1. The Review Panel revokes Medical Assessor Gerard Chew's certificate dated

27 February 2024, which found that the psychological injuries arising from the motor accident gave rise to whole person impairment of 15%. 2. The Review Panel certifies that the claimant's permanent impairment resulting from the injury caused by the accident is 17% permanent impairment arising from major depressive disorder and post-traumatic stress disorder caused by the accident, which is greater than 10%.

1. The claimant was injured in a motor accident in NSW on 13 May 2017.
2. Mr Isho Poles Kando moved to Australia in late 2016. He and his family lived through the Syrian civil war and the ISIS caliphate and they eventually fled Syria because for their safety
3. He applied himself to studying English and resuming his occupation as a panel beater in Australia. The family settled in the south west of Sydney.
4. On the day of the accident Mr Kando was a restrained rear seat passenger in a car driven by his son. He was behind the front seat passenger.
5. The vehicle was making a right-hand turn in traffic when the insured driver in a bull bar fitted Ford Ranger utility T-boned that car at the level of the passenger side doors in the area where he was seated.
6. The claimant sought damages against the insured driver under the Motor Accidents Compensation Act 1999 (the MAC Act).
7. A dispute arose about the claimant's entitlements to non-economic loss damages, because the insurer decided that the permanent impairment from the claimant's psychiatric injuries arising from the accident was not greater than 10%
8. On 27 February 2024 Medical Assessor Gerard Chew of the Personal Injury Commission (Commission) issued a certificate. The Medical Assessor found the accident caused a persistent depressive disorder and post-traumatic stress disorder and assessed the permanent impairment at 15%.
9. The insurer applied under s 63 of the MAC Act to refer this assessment to a review panel on the grounds that the medical assessment was incorrect in a material respect. The claimant opposed that application.
10. The President's delegate Stephanie Wigan issued a determination dated 29 April 2024 referring the dispute to a medical review panel because the Medical Assessor did not set out his path of reasoning regarding class 3 impairment in social and recreational activities.
11. The Commission's President constituted this Review Panel (the Panel) to review the above medical assessment (the Review).
12. Following rule 128(1) of the Personal Injury Commission Rules, 2021 (the PIC Rules) the Panel 'is to conduct and determine the proceedings in accordance with procedures determined by the panel'.
13. The Panel met on 17 April 2025 to discuss how this matter will proceed.
14. The Panel noted the claimant's treating psychiatrist Dr Mukesh Kumar's clinical notes were not included with the bundles. To facilitate assessing this matter the Panel sought copies of those notes and any recent general practitioner (GP) or psychologists' clinical notes.
15. The Panel considered re-examination was required. Medical Assessors Mason and Doris conducted this examination on behalf of the Panel on 2 June 2025.
16. An Assyrian interpreter was present.

1. Mr Kando's claim and entitlements to compensation are governed by the provisions of the MAC Act.
2. Compensatory damages under the MAC Act are awarded for economic as well as non-economic losses resulting from the injuries, disabilities and impairments caused by the motor accident.
3. Limited and restricted non-economic loss damages are provided for in Part 5.3 of the MAC Act. For example, s 131 restricts entitlement to those damages to persons who have a greater than 10% whole person impairment (WPI) as a result of the injuries sustained in the accident, and s 1.34 limits non-economic loss damages to a maximum amount.

1. Permanent impairment (or WPI) must be assessed in accordance with the Motor Accident Permanent Impairment Guidelines (the Guidelines) which are largely based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides).
2. Clause 1.35 of the Guidelines states that psychiatric impairment is assessed in accordance with 'Mental and behavioural disorders' found in cls [1.201] - [1.228] of the Guidelines.

1. If there is a dispute about the degree of the claimant's permanent impairment, damages for non-economic loss cannot be awarded and disputes must be referred to a Medical Assessor for determination.
2. Part 3.4 of the MAC Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as by Medical Assessor Chew, further medical assessments, and the review of medical assessments by this Panel.
3. Pre-existing impairment is addressed in cls 1.31-1.33 of the Guidelines. Clause 1.34 deals with subsequent injuries.
4. The Guidelines state as follows with respect to causation of injury:

1.5 An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues.

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 judgement.

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 accident. The 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. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

1. Medical Assessor Gerald Chew issued a certificate dated 27 February 2024 in which he diagnosed persistent depressive disorder and post-traumatic stress disorder with permanent impairment of 15%.
2. Medical Assessor Chew noted the history of the claimant being a restrained passenger when their vehicle was struck. He was taken by ambulance to Fairfield Hospital and discharged later the same day.
3. His physical injuries consisted of broken ribs, shoulder pain, neck pain and left leg pain.
4. Medical Assessor Chew noted "pain has been his main issue since the accident". He described recurrent images of the accident, ongoing fear, social withdrawal, lack of motivation and lack of energy. He had seen a psychiatrist and was prescribed medication but has had no treatment for 18 months.
5. The claimant was distressed by the death of his sister in Canada and had been unable to travel to see her because of his pain.
6. Medical Assessor Chew noted activities of daily living (ADLs) were limited due to pain. The claimant was avoiding social activities but could drive. Relationships with his family were intact. There was some difficulty with memory and concentration. He could not work because of pain.
7. Whole person impairment was assessed at 15%.

1. The documentary evidence before the Panel consists of material in the bundles filed in accordance with the Panel's directions. The Panel has considered all the relevant material.

1. Medical Assessor Nigel Menogue provided a certificate dated 10 February 2024 in which he assessed permanent impairment at 0% for cervical spine, 7% right shoulder and 0% lumbar spine. Left chest wall rib fractures had resolved.
2. Medical Assessor Menogue noted rheumatologist Dr Thakka's report on 17 June 2021 which stated "Mr Kando is completely preoccupied with his pain. He is depressed and feels hopeless about everything. He is not keen to explore injections or surgery." Myocardial infarction led to stent insertion on 25 September 2020.

1. Psychologist Mr Greg Anning provided an IME report dated 22 December 2021.
2. He noted the claimant's daughter was married on 16 November 2021. Mr Kando fled Syria to Iraq because it was under ISIS rule. He was a Christian and ISIS fighters had threatened him at gunpoint by because he did not immediately comply with their demands to weld a base onto a vehicle to enable it to carry a machine gun.
3. His parents and siblings moved to Canada and the US.
4. He described intrusion and avoidance of symptoms every time he sees a Ford pickup truck on the road and he tries to move away from it.
5. After the accident he noted friends were visiting him at home and they reminisced about the old days in Syria. He was able to walk his daughter down the aisle. Mr Anning diagnosed major depressive disorder and made a provisional diagnosis of post-traumatic stress disorder. Prognosis was extremely guarded. He assessed permanent impairment at 13%.
6. Psychiatrist, Dr Christopher Canaris provided an IME report dated 6 October 2021. He described Mr Kando relived the accident daily in the form of flashbacks and dreams about the accident.
7. He noted the claimant has two sisters in Australia, a sister and brother in Canada and a sister in United States. Parents are both deceased. He left Syria because of the Syrian Civil War saying ISIS militants came to assassinate him at his workshop so he escaped on foot to Northern Iraq. He confirmed he had been harassed and threatened by the members of Islamic State.
8. Dr Canaris noted Mr Kando was preoccupied with his physical symptoms and pain and as a consequence was depressed. He diagnosed post-traumatic stress disorder, persistent depressive disorder with persisting major depressive episodes and somatic symptom disorder with predominant pain, all caused by the motor vehicle accident. Prognosis was guarded because of the chronicity of all three diagnoses. He assessed permanent impairment at 19%.
9. Professor James Athanasou provided a vocational assessment report dated 1 October 2021. He concluded as a result of his injury he has lost the potential to work as a panel beater-spray painter.

1. Surgeon, Dr Antoine Sanki's complete record from Fairfield District Medical Centre is dated 24 December 2018 , 21 April 2020, and 7 December 2023. The claimant's initial consultation was 25 August 2017;

"(a) 25/08/2017 claimant was referred by Dr Toma. Syrian refugee who arrived in August 2016. Fled Syria 4 years ago to Iraq. Saw car coming and steadied himself by putting his right arm over the child restraint. Four fractured ribs on left. Height 171 cm, weight 85 kg, BMI 29.1 kg/m². Never smoked cigarettes, drinks alcohol less than monthly.

(b) 24/10/2017 Right shoulder injection resulted in 10 days improvement which did not persist.

(c) 29/01/2018 MRI shows labral tear. Tramal SR 100 mg and Celebrex 200 mg. Referred to Dr Chanda Dave. No reference to psychological symptoms.

(d) 12/03/2020 right shoulder much the same. There is reference to citalopram but no record of prescription.

(f) 25/11/2021 presents with back pain on and off over a few years. Norgesic and tramadol prescribed.

(g) 02/12/2021 the tender lower back is much better. Referred for physiotherapy."

1. Centrelink medical certificate undated by Dr Antoine Sanki indicates no capacity for work until 1 March 2018.
2. Occupational health physician Dr Robin Mitchell provided an IME report dated

16 December 2020 in which he assessed 7% permanent impairment for right shoulder and 0% for both cervical and lumbar spine. 3. Occupational therapist and mental health clinician Dr Yaser Mohammad provided a report dated 14 September 2018. 4. Mr Kando attended initially for supportive counselling for depression on 12 July 2018. He noted the car accident resulted in multiple physical problems, short-term memory loss, flashbacks, and avoidance of car travel. He also noted

"many life difficulties which had and continue to cause him substantial distress. His depressed mood worsened over the last few months and the main percipient [sic] is MVA".

1. Dr Mohammad had attempted to challenge his negative self-beliefs but the claimant demonstrated cognitive inflexibility due primarily either to the accident or possible pre-existing chronic post-traumatic stress disorder. He noted his current emotional state is greatly determined by his uncertainty about his health. He noted poor disrupted sleep and nightmares. He is currently unfit to work due to limited functional mobility.
2. Treating psychiatrist Dr Mukesh Kumar of Fairfield provided a report dated 5 December 2018. He described depressive symptoms which commenced after migration to Australia. He was involved in this accident three months after arriving in Australia caused by a drunk driver. The injuries had prevented him from learning English and from working. Both the claimant and his wife deny he had previous psychiatric symptoms. They left Syria to avoid his children being forced to enlist in in one of the contending Syrian armed groups. He noted Mr Kando's shop was damaged during the Syrian war.
3. Symptoms were described as anxiety in relation to motor vehicles. Initial nightmares following the accident had improved. The claimant denied thoughts of self-harm or suicide and denied past and family history of mental illness. He completed the equivalent of year 9 in Syria and worked as a car mechanic. He married in 1984 and has four children. While mentally slow he was generally euthymic. Diagnosis was chronic adjustment disorder and treatment consisted of referral to a psychologist and introduction of sertraline 50 mg with a plan to increase to 100 mg after one week.
4. At review on 15 February 2019 Dr Kumar interviewed the claimant with his daughter Ilina. The medication was taken for only one month. Ongoing pain continues to affect his mood and he continues to feel anxious around vehicles. This has improved to the point where he can now sit in a car. He described flashbacks and nightmares which have worsened since stopping the medication. On this occasion the diagnosis was post-traumatic stress disorder and major depressive disorder. Medication was recommenced with instructions to increase to 150 mg. He has commenced seeing a psychologist.
5. Dr Kumar reviewed the claimant again on 31 March 2021, with the claimant's wife. He had not continued to use medication for the last 12 months and prior to that adherence was not good. He is unable to work due to pain. Flashbacks and nightmares have improved. He is not able to drive but can travel in a car as a passenger. Mood remains low and sleep poor; there is no suicidal ideation. Diagnoses remained the same and there was a further attempt at treatment with sertraline.
6. General practitioner, Dr Ayad Abed's complete record from the Ware Street Medical Centre Fairfield is dated 7 September 2023, the record commences on 25 May 2018. There were no references to psychiatric symptoms since 22 March 2021. There were no prescriptions for psychotropic medication.

"(a) 25/05/2018 right shoulder complete full-thickness rotator cuff tear, right tennis elbow and post-traumatic stress disorder.

(b) 08/06/2018 claimant was referred to psychologist Mr Mahmoud Abu-Arab with K10 score of 30/50.

(c) 12/07/2018 seen by occupational therapist and counsellor Dr Yaser Mohammad. 10/08/2018 referred to psychiatrist Dr Mukesh Kumar for PTSD. Endep 10 mg.

(d) 24/09/2020 retrosternal chest pain. Referred to Fairfield Hospital.

(e) 30/09/2020 post NSTEMI episode. Atorvastatin 40 mg, metoprolol 25 mg BD, ticagrelor 90 mg BD, pantoprazole 40 mg, Atacand 8 mg in the morning.

(f) 23/11/2020 IHD stent, exercises 30 minutes daily.

(g) 22/03/2021 reference to depressed mood and low self-esteem; no other symptoms."

1. On 19 May 2021 cardiologist Dr Albert Shafransky noted the claimant had presented to hospital on several occasions with hypertension which always occurs when he is under stress or angry and settles with rest. He was advised to control his anxiety and stress rather than presenting to the hospital at the time.
2. Centrelink medical certificate dated 25 January 2022 listed conditions as lumbar back pain, ischaemic heart disease and major depression.

1. The motor accident personal injury claim form is dated 26 May 2017. The accident described conformed with other descriptions. He listed injuries as chest pain, right shoulder pain, neck, and back pain along with fear and anxiety.
2. General practitioner, Dr Fatin Toma provided a certificate dated 16 May 2017 which listed left-sided chest pain and difficulty breathing due to fractured left fifth rib and possibly sixth rib with neck pain ongoing and left shoulder pain.
3. The claimant's statement dated 2 April 2024 recorded that he had completed four years of high school and can read and write in Arabic. He is not fluent in English. He managed his own panel beating business in Syria for 26 years. He arrived in Australia in December 2016. He worked as a panel beater for two weeks in Smithfield with a man he had known in Syria; because he had difficulties with communication he was advised to study English. He commenced classes in March 2017 on four days/week; the course was due to continue until September 2017.
4. The claimant had not driven in Australia before this car accident. He denied psychological problems before the accident. He noted frequent nightmares after the accident which have diminished in frequency and intensity but do still occasionally occur. His sleep is significantly disturbed by pain. His ability to participate in sexual activity has been reduced by pain. He found physiotherapy helpful but the insurer discontinued the funding. He noted a heart attack in 2019 requiring four stents and he found the recovery process challenging over the next two or three months. He noted right knee pain in December 22 which has since resolved.
5. The claimant's wife Najah Slifo's statement is dated 24 April 2023. She had completed 12 years of high school and had worked in various positions in the government of Syria. The family left Syria on 27 March 2013 due to the war. They arrived in Australia in December 2016. Prior to this accident her husband was having driving lessons. After the accident he commenced driving again in February 2022. She noted her husband was unable to help with domestic duties as he did before this accident because of physical pain.
6. The claimant provided statements from other members of his family, which confirmed how the claimant's family had settled and obtained occupations since they moved to Australia and a friend which provided the following information.
7. The claimant's eldest son Robir Kando is married with a daughter. He noted the war had a massive impact on his family. Born Al-Hasakah Syria. He commenced work as a form worker in Australia and then became a full-time carer for his mother. He struggles to speak English.
8. Anko Kando second son age, 36 years. He completed a certificate VI in building and construction upon arrival in Australia, worked in the construction industry and in 2019 started his own construction business.
9. Ilina Kando daughter, third child, 32 years. She had worked as a physical education teacher in Syria. She commenced English studies at the Navitas English School Fairfield and in 2017 became a carer for her father at home. The family left Syria for Iraq in 2013; she did not enjoy it because it was not safe. She noted her father is depressed and no longer happy and becomes angry very easily. She married on 16 November 2021.
10. His son Pol Kando, fourth child, is 28 years old and studied English on arrival in Australia and then commenced a Bachelor of Cyber Security at Macquarie University. This was paused during the COVID-19 pandemic. He commenced work in his brother's landscaping business and continues to do this.
11. Esho Khano is a friend who runs a panel beating shop in Wetherill Park. He grew up in the same town in Syria. He had provided Mr Kando with two weeks work but put him off because of problems with the English language.
12. The claimant's statement dated 24 April 2023 covered the same material in the statement dated 2 April 2024.

1. The claimant disagrees with the insurer's submissions and submits the application should be dismissed.
2. The insurer submits that Medical Assessor Chew failed to evaluate all evidence, failed to take a history of pre-existing psychiatric illness, used incorrect criteria in the assessing social and recreational activities, and used incorrect criteria in assessing adaptation.

1. Medical Assessors Mason and Doris examined Mr Kando by video teleconference on

1. Mr Kando is a 64-year-old man who lives with his wife, son, daughter, daughter-in-law and two grandchildren in their own home in Western Sydney. He receives Centrelink benefits with an exemption from work seeking due to shoulder, neck, back and leg injuries.
2. Mr Kando is a right-hand-dominant man whose appearance is consistent with his stated age. He presented in a neat and tidy fashion. He was located alone in a room in his home. He had been assisted to join the online interview by his son. He was identified from his photograph on his NSW driver license. He was assisted throughout the interview by an Arabic interpreter. He was interviewed using the Microsoft Teams application with a good internet connection. The interview commenced at 9.00am and concluded at 10.30am.

1. Mr Kando was born in Al Hasakah Syria and described a normal birth and development. His parents died 20 to 25 years ago. He is the oldest of six children. He has a brother living in Canada and a sister in the United States. The youngest child, a sister, died at 42 years of age in Canada two years ago. The other siblings live in Sydney.
2. He described a happy childhood in Syria. He grew up in a city with a population in excess of 400,000. He said he was well treated at home and denied any form of abuse throughout childhood. He attended school until year 8, which is the equivalent of completion of primary school in Australia. He was literate in Arabic and the family practised the Assyrian Christian religion.
3. He married while living in Syria. His wife was educated to year 12 and worked in various positions for the Syrian government. They have three sons and a daughter who have all relocated to Australia with them.
4. When he left school, he worked in a panel beating shop with a tradesman and learned the trade on the job. He then opened his own business which he conducted successfully for 26 years. He said he owned his own home and other premises in the city and had savings in the bank. He sent his children to school and noted his oldest son drove a taxi and his daughter was a teacher. Another son was an engineer.
5. He described being subjected to religious persecution in Syria by members of Islamic State. He reported a nephew had been kidnapped and the family had to pay money to Islamic state for his return. He said they directly threatened his own family. They threatened to kill him if he did not repair a truck for the purpose of carrying a machine gun. He said the family immediately packed up and fled to Northern Iraq on 27 March 2013; each carrying only one bag.
6. They settled in Dohuk where they were able to find work. The entire family migrated to Australia in December 2016; they were sponsored by a friend of their son. Mr Kando said he was distressed because he had lost everything but when they were able to settle in northern Iraq these symptoms resolved.
7. After arriving in Australia, he worked for two weeks for a friend who runs a panel beating shop in Wetherill Park. He was not able to remain employed because of poor English. His friend advised him to start English language lessons which he did with Navitas Liverpool. These were held from 8.00am until 2.00pm on five days/week; his attendance ended with this accident.
8. Mr Kando stated he had no time for leisure before this accident because he was studying English and attempting to establish himself in Sydney. He denied past insurance claims and denied any history of problems with the law. He said there were no medical problems before this accident but subsequently he developed chest and shoulder pain. These were caused by blocked coronary arteries; he underwent a stent procedure in 2019 or 2020 and has since had regular cardiology follow-up.
9. He denied any past and family psychiatric history. He acknowledged he was distressed and depressed by the loss of his life and possessions in Syria but said he has come to terms with that. He was questioned about a reference in the documentation by psychologist Mr Greg Anning that he had a flashback type reaction every time he saw a Ford utility because of the ISIS threats on his life. Mr Kando said he did have flashback type reactions when he saw a Ford utility, because that was the vehicle involved in the subject accident. There was no evidence provided in the documentation that Mr Kando suffered from post-traumatic stress disorder before the accident.
10. Current medications consist of Candesartan HCT (candesartan 32 mg/hydrochlorothiazide 12.5 mg), Lipitor (atorvastatin) 40 mg, Minax (metoprolol) 50 mg, aspirin 100 mg, pantoprazole 40 mg, Maxigesic (paracetamol 500 mg/ibuprofen 150 mg) one daily and Panamax (paracetamol 500 mg) one daily. Mr Kando does not use any form of psychotropic medication.
11. Substance use consists of one glass of whisky once per month. He does not use cigarettes, vapes or recreational drugs. He drinks two cups of coffee per day and does not gamble.
12. With regard to pre-accident functioning, he was capable of working as a panel beater but was unable to do so because of English difficulties. He was attending English classes on five days/week for six hours. He said he did home chores such as looking after the gardens and helping his wife with the and shopping housework. He was able to watch television and read. His concentration was not impaired. His relationships with family members were intact and he enjoyed socialising with members of the Syrian community in Sydney. He regularly attended church services.

1. Mr Kando said he was a restrained rear seat passenger behind the front seat passenger. He explained there was a child seat fitted in the middle of the rear seat which was in contact with his right arm and shoulder. He said their vehicle was making a right-hand turn in traffic when it was T-boned at the level of the passenger side doors in the area where he was seated.
2. He said the vehicle which hit him was a bull bar fitted Ford utility. He said the force of the collision bent their vehicle into a V shape. He had tried to steady himself with his right arm which was against a child seat. He said he was not able to exit the vehicle because he could not open the door. He remembers two people helping him out but is not sure who they were. There was no head injury or loss of consciousness. Police and ambulance attended. He said the driver of the other vehicle was taken away by police in handcuffs because he tested positive for drugs. An ambulance transported Mr Kando to Fairfield Hospital.

History of symptoms and treatment following the accident

1. Mr Kando said he was at the hospital from 11.45am until 8.30pm. He was stressed and had pain all over his body. He said there he had rib pain, neck pain, back pain, and shoulder pain. He received painkillers and X-rays were taken while he was in hospital. However, he became too anxious to remain in hospital and had to leave. The ED discharge summary does not indicate he was discharged against medical advice. He said he went home but had to call an ambulance again the following day because of shortness of breath and pain; he became dizzy and fell. The paramedics provided him with painkillers at home and did not transport him to hospital.
2. He then later saw his GP who arranged further scans and investigations. He was referred to a neurosurgeon and an orthopaedic surgeon. He said he received two ultrasound-guided injections to his right shoulder which have not significantly helped. He attended physiotherapy which he said has improved things slightly.
3. He continues to experience significant right shoulder pain and he was noted at interview to function with his right hand by his side. He used his left hand to display packets of medication and his driver's licence for identification purposes. He continues to experience neck pain and lower back pain. He experiences numbness down his left leg to his toes. He described the use of a back brace to stabilise his back and minimise pain. He intermittently uses a similar shoulder brace. He said he is less able to function physically. Following cardiac stent insertion in 2020 he was able to go for a 30-minute walk but said he is unable to do that now because of pain. He is unable to sit for an extended period and is unable to lift even a light weight.
4. When asked about psychiatric symptoms he said he was depressed because of pain all over his body. He had four fractured ribs and a painful shoulder. He said he was unable to sleep for about 15 months and his eyes were red. He said he could not remain at his son's wedding because of pain. He said he was very unhappy and was crying like a child because of the pain.
5. He was redirected to psychological symptoms and said he experienced bad dreams of the motor accident. He also described flashbacks. He said every time he is reminded of the accident; he sees the bull bar of the Ford Ranger about to smash into the vehicle. He described these as visual images.
6. He also described seeing images of the vehicle during nightmares. He described intrusive ruminations of the accident. He said he became demotivated and did not feel like doing anything. He said he withdrew socially and stopped seeing friends. He also withdrew from contact with family members and isolated himself in his room. He became irritable and difficult to live with and preferred to keep to himself. He was constantly unhappy because he had lost the will to continue living. He was unable to enjoy any activities. When directly asked he said he does not have active suicidal thoughts but he would prefer to be dead.
7. Treatment consisted of referral to a counsellor but he could not remember the name. When reminded he confirmed it was Mr Yaser Mohammad. He thinks he attended seven sessions during which it was mostly talking. He was not sure it was helpful. He was also referred to psychiatrist Dr Mukesh Kumar who gave him tablets but the tablets gave him headaches so he did not continue. He could not remember the name of the medication. Documents indicate this was sertraline 50 mg which was increased to 100 mg.
8. Mr Kando said he did not receive any more help because the COVID-19 pandemic intervened and they were subject to lockdowns. He said because of this he became more stressed so he stopped trying. He said more recently he does not have the desire or motivation to try to get better. He said again that his life is empty and meaningless and he would rather be dead.
9. When asked if he had more counselling, he denied this was the case. He was then reminded he had consulted psychologist Ms Klara Georges and he confirmed this was the case. He said he saw her many times and he believes she was helpful but he did not have the motivation to continue with the treatment. The records indicate he saw her for 10 sessions between August 2023 and February 2024.

1. Mr Kando's youngest sister died in Canada at 42 years of age in 2023. He was unable to attend the funeral because of his condition. He acknowledged this caused him distress at the time but said he gradually came to accept this over a six-month period. The Panel is satisfied no impairment apportionment for this loss could be calculated.

1. Mr Kando said he continues to have nightmares and he continues to feel uncomfortable. He said he does not go out to see friends and he does not attend weddings. He said he is not able to work because he has no motivation and he does not feel worthy. He was reminded he had been able to attend his daughter's wedding but he said he was unable to remember. He said he is not happy and he does not know why. He said he feels down and stressed and without motivation. He compares himself with his friends and feels like a total failure. He continues to wish he were not alive but would not actually end his life.

1. There is no current or proposed treatment. He last saw a psychologist 15 months ago and he is not using psychotropic medication.

1. Mr Kando was significantly depressed in appearance. He confirmed passive suicidal ideation but denied active intent. His range of affective expression was severely limited. He did not display psychomotor retardation but his speech was slowed and lacked inflection. He did not spontaneously offer any information but did respond when questions were put to him. He described a lack of enjoyment of all activities. He displayed some pain behaviour throughout the interview but it was not excessive. He described ongoing trauma related symptoms which were derived from the accident. On simple cognitive testing he had difficulty registering the names of three objects; he was able to recall these objects seven minutes later.
2. Mr Kando was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.

1. When asked to describe a normal day he said he spends most of the time lying down in his pyjamas. If he is having a good day he may go for a walk in the backyard with his wife. He acknowledged in the past he did go for a 30-minute walk but he cannot be bothered to do so now. He is unable to help around the house.

1. Mr Kando stated before the accident he exercised regularly and showered and shaved daily. Now he showers once weekly with the help of his wife and his daughter. He said he is unable to use his right hand.
2. It was pointed out he had presented for the interview with a reasonable appearance. He said his wife and daughter convinced him on Saturday to have a shower and not to look like a derelict. He said they make him change his clothing twice per week. He is unable to cook or help with household chores. It was clear pain interferes with his self-care but there is a significant component of not being motivated and needing to be reminded by his relatives. He is moderately impaired.

1. Mr Kando stated he regularly went fishing or socialising with his friends before the accident. He said they also visited him at home. He said none of this happens now and he does not do it at all. He said he is lucky to be able to go for a walk. He said he is not able to read and not able to watch television because of feeling down and having no interest. He said he has no interest in external events. In the past he attended church regularly but does not do so now. He said his sons try to persuade him to go at Christmas and Easter but he has no interest in going. From a psychiatric point of view, he is moderately impaired.

1. Mr Kando confirmed he has a driver's licence and has been able to drive from a very young age. He said he did resume driving in 2022 and in 2023 he was able to drive as far as the local shops if accompanied. When he saw a Ford utility he was unable to drive home and had to someone else to drive for him. He said he does not have the confidence to use public transport alone because of back and shoulder pain. He has not travelled by air. He is mildly impaired.

1. Mr Kando said he does not have an intimate relationship with his wife. He described being short tempered and irritable with family members. His wife is supportive and they are not in danger of separation. He acknowledged his wife and children look after him. He rarely sees a friend. He is mildly impaired.

1. Mr Kando said his memory is okay but he has difficulty with concentration. He said during conversations he may look like he is involved but his mind is somewhere else. He is not able to read and is unable to concentrate to watch television. When asked if he was able to persist with tasks, he said he is not able to do any tasks. He confirmed he is very slow in everything he does. Some concentration difficulties were evident throughout the interview. Pain does contribute to these difficulties but the contribution of depression and anxiety is significant. He is moderately impaired.

1. Mr Kando is unable to work because of pain. He is also unable to help in the household because of pain. In addition to being in pain he is severely depressed and demotivated. He described a sense of helplessness and hopelessness and had essentially given up. In an overall sense he is totally impaired. From a psychiatric point he is moderately impaired.

1. Mr Kando's presentation was internally consistent, consistent with the documentation provided and consistent with the Panel's Medical Assessors' diagnosis.

1. Mr Kando is a 64-year-old man who migrated to Australia with his family from Syria in 2016. He fled Syria in 2013 because of threats to his life from Islamic State members because of his Christian religion. It is likely he developed an acute stress disorder as a consequence of these experiences.
2. He resettled in northern Iraq and was able to work there until he migrated to Australia. There is no evidence though that he suffered from post-traumatic stress disorder while in Iraq or after arrival in Australia. The documentation supports a finding that he was adapting well to life in Australia and had set about learning English in order to get himself back to work in his trade as a panel beater.
3. The Panel's Medical Assessors considered the insurer's submissions regarding psychological conditions arising from the claimant's experiences before he reached Australia. Using their clinical judgement and examining the evidence they could not discern any support for assessing impairment for apportionment arising from pre-existing condition as it did not meet the criteria under cl 1.218 of the relevant Guidelines.
4. On the day of the accident Mr Kando was involved in an objectively frightening event when the insured car T-boned the passenger side of the vehicle in which he was a near-side rear seat passenger.
5. The accident occurred five months after his arrival in Australia from Syria via Iraq. At the time of the accident, he was attending English lessons five days/week in an attempt to equip himself to work in a friend's panel beating business. Subsequently, he has been unable to work.
6. He described the development of symptoms after the accident consistent with post-traumatic stress disorder and major depressive disorder. Accident related pain has interfered with his ability to return to work. Over time the symptoms of the post-traumatic stress disorder have somewhat reduced but the intensity of the major depressive disorder has been exacerbated.

1. Mr Kando satisfies DSM-5-TR criteria for major depressive disorder as follows:

Criterion A: He described depressed mood most of the day nearly every day, markedly diminished interest and pleasure in almost all activities, insomnia nearly every day, a degree of psychomotor retardation nearly every day, fatigue and loss of energy every day, feelings of worthlessness and guilt nearly every day, diminished ability to think and concentrate, and recurrent thoughts of death.

Criterion B: He experienced significant distress and impairment in social and occupational functioning.

Criterion C: The condition was not due to a substance or another medical condition.

Criterion D: The condition is not better explained by another major psychiatric disorder.

Criterion E: There has never been a manic or hypomanic episode.

1. Mr Kando satisfies DSM-5-TR criteria for post-traumatic stress disorder as follows:

Criterion A: He was directly involved in a life-threatening motor accident.

Criterion B: He described recurrent distressing dreams, flashbacks, intrusive memories, and intense distress at external cues.

Criterion C: He avoids memories, thoughts and external reminders of the accident.

Criterion D: He described a persistent negative emotional state, diminished interest and participation in significant activities, feelings of detachment from others and inability to experience positive emotions.

Criterion E: He described increased irritability, problems with concentration and sleep disturbance.

Criterion F: Duration has been greater than one month.

Criterion G: It has caused impairment in social and occupational functioning.

Criterion H: The condition is not attributable to a substance or another medical condition.

1. Mr Kando was involved in a life-threatening motor accident which gave rise to significant physical injuries which in turn resulted in inability to continue English lessons and return to panel beating work. He developed both post-traumatic stress disorder and major depressive disorder.
2. The Medical Assessors are satisfied the accident and its sequelae were capable of giving rise to these psychiatric conditions.
3. The Medical Assessors deliberated with the Legal Member of the Panel and agreed that the subject accident was the cause of both post-traumatic stress disorder and major depressive disorder.
4. The Panel considered the insurer's submissions that the claimant's experiences before he arrived in Australia could have resulted in an assessable impairment that existed at the time of the accident. It was reasonable to put that forward and the Panel examined the evidence and questioned the claimant to discern if that was made out.
5. The Panel adopted the re-examination report as evidence in making the following conclusions.

• major depressive disorder, and
• post-traumatic stress disorder

1. It is now eight years since the accident. Mr Kando has had treatment from two psychologists and a psychiatrist. He has tried psychotropic medication but was not able to persist because of side effects. The most recent psychological treatment ended in 2024. The psychiatric members of the Panel were satisfied his condition will not change by more than 3% in the next 12 months with or without further treatment. His condition has stabilised.

1. The determination as to permanent impairment is made in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Table 11 of the Guidelines.

He stated before the accident he exercised regularly and showered and shaved daily. Now he showers once weekly with the help of his wife and his daughter. He said he is unable to use his right hand. It was pointed out he had presented for the interview with a reasonable appearance. He said his wife and daughter convinced him on Saturday to have a shower and not to look like a derelict. He said they make him change his clothing twice per week. He is unable to cook or help with household chores. It was clear pain interferes with his self-care but there is a significant component of not being motivated and needing to be reminded by his relatives. He is moderately impaired.

Mr Kando stated he regularly went fishing or socialising with his friends prior to the accident. He said they also visited him at home. He said none of this happens now and he does not do it at all. He said he is lucky to be able to go for a walk. He said he is not able to read and not able to watch television because of feeling down and having no interest. He said he has no interest in external events. In the past he attended church regularly but does not do so now. He said his sons try to persuade him to go at Christmas and Easter but he has no interest in going. From a psychiatric point of view, he is moderately impaired.

Mr Kando confirmed he has a driver's licence and has been able to drive from a very young age. He said he did resume driving in 2022 following the motor accident and in 2023 he was able to drive as far as the local shops if accompanied. When he saw a Ford utility he was unable to drive home and had to someone else to drive for him. He said he does not have the confidence to use public transport alone because of back and shoulder pain. He has not travelled by air. He is mildly impaired.

Mr Kando said he does not have an intimate relationship with his wife. He described being short tempered and irritable with family members. His wife is supportive and they are not in danger of separation. He acknowledged his wife and children look after him. He rarely sees a friend. He is mildly impaired.

Mr Kando said his memory is okay but he has difficulty with concentration. He said during conversations he may look like he is involved but his mind is somewhere else. He is not able to read and is unable to concentrate to watch television. When asked if he was able to persist with tasks, he said he is not able to do any tasks. He confirmed he is very slowed down in everything he does. Some concentration difficulties were evident throughout the interview. Pain does contribute to these difficulties but the contribution of depression and anxiety is significant. He is moderately impaired.

Mr Kando is unable to work because of pain. He is also unable to help in the household because of pain. In addition to being in pain he is severely depressed and demotivated. He described a sense of helplessness and hopelessness and had essentially given up. In an overall sense he is totally impaired. From a psychiatric point he is moderately impaired.

Apportionment - pre-existing/subsequent impairment

1. There is no evidence Mr Kando suffered from a pre-existing psychiatric condition, which could be assessed as an impairment in line with the Guidelines when he arrived in Australia in 2016. He experienced grief at the death of his youngest sister in 2023 and has made a normal recovery from that condition. It is not necessary to apportion pre-existing or subsequent impairment.

1. There is no evidence for treatment has been effective. No treatment effect allowance is made.

1. The Panel has found that the degree of permanent impairment of the claimant that has resulted from the diagnosed conditions caused by the accident is 17%, and that the permanent impairment is greater than 10%.
2. This is a different impairment rating to Medical Assessor Chew's assessment.
3. Given those findings, the Panel revokes Medical Assessor Chew's certificate dated

27 February 2024, which found that the psychological injuries arising from the motor accident gave rise to WPI of 15% and issues a new certificate certifying that the degree of permanent impairment of the claimant that has resulted from the diagnosed psychological injuries caused by the accident is greater than 10%.