessor.
2. The claimant says that the insurer's submissions have reiterated the DSM-5TR and have not explained and/or demonstrated where the certificate was incorrect in a material respect.
3. The claimant submits that the Medical Assessor has correctly determined the claimant's psychological injury on the day of assessment.

1. The Medical Assessor assessed the claimant on 24 September 2024.
2. It was reported that the claimant was involved in an earlier motor vehicle accident in 2017. She had not worked since then due to her injuries.
3. The claimant informed the Medical Assessor that she developed anxiety and depression after the accident in 2017. She saw a psychologist at the time and had multiple sessions. She explained that she was also prescribed medications. She could not recall their names. She stated that she felt "a bit better" with that treatment. There was no history of mania or psychosis.
4. The claimant reported to the Medical Assessor that she developed some fear of being in motor vehicles and around traffic after the accident in 2017. However, she said that this was significantly aggravated and made worse by the subject accident. The claimant said that she continually worried that she would be involved in another accident and, therefore, avoided being in a car in general. She said that she also developed recurrent, involuntary and distressing memories and nightmares relating to the subject accident and, when reminded of the accident, she would become acutely distressed and, therefore, tried to avoid any reminders of the subject accident. At these times, she said that her mood would also become more unstable and more depressed. She also became generally more irritable, hypervigilant, on edge and easily startled. She stated that this, together with the nightmares, has disturbed her sleep. The Medical Assessor said that there was no evidence of the development of mania or psychosis.
5. The Medical Assessor reported that the claimant's post-traumatic stress disorder diagnosis pre-dated the subject accident and that she was receiving active psychological treatment at the time of the subject accident.
6. The Medical Assessor reported that the claimant sometimes drives when she must, but she experienced significant fear and anxiety when she did so. The claimant said that she is generally able to leave home unaccompanied. She feels anxious in a car when riding as a passenger. She explained that she spent her time doing shopping and housework and watching TV and playing with her phone. Sometimes she talks to her friends on the phone. The claimant said that she had become more forgetful, and her concentration was not as good since after the subject accident.
7. The Medical Assessor diagnosed that the claimant was suffering from post-traumatic stress disorder.
8. The Medical Assessor said his diagnosis was based on a history of the claimant being involved in a motor vehicle accident in 2017, after which she developed intrusion symptoms, including recurrent, involuntary and intrusive, distressing memories and nightmares relating to the accident. She also developed a persistent avoidance of stimuli associated with the accident, negative alterations in cognitions and mood associated with the accident and marked alterations in arousal and reactivity associated with the accident. The Medical Assessor said that the claimant's trauma related symptoms had been significantly aggravated by the subject accident which contributed to the development of her post-traumatic stress disorder.
9. Neither party relies on a medico legal report. Clinical notes have been provided from Healthy Minds Psychology, Dr Lam, the claimant's general practitioner (GP), and Fairfield Central Medical Centre as well as discharge notes from Fairfield Hospital. None of these documents are specifically referred to by either party in their submissions.
10. In the clinical notes of Fairfield Central Medical Centre, there is reference to an accident on 19 December 2017. The claimant is referred to as having been a front seat passenger involved in a rear end collision when the car she was travelling in was hit from behind. This is also recorded by the claimants GP, Dr Lam in clinical notes of Alliance Medical Healthcare Centre on 26 February 2018.
11. The first notation of any psychiatric injury was entered on 8 May 2019, with reference to major depressive symptoms.
12. Within the clinical notes of Dr Lim, there is an entry recording a pre-existing injury of depression-anxiety disorder in 2017.
13. The claimant came under the care of Ms Truong, psychologist, for treatment in July 2021 and thereafter. This was all before the subject accident. The claimant had extensive treatment with Ms Truong from 15 July 2019 with the last session before the accident occurring on

18 May 2022. Her next session was on 22 June 2022 after the accident. This incident was noted but symptoms had not changed from pre-accident records. 14. Dr Lam first recorded extreme symptoms of anxiety and difficulties breathing and sleeping, teary and being emotional, on 31 May 2022.

1. The claimant was examined by Senior Medical Assessor Baker and Medical Assessor Gupta on 3 November 2025. Their report follows:

A Cantonese interpreter attended for the re-examination.

The claimant attended the assessment on 3 November 2025 by MS Teams. She was unaccompanied for the duration of the 110-minute re-examination by Medical Assessor Baker and Medical Assessor Gupta.

The claimant did require a Cantonese interpreter, who was booked and organised through the Commission. The claimant said she could understand the interpreter well. The interpreter said that she could understand the claimant. The claimant was living in the family home in Marsden Park having moved to this accommodation after the motor accident (the accident) on 25 May 2022. She said she shared the family home with her mother 67 years, her husband aged 47 years and her two children a son aged 16 years and a daughter aged 13 years. She said her husband and children were all well.

The claimant said that her mother suffered from hypertension and problems with her legs due to old age. She said her husband was a chef in his own Chinese restaurant. Her children were attending school and she said that their progress was satisfactory.

The claimant was born in Southern China. Her first language was Cantonese. She said on arrival to Australia she attended and completed the 500 hours of English study to assist with her settling in Australia. Her father was aged about 67 years and lived in China. She said her mother would visit him about once every year. She said that they lived apart but remained married.

The claimant said she had visited her father in China frequently since her first arrival in Australia in 2007. Her last visit to China was a few months prior to the accident in 2022.

The claimant was the first child of a two-sibling family. She had one younger brother aged 37 years.

The claimant said she married her husband in China and the marriage was registered in 2006. She travelled to Australia to settle in 2007.

The claimant said that she attended government primary and high school whilst living in China. She said she completed 11 years of school education. She did not continue her education after leaving school. Whilst at school she played basketball with her friendship circle. She said she was never injured and had no surgical treatment whilst living in China. She reported having moderately severe allergic reaction to penicillin as a child and she was advised by the doctor not to use this antibiotic again in the future. She said she did not smoke tobacco, drink alcohol, use cannabis or gamble.

The claimant said she was not exposed to any childhood trauma, neglect or abuse.

The claimant said she worked in a travel agency in China for about 3 ½ years prior to entering Australia as a married woman.

The claimant said after learning English she commenced work as a casual worker for a Fairfield market stallholder. She said she enjoyed the work. After about four months she became pregnant with her first child and she stopped work.

She said she had difficulty with nausea and vomiting during her pregnancies. In 2012 she had been diagnosed by her general practitioner with Hyperemesis gravidarum. In the forwarded documents on 22 February 2012, the claimant was noted to be experiencing leg pains and excessive nausea and vomiting during pregnancy (Hyperemesis gravidarum.) She said both her children were physically and psychologically well. She said they were not disabled.

During 2015 and 2016 she worked part-time in a restaurant prior to the first accident in 2017.

The claimant had no history of post-traumatic stress disorder as a result of her employment in either China or Australia.

The claimant said that she had no prior motor accident before the first accident in 2017.

The claimant stated that she had not made any Workcover claims.

Prior Functioning before the first accident on 19 December 2017

The Medical Assessors reviewed the forwarded documents and asked questions of clarification regarding the claimant's prior psychological health. The Medical Assessors agree that there was no pre-existing psychological condition that had been diagnosed before the first accident in 2017.

The claimant stated she was physically and psychologically well. She said she had two children and she was occupied with the care of them. She said that she had nausea and vomiting during pregnancy but her children were born healthy and well. About two years prior to the first accident, she worked part-time in a casual role in a restaurant that was not owned by her husband.

Symptoms and treatment after the accident in 2017

The claimant said she attended her doctor as she was in pain after the 2017 accident. She said that the pain affected her neck, and back. She said she was prescribed paracetamol for pain. She was referred for physiotherapy. She was not referred to a pain clinic. She said she could not perform her usual duties that included laundry, cleaning, helping her children attend school and be affectionate. She said she became 'cranky' and would have 'tantrums.' She said she became increasingly anxious and depressed as she could not control her nausea and vomiting which she experienced in association with her persistent somatic symptom of persistent pain.

The claimant developed the following psychological symptoms because of the accident.

The claimant said that she developed an anxious and depressed mood, a low-esteem and feelings of increased frustration, irritability, negative cognitions (I don't want bad luck) with outburst of anger. She said the main problem was her pain.

The claimant said she would have bad dreams but she could not remember the content of the dreams. She said she would have pain and on bad nights she would trying to get to sleep by watching television until she fell asleep.

The claimant said she had low energy with fatigue which she attributed to her persistent pain. Further enquiry was made as to whether the claimant's low energy and fatigue was experienced as separate from her chronic pain. The claimant re-affirmed that her primary problem was persistent pain, then the uncontrollable nausea and vomiting which was usually worse if she became anxious or depressed in her mood. For these reasons the Medical Assessors agreed that the symptoms of anxiety and depressed mood as forwarded in the documents is best understood as part of the claimant's somatic symptom disorder. The Medical Assessors note that the symptoms of anxiety and depression may exacerbate the claimant's somatic symptoms of nausea and vomiting as seen by the Medical Assessors at the re-examination.

The claimant was asked about her driving. She said initially she had not driven for a long time after the 2017 accident. She was not able to remember the length of time she had not driven before returning to driving again. She was asked the question, when was the last time she had driven a car alone? She said she had driven to the shops about 10 days prior to the re-examination. She said she did not enjoy driving and she preferred her husband to drive as she did not want more 'bad luck.'

The claimant said she had been prescribed an antidepressant after the 2017 accident. She said she could not remember the name. She said she preferred to talk with her clinical psychologist Fiona in Cantonese. She said she would have to go look for the antidepressant she was prescribed as it was not easily found at the time of the re-examination.

The Medical Assessors both agree that from the re-examination and documents forwarded with the referral for re-examination, the claimant reported psychological symptoms were not consistent with a diagnosis of DSM-5-TR F 43.10 posttraumatic stress disorder after the 2017 accident.

The claimant did report some symptoms consistent with posttraumatic stress disorder. These symptoms include anxiety (fear), irritability, angry outbursts, and poor sleep. The Medical Assessors agree that the claimant's behaviour at the time of the motor accident as well as since the accident was inconsistent with the diagnosis of posttraumatic stress disorder. The claimant did initially delay returning to driving a car as she did not want further 'bad luck.' She was not avoidant of driving a car but was more cautious whilst driving and so drove less often.

The claimant was able to sustain her independence in her home with her performing less cleaning and less cooking because of pain. She explained, the first motor accident was less severe in relation to her pain than the subject accident on 25 May 2022.

Both Medical Assessors agree that the accident in 2017 did not meet Criterion A, for DSM-5-TR F 43.10 posttraumatic stress disorder criteria. The claimant was able to exit her car unaided after the accident. She was not injured in a manner that exposed her to actual or threatened death or serious injury. She did not stop the plan of the day and she continued on with the plan to greet her father at the airport, as her injuries were insufficient to necessitate either the claimant or herself calling for emergency services. For these reasons the claimant was not diagnosed with posttraumatic stress disorder because of the accident on 19 December 2017.

The claimant had symptoms related to her physical experience of pain related to her neck and back. She did have excessive thoughts, feelings and behaviours related to her health and persistently high anxiety and fear of future symptoms. She suffered from nausea, vomiting and persistent pain, that had not fully abated from the time of the accident on 19 December 2017 until the date of this re-examination.

The claimant said her symptoms would fluctuate and she was sometimes needing to be alone, sometimes she was sad and sometimes she was able to walk and be active in the home depending on how much pain she was experiencing.

The claimant said she would spend most her day lying on the bed or sofa and when not in pain she would do simple activities within her home. The claimant did have some symptoms consistent with major depressive disorder; however - she identified her pain as causing her depressed mood. From review of the forwarded documents, the claimant's report was similar to the various documented symptoms listed over the many years since the accident in 2017- however the claimant's experience was that she had persistent pain, anxiety and depressed mood with other somatic symptoms including nausea, vomiting and dizziness which are not part of major depressive disorder.

For the above reasons the claimant was diagnosed as having a DSM-5-TR F 45.1 Somatic symptom disorder with persistent and predominant pain, as the psychological injury which remained permanent after the 2017 accident. This diagnosis enables the claimant's anxiety and depression symptoms to be included in a single diagnostic condition and is the best explanation of the claimant's complex presentation as documented in the forwarded documents and on observation of the claimant's observed behaviour at time of this re-examination.

The Medical Assessors both agree that the best diagnosis that defines the prolonged

psychological injury in relation to the 19 December 2017 accident is:

DSM-5-TR F 45.1 Somatic symptom disorder with persistent and predominant pain.

The claimant meets the following criteria to define this condition in compliance with

Criterion A: One or more somatic symptoms that are distressing or result in significant disruption of daily life.

The claimant meets this criterion as her pain significantly disrupts her activities of daily living and her nausea and vomiting disrupted her capacity to talk about the accident.

Criterion B: Excessive thoughts, feelings or behaviours related to the somatic symptoms or associated health concerns as manifested by the following:

1. Disproportionate and persistent thoughts about the seriousness of one's symptoms

2. Persistently high level of anxiety about health or symptoms.

Criterion C: Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months.)

Specifier: With predominant pain: The claimant does report constant pain which was

predominant in her presentation from the date of the accident to the date of the re-examination.

Specifier: Persistent: The claimant's severe nausea and vomiting with pain does cause marked impairment for a long duration that surpasses the minimum period of six months since onset.

Psychological Functioning before the 25 May 2022 Accident

The claimant said that she was independent in her self-care and personal hygiene. She lived with her husband, mother and children in the family home in Fairfield. She would shower less. She was able to maintain her nutrition. She was able to cook, clean and assist with the cleaning on her home. She could wash and launder her own clothes less as she had less interest in managing her family. She was able to purchase her own groceries from her local supermarket with a support person.

The claimant said that she did have physical restriction and pain in relation to her self-care and personal hygiene. She was less able to maintain her nutrition because of pain pre-occupying her thoughts and nausea and vomiting becoming more frequent. She was able to cook, clean and assist with the cleaning of her home. She could wash and launder her own clothes at a slow pace. She was able to purchase her own groceries from her local supermarket in small quantities with a support person.

The claimant said she was able to enjoy watching Hong Kong TV on You Tube. She said she would watch television and relax watching programs she knew and enjoyed. She did not participate as much as she had before the accident. She found these programs as enjoyable as before the 2017 accident. she said she was able to enjoy vacations with her father and her friends in China prior to the 2022 accident.

The claimant said that she was less interested in socialising since the 2017 accident. She said she was in more severe persistent pain after the 2017 accident. She said she would socialise less with family friends, because of pain. She said she was less interested in joining in with her children in their play and news of their school progress because she would have irritable angry outbursts due to her pain.

The claimant said that she was capable of travelling internationally alone from China to Australia. She said since the 2017 accident she had travelled to China from Australia to visit her friends and father. She last flew to China a few months before the 2022 accident.

The claimant said she had stopped driving for a long period, but she could not report when she recommenced driving. She said she would drive when it was "essential" for her family. She said her fear about driving was that she would have "bad luck" and she requested her husband drive mainly.

The claimant said that she did have physical restriction in relation to her travel. She said she would not drive more than 10 to 15 minutes as she would experience pain.

The claimant said that she was married with two children. She said she was able to be affectionate and intimate with her husband.

The claimant did continue to have contact with her brother before the 2022 accident.

The claimant said she had kept in contact with her father and she enjoyed visiting him when she was able before the 2022 accident.

The claimant did have physical restriction and pain in relation to her social functioning with her husband. She said her pain, nausea and vomiting did markedly impair her capacity to show affection and intimacy towards her husband. She described verbal angry outbursts with 'tantrums' that she could not control because of her pain and physical condition.

The claimant said that she was able to concentrate and persist at complex tasks such as reading Chinese text. She said she was not interested in reading novels or recipes as her mother would cook the meals. She was able to watch Hong Kong TV drama and soap operas that she enjoyed prior to the 2017 accident.

The claimant said that she did have pain and physical restriction in relation to concentration, persistence and pace. She described having to lie down when she became nauseous, had vomited or was in pain. She said she did watch You Tube to relax.

The claimant said since the 2017 accident she had not worked. She said she could supervise the children to ensure their safety. She could assist her mother if her pain and vomiting were not present.

The claimant said that she did have pain and physical restriction in relation to her main responsibility of caring for the home and children. She said she had pain that restricted her normal daily duties of housekeeping.

The claimant said she had continued to be psychologically treated by her psychologist up until a short period before the second accident on 25 May 2022.

History of the subject motor accident on 25 May 2022

The claimant said she remembered travelling in the car with her husband driving. She said this accident was more severe and caused more pain than the first. She said the force of the accident shunted her car forward.

The claimant said she was the front seat passenger. The car was stationary at a red light. Another car rear-ended the claimant's car. She said she was thrusted forward and restrained by her seatbelt. She said she was then thrown backwards into her seat. She immediately experienced pain in her neck and back. She immediately felt dizzy and nauseous. She started vomiting.

The claimant said her pain was more severe. She experienced pain in her neck between her shoulder blades (upper thoracic spins) and in her back. neck and shoulder muscles were pulled as a result of the impact.

The claimant's husband exchanged information with the other driver. He drove the car involved in the accident with the claimant to a nearby relative's home so she could rest and settle. The claimant said that no ambulance or police attended the accident in 2022.

The claimant attended the Fairfield Hospital and was not identified as having sustained any severe physical injury because of the accident. The claimant was noted to have pain and was vomiting. She was prescribed Ondansetron 4mg tablet 4hourly PRN (as needed) to settle nausea and vomiting by the emergency medical team in the Fairfield Hospital Emergency Room.

The claimant attended her usual general practitioner Dr Lam and her psychologist Fiona. She said she was prescribed various medications that did not assist her. She said she was not regularly using any psychiatric medication at the time of the re-examination. She explained that the antidepressant was somewhere in her new home in Marsden Park where she had lived since the 2022 accident for about 2 ½ years.

The claimant said the insurer ceased paying for her psychological treatment and this had resulted in her not receiving any psychological or psychiatric treatment at the time of the re-examination.

The claimant had received physiotherapy for her injuries sustained in the 2022 accident.

The claimant had received various analgesics, including amitriptyline (an antidepressant used to treat pain). She said nothing improved her condition. She said she would utilise paracetamol 500mg tablets if she could not sleep due to pain.

The claimant presented as an Asiatic woman who looked her stated age. She was wearing clean clothes and had washed dark hair. The claimant explained that she had outburst of anger and that she would become nauseous and vomit when thinking about the accidents.

The claimant was observed to rock backwards in her chair and would look at the ceiling frequently when she was asked to describe her condition before and after the accidents. She would frequently say, 'I don't remember.' She was irritable and became frustrated when asked to describe her life before and after 2017 accident. She complained of nausea and she was encouraged to use her cognitive behavioural skills and relaxation skills she had received from her psychologist. The claimant did experience an episode of marked vomiting, which required her to pause.

On returning to the re-examination, she had two more vomiting events for which she took water to cleanse her mouth. Progress through the re-examination was slow.

The claimant's concentration, persistence and pace were impaired by her nausea and vomiting. When talking or remembering her pain and the accident in 2022 she would become more distressed.

The claimant said she had not recovered from the 2022 accident which was worse and her pain and vomiting was worse since this accident. The claimant had an outburst of frustration and anger during the re-examination.

The claimant did not report a depressed mood, she did not report melancholia (loss of pleasure, joy or interest). She said she was fearful of 'bad luck.' She said at times she was sad, but her main complaint was pain which stopped her from performing her home duties. She said she would attend the children as they were older now and required less assistance. She lived with her mother who the claimant said was mainly independent.

The claimant would not drive on inclement days as she did not want, 'bad luck.' She reported her mood as 'cranky' and 'irritable'. She said she could enjoy watching her Hong Kong TV soap operas on You Tube. She said talking about the accident in 2022 had made her mood depressed and she had increased nausea and vomiting during the re-examination.

The claimant was able to drive and said she would drive her children to the train station. She said she was cautious. She said she was restricted by her pain when driving for more than about 15 minutes.

The claimant's rate of speech was normal throughout most of the re-examination. When she became agitated, she would speak quickly and rock back in her chair displaying frustration.

The claimant's concentration was impaired by her brief episodes of agitation and irritability. The re-examination continued at a slow pace and took about 110 minutes as the claimant required time to pause and settle her anxiety which was associated with her nausea and vomiting.

The claimant did not require prompting to remain on track during the slow progress of the re-examination. She did provide a coherent and understandable history of her condition before and after the 2022 accident.

The claimant was oriented in time, place, and person. Her form of speech did not

demonstrate any common features that might be associated with any abnormality of

The claimant did not report delusional ideas or psychotic symptoms.

The claimant did not report thoughts of death. She did not report thoughts of not being a good mother, wife or housekeeper. She did not report suicidal intent. The claimant was insightful about her condition. Her judgment was normal.

The Medical Assessors both agree that the best diagnosis that defines the prolonged

psychological injury in relation to the 25 May 2022 accident is an aggravation of:

DSM-5-TR F 45.1 Somatic symptom disorder with persistent and predominant pain (somatic symptom disorder.)

The claimant meets the following criteria to define this condition in compliance with

Criterion A: One or more somatic symptoms that are distressing or result in significant disruption of daily life.

The claimant meets this criterion as her pain significantly disrupts her activities of daily living and her nausea and vomiting disrupted her capacity to talk about the accident.

Criterion B: Excessive thoughts, feelings or behaviours related to the somatic symptoms or associated health concerns as manifested by the following:

1. Disproportionate and persistent thoughts about the seriousness of one's symptoms

2. Persistently high level of anxiety about health or symptoms.

Criterion C: Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months.)

The claimant's somatic symptoms included, persistently having a high level of anxiety and depressed mood that aggravated her somatic symptoms of nausea, vomiting and persistent pain. She was worried and would ruminate about her condition and stated she could not accept that "nothing worked" to stop her symptoms.

The claimant said that she had become more symptomatic after the 2022 motor accident, and the 2022 accident had aggravated her pre-exiting condition caused by the 2017 accident.

Specifier: With predominant pain: The claimant does report constant pain which was

predominant in her presentation from the date of the accident to the date of the re-examination.

Specifier: Persistent: The claimant's severe nausea and vomiting with pain does cause marked impairment for a long duration that surpasses the minimum period of six months since onset.

Psychological functioning after the 25 May 2022 accident.

The claimant reported that her pain was more prominent and severe since the 2022 accident. She said pain still impaired her capacity to clean and she would perform light duties in the house. She did not cook as her mother would cook.

The claimant was able to shower and maintain her independence in living as she was able to drive to the local supermarket to purchase groceries alone.

The Medical Assessors agree that the claimant's impairments in self-care and personal

hygiene is best explained as due to her somatic symptom disorder.

The claimant said she did not participate in social events inside or outside her home. She said she did not engage in celebrations often. She said her pain and vomiting restricted her and she would not be able to socialise without having to explain her condition which she did not want to do.

The Medical Assessors agree that the claimant's impairments in social and recreational functioning are best explained as due to her somatic symptom disorder.

The claimant said that she could drive and that she had returned to driving since the 2022 accident. She said she would drive her children to the train station to catch the train. She said she was able to drive short distances up to about 15 minutes. She said she did not drive further because of pain.

The claimant said she did not like driving in inclement weather as she feared 'Bad Luck.' She said she could drive in the rain but kept her travel to a minimum as she does not want any more accidents.

The Medical Assessors agree that the claimant's impairments in travel are best explained as due to her somatic symptom disorder

The claimant said that her physical condition of nausea and vomiting and pain caused her to have difficulty showing affection and intimacy to her husband. She said she could show affection and intimacy however since the 2022 accident, she was much less able to be intimate with her husband.

The claimant said she was less able to follow her children's school progress, as she spoke mainly Cantonese with her mother.

The claimant reported no change in her relationship with her mother.

The Medical Assessors agree that the claimant's impairments in social functioning are best explained as due to her somatic symptom disorder

The claimant was observed to become symptomatic at about the 46-minute mark of the

re-examination. She required about 10 minutes to settle and make her choice of whether she would continue. She had another two minor episodes of nausea. The Medical Assessors noted Assessor Sidorov's documentation of similar behaviour displayed by the claimant on page 4. of his certificate where he documented the following: 'She appeared to be nauseous on several occasions during the assessment and vomited on one occasion.'

The claimant said she could watch a full episode of her Hong Kong TV soap opera and other programs which could settle her pain, nausea or vomiting.

The claimant said she did not read by choice. She said she did read Chinese text and she could follow recipes but her mother would cook by preference.

The Medical Assessors agree that the claimant's impairments in concentration, persistence and pace are best explained as due to her somatic symptom disorder.

The claimant said that she could not perform heavy household duties because of pain. She said she might do some light cleaning duties is she was not in pain. She said she could, assist with the children's needs should they ask her and she was not in pain,

The Medical Assessors agree that the claimant's impairments in adaptation are best explained as due to her somatic symptom disorder

The claimant had no subsequent conditions since the accident in 2022.

The claimant was independent in her lifestyle and employment role before the accident in 2017.

The claimant had a diagnosed and established severe nausea and vomiting disorder (Hyperemesis gravidarum) during her pregnancy in 2012. The diagnosis was made at the same time as the claimant also reported leg pain whilst pregnant. She said the condition had remitted after this pregnancy.

The claimant experienced anxiety and depressed mood, nausea, vomiting, dizziness, neck, and back pain after the 2017 accident which was aggravated by the 2022 subject accident.

Using DSM-5-TR the following disorders were not diagnosed because whilst the claimant had reported some symptoms that may occur in posttraumatic stress disorder, and adjustment disorder the claimant did not meet all the criteria as explained below:

a. Post-traumatic stress disorder was not caused by the 2022 motor accident because the claimant failed to meet Criterion A. This is evidenced by the claimant's husband taking his wife to a relative's home which was close to where the accident happened. The claimant was in pain and had nausea and vomiting. She went to Fairfield Hospital and there were no severe or life-threatening condition diagnosed at the hospital on the day of the 2022 accident. The claimant was noted to have severe nausea and vomiting and the emergency medical team prescribed ondansetron 4mg for this condition on the day of the 2022 motor accident. For these reasons the claimant was not diagnosed with DSM-5-TR Criteria as she must meet all criteria from A to H for the diagnosis of post-traumatic stress disorder to be diagnosed in compliance with DSM-5-TR.

b. Adjustment disorder was not caused by the 2022 motor accident. The Medical Assessors note that criterion C of adjustment disorder states, "The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a pre-existing mental disorder." In this claimant's history the pre-existing disorder from the 2017 accident is DSM-5-TR F 45.1 Somatic symptom disorder with persistent and predominant pain (somatic symptom disorder.) The claimant's pre-existing condition was aggravated by the 2022 accident. The symptoms of anxiety and depressed mood can be part of somatic symptom disorder. For these reasons the diagnosis of adjustment disorder was not made as the claimant's somatic symptom disorder was a pre-existing mental condition that was aggravated by the 2022 accident.

All of the criteria for the diagnosis of an aggravation of somatic symptom disorder are meet by the claimant in relation to the 2022 accident. The claimant had this condition after the 2017 accident. The claimant, for these reasons, does not have adjustment disorder in compliance with DSM-5-TR Criterion C for diagnosis of adjustment disorder.

The Medical Assessors note that the symptoms of anxiety and depressed mood had become a focus of treatment. The focus on treatment of symptoms in clinical practice is common. Symptoms such as pain, nausea, vomiting, anxiety and depressed mood are common to many medical conditions,

The Medical Assessors agree that the motor accident could have caused the claimant to suffer from somatic symptom disorder.

The Medical Assessors agree that the motor accident did cause the claimant to suffer the psychological injury from somatic symptom disorder.

In late 2023 the claimant travelled to China. The insurer had submitted that this was not congruent with post-traumatic stress disorder symptoms. The claimant says that she travelled to China only because it was a family emergency. It is not in the opinion of the Panel that this is unreasonable as post-traumatic stress disorder symptoms do not prevent occasional travel.

The following injuries WERE caused by the motor accident:

• DSM-5-TR F 45.1 Somatic symptom disorder with persistent and predominant pain (somatic symptom disorder.)

The medical assessors both agree that DSM-5-TR F 45.1 Somatic symptom disorder with persistent and predominant pain (somatic symptom disorder) is not a threshold injury under the meaning of the Act.

• DSM-5-TR F 45.1 Somatic symptom disorder with persistent and predominant pain (somatic symptom disorder.)

The following injury referred to the Panel for assessment has been assessed and

1. The Panel met on 20 November 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 20 November 2025, the legal Member has had the benefit of reading and considering the Medical Assessors examination report. On 20 November 2025 the Panel met and 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.
2. The Panel adopts the examination report of Senior Medical Assessor Baker and Medical Assessor Gupta.

1. The Review Panel in the matter of David v Allianz Australia Insurance Ltd [2021] NSWPIC MP227, identified the test for a non-threshold injury. The Medical Assessors have considered whether the claimant, at any time post-accident, and in this claim, at the time of assessment, was diagnosed with a non-threshold injury.
2. For the reasons considered above, the Panel is satisfied that the claimant at the time of the accident was suffering somatic symptom disorder with persistent and predominant pain (somatic symptom disorder). Following the accident, the Panel is satisfied that the claimant has suffered an aggravation of her pre-existing somatic symptom disorder with persistent and predominant pain (somatic symptom disorder).
3. How the Panel is to approach the issue of causation is dealt with in various paragraphs of the Permanent Impairment Guidelines.
4. Paragraphs 1.6 to 1.7 of the Permanent Impairment Guidelines under the heading "Causation of injury" deal with this issue and provide:

"1.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows: 'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination'. This therefore, involves a medical decision and a non-medical informed judgment.

1.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. Campbell J in Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [27] held that:

"the question to be assessed [under the previous Motor Accidents Medical Guidelines which were relevantly in substantially the same terms as the 2018 Guidelines] is one of legal causation involving mixed questions of fact and law arising principally from the law of negligence as modified by Civil Liability Act 2002, s.5 D. (See s.3B(2))."

"(1) A determination that negligence caused particular harm comprises the following elements-

(a) that the negligence was a necessary condition of the occurrence of the harm (factual causation), and

(b) that it is appropriate for the scope of the negligent person's liability to extend to the harm so caused (scope of liability).

(4) For the purpose of determining the scope of liability, the court is to consider (amongst other relevant things) whether or not and why responsibility for the harm should be imposed on the negligent party."

1. In Briggs v IAG Limited trading as NRMA Insurance [2022] NSWSC 372, Wright J, regarding causation and the issues to be addressed, said:

"67 The second ground of review concerned the second review panel's approach to the issue of causation. It was submitted that the panel applied an erroneous test in relation to causation and thus failed to exercise its jurisdiction.

69 The substance of the reasoning was that since there could be no scientific certainty that the L4/5 left posterolateral annular tear with mild disc desiccation was caused by the accident based on medical imaging and there was a possibility that the injury was not a tear and may not have been what led to Mr Brigg's pain and disability, causation had not been established.

70 This reasoning does not accord with the relevant legal test in relation to causation, which does not require scientific certainty. In Metro North Hospital and Health Service v Pierce [2018] NSWCA 11, the Court of Appeal said, in relation to causation in a similar context, as follows at [138] (White JA, Macfarlan and Payne JJA agreeing):

'138 Whether the Hospital's negligence in not responding to the induced seizures in a timely manner materially contributed to Ms Pierce's worsened condition is not to be determined on the basis of scientific certainty, but on the balance of probabilities. As Spigelman CJ said in Seltsam Pty Ltd v McGuiness (2000) 49 NSWLR 262; [2000] NSWCA 29 at [143]:

'An inference of causation for purposes of the tort of negligence may well be drawn when a scientist, including an epidemiologist, would not draw such an inference.''

71 The relevant principles were stated by Herron CJ, with whom Asprey and Holmes JJA agreed, in EMI (Australia) Ltd v Bes [1970] 2 NSWR 238 as follows, at 242:

'... it is not incumbent upon the applicant, upon whom the onus rests, to produce evidence from medical witnesses which proves to demonstration that the applicant's contention is correct. Medical science may say in individual cases that there is no possible connexion between the events and the death, in which case, of course, if the facts stand outside an area in which common experience can be the touchstone, then the judge cannot act as if there were a connexion. But if medical science is prepared to say that it is a possible view, then, in my opinion, the judge after examining the lay evidence may decide that it is probable. It is only when medical science denies that there is any such connexion that the judge is not entitled in such a case to act on his own intuitive reasoning. It may be, and probably is, the case that medical science will find a possibility not good enough on which to base a scientific deduction, but courts are always concerned to reach a decision on probability and it is no answer, it seems to me that no medical witness states with certainty the very issue which the judge himself has to try.'

72 Furthermore, a finding of causal connection may be open without any medical evidence at all to support it, or when the expert evidence does not rise above the opinion that a causal connection is possible: Fernandez v Tubemakers of Australia Ltd [1975] 2 NSWLR 190 at 197 (Glass JA); Metro North Hospital at [140].

73 The second review panel did not address the question of whether on the balance of probabilities the motor vehicle accident caused the annular tear even though there might be no scientific certainty. Furthermore, the second review panel's reasoning did not reflect the approach to determining causation in cll 6.6 and 6.7 of the Guidelines, which in my view is consistent with the legal principles I have outlined.

74 The present case is not one where medical science established that there was no possible connexion between the motor accident and Mr Brigg's relevant injuries. From the material available, the second review panel accepted that the motor accident in this case could have caused or contributed to Mr Brigg's L4/5 left posterolateral annular tear. Indeed, the panel expressly accepted that:

'the plaintiff was involved in relatively severe front-end collision. The medical and biomechanical literature supports the conclusion that spinal injuries with resulting pain and disability can arise from this type of trauma.'

75 This being so, it was necessary for the panel to consider whether the motor accident did cause or contribute to Mr Brigg's condition. This required, not a consideration of material derived as a result of an internet search for "all past and recent high-quality research articles pertaining to MRI imaging of the lumbar spine, with a focus on injury, degeneration and pain", but rather a consideration of the material referred to in cl 5.6 of the Guidelines, namely all the evidence available to the panel including all relevant findings derived from:

(1) a comprehensive, accurate history, including pre-accident history and pre-existing conditions;

(2) a review of all relevant records available at the assessment;

(3) a comprehensive description of the injured person's current symptoms;

(4) a careful and thorough physical examination; and

(5) diagnostic tests available at the assessment, noting that imaging findings that are used to support the assessment should correspond with symptoms and findings on examination.

76 In Mr Briggs's case that would include, without attempting to be exhaustive:

(1) Mr Briggs's age, circumstances and relevant medical history at the time of the motor accident, including whether there was any previous history of lumbar spine pain;

(2) the particular nature and extent of the accident and the forces that would have been operative on Mr Briggs as a result of the accident; and

(3) Mr Briggs's circumstances and relevant medical history including the MRI results and results of other medical examinations and testing, after the motor accident.

77 In light of all that material and in accordance with cll 6.6 and 6.7 of the Guidelines, the panel should then have made 'a non-medical informed judgment' as to whether it was likely that the motor accident caused or contributed to Mr Briggs's injury in question."

1. The Panel must also ask itself in considering whether the accident contributed to the claimant's physical and psychiatric injuries as referred to it by the Commission, whether the accident materially contributed to that condition and need for treatment.
2. On the balance of probabilities, can it be said that the aggravation of the psychiatric injuries suffered by the claimant was caused by the accident? The Panel is satisfied that this is the case. The claimant, at the time of the accident, continued to have symptoms similar to those she had before the accident the subject of this claim but her symptoms were worse and continued so.
3. This review is an assessment of all matters with which the medical assessment is concerned. The original medical assessment related to whether the injuries sustained in the motor accident were threshold or non-threshold as defined under the Act.
4. The diagnostic criteria for post-traumatic disorder under DSM-5-TR, for the reasons provided above, have not, in the finding of the Panel, been satisfied.
5. The Panel refers to the decision of Mandoukos v Allianz Australia Insurance Limited [2023] NSWSC 1023. It might be argued that the scope of the medical dispute referred to the Commission for determination is not defined by law but by the parties' submissions. 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 somatic symptom disorder with persistent and predominant pain (somatic symptom disorder).
6. The Panel has not "gone looking" for alternative diagnosis when the specific diagnosis of an adjustment disorder with anxious mood 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 overtime and disappear overtime for that matter. In this case, the Panel was not satisfied that the claimant had a diagnosis of a post-traumatic stress disorder but was satisfied on the basis of the history provided by the claimant, that she was suffering a psychiatric disability of a somatic symptom disorder with persistent and predominant pain (somatic symptom disorder).
7. The Panel adopts the reasoning in Lynch v AAI Ltd [2022] NSWPICMP 6 that the psychological condition can be present at any time to establish that the injury is not threshold for the purposes of the Act. This principle was also applied in QBE Insurance (Australia) Pty Ltd v Chebat [2024] NSWPICMP 611.
8. Furthermore, an accident can cause a non-threshold psychiatric condition if the evidence establishes that the accident caused or materially contributed to the psychiatric condition, even if only by way of aggravating a pre-existing condition - see Todev v AAI Limited t/as GIO [2023] NSWSC 836 and AAI Limited t/as GIO v Hoblos [2023] NSWPICMP 210. The Panel is satisfied that the accident has caused such an aggravation because in the accident, the claimant reported increased symptoms. It is therefore plausible that on the balance of probabilities, the additional pain and physical and psychiatric restrictions exacerbated the claimant's pre-existing somatic symptom disorder, which aligns with her account of worsening severity of symptoms.
9. The Panel adopts the finding 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.
10. 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 arises because of contribution by the accident, and whether the accident materially contributed to that condition. The Panel is satisfied that this is the case. The claimant did have a somatic symptom disorder following her accident in 2017 but following the accident the subject of this claim, that disorder was aggravated. That subsequent accident aggravated the claimant's condition from 2017 and materially contributed to it.
11. Scientifically, there is a possibility that the accident could have caused an aggravation of the claimant's pre-accident injuries. The Panel considers that the accident did contribute to the claimant suffering such an aggravation after the accident.
12. 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.
13. 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 the claimant experienced increased anxiety and depressed mood, nausea, vomiting, dizziness, neck, back pain after the 2017 accident which was aggravated by the 2022 subject accident. This was confirmed by the history provided by the claimant and on clinical examination.
14. As the Medical Assessors have said, all of the criteria for the diagnosis of an aggravation of somatic symptom disorder are met by the claimant in relation to the 2022 accident. The claimant had this condition after the 2017 accident. The claimant has satisfied all of Criterion A, B and C of DSM-5-TR Somatic symptom disorder with persistent and predominant pain (somatic symptom disorder) for the reasons given in its examination report.
15. The claimant does not have an adjustment disorder in compliance with DSM-5-TR Criterion C for diagnosis of adjustment disorder. As the Medical Assessors noted, the symptoms of anxiety and depressed mood had become a focus of treatment and the stress related disturbance meets the criteria for another mental disorder.

1. The Panel is satisfied that consequent upon the motor accident which occurred on

25 May 2022, the claimant developed an aggravation of a psychiatric disability of somatic symptom disorder with persistent and predominant pain (somatic symptom disorder). This is a non-threshold injury. 2. The Panel is not satisfied that the claimant has post-traumatic stress disorder.

1. The Panel revokes the certificate of Medical Assessor Sidorov dated 10 October 2024.
2. The Panel determines that consequent upon the motor accident which occurred on

25 May 2022, the claimant developed an aggravation of a psychiatric disability of somatic symptom disorder with persistent and predominant pain (somatic symptom disorder). This is a non-threshold injury.