1. The Panel revokes the certificate of Medical Assessor Sidorov dated 7 May 2024.
2. As a result of the accident on 23 March 2023, the claimant suffered a persistent depressive disorder.
3. The claimant has suffered a non-threshold injury.

1. This is an application for review by the insurer of a certificate and reasons of Medical Assessor Sidorov (the Medical Assessor) dated 7 May 2024.
2. The following injuries were referred by the Personal Injury Commission (Commission) for assessment:

(a) anxiety;

(b) depression, and

(c) post-traumatic stress disorder.

1. 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).
2. The Medical Assessor initially found by certificate dated 2 December 2023 the following injury caused by the motor accident:

(a) adjustment disorder with mixed anxiety and depressed mood,

was a threshold injury for the purposes of the Act.

1. The claimant sought review of that certificate and while the review application was dismissed, the matter was remitted back to the Medical Assessor as an 'incomplete' certificate, for him to consider additional clinical records.
2. By way of further assessment and review of additional clinical records, the Medical Assessor found, by certificate dated 7 May 2024, that the following injury caused by the motor accident:

was a non-threshold injury for the purposes of the Act.

1. It is from this certificate that a review is sought by the insurer.

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 accident occurred on 23 March 2023. The claimant was stationary at a set of traffic lights with several vehicles in front of him. Unexpectedly, the insured vehicle collided into the rear of the claimant's vehicle causing his car to collide into the rear of the vehicle in front of him.
2. A photograph of the insured car and the damage to its front bodywork follows.

1. Two photographs of the claimant's car and damage to its rear bodywork follow.

1. On the observation of the Panel, the impact of the insured car with the rear of the claimant's car would be to be at the point of the exterior rear wheel and surrounds. The Panel acknowledges however that there is no certainty about this observation.

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. For motor accidents occurring on or after 1 April 2023, the entitlement to statutory benefits for a threshold injury have increased from 26 weeks to 52 weeks. The accident the subject of this claim occurred on 28 June 2022. 4. 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 insurer submits that each disorder identified in the DSM-5-TR must meet the definition of a "mental disorder". The insurer says that the following elements are required:

"A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior (sic) that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities."

1. The insurer says that an expectable or culturally approved response to a common stressor or loss is not a mental disorder.
2. The insurer says that many DSM-5-TR mental disorders require the presence of 'clinically significant distress or impairment'. Factors such as social, occupational, or other important areas of functioning, are usually included as part of the criteria for "clinical significance". The insurer submits that the essential rationale for the clinical significance criterion is that it helps establish disorder thresholds for situations in which the symptomatic presentation by itself, particularly in its milder forms, is not inherently pathological.
3. The insurer has noted that Criterion A of the DSM-5-TR requires that the directly experienced traumatic events include, inter alia, 'severe motor vehicle accidents.'
4. The insurer referred to the event criterion having been considered by the Supreme Court of NSW in Insurance Australia Limited t/as NRMA Insurance v Momand [2024] NSWSC 1529. In that case, the court considered a decision of the delegate of the President that arose in the context of a dispute about a certificate of an assessor who had diagnosed post-traumatic stress disorder, in circumstances where there was dispute about the severity of the accident and criterion A. The court said that:

"In the present case, there was more than one conclusion open to the medical assessor. He was required to consider the plaintiff's [i.e. the insurer's] argument that the motor vehicle accident was minor and the diagnosis of PTSD was not consistent with Criterion A in DSM-5 as the defendant had not been exposed to actual or threatened death or serious injury by directly experiencing the traumatic event of a severe motor vehicle accident. This was a fundamental consideration before a diagnosis of PTSD could be made.

The medical assessor was required to set out the actual path of reasoning by which he arrived at his conclusion that the defendant's diagnosis of PTSD 'was caused by the subject MVA as it was a significant accident where [the claimant] was exposed to death.'

...

The medical assessor's reasons for issuing the MAC neither provide his actual path of reasoning nor any explanation as to why he accepted what had been said by [the claimant]..."

1. The insurer submits that while a 'severe motor vehicle accident' for Criterion A is largely undefined, the context in which it is listed in the DSM-5-TR, alongside torture, exposure to war and kidnapping, provide a guide as to the severity of collision that was envisaged. The insurer submits that accidents that are minor in nature and do not result in serious injury or exposure to serious injury, would not satisfy Criterion A.
2. The insurer submits the following factors relevant to accident severity and the claimant's alleged psychiatric injury:

(a) photographs of the vehicles show a moderate indentation to the front bumper and bonnet of the insured vehicle (DYV30X), which is expected given car bonnets are engineered to crumple upon frontal impact, absorbing energy and reducing the force transferred to passengers;

(b) there was also a photograph of the claimant's vehicle (SGO 173), which appeared to show minor damage to the front bumper. Similarly, a photograph of the rear of the claimant's vehicle appeared to show some minor damage to the rear back bumper;

(c) there were also photographs of the rear of third-party vehicle (1PY 3DF), which showed possible minor scratching to the rear bumper although again it was difficult to see;

(d) an accident report form completed by the insured on 19 April 2023 indicated that he was travelling at less than 50 kmph at the time of the subject accident;

(e) police did not attend the accident scene which, the insurer submits, it consistent with the minor nature of the subject accident;

(f) in his application for personal injury benefits completed on 17 April 2023, over three weeks post-accident, the claimant alleged that as a result of the subject accident he suffered injuries to his head, neck, back and shoulders;

(g) an ambulance was not required to attend the accident scene and the claimant did not seek treatment in hospital following the accident;

(h) various certificates of capacity were completed by the claimant's general practitioner (GP) in the months following the subject accident but none of these made reference to any psychiatric disability;

(i) Dr Hassan, treating neurologist, reported on 31 May 2023, recorded that since the accident the claimant had developed low mood and had started taking Mirtazapine. The insurer submits low mood is not a recognised psychiatric illness and is, therefore, a threshold injury;

(j) the claimant reported feeling anxious driving to his GP and treating psychologist;

(k) the claimant's PBS records show that in the five years prior to the subject accident, he was prescribed Pregabalin, Diazepam, Tramadol, Tapentadol, Amitriptyline, Paracetamol + Codeine, all of which are suggestive of pre-existing physical and psychological problems;

(l) a Centrelink employment services assessment report completed on 5 June 2024 indicated the claimant suffered from depression and a musculoskeletal disorder which onset in February 2023, which the insurer notes was the month prior to the subject accident occurring;

(m) the surveillance material shows that the claimant's observed behaviour, including routine activities such as driving, shopping, carrying items, and engaging with family, is inconsistent with the symptoms typically associated with a recognised psychiatric illness that would significantly impair daily functioning;

(n) the insurer submits that individuals suffering from conditions like major depressive disorder or post-traumatic stress disorder often exhibit avoidance behaviours, social withdrawal, or visible distress that interferes with their ability to perform these everyday tasks. In contrast, the insurer says that the claimant appears to be maintaining regular responsibilities and social interactions without obvious signs of severe psychological impairment, and

(o) the insurer submits that this pattern of behaviour is more indicative of an adjustment disorder, consistent with the Medical Assessor's initial diagnosis.

1. The insurer submits that that any psychiatric injury caused by the claimant's involvement in the subject accident is a threshold injury for the purposes of the Act.
2. The insurer submits that the Medical Assessor fell into material error by not setting out how he reached his diagnosis and/or by failing to address the actual criteria set out by the DSM-5-TR referring to Criterion A-H inclusive.

The insurer noted that while the Medical Assessor set out his diagnosis and reasons, he did not identify the selected criteria below:

"Based on the account provided by Mr Noun, his presentation and review of provided documentation, he meets the diagnostic criteria for Posttraumatic Stress Disorder as per DSM-5. This is based on a history of Mr Noun being involved in a motor vehicle accident where he experienced significant shock and developed fear for his safety (criterion A?). Following the subject accident Mr Noun developed intrusion symptoms (criterion B), alterations in cognitions and mood associated with the accident (criterion D), and marked alterations in arousal and reactivity associated with the accident (criterion E)."

1. The insurer submits that the Medical Assessor has not addressed or mentioned the essential criterion F, G and H. The insurer submits that in the absence of all the essential criteria being met, then the Medical Assessor erred in diagnosing the claimant with post-traumatic stress disorder.
2. In relation to criterion A, the diagnostic test requires "exposure to death, threatened death, serious injury, or sexual violence." However, the insurer says that the Medical Assessor only referred to the claimant being involved in the subject accident "where he experienced significant shock and developed fear for his safety." The insurer submits that experiencing shock and developing fear for his safety is not the same as being exposed to "death, threatened death, serious injury, or sexual violence." As such, the insurer submits that the Medical Assessor has not correctly applied the test and the history provided does not satisfy criterion A.
3. Furthermore, the insurer submits that the circumstances of the subject accident, whereby the claimant was rear ended at traffic lights, would not satisfy the criteria of 'exposure to death, threatened death, serious injury, or sexual violence' in any event.
4. The insurer submits that according to the DSM-5-TR, to satisfy criterion C, there must be either an avoidance or efforts to avoid distressing memories, thoughts or feelings about or closely associated with the traumatic event(s), or avoidance or efforts to avoid external reminders, such as people, places, conversations, activities, objects, situation, that arouse distressing memories, thoughts or feelings about or closely associated with the traumatic event/s. The insurer submits that the sub-criteria are essential however, the Medical Assessor only stated there was an avoidance of stimuli, without providing clarity as to the basis of the avoidance. This, in the insurer's submission, is unclear.
5. Regarding criterion D, the insurer says that the Medical Assessor noted that there were "negative alterations in cognitions and mood associated with the subject accident". However, again, the Medical Assessor did not provide examples of two or more of the sub-criteria required to satisfy the DSM-5-TR criteria. Without providing examples of the sub-criteria, the insurer submits that it is unclear as to the basis upon which criterion D is satisfied.
6. The insurer submits that the Medical Assessor has not addressed the basis upon which he considered the claimant satisfied criterion G**.** For this criterion to be satisfied, the insurer says the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
7. The insurer submits that the Medical Assessor's failure to refer to criterion G is, in and of itself, an error. Even in circumstances where the Medical Assessor had referred to the criterion, the insurer disputes the criterion would be satisfied. This submission is made on the basis there is no evidence to suggest the claimant suffers from significant distress or impairment in social, occupational, and other important areas of functioning.
8. The insurer referred to the history taken by the Medical Assessor, which demonstrated that the claimant's reported psychological symptoms had not significantly affected his daily functioning, but that this was inconsistent with the reported avoidance symptoms in the clinical notes of Dr Onuoha. The insurer said that this was also inconsistent with the Medical Assessor's diagnosis of post-traumatic stress disorder.
9. The insurer submits that the Medical Assessor similarly did not provide any reasons to explain why he accepted the history taken in the clinical records from Dr Onuoha over the history taken during the Commission's medical assessment and why the inconsistency was not brought to his attention.

1. Essentially, the claimant submits that the insurer has failed, to grapple with any specific alleged entries in the claimant's treating records which act, or could potentially act, to contradict the findings and reported symptoms contained within the subject certificate and reasons and which the claimant says do not find any support in any medico-legal or other evidence.

1. The insurer had surveillance of the claimant undertaken for a period of approximately 40 hours. The insurer has submitted video surveillance of just over 50 minutes regarding movements and activities of the claimant.
2. The surveillance is not particularly revealing and is mainly of the claimant getting in and out of his car at his home and some amounts of driving and refuelling at a petrol service station as well as attending and proceeding through a shopping centre.
3. At best, it might be regarded that the claimant is able to get out and about without apparent difficulty but little else can be gleaned from the observations.

1. The insurer has not relied on any medicolegal psychiatric report about the claimant.
2. The insurer has provided voluminous Allied Health Recovery Requests (AHRR) but has not referred to them in its submissions. Some of these refer to a continuation of psychological counselling but otherwise provide no assistance. Most of these documents relate solely to the claimant's physical condition.
3. A neurologist report from Dr Hassan has forms part of the bundle of documents of the insurer but it does not assist the Panel.
4. Trinity Health Care Centre, clinical notes make reference to a first consultation after the accident on 27 March 2023 when physical injuries only were noted.
5. A clinical note of Dr Barich for 24 April 2023 refers to;

"Neck and headache associated with insomnia anxiety, insomnia since the accident tiredness and depressed mood and decreased memory ? PTSD counselling and advice awaiting MRI scan M/C next week Diagnosis**:** Insomnia depression"

1. After 18 May 2023 there were no further references to any psychiatric disability.
2. Clinical records of Health Centre Point Medical Centre and Trinity Medical Centre have no references of note to psychiatric complaints following the accident.
3. A Commonwealth Employment Services Assessment Report of 26 May 2024 is contained within the insurers bundle of documents and, dealing with barriers to be assessed. These barriers to be addressed of a psychiatric basis, refer to a mood disorder and motivation but nothing else of a psychological or psychiatric nature.
4. The first certificate of the Medical Assessor is dated 2 December 2023.
5. The Medical Assessor found that the claimant met the diagnostic criteria for an adjustment disorder with mixed anxiety and depressed mood, as per the DSM-5. This is a threshold injury. The diagnosis was said to be based on a history of the claimant developing symptoms of a depressed mood and anxiety in the context of pain, secondary to the injury sustained in the subject accident. The Medical Assessor said that this diagnosis was caused by the pain and physical impairment that occurred secondary to the subject accident.
6. The claimant was also recorded as describing some anxiety when driving a motor vehicle. However, the Medical Assessor said that he did not meet the full diagnostic criteria for a post-traumatic stress disorder, as per the DSM-5.
7. In the Medical Assessors second certificate dated 7 May 2024, he found that the claimant had a post-traumatic stress disorder and that this was a non-threshold injury.
8. This second certificate came about because of the introduction of subsequent clinical notes which were not available at the time of the first assessment of the Medical Assessor.
9. Regarding these additional clinical notes, the Medical Assessor said;

"I have reviewed the clinical notes of Dr Leroy Onuoha, dated 13 October 2023.Noted to have attended telehealth session on 25/07/2023, 29/08/2023 and 5/10/2023. Noted to present with trauma-related, mood and anxiety symptoms. The symptoms described include intrusion symptoms, mood symptoms, avoidance symptoms, symptoms of increased arousal and reactivity."

1. Following on from this, the Medical Assessor said;

"Based on the account provided by Mr Noun, his presentation and review of provided documentation, he meets the diagnostic criteria for Posttraumatic Stress Disorder as per DSM-5. This is based on a history of Mr Noun being involved in a motor vehicle accident where he experienced significant shock and developed fear for his safety. Following the subject accident Mr Noun developed intrusion symptoms, 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."

1. There was no other discussion by the Medical Assessor going to his diagnosis and satisfaction of DSM-5 criteria.
2. Dr Onuoha provided a report to Centrelink for the claimant, dated 29 May 2024. He diagnosed the claimant as having major depressive disorder with mixed features.
3. Dr Onuoha said;

"Diagnoses of Mr. Noun's various mental health conditions are made on the basis of the history of his severe symptoms.

His depression is also severe with marked impairments. He manifests many of the neurovegetative signs of severe mood disturbance, Including motivation and sleep disturbance. A typical day he said is one where he arises after a broken sleep pattern, and attempts to manage his pain and anxiety. He is unable concentrate; he experiences loss of appetite and the motivation to leave the house. In my observation Mr. Noun's symptoms are significant and severe, and impact multiple domains of his functioning."

1. The following physical injuries were considered by another Medical Review Panel:

(a) cervical spine - soft tissue injury;

(b) head - soft tissue injury, there was no evidence of concussion, and the head was not causally related to the subject motor vehicle accident;

(c) lumbar spine - soft tissue injury;

(d) left shoulder - soft tissue injury, and

(e) right shoulder - soft tissue injury.

1. The Medical Review Panel issued a certificate on 17 April 2025. That Medical Review Panel found that the claimant's physical injuries were threshold injuries.
2. In the claimant's application for personal injury benefits completed on 17 April 2023, over three weeks post-accident, the claimant alleged that as a result of the subject accident he suffered injuries to his head, neck, back and shoulders. At that stage, there was no mention of him suffering from any psychiatric injury.
3. There are various certificates of capacity which were completed by the claimant's GP in the months after the accident. The Panel observes that none of these certificates of capacity recorded any psychiatric diagnosis.

1. The claimant was examined by Medical Assessor Canaris and Medical Assessor Singh on 16 September 2025. Their report follows,

The appointment was attended by Mr Noun over a Microsoft Teams meeting. He attended the appointment by himself. The appointment was conducted by Medical Assessors Canaris and Singh over the Microsoft Teams meeting, located in their respective offices.

Mr Noun was born on 6 July 1983 in Lebanon. He initially said his age is 43 but on being corrected then reported his age as 42. He stated that he tends to forget things and struggles with his memory. He was today at his lawyer's office. He said that he does not have a computer, so he got dropped there by his ex-wife.

Mr Noun stated that he grew up with his mother and his father used to live in Australia and used to come and go. His father had another wife and children in Australia. He said that his father had two wives including his mother and had five children from his other marriage. His father used to come and go, and he came with his first wife to Australia and left his mother in Lebanon. Mr Noun stated that his childhood was good. He has two brothers and two sisters, and he is third in order, and they all came to Australia to live with their father. He came to Australia when he was in Year 6, up until then he studied in Lebanon. He reported that he had a good childhood. He grew up in a village near Baalbek in Lebanon. He stated that there was no trauma or abuse growing up. He went to a very strict school. He stated that it was hard to leave his mother back in Lebanon, but he always thought that he had to sacrifice something to have a better life.

He stated, 'we had wars in Lebanon and with all those things happening there, it was a disadvantage, and I wanted to help my mother as we were struggling'. He denied any trauma or abuse. He denied being exposed to any war directly stating, 'we were far away - It was towards the north where we used to live, and the war was in the South'. When he moved to Australia, he was around the age of 11 or 12 in the mid 90s and he came with all his brothers and sisters and his mother stayed overseas. He studied from Year 7 and finished Year 12 in Australia. He did a Tafe course in mechanical engineering for 2 years. Mr Noun stated that moving to Australia was hard. He often used to talk to his mother and later he was able to bring her here. He was living with his father and his stepmother. He stated they were not bad, they were alright. However, 'later we moved out and lived separately - I was around 15 and my older brother was an adult - we moved to Liverpool and then to Bankstown - my mother came somewhere in 2002, but I am not sure'.

Mr Noun stated that he started to work since the age of 16 and was studying as well. He would work filling up shelves in a shopping centre and at petrol station. His brother had a metal engineering company, so he joined his brother and took over from him after he finished his TAFE. However, the company was sold not long after. He then worked in computers with his brother who used to work in IT and helped him a bit and helped his brother in petrol station and setting up his business. He then did a security course and started working in security and left his brother's business. He initially started to work as a security guard and then as a security manager in control rooms. He went from company to company. Before the accident, Mr Noun stated that he was working at Sydney airport and managing the security guards over working indirectly with the logistic company DHL. Until the day he had the accident, he was working. He was working full time. After he had the accident, his life went backwards due to "the stupid accident". He had to change everything in his life. He was planning to do something for his children which fell apart. He cannot do anything. He cannot return back to work.

Mr Noun stated that he first got married in 2008. The initial marriage was on papers, and he did the wedding function in 2009. However, the marriage only lasted for around 6 months. He was divorced by the end of 2007. He stated that it was quick. He had problems with his wife straight away and with her family. She wanted to stay with the family and there were other problems that he found out later. He asked his ex-wife to stay with her parents, and they got divorced. Mr Noun got married the second time. He stated that he is separated from his second wife, and they separated around 4 years ago in 2021. He stated, 'I had just problems with her, and I just told her to go and live by herself- we are not divorced - I would still go to my ex-wife's place and stay with her and see my children -yesterday, I was with my children and stayed with my ex-wife for the night and she drove me here in the morning for the appointment at the solicitor's office'. He has 3 children from his marriage, 2 daughters aged 15 and 13 and a son who is 9. He moved out 4 years ago and has been living with his sister and mother.

Mr Noun denied any past history of mental health issues. He stated that he had never seen a psychiatrist or psychologist in the past. He had never been on any psychiatric medication. He has never attempted self-harm or suicide. He has never been admitted to a psychiatric unit. He denied any previous worker's compensation claim. He denied any previous motor vehicle accident-related injuries.

Mr Noun denied any family history of mental illness.

Mr Noun denied any significant issues with alcohol or illicit substances. He stated that he drank alcohol once in his entire life and had never used drugs. He has been a smoker. He used to smoke a packet of cigarettes over 4 to 5 days but his smoking has gone up since the accident. He is smoking around 1½ packets. Each packet has 20 cigarettes. He denied gambling.

Mr Noun stated that once he fell when he slipped in Woolworths and sustained injuries to his lower back. He had put in a claim for lower back injury and had muscle strain. He received $20,000 in compensation. He stated that he did not do it for money. but 'Just wanted them to understand that how dangerous it can be', and he had suffered income loss and he stopped working for a few months. He cannot remember which year was this. He denied any psychological issues following this incident. He stated that his head did not hit anything. He fell down on the floor as it was wet due to water or some other liquid and he hit his back very hard.

Mr Noun stated that he was involved in a motor vehicle accident on 23 March 2023. He remembers the date clearly as it was before his son's birthday. He was driving his Honda CRV 2002 model probably and was going to work. He was alone and he thanked God for it that there was no one else with him in the accident. He was wearing a seat belt. There were two cars in front of him, and he was stationary at a traffic light, at the red light. Suddenly he felt a strong impact. He heard the sound of the car applying brakes and his car was hit from behind. It hit him so hard that he hit the car in front of him. His head hit the steering wheel. He was not sure about loss of consciousness, but he said that probably he did. He stated, "I think I did lose my consciousness as what I knew after that, that some guy opened the door of my car and checked on me and said 'are you alright?.' There were no airbags deployed, there was no police or ambulance on-site. He was wearing seatbelts. He said that it was then he woke up when the other man knocked his door.

They sat him down and he sat frozen for around 20 minutes. After that he was able to stand up and take the details from the other person. The other person put details in his phone, and he took photos of the car behind him and the car in front of him as well. He called his ex-wife and his brother, and they came and picked him up. His brother took the car home and he went with his ex-wife. He did not go to the hospital on the same day. He later saw his GP next day morning.

History of symptoms and treatment following the motor accident

Mr Noun said that after the accident he developed pain in his shoulder, neck and back. He also developed headaches. He started to forget everything. He would put his phone next to him and would keep looking for it. He would keep something in his pocket and then forget where he had put it. It started to occur more and more to him. When he saw his GP, he was advised to have X-rays and blood tests. He stated that he cannot remember what was the outcome but he was given painkillers, and he was prescribed medications which he continues to take up until now. He was referred to a physiotherapist and saw them twice weekly. He also was referred to a psychologist because he started to feel anxious to drive. He also struggled to sleep for which he was prescribed medications. He was not able to drive. He was scared of everything and would often get headaches.

Mr Noun stated that he would not want to talk to anyone. He stopped talking to anyone. He wanted to stay in his room, locked up.

Mr Noun stated that since the day of accident, his life went from being on the top to being down on the bottom. He does not deserve to be alive anymore. He cannot get anything for his kids. He cannot do anything that he wanted to do. He has to take medications. He does not want to leave his room and does not want to talk to anyone. He stated that he has left his room for the first time in a long time. He will go out to have cigarettes and then again goes back to his room.

Mr Noun stated that he stopped working after the accident and has not returned to work as he cannot work. If he goes out to drive, then he is scared if a car is behind him. If a car hits the brake hard or if a truck or car goes past him, then he gets anxious. If he hears a big brake or a hard brake being applied, he gets scared and it is not easy. He has lost interest and does not want to see anyone. When he would sleep, then he would have the vision in his dreams, and he does not get out of his head. He also forgets a lot. He has been taking medications that have been prescribed to help him sleep. He denied any self-harm or suicidal thoughts. He denied any self-harm or suicide attempts. There was no evidence of mania and there was no evidence of any psychotic symptoms.

Details of any relevant injuries or conditions sustained since the motor accident

Mr Noun did not report any relevant injuries or conditions sustained since the motor accident.

Mr Noun stated that he is currently not working. He receives Centrelink benefits. He does not receive any payments from the insurance company. He continues to experience pain in both his shoulders and pain in the middle of his neck. He also reported headache in the front. He stated that it does not go out of my head and I keep thinking about it. He stated that he is mostly at home. He will go out to have a cigarette and to see his children and then he will come back home and stay in his room. He takes sleeping tablets to sleep sometimes, may take two tablets of amitriptyline instead of one and the other prescribed medications.

Mr Noun stated that he may wake up in the middle of night with big nightmares and is often driving in his nightmare and someone would hit him. He would see big lights coming in his face and he does not know how to mention that.

In his nightmares he is often driving on highway and a big truck may come and run over him. When he closes his eyes, he may have the nightmare few times a week and sometimes it is every night. He stated that for the last years nothing has changed, and the nightmares continue to happen two to three times in a week.

Mr Noun was upset and distressed when talking about his current issues. He was often holding his head and looking down. He stated that he often thinks why he should be living though he denied any self-harm or suicidal thoughts. He stated it is wrong for my religion to think like that. He described himself as a religious person and would pray at home around five times a day. He has not been to the mosque since the accident. He stated that 'it is wrong for my religion to think to end one's life'.

Mr Noun stated that it upsets him a lot to think that he cannot help his children. He cannot do anything. He never thought that he will be on Centrelink and will be taking those medications. He is not able to work and study. He was planning to buy a house for his children. Now he cannot afford it. He only goes to his ex-wife's place to see his children. He stated he does not talk much to his ex-wife and does not come near her personal life. He is not looking forward for work.

Mr Noun continues to receive treatment under the care of his GP. He has seen a psychologist or a psychiatrist but was not sure which. He said that he has seen Dr Roy. He continues to take Naprosyn 1000 mg, Tramadol 100 mg, Escitalopram 10 mg, Mirtazapine 45 mg, Amitriptyline 10 mg or, sometimes 20 mg, Formet (metformin) 500 mg for diabetes mellitus and Ozempic as a weekly injection, he also takes Panadeine Forte for pain. He stated that Dr Roy talks to him. He stated the treatment has not helped him much and he pretty much feels the same.

Mr Noun was seen over a video conference. He attended the appointment by himself over Microsoft Teams meeting. He was located at his solicitor's office and the medical assessors were located in respective offices. He was seen on 16 September 2025. The appointment was conducted over 1 hour and 40 minutes. He was dressed appropriately. He had short hair and a light beard. Overall, he appeared clean. He had spontaneous speech with normal rate, tone and volume. He described his mood as low and depressed, and his effect was distressed. He was often holding his head with his hands and looking down. He was teary at times. He reported feeling helpless about his situation. He often continued to mention that how the accident has changed his life. He reported disturbed sleep and appetite and has lost weight. He described low levels of energy and motivation. He reported nightmares and also avoidance of driving. However, he is able to drive locally. He denied having any active or passive suicidal thoughts, intents or plans and there were no thoughts of harming others. He did not describe any grandiosity, racing thoughts or increased energy levels. There was no formal thought disorder. There was no delusional pattern of thinking and no perceptual abnormalities. He described his difficulty with focus and concentration. He had an intact judgement and had reasonable insight into his issues and was help seeking.

Mr Noun currently lives with his mother and sister. He will shower once in a week, sometimes once in two weeks. He stays mostly in his room, is not seeing anyone. He stated that his appetite has gone down.

He had lunch yesterday and has not eaten since then. He had some fruits in the night to have his medication, and his sister forced him to eat. He has lost 5 kilos since the accident. He will drive rarely. He will drive down the road when no one is there to drive. He will drive to see his children. He will wait for the night as it has lighter traffic and it takes about 20 minutes. Driving from Villawood to Greystanes, sometimes he will sleep over there and his daughter will look after him. His children are good to him and they help him out. He has a room downstairs to himself at his ex-partner's place, which he will use to sleep and has an attached bathroom to it. He will often spend time just in his room, may watch a little bit of TV and sit with his children if they want to watch the TV to make them feel happy. At his own place, his mother and sister will do everything for him and he does not do any household chores. At his ex-wife's place, she will do everything for him or his children will help him.

The panel raised the surveillance footage with Mr Noun stating that he has been seen driving and in a shopping mall. Mr Noun stated that he goes out with his sister or his ex-wife, and they help him and take him to the shopping centre. They take him out sometimes. He drives as well locally. He stated he mainly drives between his house and the house of his ex-wife. He said that he has to go down the road. The shopping centre is two minutes away from the house and it is just down the road. He does not drive far from home. He would go to the shopping centre to buy something for his children. He stated that when he gets payments from Centrelink then he would get some food, drinks or something to eat for his children or grab them food from Oporto.

On being asked about his hygiene, he stated that his sister will take him to a hairdresser for a haircut. She took him last Thursday when she sees his hair is long. That may be once a month or once every few months. It depends if she is available. Mr Noun denied engaging in recreational activities. He does not go out for picnics. Sometimes he will go to a movie theatre with his children. He stated that he may stay outside and does not go inside the cinema hall and will wait in the hallway. He will be talking to his ex-wife in the hallway, and she will be with him. She does not want the kids to be with him on their own.

He does not go out for meals outside. He stated that he only wants these things to be out of his head and has tried everything. He is not sure how things are going to change. Various doctors have tried many things, and they all say the same things. He state that he may be happy for a minute if he is with his children but again he starts to think that he is unable to help his children and is not able to earn. His ex-wife does not work as well. She lives in a rental house. He was not sure of her source of income but said that he will help her when the Centrelink pays him.

The panel noted that this footage corroborated with what Mr Noun had mentioned earlier. He did mention that he drives for short distance, and he will mostly go out with his ex-wife or his children or his sister. He does drive on his own for short distance between his own house and the wife of his ex-wife and may go to the shopping centre at times. On being asked about his appearing cleaner and better than what he was during the assessment, he said he cannot comment on that as there are days when things change. However, overall, he said that he does not look after himself.

Mr Noun is a 42-year-old male separated from his wife, currently living with his mother and sister with no significant past history, no significant family history, and no significant substance use history, who was involved in a motor accident on 23 March 2023, where he was rear-ended by another car. He was the only person in the car and was a seat belted driver. With the impact, his car hit the front car as well. He alleges that he sustained injuries to his neck, shoulders, and back. He hit his head on the steering wheel and developed headache following the accident. He also developed psychological / psychiatric symptoms following the accident, which included low mood, disturbed sleep with nightmares, lowered appetite, feeling anxious, low motivation and low energy, forgetting everything, poor memory, not wanting to socialise or talk to anyone, isolating himself and increasing his cigarette smoking.

Mr Noun has not returned to work due to his ongoing pain and his psychological symptoms. He declined in his self-care and is driving less often, only drives locally on his own if required, does not go out much, apart from visiting his ex-wife and his children. He has continued to take medications as prescribed and has had some psychology sessions in the beginning, though none currently. He also has co-morbid diabetes mellitus, for which he takes metformin and Ozempic injections.

In the panel's opinion, Mr Noun currently presents with symptoms that meet the DSM-5-TR criteria of a persistent depressive disorder (dysthymia). He presented with following symptoms:

a) Depressed mood for most of the days for over 2 years

b) He presented with depressed mood and poor appetite, insomnia, low energy, low self-esteem, poor concentration and difficulty making decisions and feelings of hopelessness.

c) During the two-year period, he has never been without symptoms.

d) The criteria for major depressive disorder may have been continuously present.

e) There has never been a manic or hypomanic episode, and he has never met the criteria for cyclothymic disorder.

f) The symptoms are not attributable to physiological effects of a substance or another medical condition.

g) The symptoms have caused clinically significant distress or impairment in social, occupational or other areas of functioning.

Based on the history provided, the mental state examination and the review of available documents he meets the diagnostic criteria of persistent depressive disorder as per DSM-5-TR. There is a direct temporal relationship between the onset of his psychological / psychiatric symptoms and the subject accident. He did not report any other factors which would have caused the ongoing psychological symptoms. The onset of the psychological symptoms dates back to the accident and the symptoms have continued despite receiving psychological treatment in the beginning and ongoing treatment with psychotropic medications.

The following injuries WERE caused by the motor accident:

The following injuries WERE not caused by the motor accident:

Mr Noun does not meet the criteria A for post-traumatic stress disorder as he was not exposed to a serious or life-threatening injury or accident with actual or threatened death in the accident. He also does not present with other symptoms which meet the threshold to make a diagnosis of post-traumatic stress disorder. We have noted that Mr Noun has seen clinical psychologist, Dr Roy Onuoha as mentioned in the documents and had some sessions of cognitive behaviour therapy and was diagnosed with Generalised Anxiety Disorder and Major Depressive Disorder. He is also struggling with other physical concerns. His application for the Disability Support Pension was supported by his treating psychologist, Dr Onuoha. The notes extended over various dates, 29 May 2024 up until 9 May 2025 and referred to pain management strategies, CBT, management of mechanisms of chronic pain discussed with treatment starting around July 2023 under the care of Dr Roy Onuoha, Clinical and Consultant Clinical Psychologist.

_'For the purposes of this Act, a threshold injury is, subject to this section, one or more of the following - _

(b) a psychological or psychiatric injury that is not a recognised psychiatric illness.'

'A Threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness.'

'2) Each of the following injuries is included as a threshold psychological or psychiatric injury for the purposes of the Act

3) In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5)'

The assessment of whether the injury is a 'threshold injury' is not a direct measure of symptoms or disability. A finding that the injury is a 'threshold injury' indicates that there was an injury caused by the motor accident and that there may be continuing symptoms, however the injury satisfies the definition of a threshold injury under the Act and the Regulation.

The following injuries are not threshold injuries: Persistent depressive disorder.

1. The Panel met on 30 September 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 30 September 2025, the legal Member has had the benefit of reading and considering the Medical Assessors examination report. On 30 September 2025 the Panel met and all discussed the examination findings and the issues going to causation and assessment of WPI. It is from this teleconference of the Panel that the Panel has agreed and reached its final conclusion and determination.
2. The Panel jointly adopt the report of Medical Assessor Canaris and Medical Assessor Singh.

1. The claimant was not receiving medical treatment or counselling for any psychiatric disability before the accident. It was only after the accident that he sought medical treatment. The Panel is satisfied that the need for treatment has only come about as a result of the accident having occurred.
2. The Panel adopts the reasoning in Lynch v AAI Ltd [2022] NSWPICMP 6 (Lynch) that the psychological condition can be present at any time to establish that the injury is not threshold for the purposes of the Act. However, in this claim, the Panel is satisfied that at the time of examination by the Panel's Medical Assessors, the claimant was suffering a persistent depressive disorder.
3. The Panel also adopts the reasoning in Lynch that the claimant bears the onus of proof in establishing that any injury is not a threshold injury for the purposes of the Act. The Panel is satisfied, following examination of the claimant, that this onus has been satisfied.
4. The Panel must also ask itself in considering whether the accident contributed to the claimant's injuries as referred to it by the Commission, whether the claimant's condition was caused by or materially contributed to by the accident. The Panel is satisfied that this can be answered affirmatively. The claimant is no longer employed, does not travel far, has limited contacts with friends and family and his symptoms only commenced after the accident and have persisted.
5. 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. The claimant has a persistent depressive disorder.
6. Would the impairment have occurred, if not for the accident? The Panel is satisfied that the accident and impact has had a more than negligible effect on the claimant's psychiatric condition suffered by the claimant. This is because up to and at the time of the accident his activities of daily living were not restricted. He had a job, he had a car and could visit friends and relatives. Prior to the accident the claimant was driving without restriction and without anxiety. Following the accident though, his driving has been curtailed due to his anxieties arising from this such that he is not able to drive all the time. When the claimant does drive, it is only small distances.
7. The insurer has relied on various moments of activity by the claimant, captured on video footage. The Panel has previously commented on this. The Panel is not satisfied that the observations are contradictory of any comment or history provided by the claimant. He admits that he can go for short drives to the shops, he can occasionally go to the movies with his children and he can visit his family occasionally.
8. The following injuries were referred by the Commission for assessment:

(a) anxiety;

(b) depression, and

(c) post-traumatic stress disorder.

1. As previously noted, the Medical Assessor initially found by certificate dated

2 December 2023 that the injury caused by the motor accident: was an adjustment disorder with mixed anxiety and depressed mood. This was a threshold injury for the purposes of the Act. 2. The claimant sought review of that certificate and while the review application was dismissed, the matter was remitted back to the Medical Assessor as an 'incomplete' certificate, for him to consider additional clinical records. 3. A further assessment and review of additional clinical records was undertaken by the Medical Assessor who found, by certificate dated 7 May 2024, that the injury caused by the motor accident was post-traumatic stress disorder. As the Medical Assessor had determined, this was a non-threshold injury for the purposes of the Act. 4. The Panel refers to the decision of Mandoukos v Allianz Australia Insurance Limited [2023] NSWSC 1023. 5. Arguably, the scope of the medical dispute referred to the Commission for determination is not defined by law but by the parties submissions. The claimant has not put before the Panel submissions alleging a differential diagnosis. This review is however, a hearing de novo and those issues raised before the Medical Assessor and for determination by the Panel include consideration of a differential diagnosis. 6. The Panel has not "gone looking" for alternative diagnosis when the specific diagnosis of anxiety, depression and post-traumatic stress disorder had been referred to it. The Panel must examine the claimant and perform its assessment on the basis of its discussions with the claimant on the day of assessment. A psychiatric symptom might evolve overtime and disappear overtime for that matter. In this case, the Panel was not satisfied that the claimant had a post-traumatic stress disorder but was satisfied on the basis of the history provided by the claimant, and the clinical assessment of the Medical Assessors, that he was suffering a psychiatric disability of a persistent depressive disorder.

1. The claimant was injured in a motor vehicle accident on 23 March 2023.
2. As a result of the accident, the claimant suffered physical injuries for which the Panel is aware that these have been assessed as threshold injuries.
3. The Panel is satisfied that the claimant has suffered a persistent depressive disorder which is a non-threshold injury.

1. The Panel revokes the certificate of Medical Assessor Sidorov dated 7 May 2024.
2. As a result of the accident on 23 March 2023, the claimant suffered a persistent depressive disorder.
3. The claimant has suffered a non-threshold injury.