1. The Review Panel revokes the certificate of Medical Assessor Gerald Chew dated

11 June 2024 and issues a new certificate as follows:

(a) The Review Panel certifies the following injury was caused by the motor accident:

(i) major depressive disorder.

(b) The Review Panel finds that the above injury results in a whole person impairment of 17% which IS greater than 10%.

1. Carl Anderson (the claimant) was involved in a motor accident on 14 October 2020. He was driving his car through an intersection when a car coming from the opposite direction turned into his car resulting in a head-on collision.
2. The claimant says he suffered musculoskeletal and psychiatric injuries as a result of the motor accident.
3. He made an application for personal injury benefits with GIO (the insurer), the third-party insurer of the vehicle that he says caused the accident.
4. A medical dispute arose about whether the degree of the claimant's whole person impairment (WPI) is greater than 10% WPI. This is important because if there is a dispute about the degree of a claimant's WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
5. On 7 May 2024, Medical Assessor Gerald Chew found that the claimant suffered from a persistent depressive disorder caused by the motor accident. The Medical Assessor declined to assess the degree of permanent impairment because he considered there were significant treatments available that would improve the claimant's symptoms and functioning. The Medical Assessor stated that permanent impairment should be capable of assessment in 6-12 months' time.
6. The following month, the dispute was returned to Medical Assessor Chew and a certificate and reasons was issued on 11 June 2024. On this occasion, the Medical Assessor was satisfied that the impairment from the persistent depressive disorder was permanent. The claimant's WPI was assessed at 17%.
7. The insurer lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Chew's decision dated 11 June 2024. This was allowed by the President's delegate (Ms Melinda Drew) and this Panel was convened to conduct the review.

1. Medical Assessor Chew noted that following the motor accident, the claimant went to his general practitioner (GP) complaining of pain in his neck, shoulder and back. Within a few weeks, the claimant started feeling anxious and had panic attacks. He reported ongoing symptoms to his neck and shoulder.
2. Psychologically, he had symptoms of low mood, no energy and no motivation. He found it difficult leaving the home because he feared having a panic attack. He had a decrease in libido. He had poor concentration. He had thoughts of hopelessness, worthlessness and passive suicidal ideation. He had bad dreams but not directly related to the accident. He did not report flashbacks of the accident but often thought about it.
3. The Medical Assessor found that the claimant's depressive symptoms were caused by the motor accident and appeared to be perpetuated by ongoing pain from the accident. The symptoms met the criteria for persistent depressive disorder.
4. The claimant was found to be consistent in his presentation. There was no evidence of pre-existing conditions or impairment.
5. The Medical Assessor assessed the claimant as having a median class value of 3 under the psychiatric impairment rating scale (PIRS) and assessed WPI at 17% (2,2,3,3,3,3).

1. The insurer alludes to the possibility of missing records pre-2020 stating that documents from Medicare indicate that the claimant was seen by the following doctors/providers either before or after the motor accident:

(a) Pioneer Medical Practice;

(b) MyHealth Medical Centre Merrylands;

(c) Dr Henry Stenning, and

(d) Dr Amit Kshatriya.

1. The insurer says it requested clinical records from the above doctors/providers on

2 April 2025. None have been provided to date. The insurer says it needs to consider whether the records reveal a relevant psychiatric history. 2. In relation the claimant's alleged accident-related psychiatric injuries of post-traumatic stress disorder and major depression, the insurer relies on the report of psychiatrist Dr Robert Kaplan dated 10 October 2024. Dr Kaplan opined that there were inconsistencies in the claimant's presentation and that it was "doubtful whether his physical complaints influence his psychiatric diagnosis..." 3. The insurer submits that the claimant's psychiatric impairment does not exceed the 10% WPI threshold and relies on the report of psychiatrist Dr Graham Vickery dated 3 January 2023. 4. The claimant provided a bundle of documents for the review (as detailed below). The claimant did not include in the bundle any submissions in reply to the application for review nor in the original application.

1. On 25 March 2025, the Panel issued a direction to the parties requesting indexed and paginated bundles of the information they relied upon. The Panel advised that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The parties responded with the insurer's bundle comprising of pages 1-135 and the claimant's bundle comprising of pages 1-154.
2. On 20 May 2025, the Panel met at an initial teleconference where the further directions were made providing the insurer with additional time to obtain the "missing records" it had alluded to in its submissions (see above paragraph 8). The clinical records were to be provided by

27 June 2025. 3. In a message on the Commission's Portal dated 21 May 2025, the insurer asked whether it is required to prepare draft Directions for Production. The Panel responded on 24 June 2025 stating that it was happy for the insurer to prepare draft Directions for Production for the Panel Member to approve. 4. The Panel notes that to date, no further correspondence was received from the insurer and no draft Directions for Production were received. The Panel is mindful of the objects of the Motor Accident Injuries Act 2017 (MAI Act) in encouraging the quick, cost effective and just resolution of disputes.[2] 5. Having provided the insurer with an opportunity to obtain further material that may or may not assist its case, the Panel proceeded with the re-examination of the claimant on 9 July 2025 in the absence of the information. 6. A summary of the bundle documents relevant to the issues in dispute is provided below.

1. Application for personal injury benefits - completed by claimant on 30 October 2020. Described neck pain with numbness in arms and hands. Lower back pain running down the leg. Pain in-between shoulders at back. Left side of neck and body pain. Ringing in ears, insomnia and anxiety.
2. Certificates of capacity/fitness - various from GP Dr Prashant Pareek. Diagnosis of whiplash injury of cervical spine with pain and spasm in neck.
3. Allied health recovery request - start 7 June 2021, end 15 August 2021. By PsychWell Consultants. Notes no psychiatric diagnosis in certificates of capacity/fitness. Completed psychological psychometric assessments which indicate significant mental health barriers and flags that require ongoing psychological and psychotherapeutic treatment to assist in return to work.

1. Clinical records of Good Street Medical Centre - notes active past history of anxiety/depression in April 2021. No other relevant psychiatric history. Disc prolapse in October 2020. Clinical note entries range from 2 November 2020 to 27 October 2021. Describes neck pain, neck spasms and left arm pain following the motor accident. Physiotherapy treatment. Psychological symptoms of anxiety, depression and panic attacks. Disturbed sleep. GP mental health care plan made with counselling. Referral to see psychologist
2. Westmead Hospital - admission 25 September 2016, discharged same day. Throat pain and headache following alleged assault. Altercation with security guards. Haematoma to right side of neck.
3. Westmead Hospital - admission 30 October 2020, discharged same day. Presented post argument with girlfriend hyperventilating at triage, c/o tingling to arms. Patient teary ++ easily calmed at triage.
4. Westmead Hospital - admission 7 July 2021, discharged 8 July 2021. Unable to manage panic attack today. Presents with severe anxiety and panic attacks, worsening over last few months. Unable to go back to work. Ongoing thoughts of self harm. Not sleeping well due to nightmares from motor vehicle accident. Unable to drive due to panic attacks. Looks distressed, laboured breathing. History of panic attacks. Nurse comment: wants to fly to Switzerland to kill himself legally. Had car accident and feels he is a financial burden to his family. Disclosed plans of self-harm to girlfriend and she recommended him to self-present.

Progress notes by CNC Bonyface Mackoni - unemployed with background of depression, anxiety and post-traumatic stress disorder. Since motor vehicle accident in October 2020, experiencing nightmares, flashbacks, anxiety, low mood and fleeting suicidal ideation. Anger outbursts due to insurance company knocking back claim and refusing psychology payment. Lots of arguments with girlfriend. Drinking excessively (daily). Reports poor concentration, low energy and focus. Inability to enjoy things he used to do. Denies any pain. Denies any current suicidal ideation or DSH thoughts. Past psychiatric history of depression and anxiety. Post-traumatic stress disorder - motor vehicle accident in October 2020. Has seen psychologist through insurance. Back pain secondary to motor vehicle accident. Unemployed since motor vehicle accident. Impression: post-traumatic stress disorder and anxiety exacerbated by alcohol use disorder.

1. Dr John Bentivoglio, orthopaedic surgeon, dated 27 October 2022 - appears to be a joint report commissioned by both the claimant and the insurer. Diagnosis of muscular ligament strain of the cervical and lumbar spine caused by the motor accident. As MRI scans of both spinal regions being normal, the claimant's symptoms will settle completely. WPI assessed at 0% (cervical and lumbar both DRE I).
2. Dr Hugh O'Neill, neurologist, dated 18 November 2022 - accepted neck pain without radiculopathy as a result of the motor accident. There was initial radiation of the pain into the left arm. Original symptoms noted to change over time so that there is now continuing neck pain and a burning pain from behind both shoulders (now worse on right) into the arms with altered sensation in the fingers of both hands. This could not be explained on the basis of the accident and nerve conduction studies was recommended. Low back complaints stated to have resolved. WPI assessed at 0% (cervical DRE I).
3. Dr Graham Vickery, psychiatrist, dated 3 January 2023 - diagnosed panic disorder in partial remission caused by the motor accident. Injury has stabilised and no further treatment required. WPI assessed at 0%.
4. Dr Andrew Porteous, occupational physician, dated 28 June 2023 - accepted neck and thoracic spine injury and injury to both ulnar nerves in the upper extremity. WPI assessed at 14%.
5. Dr Abhishek Nagesh, psychiatrist, dated 11 December 2023 - diagnosed post-traumatic stress disorder and persistent depressive disorder. WPI assessed at 17%.
6. Dr Robert Kaplan, psychiatrist, dated 10 October 2024 - diagnosed panic disorder but questioned reliability of history and the possibility of symptoms rehearsal and exaggeration. Doubtful whether physical complaints influence the psychiatric diagnosis but this may indicate a tendency to exaggerate complaints and lead to over-reporting. WPI cannot be assessed because it is not accepted that claimant has a Panic Disorder due to inconsistent history.
7. Physiotherapy Professionals Parramatta - various appointments from 25 January 2021 to 20 April 2021. Noted motor vehicle accident October 2020. Initially felt ok but next day felt strong pain all down left side of body. CT scan showed C6/7 disc bulge. Report of left upper limb pain and neural symptoms too. Initially had physiotherapy 1/week for five sessions then stopped. In this time, pain worsened significantly 7-9/10 VAS at worst.

1. Certificate of Medical Assessor Alexey Sidorov dated 29 June 2022 - assessment of minor injury. Diagnosed accident-related major depressive disorder and panic disorder which are not minor injuries for the purposes of the Act.
2. Certificate of Medical Assessor Robin Fitzsimons dated 23 September 2024 - Cervical "whiplash" soft tissue injury without radicular symptoms or radiculopathy. Thoracic spine soft tissue injury. Ulnar nerve lesions to both upper extremities not considered caused by the motor accident. WPI assessed at 0% (DRE I for both cervical and thoracic spines).

1. At the initial teleconference on 20 May 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessors Canaris and Singh is below:

The assessment was attended by Mr Anderson over a video conference on 9 July 2025. Mr Anderson was sitting in a stationary car in a car park at the time of assessment. The assessment was conducted by panel members, Christopher Canaris and Himanshu Singh over a Microsoft Teams meeting.

Mr Anderson was born in Australia near Coffs Harbour. He grew up in Sydney. He grew up with his parents and his younger brother. His parents worked together until his dad died 7 years ago. His mother currently lives in Melbourne. He has his younger brother who also lives in Sydney and speaks to him regularly and provides support.

Mr Anderson stated that his childhood was fine. He denied any trauma or abuse growing up. He finished Year 11 and then he left school. He did not attend Year 12. He did a fitness course and became a personal trainer. He went to the Australian Institute of Fitness and did a certificate 3. He started working as a personal trainer at the age of 17 and worked at a gym for a year. He then worked at Vision as a personal trainer. He did a marketing course at TAFE and got a job as a business development manager at a legal firm known as ERA Legal at the age of 23. He was working 5 days a week, at least 40 hours in a week at the time of motor accident. After the motor accident, he could not go back to his previous job.

Mr Anderson denied any past history of mental health challenges. He denied a past history of anxiety, depression, mania or psychosis.

Mr Anderson stated that he has a history of moles being removed and does not have any other medical history.

Mr Anderson denied family history of mental illness.

Mr Anderson reported history of speeding tickets in the past and he lost his licence when he was young due to the accumulation of the demerit points. He denied any other forensic history.

Mr Anderson stated that he has tried and smoked cannabis on two to three occasions when he was younger. He denied any problems with drug use. He denied any history of dependence or drug withdrawal. He would drink alcohol socially when he would be out in social situations with his friends and family.

Mr Anderson stated that he does not remember the exact date of the motor accident, but he remembers that it was a nighttime. We have noted from the documents that the motor accident was on 14 October 2020. Mr Anderson stated that he was driving in the left lane towards an intersection and was hit head-on by a car which turned right into his wake resulting in a head-on collision on the driver's side. The other car hit in front of his car on the driver's side; he was with his partner who was sitting in front of the car. His car was repaired following the motor accident. At the time of the accident, the airbags were not deployed and there was no loss of consciousness.

Mr Anderson was able to come out of the car by himself. He was wearing his seat belt. He did not report any visible injuries at the time of the accident and does not remember everything from the time of accident as well. He was probably going at 40 to 50 km per hour and the other car hit the front of his car. His car had to be towed. There was no presentation to the hospital on the day of accident. There were no ambulance and no police at the sight of accident. He stated that he cannot remember how he came back home. A tow truck arrived and his car was towed.

History of symptoms and treatment following the motor accident

He stated that following the accident, he has problems all the time. Mr Anderson stated that following the accident on the very next day itself, he had a sore neck. The left side of his whole neck was sore and he woke up stiff. He felt sore in his back and has 'fuzziness' in his left arm. The soreness was on the left side of the back. He then went to his GP and was given tablets for inflammation. He had some scans. He stated he probably had a CT scan and was told he had whiplash and slight bulge in his disc and that it was not a major problem.

He had physio for a long time with ups and downs in his physical recovery. He stated that the physiotherapy sessions were good and they helped with the pain and the stiffness. He did not require any surgeries. There were no fractures and no haemorrhage in the brain or internal bleeding. He was mainly told he had whiplash and soft tissue injuries.

Mr Anderson stated that following the motor accident, he had panic attacks after few days. He does not remember the exact date, but he stated that he went to the hospital. He thought that he was having a heart attack and this was close to sometime after the motor accident. His whole left side of the body felt tingly with bad chest pain. He thought that he was having a heart attack and his wife took him to the hospital. He was investigated in the hospital where his heart rate was high and was told that he was having a panic attack. He later saw his general practitioner who gave him tablets to relax his muscles and to help with the panic attacks. He was also having muscles spasms in his neck and tingling in his body. The tablets were not much helpful. He then started to see a psychologist for weekly sessions. He saw the psychologist for almost 6 months and he worked on his cognitive thinking to understand the processes and learn breathing techniques to help with the panic attacks. The panic attacks were the biggest problem at that point of time.

Mr Anderson stated that he did not work for almost 2 years because of the panic attacks and the fear of having the panic attacks. He continued to struggle with no energy and no motivation to indulge in any task. He struggled to get up in the morning and to do things. He was not able to look for a job as he was worried of having a panic attack. He was also prescribed anti-depressant medication to which he developed side effects and it made him feel worse with having self-harm thoughts. He did attempt self-harm cutting himself few times on his hand with a knife which needed stitches as well getting bruises on his elbow. He denied any suicide attempt. He has been to hospital few times to the emergency department for the panic attacks. He denied any psychiatric admission.

Mr Anderson stated that when he was able to work, it helped him to relieve financial pressure. He could not return to his pre-injury duties. However, through a labour hire company, he joined a demolition company and worked there as a spotter and a safety person. He worked in different roles with the company and worked in different hours. He worked for almost 2 years and he has not worked for more than a year now.

Mr Anderson stated that when he was working, it was a struggle. He had to force himself every day to get out of the bed and he struggled to wake up, get ready and leave for work in the morning. He was taking a lot of days off from work and towards the end stopped attending work. It was a build-up of things. He was often late at work or would not show to work and then he was asked to resign. He has not been able to return to any other employment since then.

Mr Anderson stated that at one point he was drinking alcohol almost daily every night. He would drink until he would fall asleep. He does not remember how much he would drink but it would be beer, wine or spirits, anything that he could get hold of and it continued for almost 8 months up until his wife made him stop alcohol. He is not drinking regularly now. He is a non-smoker and he denied any current illicit substance use.

Mr Anderson denied any previous history of worker's compensation claim for physical or psychological injuries. Mr Anderson denied any previous motor vehicle accident-related personal injury claims.

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

Mr Anderson denied any relevant injuries or conditions sustained since the motor accident. On being questioned by the panel about his recent fatherhood and having an 8 weeks' 8-week-old, Mr Anderson stated 'I do not know how I am coping with becoming a father, I keep thinking that I am not enjoying it and I am another person.' The panel has noted that becoming a father may have added to his stress. His inability to work, inability to earn financially, and inability to look after himself and his family would have added to his current ongoing stress.

Mr Anderson stated that the panic attacks are not as frequent as they were in the beginning. He continues to experience a fuzziness in his mouth and an uncomfortable feeling in his chest. He has not been getting the panic attacks as often as they were, but he has experienced decline in his mental health and experienced the worst symptoms. He has no energy to do any activity, does not enjoy anything in his day. He would like to spend time in his bed. He has stopped drinking and is not smoking. He experiences tightness in his neck and back. He does some breathing exercises to help with his anxiety. He stated that he feels stuck.

He is aware that he needs to work. He has never returned to his normal self psychologically since the motor accident happened. He was working due to the financial side of things. However, he did not enjoy work even when he returned to alternate employment. He complains low energy. He finds it hard to get motivated. He may do breathing techniques which may help at times to relieve his anxiety. He is not enjoying the time with his newborn son. He tries to push himself to spend time with him and to bond with him. He may cry sometimes when he has the overwhelming feeling and feels like a burden. He feels hopeless and helpless and has guilt feelings of not doing things and not being available to his partner and his son.

Mr Anderson stated that he does not dream. He no longer has any nightmares. He struggles to fall asleep. When in a car he gets a tight feeling in his chest. He gets anxious and jumpy when he would see a car pulling out of a driveway. He is not able to relax and always has a tightness in his chest. He reported a generalised feeling of anxiety with neck tension and things startle him easily. He gets anxious when his phone rings as he does not want to talk to anyone. He may sleep a lot. He tries to help with the baby at home and hold him and have a sleep. His partner does most of the things at home. He also reported effects on his relationship and has been low in his libido and sexual desire.

Mr Anderson currently has regular visits with his general practitioner. He is not receiving any current treatment from a psychologist or a psychiatrist. He does breathing exercises that he learnt during the therapy sessions. He has tried a few medications on a few occasions. He stated that with the effect of medications, he was not feeling himself and did not like the effect. First time he felt like he was having a monotone in his head and felt numb. The second time the medication also made him feel suicidal. He stated that the medications have not worked for him. He was worried about taking another medication again and having side effects. He stated that he would not be open to try any new medication. He stated that he is too scared of medications and worried about its effect and side effects.

Mr Anderson stated that he does want to get better. He is working on other ways to manage his symptoms. He is working on his diet. He tries to take Vitamin D and trying a bunch of things to feel better. His wife does a lot of research about depression and managing symptoms of depression. He has a good support system around him.

Mr Anderson stated that he is motivated to work and to get better. However, he feels stuck. He does not know at this stage of time how things are going to improve.

Mr Anderson was reviewed over a video conference on 9 July 2025. Mr Anderson was sitting in a stationary car at the time of the assessment. Mr Anderson was wearing a T-shirt that had stains on it. He maintained intermittent eye-to-eye contact, and the rapport was established. He had a light beard and short hair. He appeared dishevelled. He described his mood as low and sad, and his affect was restricted. There were signs of mild psychomotor retardation. He described his sleep and appetite as disturbed.

He reported low levels of energy and motivation and lack of pleasure and enjoyment. He described low self-esteem, low levels of confidence. He reported feelings of hopelessness and helplessness and feelings of guilt. He denied having any active or passive suicidal thoughts, intents or plans and there were no thoughts of harming others. He did not report any grandiosity, racing thoughts or increased energy levels. There was no evidence of formal thought disorder, no delusional pattern of thinking and no perceptual abnormalities. He struggled with his focus and concentration and struggled to recall the events from the past. He had an intact judgment and good insight into his issues and was a help-seeking individual.

Mr Anderson stated that he sleeps a lot at home and feels exhausted and tired. He tries to cook on and off. He did some cooking on Monday. He may cook once a week. He is not doing the laundry regularly. The cleaning and other chores at home are attended by his wife or her sister will come over to help them.

His presentation was consistent with the history given during the clinical interview, documentation reviewed and the mental state examination. The Panel Medical Assessors did not detect any exaggeration or rehearsed responses as found by Dr Kaplan."

1. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (Guidelines).
2. Version 9.3 of the Guidelines applies to the review.
3. The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.
4. Permanent impairment is assessed in accordance with Chapter 6 of the Guidelines. Specifically, the assessment of psychiatric impairment draws from the chapter "Mental and behavioural disorders" which commence at cl 6.201 of the Guidelines.

1. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition.
2. Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:

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

1. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and 5E.

1. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[3]
2. The evaluation should only consider the impairment as it is at the time of the assessment.[4]
3. The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[5]
4. The Panel refers to the above re-examination report of Medical Assessors Canaris and Singh. The Panel reconvened on 23 July 2025 and discussed the re-examination report findings before collectively making the below determinations.

1. On the review of documents provided, the clinical assessment and mental state examination, the Panel is of the opinion that Mr Anderson has sustained a psychological/psychiatric injury following the motor vehicle accident on 14 October 2020, where Mr Anderson was involved in a head-on collision with another car and he was the driver of the car. Following the accident, Mr Anderson developed physical symptoms such as stiffness and pain in his neck and his arms. He developed panic attacks to the extent that it affected his ability to work to leave home and have social interactions. Mr Anderson continued to experience psychological/psychiatric symptoms despite some treatment with psychological sessions and medications. He struggled to tolerate the effect of medications. He reported side effects and minimal benefits from the medications prescribed.
2. Mr Anderson continues to present with symptoms which meet the DSM-5-TR criteria of major depressive disorder.
3. The Panel noted the insurer's submission that the evidence does not support the presence of physical disability that could impact psychological health. The Panel does not agree with this submission as consistent with cl 6.129 of the Guidelines, a person can still suffer from physical symptoms even if his impairment is assessed at 0% WPI or DRE Category I.
4. The Panel considers the submission moot however as the Panel was satisfied that the claimant developed psychiatric symptoms of panic attacks, anxiety and depression soon after the motor accident. Such symptoms are consistent with the primary documentation in the clinical notes of Goodstreet Medical Centre and Westmead Hospital.
5. The Panel was satisfied that Mr Anderson presented with following symptoms:

(a) depressed mood most of the day nearly every day;

(b) markedly diminished interest or pleasure in almost all activities most of the day;

(c) significant changes in weight and appetite;

(d) insomnia nearly every day;

(e) psychomotor retardation nearly every day;

(f) fatigue or loss of energy nearly every day;

(g) feeling of worthlessness and guilt;

(h) diminished ability to think or concentrate, and

(i) recurrent thoughts of self-harm.

1. The Panel notes that all his symptoms have been present for a period well in excess of the requisite two-week period.

The symptoms have caused clinically significant distress in social, occupation or other important areas of functioning.

The episode is not attributable to the physiological effects of a substance or to another medical condition.

The symptoms are not better explained by another psychotic illness.

The symptoms are not explained by a manic or hypomanic episode.

1. The Panel is of the opinion that Mr Anderson has sustained a psychological/psychiatric injury as a result of the motor vehicle accident. He developed psychological symptoms in following the motor vehicle accident and he currently meets the DSM-5 TR criteria of major depressive disorder. Mr Anderson has received treatment in the form of medications to which he did not respond very well and developed side effects. He also received six months of psychological intervention, though he is currently not on any medications and psychological treatment, he reported not much improvement in his symptoms. He still continues to have depressive symptoms along with anxiety.
2. He has been unable to return to work. He reported his lack of motivation and lack of energy on a day-to-day basis. He reported that he was not open to try any other form of treatment. He was worried and was fearful about having side effects from a medication and stated that having a failed trial of two medications was enough for him. He does employ self-help techniques such as listening to podcasts and doing his breathing exercises. He has been using support from his family especially his wife and brother to help with this to manage his symptoms.
3. He did not report any previous history of anxiety, depression or other mental health issues before the accident. He did not report any family history of mental illness. He did not report any significant issues with substance use. In the opinion of the Panel, the current diagnosis of major depressive disorder is directly and temporally related to the motor vehicle accident. There is a close temporal relationship between the motor vehicle accident and the onset of his psychological symptoms

1. The injuries referred for assessment included major depression. The Panel was satisfied that there was sufficient scope within the referral and the medical opinions on file for the Panel's diagnosis of major depressive disorder.

1. The claimant's symptoms have been continuously present since late 2020. Over this time, he has been referred to psychologists and had counselling sessions. He ceased prescribed medication because of side effects and is currently self-managing his symptoms together with regular visits to his GP. He indicated to the Panel that he is was not open to try any further treatment. The Panel considers the claimant's condition to have reached a state of permanency for an assessment of permanent impairment to be made.

Degree of permanent impairment - Psychiatric Impairment Rating Scale

Under the care of a GP, currently not on any form of treatment. He has received treatment previously with medications and psychological intervention.

Mr Anderson stated that his self-care could be better. He showers every few days. He may forget to brush his teeth daily. The change of clothes depends. He may still wear the same clothes if they are not dirty. He does not feel hungry and may have one full meal in a day. He has not checked his weight. He struggles to sleep. He finds it hard to sleep and may not sleep up until morning at times.

He has a broken sleep and wakes up all the time. He struggles to fall asleep then once he is awake. He stated that his baby sleeps perfectly fine during the day and sleeps much more than him and he is lucky to have a 3-hour sleep. He may do some cooking on odd occasions.

Mr Anderson mostly spends time at home. He gets things delivered at home to avoid social situations. He may come up with excuses when someone asks him to go out. He sometimes may attend birthday parties and wedding events and has been dragged to do so. If he is uncomfortable to go, he finds it tough to sit down and interact with people. He may not ignore them but he does not initiate conversation and will reply if someone talks to him. He tries to put on an act.

He does not enjoy going out and does not go out by himself. He reported a decline in his recreational activities and almost stopped doing any of those. He used to play basketball which he has stopped completely. He tries to avoid TV and may just lie down during the day and nap in the day for 1 or 2 hours. He may still watch TV shows with his partner to keep her happy. However, he does not enjoy it.

Mr Anderson stated that he has been driving now. He does not drive more than 15 to 20 minutes. He is not comfortable to drive more than this duration and distance. He mostly gets his wife to drive. He has travelled to the city with someone for appointments or for other reasons. He has been once to Melbourne and caught a plane with his family. He has not been on any long drives. He mostly prefers to be a passenger in a car.

Mr Anderson stated that he currently lives with his partner and his 8 weeks old son. He has been married for few years and they have known each other since high school. He stated that he has a good relationship with his brother who supports him financially and he had to borrow money from him. He lives in a one-bedroom apartment with his partner. His brother has helped him. He has also helped him with the family business as at times giving some advice. Mr Anderson stated that it is pretty hard in their relationship.

They argue about things, especially him not going to work. They have spent nights away from each other and his partner has gone to her mother's house at times. He denied any period of domestic violence or ongoing separation.

Mr Anderson stated that he is always thinking of other stuff and lot of other things. He gets distracted. He may watch TV and may just get the gist of it but does not pay much attention to it. He just does it to please his wife. He may read an article someone sends to him, it may be a page or few paragraphs and he mostly gets it, but he struggles to focus and concentrate for prolonged period.

His wife manages his finances as he no longer feels able to do this. He is not very good in his memory. His wife often tells him that he forgets things and he does not remember when he is reminded. The panel noticed that Mr Anderson had delayed responses and struggled with his recall during the assessment. He has moderate impairment in this category.

Mr Anderson is currently not working. He has not worked for the last one year. He had to borrow money from his brother who may ask him some questions and get some advice from him. He stated that he wants to do something in construction, but first he needs to find out what he can do. While Mr Anderson worked in labour hire as a spotter and safety person for about 2 years, he had a lot of days off, had to force himself out of bed and only worked to relieve financial pressure on his family. Ultimately, he was forced to resign from this role. Mr Anderson cannot work more than one or two days at a time. He suffers from excessive anxiety, low energy and difficulties with motivation. His pace will be reduced and his attendance will be erratic due to his ongoing psychological symptoms.

1. There is no pre-existing or subsequent impairment. Hence, the Panel has not made any apportionment for pre-existing or subsequent impairment.
2. The Panel acknowledges that there may be some ambiguity in the Westmead Hospital note entry of 7 July 2021 which refers to "...a history of depression, anxiety and PTSD". This could represent both pre-accident and post-accident psychological symptoms given that the entry was made nine months post-accident. Without any documented evidence of pre-existing psychological symptoms or diagnoses however, the Panel, on balance, is of the view that the claimant's psychiatric disorder and impairment are causally related to the motor accident.
3. Should the insurer obtain evidence to the contrary, the Panel notes that this could constitute grounds for an application for further medical assessment under s 7.24 of the MAI Act.

1. There has been no regular treatment and there has been no significant effect from the treatment. Hence, the Panel has not made any adjustment for the effects of treatment.

1. The Panel concludes that the claimant's injury caused by the motor accident results in a WPI of 17% which is greater than 10%. Although the WPI outcome is the same as that found by Medical Assessor Chew, the Panel diagnosed the claimant's psychiatric injury as major depressive disorder (as opposed to persistent depressive disorder).
2. Accordingly, the certificate issued by Medical Assessor Chew dated 11 June 2024 is revoked. A new certificate is issued at the front of this determination.