MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); threshold injury dispute; psychological injury; issues of causation; claimant examined; Held - claimant meets the criteria for adjustment disorder with anxiety caused by the accident; claimant meets criteria for persistent depressive disorder but this is not caused by the accident; MAC revoked.

Issued under Division 7.5 of the Motor Accident Injuries Act 2017

(a) revokes the certificate of Medical Assessor Alexey Sidorov dated 22 February 2024, and

(b) issues a new certificate determining that the injury caused by the motor accident, being adjustment disorder with anxiety related to driving, is a threshold injury for the purposes of the Motor Accident Injuries Act 2017.

1. On 25 February 2019, Farid Soliman (claimant) was involved in a motor accident on the M5 when his vehicle was hit by a truck, causing his vehicle to hit both walls of the road and catch fire (accident).
2. The claimant made a claim for statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act) on AAI Limited t/as GIO (insurer).
3. A dispute has arisen between the insurer and the claimant as to whether the claimant's psychological injuries are "threshold injuries" within the meaning and for the purposes of the MAI Act. Whether a person has suffered threshold injuries as a result of a motor vehicle accident affects their entitlement to both statutory benefits and damages.[1]
4. The dispute was referred to Medical Assessor Alexey Sidorov. On 13 February 2024, the claimant was assessed by Medical Assessor Sidorov. The Medical Assessor issued a certificate on 22 February 2024 certifying that the claimant's persistent depressive disorder, caused by the motor accident, was a non-threshold injury for the purposes of the MAI Act.
5. The insurer lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Sidorov's assessment. On 17 May 2024, a delegate of the President determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect, on the basis that Medical Assessor Sidorov failed to sufficiently engage with the evidence and did not address causation of the injury or psychiatric diagnosis. Accordingly, the delegate referred the application to a Review Panel.
6. This Review Panel (the Panel) has been constituted to conduct a review of Medical Assessor Sidorov's certificate dated 22 February 2024.

Threshold injury (formerly minor injury) provisions

1. The Motor Accident Injuries Amendment Act 2022 (the MAI Amendment Act) was assented on 28 November 2022 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". The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
2. The accident occurred and the original liability notices were issued by the insurer when the relevant term was "minor injury" which, because of the MAI Amendment Act, is now described as a "threshold injury". Any reference in these reasons to "minor injury" is taken to be a reference to a "threshold injury".
3. A threshold injury is defined in s 1.6 of the MAI Act and includes a "soft tissue injury" or a "psychological or psychiatric injury that is not a recognised psychiatric illness".
4. Section 1.6(4) of the MAI Act provides that the regulations may exclude or include a specified injury from being a threshold injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) further defines threshold injury as follows:

"4 Meaning of "threshold injury", section 1.6(4) of the Act

(2) Each of the following injuries is included as a threshold injury for the purposes of the Act -

(a) acute stress disorder,

(b) adjustment disorder.

Note - See section 1.6 (5) of the Act in relation to the making of Motor Accident Guidelines for or with respect to the assessment of whether an injury is a threshold injury.

(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), published by the American Psychiatric Association in May 2013."

1. Sub-section 1.6(5) provides that "[t]he Motor Accident Guidelines may make provision for or with respect to the assessment of whether an injury is a threshold injury for the purposes of this Act".
2. Part 5 of the Motor Accident Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. Version 9.3 of the Guidelines is effective from 6 December 2024 and replaced version 9.2, except for claims arising from accidents before 1 April 2023.[2] For such accidents, such as the current accident, certain clauses do not apply, and specific clauses from version 9 of the Guidelines continue to apply.
3. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the MAI Act, and provide the following general provisions for assessment:

"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.

5.4 Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. Diagnostic imaging is not considered necessary to assess threshold injury.

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. Relevantly, cls 5.10 to 5.12 regard threshold psychological or psychiatric injury assessment and provide:

"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. Pursuant to Schedule 2, cl 2(e) of the MAI Act, whether the injury caused by the accident is a threshold injury for the purposes of the Act is a medical assessment matter. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act, at first instance by a Medical Assessor,[3] and on review by a review panel.[4]
2. Section 7.26(5A) of the MAI Act provides that the review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission.
3. The review of the medical assessment is not limited to a review of only that aspect that is alleged to be incorrect and is to be by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act. The function of the medical assessors is to form his or her own opinion on the medical question in dispute by applying their experience and expertise; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[5]
4. Part 5 of the Personal Injury Commission Act 2020 (PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a panel reviewing a decision of a Medical Assessor: s 41(2) PIC Act. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5. A review panel determines how it conducts and determines the proceedings.

1. On 6 March 2025, the Panel was convened in this matter. Also on 6 March 2025, the Panel made directions for provision of a bundle and written submissions from each of the parties for the purposes of the Review.
2. On 4 June 2025, the Panel met to discuss the proceedings. It was determined that a medical examination of the claimant was required and the claimant was informed of the details.

1. On 13 February 2024, Medical Assessor Sidorov examined the claimant and issued a certificate on 22 February 2024. The threshold injury dispute to be assessed was noted by the Medical Assessor as "Psychiatric condition - Anxiety and Posttraumatic Stress Disorder". The Medical Assessor concluded that the motor accident caused persistent depressive disorder, which is not a threshold injury for the purposes of the MAI Act.

1. The claimant was noted to be a 65-year-old man who resides with his wife and four children. He grew up in Egypt and commenced work as a cleaner after arriving in Australia in around 1992 or 1993. He denied any history of mental illness prior to the accident. The claimant's family and health history were noted.
2. The history of the accident was noted. The claimant could not recall the precise year the accident occurred. He stated he was driving on the M5 on his way home from work. There were two cars in front of him who were driving rather slowly so he decided to overtake them. He was travelling in the left lane when a truck that was also over taking the cars started changing into his lane, did not see him, and struck the right side of his car. His vehicle hit the concrete barrier on the left side then bounced off and hit the barrier on the right side, then was pushed to the left again. He was wearing a seatbelt and airbags deployed. Emergency services attended. The engine in his car was on fire. He was transported to Bankstown-Lidcombe Hospital via ambulance.
3. The claimant's post-accident symptoms and treatment were noted. The claimant stated that, in the context of his ongoing pain, he has developed a low mood that occurs more often than not. He is reported to have developed a sleep disturbance associated with his low mood where he finds it difficult to fall asleep and an associated reduction in his appetite. He also stated that he often feels low on energy and fatigued, and his self-esteem has been significantly affected by not being able to work and function physically. He denied any thoughts of self-harm, suicidal ideations or thoughts of harm to others. The Medical Assessor noted there was no evidence of the development of mania or psychosis. He did not consult with a psychologist or psychiatrist and had not commenced antidepressant medications.

1. In terms of current symptoms, the claimant reported that his pain in his right shoulder and back continues to drive his depressive symptoms. It was noted that the claimant was not receiving any psychological or psychiatric treatment.

1. The claimant was noted to have no evidence of self-neglect. His affect was dysphoric. He described his mood as "same as every day, nothing is changing". There was no evidence of formal thought disorder, he denied any thoughts of self-harm, suicidal ideations or thoughts of harm to others. There was no psychotic symptoms present. He was oriented to time, place and person, had good insight and good degree of rational judgment.
2. In terms of his current functioning, he was noted to be independent with his activities of daily living. He reported not driving regularly as he feels scared and generally does not leave his house alone due to pain and a lack of motivation. He has become socially withdrawn. He does not do much, aside from reading, listening to audiobooks and watching videos and shows. His relationship with family is generally OK. He has some friends who he meets occasionally. He does not have any concentration difficulties. He is unable to work due to physical impairments and reduced motivation and energy levels.

1. The Medical Assessor formed the view that the claimant met the diagnostic criteria for persistent depressive disorder as per the DSM-5. This was based on the claimant presenting with a history of depressed mood for most of the day, for more days than not, for at least the past two years associated with disturbed sleep and appetite, experiencing low energy and fatigue and low self-esteem.
2. The Medical Assessor opined that the claimant's depressive symptoms have developed in the context of pain and physical impairment. It was recognised by the Medical Assessor that some of this pain and physical impairment has been determined not to be related to the accident. However, the Medical Assessor opined that, even though the persistent depressive disorder was multifactorial in nature, there was a material contribution from the accident.

1. On 25 April 2024, Medical Assessor Sidorov issued a certificate regarding the claimant's permanent impairment (psychological), based on an assessment on 13 February 2024 and 15 April 2024. He certified that the claimant's persistent depressive disorder gave rise to a permanent impairment of 5%, being not greater than 10% for the purposes of the MAI Act.
2. It is noted that this assessment is not before the Panel for Review.

1. The claimant relies on his submissions dated 9 April 2024, lodged in reply to the insurer's application for review pursuant to s 7.26 of the MAI Act before the delegate of the President. The claimant did not lodge additional submissions for the purposes of this Review. While these submissions are directed to the delegate, the Panel has considered them for the purposes of its Review.
2. The claimant submits that the clinical notes of Bankstown-Lidcombe Hospital refer to a psychological injury. The claimant submits that Medical Assessor Sidorov exercised his clinical and professional judgment and assessment to determine that the claimant's psychiatric injuries were sustained as a result of the accident and were not threshold in nature.
3. The claimant's submissions dated 27 April 2023 have been considered. The claimant notes that in his application for personal injury benefits claim form, he recounts the circumstances of the accident which led to him sustaining significant injuries. It is explained that the claimant was "travelling westbound along M5 near river road exit" when a truck collided into the back side of his vehicle. The claimant was attended to by paramedics before being conveyed to Bankstown-Lidcombe Hospital. The clinical notes of Bankstown-Lidcombe Hospital regarding the accident state the claimant sustained "Left ankle bruising/haematoma; left ankle pain; left lower arm pain; left lower arm, abrasion/graze; anxiety".
4. It is submitted that the claimant has ongoing psychological injuries, being anxiety and depression. The claimant refers to the clinical notes of Bankstown-Lidcombe Hospital which reference anxiety in support of this submission. The claimant also refers to the claimant's affidavit where it is mentioned that, due to the injuries suffered in the accident, he is experiencing anxiety, depression, and facing challenges with sleeping and focusing.

1. The insurer's submissions dated 11 April 2025 have been considered. The Panel notes that, pursuant to its directions, these submissions incorporate the insurer's previous submissions in this matter.
2. The insurer submits that the dispute is framed by four key issues:

(a) the claimant's lack of reporting of any psychological injury or symptoms post-accident;

(b) the claimant's delay in reporting the accident, and/or any accident-related injuries, to any treatment provider;

(c) the lack of any treatment specific to any psychological injury post-accident; and

(d) the claimant's credibility, in view of the above.

1. The insurer notes that the claimant was attended to by NSW Ambulance at the scene of the accident and taken to Bankstown-Lidcombe Hospital. The insurer submits that no significant injury was reported or treated at this time. Further, the insurer submits that there is no report of any injury to the right arm/shoulder or cervical spine in these records. The insurer submits that the first report of these symptoms arose in July 2022, over three years post-accident.
2. The insurer submits there are significant issues of causation, particularly given that the claimant, when first mentioning any symptoms, did so in the context of his previous employment as a cleaner.
3. The insurer submits that there is an absence of any psychological complaints, formal psychiatric diagnoses or mental health treatment following the accident in the available treating medical evidence.
4. The insurer submits that the DSM-5 criteria for a persistent depressive disorder (as diagnosed by Medical Assessor Sidorov) requires the relevant symptomology to have been present for a period of at least two years. The insurer submits that, despite the claimant's submissions to the contrary, the totality of the available medical evidence suggests this is not the case.
5. The insurer notes that the records of the claimant's longstanding general practitioner, Dr Su, show that the claimant did not present for medical assistance until some three weeks after the accident. On that occasion, there was no reference to the accident or any resulting symptoms, he discussed his smoking and nicotine patch use only.
6. The insurer notes that the claimant attended upon Dr Su on a regular basis between March 2019 and April 2023. The insurer submits that there is no reference to any symptoms of the right arm/shoulder, cervical spine, lumbar spine or any psychological injuries in those records. There is also no reference to the accident, nor the claimant suffering an injury as a result of the accident. There are no reports of any psychological symptoms or injuries.
7. The insurer submits that the records from Miller Medical and Dental Surgery are similarly absent with respect to any psychological complaints or symptoms arising from the accident, despite the claimant attending the practice on multiple occasions during 2022 and 2023. The insurer notes that the claimant first attended this practice on 27 June 2022, being three years and four months post-accident. The insurer submits that there was no reference to the accident by the claimant when reporting his right shoulder pain. Rather, it appears the claimant connected his symptoms to his employment as a cleaner.
8. The insurer notes the NSW Ambulance report confirming that the claimant's injuries were an abrasion to the left arm and swelling to the left foot. The claimant specifically denied any neck, chest, abdomen, headache, nausea or any further abnormalities.
9. The insurer notes the Certificate of Capacity dated 12 August 2022 diagnosed a shoulder injury and ruptured tendons. There was no reference to any psychological injuries or symptoms.
10. The insurer notes the claimant never complained of accident-related right arm/shoulder or back pain to his general practitioner in the post-accident period and submits that the claimant's Medicare records confirm he had never been referred to any specialist for accident-related issues or for any radiological imaging of any body part allegedly injured in the accident.
11. The insurer notes that the claimant's Centrelink application for a disability support pension, lodged in May 2022, makes no reference to any psychological impairment, injury or symptoms, or the physical injuries which he alleges to have been caused by the accident. It is submitted that the claimant's Centrelink application is objective evidence that his difficulties at work and need to stop working, as well as his consequent self-esteem issues, were related to medical conditions of no relevance to the current claim.
12. The insurer submits that there is no evidence of the claimant reporting any psychological injuries or symptoms to his general practitioner or treatment providers. That there is no diagnosis offered of any psychological injury or illness in the medical records, nor is there record of any psychological condition. The insurer further submits that there is no diagnosis of any psychiatric illness that would fit the criteria of DSM-5. The claimant has not been referred to any specialist for treatment of any psychological injury.
13. The insurer submits that the medical evidence supports an inference that the claimant's pain and in turn any psychological symptoms arose sometime after the accident as a result of his work or other unrelated medical condition as opposed to his involvement in the accident. The insurer submits that the evidence gives rise to significant causation issues.
14. The insurer notes that the claimant is yet to serve any qualified medical evidence, or treating report, in support of his application.
15. The Panel notes the insurer's submissions in respect of Medical Assessor Sidorov's alleged errors in his assessment.
16. The insurer raises issues with the claimant's credit with his reported symptoms and treatment, noting that the claimant reports he was required to take Celebrex 200mg daily. The insurer submits that Celebrex is a prescription only medication and there is no documented prescription of Celebrex post-accident, nor is there a purchase record in the claimant's PBS records.

1. In accordance with the directions issued by the Panel, the claimant and insurer have both provided a bundle of documents which contains material relevant to the Review. These bundles have been considered and evaluated by the Panel.
2. In conducting this medical review, the Panel has sought to follow and implement the words of Justice Basten in Rahman v Insurance Australia Ltd (t/as NRMA Insurance) [2022] NSWSC 1079, where his Honour noted, at [63], that the Court of Appeal has remarked on the volume of material routinely provided to medical assessors, and noted there is no general principle requiring an assessor to refer to all the documentation to which they have access.
3. Accordingly, and in endeavouring to carry out its statutory function and promote the objects and guiding principles of the Commission, the Panel has not referenced or summarised all records relating to the claimant's symptoms or injuries: see ss 3 and 42 of the PIC Act. If a document is not referred to in the Panel's review, it should not be assumed that the Panel was unaware of that material or that the Panel failed to take the material into account.

1. The claimant's application for personal injury benefits dated 11 October 2022 has been considered. This describes the accident as:

"Travelling westbound along M5 near River Road exit. I changed lanes, was in the left lane, when the truck [registration no.] hit the back right side of my car, my car was pushed to the left wall, bounced back, hit the right wall and was pushed back to the left. The car caught on fire."

1. The claimant's injuries resulting from the accident are listed as "R arm - torn ligaments; neck; lower back; psychological".
2. In terms of the claimant's employment details, it is noted that he was off work for one week following the accident, then since February 2020 to date.
3. The claimant's application for damages under common law dated 11 October 2022 has also been considered.

1. The clinical notes of Bankstown-Lidcombe Hospital as at 20 May 2023 have been considered.
2. The Admission Summary on 25 February 2019 records that the claimant "had come to ED post significant MVA but with minimal injuries". In respect of the description of the accident, it is noted "Felt little shaking while coming out in shock". There is no other reference to psychological injuries.

1. The records of Miller Medical & Dental Centre under cover letter dated 10 March 2023 have been considered.
2. It is noted that under "Active Past History" there are numerous items listed, dating back to 1983. There is no reference to the accident. There is nothing listed under "Inactive Past History".
3. The notes of the consultations with Dr Vijayathasan Krishnapillai from 27 June 2022 to 9 March 2023, inclusive, have been reviewed. On 8 December 2022, there is a reference to "neuropathic pain". There is no reference to any psychological symptoms or injuries.
4. The consultations with Dr Iffaf Jarin Khan from 5 July 2022 to 30 September 2022 have been noted. On 12 August 2022, it is noted "had car accident in 2020 and got badly injured; since then could not work as a cleaner; seen lawyer and advised to claim CTP, had usg [sic] here with Dr Hala - checked". There is no reference to psychological symptoms or injuries.
5. The consultation with Dr Hala El Naouchi on 18 July 2022 notes "Hx of recurrent right shoulder pain for few yrs. He worked as a cleaner. U/S right shoulder". The results of the ultrasound are noted. There is no reference to the accident.
6. The consultation notes of Dr Shantha Batuwangala Kariyakaranage have been considered. There is no reference to psychological symptoms or injuries.

1. The records of Dr Su Surgery scanned on 11 December 2023 have been considered.
2. These records consist of handwritten clinical notes with a practitioner stamp reading "Dr S Hengpoonthana", with the first consultation being 1 September 2006. Based on the Panel's review of these notes, there is no reference to the accident or any psychological symptoms or injuries.

1. The letters of Dr Andrew Dimitri of The Lung and Sleep Clinic dated 6 October 2022, 19 April 2023, 10 October 2023 and 17 October 2023 have been considered. The consultation was to check on the claimant's breathing. There was no reference to the accident or any pain, injuries or symptoms resulting from the accident.

1. The NSW Ambulance report dated 25 February 2019 has been considered.
2. It is recorded that the claimant was standing on the side of the road in the presence of police, fire and rescue, and the insured driver. The circumstances of the accident were noted. It was noted that both front airbags were deployed, the car caught alight, however the claimant self-extricated without sustaining burns. The claimant was noted to appear well-perfused, alert and oriented.
3. The "Secondary Survey" records "anxiety" in addition to observations on the claimant's physical condition. The "Final Assessment" is recorded as "abrasion / graze".
4. The claimant was administered paracetamol and transported to Bankstown Emergency Department for further assessment.

Certificate of capacity / certificate of fitness

1. The certificate of capacity / certificate of fitness dated 12 August 2022 has been considered. This diagnoses "shoulder injury and ruptured tendons". Treatment and medication are listed as "painkiller, deep heat, rest, ohysio [sic]". The claimant is certified to have no capacity for work.

1. The Centrelink records provided by Services Australia on 27 April 2023 have been considered.
2. The records note that the claimant received the Newstart benefit for the financial years ending 2020, 2021, 2022 and 2023.
3. The records note the medical certificates with date of effect being 30 May 2022, 31 May 2022 and 10 February 2023. None of the listed medical conditions regard psychological injury or illness.
4. The Employment Servies Assessment Report dated 13 May 2022 has been considered. "Chronic pain" is listed as one of the seven "barriers to be addressed". Under "Employment History / Goals" it is noted that the claimant reported working in cleaning until before COVID-19 and stopped work due to lack of hours available. There is no reference to the accident in the report.

1. The Medicare records provided by Services Australia on 24 May 2023 have been considered. These provide a patient service history for the claimant for the period 25 February 2014 to 13 February 2023.
2. The Panel has reviewed the claimant's Medicare Records and notes there are no records of psychotropic medications having been prescribed to the claimant, including Celebrex.

1. The claimant's statement dated 12 December 2022 has been considered.
2. The claimant describes the accident as follows:

"On 25 February 2019, I was driving in the left lane along the M5 near the River Road exit, when I was hit from behind by a truck. My vehicle was pushed into the wall on the left hand side. My car then spun around hit the right wall then was pushed back to the left again. My car also caught on fire and a driver drove past yelling out to me to get out of the car."

1. He notes his injuries to be "psychological" as well as specific physical injuries.
2. He notes that he attended upon his usual general practitioner, Dr Su, in or around March or April 2019, and attended upon her every couple of months for his "regular check-ups".
3. The claimant outlines his medical treatment since the accident. His statement does not refer to any treatment or attendances for his psychological injuries.

1. On 26 June 2023, Medical Assessor Alan Home issued a Medical Assessment Certificate in respect of the claimant's physical injuries. He certified that the claimant's lumbar spine injury was caused by the accident and was a threshold injury. It was determined that the claimant's permanent impairment resulting from that injury was 0%.
2. Medical Assessor Home certified that the claimant's injuries of the cervical spine and right shoulder were not caused by the accident.

1. The claimant was examined by Senior Medical Assessor Mason and Medical Assessor Verma on 8 August 2025.

1. Mr Soliman is a 66-year-old man who lives with his wife and four children in their own home in a Western Sydney suburb. He had been employed as a cleaner and last worked in 2020.

1. Mr Soliman was born in Egypt and described a normal birth and development. His father died of cancer at 80 years of age. His mother passed away 10 years ago as a result of multiple medical problems; she was 84 years of age. He is the middle of five children. His siblings remain in Egypt.
2. He described a good childhood in which he suffered no form of abuse. He completed high school and attended three years of an accounting and commerce degree but did not graduate.
3. He then moved to the Netherlands at 21 years of age and worked there in various occupations including farm work and hospitality; he said he moved back and forth between the Netherlands and Egypt. He spent one year of compulsory service in the Egyptian Army. He then worked with his father in a grocery store in Egypt for two or three years.
4. He married at 33 years of age. He and his wife were neighbours in Egypt. She had Australian citizenship and they moved to Australia together. His wife is 56 years of age and works full-time as a support worker for children with disabilities in a school. They have a 32-year-old son and daughters age 28 and 25 who are working. Their 20-year-old son is a student. None of the children are married.
5. On arrival in Australia he found work as a cleaner and initially worked for a company with a contract at Sydney airport for a few years. He then became an independent cleaning contractor and has worked in his own cleaning business for many years. He said work hours varied between six and ten hours per day and he normally worked up to seven days per week. He said most of the work was located in Coogee and he mostly worked during the night.
6. When asked about leisure activities prior to the motor accident he said he had none. He said he did not have time for fun because he was working seven days per week. He denied having any hobbies or pastimes.
7. He was asked about previous motor accidents. Mr Soliman said many years ago he had a small motor accident in which his vehicle suffered some damage to the side. He said it was not a big deal, no one was injured and he did not make a claim. He said he could not remember if the car was repaired by the insurer, stating it was a very long time ago. He was specifically questioned about a motor accident in 2020 recorded in the Miller general practitioner record. He said there had been no motor accident subsequent to the February 2019 motor accident and the general practitioner must have mistakenly recorded the date as 2020. He confirmed there had been no previous worker's compensation claims. He also stated there had been no history of problems with the law.
8. Mr Soliman stated he had fractured his right femur while serving in the Egyptian Army. He had been repairing a roof and fell four metres to the ground. As a consequence of surgical treatment he received a blood transfusion and contracted hepatitis C. He has been successfully treated for hepatitis C in Australia although some liver fibrosis had been noted in the documents.
9. In 2009, he had a fall while painting his house and fractured his heel (calcaneus). He noted a past medical history of colon cancer. He said one third of his colon had been removed in 2010. He has undergone regular colonoscopies since then and has had a number of small polyps resected. He said he has remained cancer free.
10. He noted he had some skin cancers removed. The distal two phalanges of his left little finger have been resected due to cancer. He suffers from asthma, eczema and emphysema. He denied high blood pressure or high cholesterol.
11. Mr Solomon denied any past or family history of psychiatric illness.
12. Medications consist of puffers for the treatment of asthma consisting of Ventolin and Symbicort. He said he does not use any medications for the treatment of arthritis, only topical creams such as Voltaren. He also uses steroid creams for the treatment of eczema. He denied the use of regular analgesics and anti-inflammatory agents. He specifically denied the use of Celebrex.
13. Mr Solomon denied the use of cigarettes although said he is now using vapes but not much. He consumes one standard drink of alcohol once weekly. He does not use recreational drugs and does not gamble. He consumes two or three cups of coffee per day.
14. Pre-accident functioning consists of living with his family and working seven days per week. His self-care and personal hygiene activities were not impaired. He said he was not particularly socially active because of his busy work life but he did relate to some friends. His ability to travel was unimpaired. He got along well with his wife and children. He had no difficulty with concentration and was able to work full-time.

1. Mr Soliman was a restrained driver coming home from work at approximately 5.00am or 6.00am in a Ford Fairmont or Fairlane sedan. He said he had just exited the M5 tunnel heading West in the right-hand lane. He said there were two slow cars ahead of him so he decided to move to the left-hand lane to pass them. He said at the same time a truck in front of him decided to do the same thing, however the truck driver did not see him. As soon as he had passed the truck it hit him in the rear with some force. This caused his car to impact the concrete barrier on the left-hand side of the road. He said at this point the car was "crazy". It spun across the road and hit the concrete barrier on the right-hand side and then came back to the left-hand side of the road and stopped. At all times the car remained upright.
2. Mr Soliman said he was shocked and did nothing. He said he was not unconscious but he could not talk or move. He said he gave up and sat there. He said people gathered around him and then flames began to come out of the engine compartment. Bystanders told him to get out but he said he could not even stand up. They helped him out of the car and sat him down on the concrete on the side of the road. He waited there for the ambulance to arrive and was then taken to Bankstown-Lidcombe Hospital.

History of symptoms and treatment following the accident

1. Mr Soliman said he spent a few hours in hospital and they did X-rays. He initially said he had developed a sore back and a sore right shoulder. He was reminded the hospital record noted a swollen left foot and an abrasion on his left arm. He confirmed this was the case and went on to say that the painful back and right shoulder developed gradually over the year or two following the motor accident. He said he did not undergo any surgery for these conditions.
2. He said following the accident he continued to work but the pain in his shoulder and back gradually increased and he had to reduce his hours. He said because he could not complete his work he started to lose jobs. The situation was complicated by the COVID-19 lockdowns and he was unable to keep working after the end of 2020. Mr Soliman was not able to provide an accurate account of when he last worked citing poor memory and the fact that the events occurred a long time ago. He did note however that he was able to continue driving while he continued to work.
3. The current situation regarding his physical condition is that he has debilitating pain in his right shoulder. He also has lower back pain which has been exacerbated and he experiences numbness which proceeds down both legs. He added the lower back pain has extended upwards to the upper back. He said he is able to do some small household maintenance tasks but mainly relies on his older son to do these jobs.
4. When asked about psychological symptoms he said he was very worried at the time of the accident. He described a sense of "shock" at what had happened. Mr Soliman was using this term in a general psychological sense rather than in the specific medical sense which refers to low blood pressure. He did not describe nightmares or intrusive memories of the motor accident. He said he was less confident as a driver than he was before the accident, although he continued to be able to drive to and from work.
5. Mr Soliman described the slow exacerbation of physical pain which resulted in his inability to continue working. He was asked to describe how stopping work affected him psychologically. He said initially it was a relief because he did not have to suffer the continuing exacerbation of pain. However, it then began to get him down.
6. He said he felt useless and depressed because he did not feel he was able to make a useful contribution. He said "that feeling is very bad, you are nothing, you are disappointed, why are you living, what is it all about?" He was specifically asked if he wished he had died in the accident but he was very clear this was not the case. He said the main issue is his self-esteem because he is unable to contribute financially to the family because he cannot work. He went on to say he had worked all his life and took pride in the fact that he was a good provider for his family. He denied ongoing suicidal ideation.
7. In response to direct questioning Mr Soliman said he had not reported psychological symptoms to his general practitioner. He agreed he had not described any symptoms arising from the motor accident to his general practitioner until at least two years after the motor accident. He said he had not consulted a psychologist or psychiatrist. He said he had not been treated with psychotropic medication and denied the use of Celebrex.

1. Mr Soliman said the main issue since the accident is the fact that he has had to stop work. He denied any other accidents or conditions.

1. Mr Soliman stated in general terms he does not enjoy life because he is not able to work due to his physical problems. He is less confident as a driver and prefers his wife to do the driving but he is able to drive when required, such as in an emergency. He said he did drive two weeks ago.

1. Mr Soliman said he has no current or proposed psychological or psychiatric treatment.

1. Mr Soliman is a 66-year-old right-hand-dominant man whose appearance is consistent with his stated age. He was located in a room in his home. His wife was present throughout the interview but did not participate. The interview was conducted using the Microsoft Teams application with a good internet connection. Mr Soliman had required his wife to establish the connection. He was assisted during the interview by Arabic interpreter Mr Bassam Ashqar, NAATI number CPN3EM41T. Mr Soliman displayed a good command of the English language and required assistance from the interpreter only intermittently throughout the interview. The interview commenced at 1.00pm and concluded at 2.20pm.
2. Mr Soliman was a cooperative and appropriate interviewee. He provided information willingly and without prompting. He presented as an intelligent man with good insight into his situation. He was neither anxious nor depressed in appearance. He displayed a rather ironic capacity for humour. He was not irritable or intolerant. His range of affective expression was full and appropriate to the content of the discussion.
3. He did not describe trauma related symptoms arising from the motor accident. He did not describe symptoms of depression arising from the motor accident. He did describe the development of some anxiety symptoms in relation to driving. He described the development of low level depressive symptoms as a consequence of being unable to work due to pain.
4. Mr Soliman was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.

1. When asked how he spends his day, Mr Soliman said he mostly watches television. He watches the news, he follows politics, and he watches documentaries on YouTube concerning history and geography.
2. Self-care and personal hygiene: Mr Soliman said he showers every two days. He changes his clothing regularly. He said he prefers not to go to the barber very often but does get his hair and beard trimmed occasionally. He complained he has put on weight since the accident. He weighed 75 kg in the past and now his weight varies between 85 and 90 kg. He attributes this to inactivity.
3. Social and recreational activities: Mr Soliman said he sits with the family. He does not see friends very often because everyone else is working. He is a member of the Coptic Orthodox church and occasionally will attend services for 30 minutes and speak to people there. He said he cannot sit through a full service because of pain.
4. Travel: Mr Soliman prefers not to drive and leaves that mainly to his wife. He said he does not use public transport but could do so if necessary. He travelled to Egypt with his family in 2023.
5. Social functioning: Mr Soliman gets along well with his wife and children and members of his extended family in Egypt. He said he does not see much of his friends because they are working.
6. Concentration, persistence and pace: Mr Soliman said he is able to watch a documentary on television for one hour. He said he is having some memory problems and forgets a lot of things. He said it is necessary for his wife to remind him to do things.
7. Adaptation: Mr Soliman is not able to work because of pain. He said he does help out around the house within the limits of his physical capacities. He relies on his son to do the heavier household maintenance. He tries to make himself go for a 10-minute walk each day.

1. Mr Soliman's presentation was internally consistent, consistent with the documentation provided and consistent with the diagnosis made.

1. The Panel adopts the reasons and findings of the examination undertaken by the Medical Assessors of the Panel as set out above. Reliance has been placed on the combined clinical expertise of the Medical Assessors on the Panel.

1. A medical review panel is a new assessment of all matters with which the medical assessment is concerned. The Panel is not required to choose between competing medical opinions and is required to form its own opinion.[6]
2. The Panel adopts the reasoning in Lynch v AAI Limited t/as AAMI that the psychological condition can be present at any time to establish that the injury is not a threshold injury for the purposes of the MAI Act. [7]
3. The Panel also notes that the claimant bears the onus of establishing that any injury is not a threshold injury for the purposes of the MAI Act.[8]
4. Mr Soliman is a 66-year-old man who was involved in the accident on 25 February 2019, now six and a half years ago. It was a particularly frightening accident in which his sedan car was shunted by a semitrailer and bounced from side-to-side of the M5 motorway before coming to rest against a concrete barrier. The engine of the vehicle then caught fire. Mr Soliman was in a state of shock and said he was unable to self-extricate. Bystanders helped him out of the vehicle. He was transported by ambulance to Bankstown-Lidcombe Hospital where no serious injuries were diagnosed and he was discharged.
5. He continued to work as a cleaner until increasing shoulder and lower back pain forced him to stop work. The work situation was somewhat complicated by COVID-19 lockdowns. He did not report physical symptoms to his general practitioner until approximately three years after the accident. At no point did he report psychological symptoms or undertake psychological or psychiatric treatment. He did acknowledge some ongoing minor anxiety related to driving and prefers his wife to drive although is able to do so if necessary. He also acknowledged ongoing low level depressed mood as a consequence of being unable to continue working.
6. The Panel notes there is limited to no evidence of Mr Soliman reporting psychological symptoms or injuries to his general practitioner or treating doctors in the years following the accident.

1. Mr Soliman does not meet DSM-5-TR criteria for specific phobia (driving). Relevantly,

(a) the fear or anxiety around driving was not severe (criterion A);

(b) driving does not almost always provoke intense fear or anxiety (criterion B);

(c) driving is not actively avoided or ensured with intense fear or anxiety. He was able to continue to drive to work for many months following the accident and he can now drive when it is necessary to do so, albeit that he prefers his wife to do so (criterion C);

(d) Mr Soliman was able to continue to drive to work and can now drive when required (criterion F), and

(e) the fear does not arise from the accident and is better explained as an adjustment disorder with anxiety in relation to driving because the anxiety and impairment is not as intense as a specific driving phobia (criterion G).

1. Mr Soliman presents with an adjustment disorder with anxiety in relation to driving.
2. He meets DSM-5-TR criteria as follows:

(a) he developed symptoms of anxiety subsequent to the accident (criterion A);

(b) the anxiety described is out of proportion to the severity of the stressor and it does result in mild impairment in social functioning (criterion B);

(c) the condition does not meet criteria for another mental disorder (criterion C);

(d) his symptoms do not represent normal bereavement (criterion D), and

(e) it is present in persistent form (criterion E).

1. Mr Soliman presents with a persistent depressive disorder as a consequence of being unable to continue to work.
2. Mr Soliman meets DSM-5-TR criteria for persistent depressive disorder as follows:

(a) he described depressed mood on more days than not for at least two years (criterion A);

(b) he described over eating, low energy, low self-esteem, poor concentration and feelings of hopelessness (criterion B);

(c) the symptoms have not been absent for more than two months at a time (criterion C);

(d) criteria for major depressive disorder have not been present (criterion D);

(e) there has never been a manic or hypomanic episode (criterion E);

(f) the condition is not better explained by another major psychiatric disorder (criterion F);

(g) it is not due to a substance or another medical condition (criterion G), and

(h) it does cause distress and impairment in social functioning (criterion H).

1. Causation is not specifically addressed in Part 5 of the Guidelines. However, in Part 6, which deals with assessing the degree of permanent impairment arising from an injury caused by a motor accident, cls 6.5 to 6.7 set out how causation of injury is to be assessed:

6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:

'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.' [emphasis in original]

This, therefore, involves a medical decision and a non-medical informed judgement.

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. Justice Wright stated in Briggs v IAG Ltd (t/as NRMA Insurance)[9] at [35]:

"The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principles were intended to be applied when a medical assessment was being made in relation to causation of minor injuries."

1. In Raiana v CIC Allianz Insurance Ltd, Campbell J noted[10]:

"One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002 (NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely."

1. The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining the issues of negligence and causation.[11] It is therefore necessary for the Panel to consider whether the accident caused or contributed to the injuries. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[12]
2. Mr Soliman was involved in a frightening motor accident which the Panel finds was capable of causing a psychiatric condition.
3. The Panel finds that the accident did cause a mild adjustment disorder with anxiety related to driving.
4. The Panel finds that the accident was not the cause of the persistent depressive disorder. The Panel finds that this disorder is a result of Mr Soliman being unable to continue working due to right shoulder and neck pain. Mr Soliman explained he attempted to continue working but gradually reduced his hours as the pain worsened. The COVID-19 lockdowns ensued. Mr Soliman was unable to resume work when they ended because of this pain. He reported that he initially enjoyed not working but gradually became depressed because he felt useless.
5. While it is possible that the accident contributed to Mr Soliman's pain, the Panel relies on Medical Assessor Home's findings that Mr Soliman's right shoulder and cervical spine (neck) pain were not caused by the accident. For this reason, the Panel finds that Mr Soliman's inability to work and therefore any resulting psychological injury was not caused by the accident.

1. The Panel finds that the adjustment disorder with anxiety related to driving was caused by the accident and is a threshold injury for the purposes of the MAI Act.
2. The Panel finds that the persistent depressive disorder was not caused by the accident.

1. The Panel revokes certificate of Medical Assessor Alexey Sidorov dated 22 February 2024 and issues a new certificate, certifying that the claimant's adjustment disorder with anxiety related to driving, caused by the motor accident, is a threshold injury for the purposes of the MAI Act.

[1] See ss 3.11, 3.28 and 4.4 of the MAI Act.

[2] The current version of the Guidelines, v9.3, applies to policies that come into effect immediately after midnight 14 January 2025. For policies that come into effect from 15 January 2024 to 14 January 2025, Part 1 of the Motor Accident Guidelines v9.2 continues to apply: see clause 1.2. The Panel notes that version 10 of the Guidelines has been published but does not commence until 15 September 2025.

[5] Wingfoot Australia Partners Pty Ltd v Kocak (2013) 252 CLR 480; [2012] HCA 43 at [47]. See also Insurance Australia Group Ltd t/as NRMA Insurance v Keen [2021] NSWCA 287 and Insurance Australia Ltd v Marsh [2022] NSWCA 31.

[6] Insurance Australia Group Ltd t/as NRMA Insurance v Keen (2021) 399 ALR 765; [2021] NSWCA 287; Insurance Australia Ltd v Marsh (2022) 99 MVR 1; [2022] NSWCA 31.

[7] Lynch v AAI Limited t/as AAMI [2002] NSWPICMP 6 (Lynch).

[9] [2022] NSWSC 372.

[10] [2021] NSWSC 13 at [65].

[12] Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50].