Issued under Part 3.4 of the Motor Accidents Compensation Act 1999

1. revokes the certificate of Medical Assessor Abhishek Nagesh dated 7 June 2023, and
2. certifies the following injuries were caused by the motor accident and gives rise to a permanent impairment of 5% and is NOT greater than 10%:

Persistent Depressive Disorder with Anxious Distress

1. Ms Kristie Waite (the claimant) alleges injury from a motor accident occurring on

19 January 2017. 2. She subsequently lodged a claim under the Motor Accidents Compensation Act 1999 (MAC Act) upon AAI Limited t/as GIO (the insurer), the compulsory third party insurer of the vehicle considered at fault. 3. The insurer is liable for payments of statutory benefits and/or damages under the MAC Act. 4. The issue in dispute between the parties is whether a psychological injury caused by the motor accident gives rise to a whole person impairment (WPI) greater than 10% (s 131 of the MAC Act). 5. This is a review of a medical assessment pursuant to s 63 of the MAC Act. The medical assessment the subject of this review was conducted by Medical Assessor Nagesh. In a certificate dated 7 June 2023, the Medical Assessor assessed the claimant's WPI as 17% due to a major depressive disorder caused by the motor accident.

1. The insurer sought a review of the medical assessment of Medical Assessor Nagesh. On

14 September 2023 the President's delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel). 2. Pursuant to s 63(3) of the MAC Act the Panel consists of two Medical Assessors and a Member of the Motor Accidents Division of the Personal Injury Commission (Commission). 3. 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 Merit Reviewer or Medical Assessor. 4. Rules 127 and 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the Rules. 5. The review is by way of a new assessment of all mattes with which the medical assessment is concerned (s 63(3A) of the MAC Act). 6. The Panel met via video conference on 4 December 2024 and determined that a

re-examination of the claimant was required. A medical examination was arranged to take place on 30 January 2025 with Medical Assessor Roberts and Medical Assessor Hong via Microsoft Teams. The examination did not take place as scheduled. In this regard, the claimant's representatives indicated an objection to the insurer relying upon surveillance of the claimant's activities for the purposes of the Review. The examination was thereafter cancelled. 7. After provision of submissions from the parties, a decision was ultimately made and issued to the parties on 21 March 2025 that allowed the insurer to rely on the surveillance. A further direction was made allowing the claimant to rely on any additional material by 6 June 2025. 8. An examination was arranged to occur on 31 July 2025 via Microsoft Teams with both Medical Assessor Roberts and Medical Assessor Hong. 9. The Panel reconvened via videolink for a teleconference on 27 August 2025.

1. Medical Assessor Nagesh examined the claimant on 8 May 2023 and provided a certificate dated 7 June 2023.
2. He diagnosed the claimant as suffering a major depressive disorder caused by the motor accident giving rise to a 17% WPI. The symptoms recorded by the Medical Assessor at the time were:

"..depressed mood, anxiety, insomnia, fluctuating appetite, lack of energy and motivation, social withdrawal, diminished ability to concentrate, feelings of worthlessness, and suicidal thoughts. For her above symptoms, Ms Waite has seen a psychiatrist. She has been prescribed diazepam, medications for migraine, cannabis oil, and she also continues to see a psychologist."

1. At the time the claimant is reported as working 20 hours per week and was struggling with various aspects of daily living, including concentration and cooking. The claimant was noted to be socially withdrawn and could travel independently only locally.
2. The Medical Assessor found since the motor accident the claimant has experienced chronic pain which has resulted in functional losses which have given rise to a her depressive and anxiety symptoms. He found a class 3 impairment in respect of the Psychiatric Impairment Rating Scale (PIRS) categories of social recreational activities; social functioning; concentration, persistence and pace; and, adaptation. A class 2 impairment in respect of categories of self-care and personal hygiene; and, travel.

1. The insurer submits that the Medical Assessor demonstrably failed to consider the material that was provided to him, and in so doing failed to apply the test of consistency.
2. In addition, the insurer submits that the Medical Assessor made findings when applying the PIRS based on the claimant's self-reporting and in so doing failed to engage with the contemporaneous clinical evidence which contradicts significant important aspects of the claimant's evidence.
3. For example, the insurer refers to the claimant's work history where the Medical Assessor noted that the claimant had work-related stress 10 years prior. The insurer notes that the claimant's general practitioner (GP) records suggest that the work-related stress was still in train up to at least six months before the accident and not 10 years prior. She ended up ceasing work in August 2016. It is further noted the claimant had hospital admissions in 2016 in respect of left sided facial droop considered to be due to anxiety and a conversion disorder.
4. Other inconsistencies are noted in respect of the claimant's work history including the claimant not working as a strategic manager for News Ltd for six years, but instead only a matter of months since September 2016.
5. It is further noted that reports of loss of libido and the separation from her husband due to the accident are inconsistent with the GP records.

Claimant's review submissions in reply dated 1 September 2023

1. The claimant submits that the insurer's contention that Medical Assessor failed to give sufficient weight to relevant material should be rejected.
2. It is submitted that the Medical Assessor's reasons clarify that all material was considered and he gave a clear and cogent basis of reasoning in his assessment.
3. In response to the insurer's reliance on references to stress in GP records the submissions note that:

(a) The insurer's reference to Caloundra Hospital Emergency Department Clinical Summary (11 June 2016) recording work-related stress 12 months prior is inconsistent with the Queensland Health Discharge Summary provided in the Sunshine Coast Family Clinic records. This discharge summary documents the claimant's admission to Nambour Hospital on 7 July 2015, which recorded her principal diagnosis as defacation syncope and left sided weakness and deficits in upper and lower limbs with inability to mobilise as most consistent with functional neurology. There is no mention of work-related stress.

(b) The insurer's submission is also inconsistent with the Discharge Summary provided by Sunshine Coast University Private Hospital on 3 July 2015. The principal diagnosis was gastritis.

(c) The claimant was not admitted to hospital on those occasion s as a psychiatric patient or for a primary psychiatric complaint.

1. It is further noted that the assessment of Medical Assessor Samuels was considered as relevant material noting the mention of same in his findings on WPI.
2. The claimant submits that the insurer's reliance on discharge summaries to demonstrate psychological morbidities is misconceived. Firstly, stress is not a recognised psychiatric illness and therefore cannot constitute a pre-existing psychological injury. Further, the insurer is required to take the claimant as they find them pursuant to the egg shell skull rule.
3. The opinion of Dr Byth is relied upon in terms of how the claimant's prior psychological complaints.

1. The claimant did not lodge a bundle of documents in compliance with Panel directions dated 4 July 2024. The Panel has nonetheless considered all documentation included in the claimant's bundle of documents that was lodged on 1 September 2023 consisting of 627 pages - "waite". The Panel has also considered the documents lodged on behalf of the claimant on 5 June 2025 that includes a statement of the claimant and a report of Dr Varma dated 5 June 2025.
2. The insurer lodged a bundle in compliance with Panel directions and the Panel has considered all documents included. The bundle was lodged on 8 August 2024 and comprises of 1117 pages - "2024.01.02 - Insurer's final bundle (review of Ax Nagesh)". The Panel has also viewed the included surveillance footage - "RV19-2023.12.01 M&A investigations surveillance footage 67221", "RV20-2024.02.29 - surveillance footage", "RV21-X051480011 surveillance footage 69556(1)".
3. Not all documentation has been directly referenced within these reasons, some documentation has been summarised or referred to when directly relevant to findings made. However, the certificate and reasons have been prepared in the context of all material having been considered.

1. Medical Assessor Samuels provided a certificate and reasons dated 14 February 2020, through the Medical Assessment Service of the State Insurance Regulatory Authority.
2. He assessed a 6% WPI arising from a major depressive disorder caused by the motor accident.
3. The Medical Assessor took a history from the claimant that she had suffered stress problems prior to the accident in relation to work. She was also stressed around her move to Queensland. She stated that she did not require any psychiatric or psychological treatment, however, she did see a psychologist 20 years prior in the context of a marriage breakdown.
4. A major aspect of the presentation was noted to be chronic pain. No deficits were found in respect of self-care and personal hygiene, and travel. A mild impairment was found in respect of all other PIRS categories.

1. The records of Sunshine Coast Family Clinic begin on 13 May 2016 where unrelated health conditions are recorded.
2. She was noted to be on stress leave on 16 May 2016 with counselling completed. On

30 May 2016 it was noted that the claimant remained on leave and still was not comfortable returning to work and had "severe anxiety" thinking about work. Bullying at work is mentioned. Cognitive function remained intact. 3. On 7 December 2016 the claimant was noted to have a left sided facial drop and had been seen in hospital. It is noted that "ongoing L sided facial droop over the last year that has been put down to "stress"/psychosomatic". 4. The claimant attended on 23 January 2017 and reported the motor accident four days prior occurring in Sydney. She reported having headaches and neck pain. Ongoing complaints related to neck and back pain are made in subsequent visits. 5. On 10 March 2017 the doctor advised to use Valium as required and a "CBT" session is noted to encourage a positive attitude. 6. On 1 April 2017 the notes state the claimant had been under a lot of stress in Sydney from her work which prompted the move. Her husband's low mood had been affecting her mentally and supportive counselling was completed. 7. On 5 May 2017 it was noted that the claimant had changed work conditions and was working four days a week, six hours a day and workers compensation paperwork was completed. 8. On 1 August 2017 the claimant was referred to a psychologist, Dr Alanda Thompson. She was referred to a different psychologist, Ms Rosemary Crake, on 2 December 2017. 9. The claimant was reviewed on 8 March 2019 and was starting to feel better and was advised to remain on her current dose (presumably Zoloft 50mg). There were concerns regarding her son. The reason for the visit is noted as depression/anxiety. 10. A report of Lisa Lindley, psychologist, dated 18 March 2019, who notes the claimant was referred for treatment of depression and anxiety largely arising from her chronic neck and back pain. The claimant was noted to exhibit extremely severe depression and severe stress levels and moderate anxiety. 11. A further report of 17 June 2019 noted the claimant had attended six sessions. Ms Lindley felt the claimant would benefit from more assistance and requested further sessions. 12. A Nambour General Hospital Emergency Department letter confirms the claimant attended on 3 June 2016 with acute onset facial droop. She was diagnosed with anxiety and noted that she was then on sick leave for stress from Australia Post. She was happy with her family life, however had been working at her computer that day and reported feeling very stressed. 13. A clinical summary for Caloundra Hospital notes the claimant presented with left sided facial droop. She was noted to have been under a lot of work-related stress.

1. Dr Varma noted that the claimant has a long standing history of engagement with Dr Frank Thomas and has undergone repeated interventional procedures, including nerve ablations which have provided significant symptoms relief. A transition of care meant that the transition has delayed access to essential procedures and that has caused significant deterioration in her pain levels. A panic attack was noted at the clinic in May 2025.

1. The claimant relies upon the opinion of Dr Byth, Psychiatrist, dated 15 December 2021. The insurer has also included a copy of the earlier report of 30 May 2019. The doctor records a history of the claimant having work-related stress in 2013 and 2016, with her symptoms settling without any specific treatment.
2. He diagnosed the claimant with adjustment disorder with anxiety and depressed mood caused by the motor accident. It was also noted there were some ongoing features of specific traffic phobia, and some symptoms resembling post-traumatic stress disorder. He provided an assessment of WPI of 26% with an earlier assessment in 2019 apparently being 19%.
3. The insurer relies on reports of Dr Gray. In a report of 6 January 2020 the doctor took a history of the claimant seeing a counsellor when her first marriage broke down, but there had been no other contact with mental health practitioners prior to the subject accident.
4. He summarised by stating the claimant described developing a range of psychological symptoms associated with ongoing physical pain and functional losses. He found the response to be indicative of an adjustment disorder with mixed anxiety and depressed mood. He also considered that a somatic symptom disorder, however, did not formally make that diagnosis. He assessed WPI at 1%.
5. A further report of Dr Gray dated 3 May 2023 is noted. The doctor noted the history of work related stress prior to the accident that may have given rise to a conversion disorder, however, it appears that it was in remission at the time of the accident and he did not identify any pre-existing impairment. He found a 6% WPI on this occasion.
6. Dr Gray provided a further report dated 24 April 2024 in response to the surveillance footage relied upon by the insurer. He noted that the footage was "highly significant" in that it does not seem to reflect an individual encumbered by pain, albeit being outside his area of expertise. He comments as follows:

"In any event, the footage and video material are not entirely inconsistent with what Ms Waite told me, taking into account the impact of pain, namely that when she would be suffering less pain she would have a corresponding improvement in her emotional well-being. It is also noteworthy that, even when she was in pain, she described her symptoms and function in such a way that I thought there was a mild impairment, and it would be possible for her to undertake social and recreational activities (for example). I am quite unable to make any conclusions about her capacity for work from the footage and surveillance reports. I would advise similarly with respect to her cognition (concentration, persistence and pace on the PIRS).

1. The doctor states that the claimant appears to be considerably less depressed than when he saw her. He was unable to provide any definitive revised opinion with respect to assessment of WPI.

1. The Panel has viewed the surveillance footage noted above, along with the accompanying investigator reports.
2. The investigators obtained film of the claimant attending to activities on 13 November 2023. She attended a shopping centre and driving her vehicle to various locations. She also lifted a bicycle into the vehicle.
3. The following day the claimant was filmed driving to the main beach of Noosa and utilising a boogie board in the surf and was accompanied by children.
4. Investigators carried out a further round of surveillance in January 2024 and was filmed driving to various locations and attending a Bunnings outlet and buying painting supplies, and other shopping outlets over a number of days.
5. The claimant was again filmed over the course of a number of days in May 2024. Again the claimant was filmed driving her vehicle and attending shopping outlets and a hair salon.
6. The claimant has provided a written statement responding to the surveillance, dated 5 June 2025. The claimant expresses disgust at the surveillance including film of her children.
7. She states that she tries to "hold it together" for her children and then at night she will cry, take medication or drink alcohol to help with the distress. She states "the footage doesn't show all aspects of my life and doesn't give any context". The claimant provides a list of the many medications she is taking and notes that everything she does is to try and make sure that her kids have the best chance in life.

1. The below are the clinical examination findings of Medical Assessor Roberts and Medical Assessor Hong.

1. The assessment was undertaken using Microsoft Teams. Medical Assessors Roberts and Hong undertook the assessment.

1. Ms Waite is a 48-year-old single mother of two. Her son, Harry, is 12 years of age and her daughter, Emma, is 17 years of age. Both are in school. Ms Waite lives with her two children on the Sunshine Coast, Queensland. She is self-employed.
2. Ms Waite was born in Sydney. She is the elder of two siblings. She was very close to her younger brother previously, but for the past two years, they have not been speaking. She explained that he verbally attacked her in his home and threw her out. She had sought to facilitate reconciliation of the relationship between her brother and his daughter.
3. Ms Waite explained that she was 21 or 22 years of age when her parents divorced. They experienced a difficult relationship. During her childhood, her father did not attend any activities in which Ms Waite was involved. She was heavily involved in dancing and therefore did not spend much time at home. Notwithstanding her comment about her father's lack of direct involvement in her activities, she felt that her parents were supportive of her.
4. Ms Waite enjoyed school. She performed well academically. She was sociable. She went on to undertake a TAFE Certificate in Office Administration. While working at Red Rooster, she was offered a role as a secretary and personal assistant. She went on to work at a printing business in an administration role and then worked in sales in the same business. She went on to work at newspapers, receiving promotions and ultimately achieving the position of national sales manager. With a view to further promotion, she undertook a course in financial reporting.
5. Ms Waite had been in the workforce consistently since her son was born. On her return, she had a supportive female manager whose employment was subsequently terminated. Her replacement would make negative comments to Ms Waite such as, "My wife is at home looking after my children, that's where you should be." This led to Ms Waite moving to a different part of the business. She had been working at News Ltd for two and half to three years at the time of the accident and she was made redundant because travel was a significant component of her role and she could no longer do so due to her physical condition. When the subject accident occurred, she required flexibility with respect to work in to manage her physical symptoms and established her current business. She explained that her physical discomfort and migraines affect her ability to work longer hours than she is currently undertaking and she finds that she needs to lie down by 3.00pm each day.
6. Ms Waite explained that she was previously a more social and extroverted person. She was in a relationship with the father of her children for 18 years until 2021. Since their separation, his involvement with their children has been limited. He contributes little by way of financial support. Ms Waite has not been in a long-term relationship since then.
7. Ms Waite underwent an ovarian cystectomy about two years after the birth of her daughter. She has undergone two Caesarean deliveries. The first was in the context of foetal distress and the second was elective. When she was 18 years of age, she was involved in a motor vehicle accident from which she recovered well. The recovery process stimulated her interest in physical fitness, and she became a part-time fitness instructor and personal trainer. She referred to having sustained a lower back injury from which she recovered readily. She was diagnosed with celiac disease in 2014 or 2015. She recently underwent surgical repair of an abdominal muscle injury which necessitated a transverse laparotomy incision.
8. Ms Waite is a non-smoker. She did not report having used illicit drugs. She drinks daily to a maximum of six alcoholic drinks, attributing her level of consumption to stress and pain. She has been drinking at this level for the past six or seven years.
9. Ms Waite recalled having seen a psychologist during the period when she was living in Sydney. This occurred during her first marriage. Her husband was attending bars with "scarcely dressed women". He was drinking and gambling. Ms Waite could not recall the nature of the symptoms that she was experiencing at the time or the extent of the treatment that she received. She recalled having been treated for postnatal depression after Harry's birth. She recalled that she was irritable at the time but did not otherwise remember her symptoms.
10. Ms Waite was asked about reference to bullying and harassment in May or June 2016. She stated that this was not accurate. She was asked about the prescription of Diazepam six months prior to the motor accident. She could not recall the basis for this prescription or that it even occurred.

1. Ms Waite was stationary at a set of traffic lights in peak hour traffic in Sydney when her vehicle was struck from behind. She recalled that she was driving a Toyota Corolla at the time and the other driver was in a four-wheel drive. She explained that it was "not a massive hit" and she was not shunted into the car in front. She drove her car to the side of the road out of traffic. The other driver left the scene. Ms Waite drove after the other driver. She stated that she was "so tense" as to cause a neurological condition.

History of symptoms and treatment following the motor accident

1. Ms Waite recalled that she was sore during the meetings in which she participated on the day of the motor accident and between her appointments, she applied ice packs. Following the day's meetings, she made a police report. That evening she was "in agony" and she cut short the work trip to Sydney and returned home.
2. Within one to two days after the motor accident, Ms Waite sought medical assessment. She was referred to a chiropractor who declined to treat her because she was in too much pain. She was referred to a physiotherapist, Jenny Frangos. She recalled that physiotherapy was of no benefit to her. The pain was so severe as to cause her to vomit and she would leave the sessions with migraines. She changed physiotherapists and engaged in 70 sessions with a clinician named Tim. He undertook massage, physiotherapy and acupuncture. She derived some benefit. She was also prescribed medication which caused weight gain.
3. Ms Waite stated that she has derived benefit from occupational therapy input aimed at increasing strength and muscle conditioning and from nerve ablation. Ms Waite spoke of the negative effects of analgesia with respect to energy and sleep. She is careful to avoid sleeping tablets because she cannot afford to feel sedated during the day.

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

1. Ms Waite did not report any subsequent injuries or conditions.

1. Ms Waite stated that she could not recall the course of her psychiatric decline but attributed the advent of symptoms to pain and insomnia. She described herself as miserable and cranky. She reported persisting insomnia. She acknowledged that she is no longer a fun person. She stated that she does not want to answer the phone when it rings.
2. Ms Waite stated that she was encouraged to see a mental health clinician by her general practitioner. When he first commented on the presence of mood and anxiety symptoms, she was shocked. She nevertheless accepted the referral to a psychologist whom she saw for a couple of years. She could not however recall when it was that she saw this clinician.
3. Ms Waite recalled that she was prescribed antidepressant medication but stated that she could not tolerate the side effects. She found that they made her feel withdrawn and "spaced out" and she found herself unable to comprehend what people were saying.
4. Ms Waite stated that she had been diagnosed with clinical depression, obsessive compulsive disorder, post-traumatic stress disorder, "avoidance syndrome" and severe anxiety. When asked what she meant by avoidance syndrome, Ms Waite replied that the diagnosis was made because she panics when people talk about her injury. She went on to explain that she continues to feel devastated at the loss of her health, her joy and her career. She reported a decline in her self-esteem. She explained that she does not feel attractive and desirable. She does not want to expend energy and she experiences anxiety about the prospect of pain which is relentless. When asked further regarding he anxiety in relation to pain, she replied that she does whatever she can to avoid pain. By way of example, she stated that she goes to the beach, puts her feet in the water and wades into small waves only, but she is scared to go out in waves and scared to surf or body surf. She stated that she would love to be able to resume physical exercise.
5. Ms Waite acknowledged irritability in her interactions with the children and her mother. Her energy levels are compromised. She attributed this to insomnia which she ascribed to pain. She typically finds herself awake from 1.00am to 4.30am. She reported a variable appetite. At the time of the interview, she reported a diminished appetite as a result of nausea but a couple of weeks prior, she recalled overeating. She explained that the Brintellix removes the "low feelings" and evens her moods out but makes her feel nauseated.

1. Ms Waite acknowledged the presence of suicidal thoughts, but she did not express any intent in this regard. She reiterated a tendency to anxiety about her pain and about insomnia. She also becomes anxious about her ability to deliver quality work for her clients. She is anxious about her children and her relationship with them. She stated that her anxiety is debilitating and relentless. It causes her to shake. It affects her appetite, her sleep, her relationships and her self-esteem.
2. Ms Waite is not under the care of a psychiatrist. She ceased seeing her psychologist because she found it to be of no benefit. She stated that she does not like talking about her circumstances and she does not find it helpful.

1. Ms Waite has been prescribed THC 0.6mg for the past four or five years. She takes Diazepam 5mg at night. She is on the anti-depressant Brintellix 30mg at night. To manage her pain, she takes Panadol, Nurofen and Mobic 15mg and each night she takes either one tablet of oxycodone or one tablet of Palexia. She uses Mersyndol Forte for migraines. She requires it consistently for two to five days at a time. Twice a day she takes a tablet to prevent migraines. She stated that her medication regime was reviewed a couple of months prior to the assessment by her new pain specialist.

1. As stated above, the assessment was undertaken using audiovisual technology. The quality of the connection was satisfactory. Ms Waite presented with groomed hair, but she did not appear to be wearing makeup. No psychomotor agitation or retardation was apparent that might arise in the context of an acute psychiatric condition. She exhibited a restricted range of emotional expression, and she described a tendency to depressed mood. She also expressed anxiety. Her speech was normal in terms of rate, tone and volume. She was able to present a cogent account of her work history in some detail but was limited in the extent to which she could recall her past psychiatric history. This was presented in a moderately disorganised manner. No deficits of concentration were apparent at interview. No features of a psychotic nature were apparent.

1. Ms Waite is self-employed as a mortgage broker. She explained that she has a client list and she acts as a contractor to a mortgage brand. She pays for marketing and for the Customer Relationship Management software platform. She works 20 to 24 hours per week. She does not meet the clients face-to-face. She manages her business remotely. She works four to four and a half hours per day. She explained that she can be flexible with her hours of work. In addition to running the business, she mentors colleagues and is paid for her expertise.
2. Ms Waite oversees management of the household. She has a cleaner who comes weekly to do the heavier cleaning. She parents her children without assistance. Her son has diagnoses of Attention-Deficit Hyperactivity Disorder and Autism. She drives her son Harry to and from school. He has a carer for social and community development tasks. He engages in surf lessons with his carer. She takes him to a psychologist. Her daughter is in Year 12 and works. She acknowledged that she feels detached from her children and finds herself preoccupied with her own circumstances. She stated that her son talks a lot and she often puts in air pods to drown out his talking. She stated that her children consider her to be snappy. She acknowledged that she spends a lot of time in bed and does not engage with them as much as she would like. Ms Waite has limited contact with her mother and only visits once or twice each year. Her father, who is 80 years of age, lives in Sydney. He suffered a heart attack and a brain aneurysm, and Ms Waite went to visit him in July 2025. She explained that she cannot drive for more than an hour without a break. She spoke of having lost friends when she left a group chat and she referred to a limited social circle. It was not clear to the Medical Assessors when this occurred.
3. When asked how she spends her free time, Ms Waite stated that she goes to the beach. She initially stated that she goes most days but then said that she goes a couple of times each week. She occasionally goes out for a meal. Her social life is limited. She stated that she has one friend who is the mother of one of her son's friends.
4. Ms Waite stated that she spends much of her time at home wearing comfortable clothes. She maintains her personal hygiene and she seeks to eat a healthy diet. She acknowledged that her attention to her diet declines when she is depressed. She explained that she saw a nutritionist who recommended that she eat five smaller meals per day. When she undergoes nerve ablation, her mobility increases but she remains scared of flare-ups and is wary of exercising. Her flare-ups typically occur in response to physical exertion.

1. No overt inconsistencies were identified with respect to Ms Waite's account nor were the inconsistencies on mental state examination. The vagaries and Ms Waite's limited memory of past psychiatric symptoms and treatment was not of a degree beyond that which would be considered to represent the natural erosion of memory that occurs with the passage of time.

1. The history presented by Ms Waite, notwithstanding the vagaries about its time course, reflected the presence of enduring anxiety and depressive symptoms of a mild to moderate severity which she attributed to the effects of her physical condition, specifically pain and insomnia. This condition has compromised her ability to parent the children in the way that she would like, but she is able to do so at a satisfactory level. It has not prevented her from establishing and pursuing a new career. In addition, Ms Waite expressed anxiety symptoms. In particular, she described having curtailed her level of participation in certain activities due to the extent of her caution at the prospect of causing herself injury and exacerbating her pain. The nature and extent of the anxiety expressed by her were such that the Medical Assessors considered it to represent a manifestation of a psychiatric injury.
2. Having regard for Ms Waite's account of symptomatology, a diagnosis of persistent depressive disorder with anxious distress was made based on the criteria stipulated in

1. Accepting the account presented by Ms Waite, the Medical Assessors concluded that the psychiatric diagnosis made above was caused by the subject accident. No other factors were identified as contributing to the diagnosis.

1. The following injuries WERE caused by the motor accident:
   • Persistent Depressive Disorder with Anxious Distress

1. Permanent impairment is defined in the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) (p 315) as follows:

"Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment.

A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment."

1. Having regard to the chronicity and severity of Ms Waite's condition, the Medical Assessors concluded that the prospect of a substantial change and a change by more than 3% in the next year with or without medical treatment was unlikely. On this basis the Medical Assessors found that the condition had stabilised.

Degree Of Permanent Impairment Psychiatric Impairment Rating Scale

1. The determination as to permanent impairment is made in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Motor Accident Guidelines.

1. Persistent Depressive Disorder with Anxious Distress

Ms Waite attributes diminished engagement in physical exercise to anxiety about the prospect of causing pain. She reported a variable appetite referring to the effects of nausea associated with Brintellix. She spoke of her need for a cleaner to assist with physically onerous household tasks. Her self-care and personal hygiene have deteriorated since the accident. The Medical Assessors found that Ms Waite's psychiatric symptomatology contributed to diminished participation in this area of functioning to a mild degree.

Ms Waite reported a decline in her level of social and recreational participation. She continues to go out however. She spoke of going to the beach and undertaking outings with friends, and continues to have regular social and recreational activities. Her account indicated the role of physical symptoms in limitation with respect to recreational activities. The Medical Assessors identified the influence of diminished motivation and reduced enjoyment as factors leading to a reduction in social and recreational engagement beyond that which could be accounted for by non-psychiatric factors and concluded that the psychiatric injury contributed mild impairment in this area.

Ms Waite reported driving up to an hour after which she requires a break. Based on her account, it is physical factors that limit her ability to travel freely. No psychiatric impairment was identified in this area of functioning.

Ms Waite dated the failure of her marriage to the father of her children in 2021. Notwithstanding the limited account with respect to the time course of Ms Waite's symptoms, the Medical Assessors accepted the likely influence of her symptomatology undermining her relationship. Her account reflected enduring compromise with respect to relationships reflected in her description of poor relationships with her children, the absence of any long-term intimate relationship and the loss of friendships. While she attributed this to her departure from a group chat, the Medical Assessors found that this would not ordinarily represent a sufficient act to cause the demise of previously established relationships. The Medical Assessors considered that she was moderately impaired in this area.

Ms Waite reported reduced concentration, persistence and pace. She can focus on intellectually demanding tasks, working on mortgage paperwork for a couple of hours at a time, which is more than 30 minutes. Ms Waite stated that she works for four to four and half hours before the effects of pain intervene. The Medical Assessors also noted that she is prescribed opioid medications for pain which are expected to undermine concentration, persistence and pace. Notwithstanding Ms Waite's attribution of limitations with respect to sustained concentration to factors of a non-psychiatric nature, the Medical Assessors found that the nature and severity of Ms Waite's psychiatric symptomatology was such that mild impairment would likely be present irrespective of other factors.

The Medical Assessors noted that Ms Waite had changed work roles since the subject accident. She described having established herself in a new career. The Medical Assessors considered the nature of Ms Waite's current role. As a mortgage broker, it is expected that she engages with clients, establishes relationships, interacts with providers and collates financial documents necessary to apply for loans. It is expected that this requires a detailed understanding of the available financial products and their relative benefits. The Medical Assessors concluded that that work of this nature requires a higher level of sophistication and acumen. In addition, Ms Waite engages in the mentoring of colleagues in her industry. Based on Ms Waite's account, the limitations on the number of hours worked is an effect of her physical symptoms. The Medical Assessors concluded that there was no psychiatric impairment in this area and she has adapted to her injuries well.

1. As specified in paragraphs 7.14 and 7.15 of the Guidelines, only those aspects of impairment attributable to psychiatric factors may be considered in the calculation of psychiatric whole person impairment. Namely, impairment arising as a result of pain and physical compromise has been excluded from the assessment of psychiatric whole person impairment.

1. The history presented by Ms Waite supported the impression that a pre-existing adjustment disorder in response to unrelated circumstances and a possible history of postnatal depression. Accepting Ms Waite's account, her pre-existing symptoms had remitted prior to the motor accident. Base on the information contained within the documents and that provided by Ms Waite, the Medical Assessors concluded that there was no pre-existing psychiatric condition, and any prior condition had resolved by the time of the motor vehicle accident.
2. The history presented by Ms Waite did not support the conclusion that there has been any subsequent psychiatric injury.

1. Ms Waite ascribed minimal benefit to the antidepressant medication which she is currently taking. She is not under the care of a psychologist. Based on her account, the effects of Brintellix have not influenced her impairment. On the basis of these factors, the Medical Assessors concluded that no adjustment for the effects of treatment was necessary.

B Pre-existing/subsequent % permanent impairment 0%

1. Permanent impairment ratings take symptoms into account, however the percentage permanent impairment is not a direct measure of disability.

1. The above clinical examination findings and assessment of WPI was assessed by the Panel at the post-examination teleconference. It was collectively agreed by all three Panel members that the findings would be accepted and adopted as part of these reasons.
2. The Panel discussed the surveillance footage and the accompanying investigation reports relied upon by the insurer. It was noted that the footage was raised with the claimant during the examination. The claimant acknowledged the activities depicted including her attendance at the beach. She noted that she does go to the beach relatively often and will swim, however, was anxious about going into the waves.
3. Overall, the Panel was of the opinion that the surveillance was of limited to nil significance. The activities depicted were not generally inconsistent with the claimant's history and the documentation, from a psychological perspective.
4. It was discussed by the Panel that overall, the Medical Assessors formed the conclusion that the claimant's psychological presentation and complaints were genuine.

1. The findings of the Panel as to WPI differ from that Medical Assessor Nagesh. Accordingly, the certificate of 7 June 2023 is revoked, and a new certificate is provided at the beginning of these reasons.