Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017

1. revokes the certificate of Medical Assessor Gerald Chew dated 12 April 2024;
2. certifies that the following injuries caused by the motor accident give rise to a permanent impairment of 7% and is not greater than 10%:
   • persistent depressive disorder
   • somatic symptom disorder;
3. certifies that the following treatment and care:
   • Sertraline and Diazepam, and
   • 12 weeks of fortnightly cleaning assistance

relates to the injury caused by the motor accident;

1. certifies the following treatment and care:
   • Valerian

does not relate to the injury caused by the motor accident;

1. certifies that the following treatment and care:
   • Sertraline and Diazepam;
   • 12 weeks of fortnightly cleaning assistance, and
   • Valerian

is not reasonable and necessary in the circumstances.

1. Ms Taghreed Al-Obaidi (the claimant) alleges injury from a motor accident occurring on

6 March 2021. 2. She subsequently lodged a claim under the Motor Accident Injuries Act 2017 (MAI Act) upon Allianz Australia Insurance Limited (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 MAI Act. 4. A dispute has arisen between the parties as to whether a psychological injury caused by the accident gives rise to a whole person impairment (WPI) greater than 10%. 5. A further dispute remains as to whether certain treatment is causally related to the motor accident and is reasonable and necessary. 6. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor. 7. The dispute about whether the injury caused by the motor accident gives rise to a WPI of greater than 10% is a medical dispute and whether treatment is causally related to the motor accident and is reasonable and necessary are medical disputes, as defined by s 7.17 of the MAI Act, and is a medical assessment matter: schedule 2, cl 2of the MAI Act. 8. The threshold injury dispute was originally determined by Medical Assessor Chew who issued a certificate dated 12 April 2024, which certified the claimant as suffering a persistent depressive disorder, giving rise to a WPI of 6% which is not greater than 10%. 9. He further found that the following treatment and case related to the motor accident: * Sertraline and Diazepam, and * 12 weeks of fortnightly cleaning assistance. 10. That the following treatment and care did not relate to the motor accident: * Valerian. 11. In addition, he found that the above was not reasonable and necessary in the circumstances.

1. The claimant sought a review of the medical assessment of Medical Assessor Chew in accordance with s 7.26 of the MAI Act. On 14 June 2024 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. Section 7.26(5A) of the MAI Act provides that a Review Panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
3. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act.
4. Rules 127 and 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (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 Panel met via video conference on 3 June 2025 and determined that a

re-examination of the claimant was required. A medical examination was arranged to take place on 13 August 2025 with Medical Assessors Singh and Canaris via MS Teams. 6. The Panel reconvened via video link for a teleconference on 27 August 2025.

1. Medical Assessor Gerald Chew examined the claimant on 8 April 2024. In his certificate dated 8 April 2024 the Medical Assessor found a 6% WPI due to a persistent depressive disorder caused by the motor accident.
2. He also found that treatment of Sertraline and Diazepam and 12 weeks of fortnightly cleaning assistance relates to the injury caused by the accident and the treatment of Valerian was not related to the injury caused by the motor accident. He found that the treatment was not reasonable and necessary.
3. The Medical Assessor found that the main current problem was lower back pain. He noted a history that the claimant was employed full time as a registered nurse at Liverpool Medical Centre and had resigned around four to five weeks prior from Cecil Hills Medical Centre.
4. He assessed a class 2 impairment for self-care and personal hygiene, a class 3 impairment for social and recreational activities and social functioning. A class 2 impairment was assessed for travel. A class 1 impairment was found for concentration, persistence and pace as well as adaptation.
5. The Medical Assessor found that Valerian has no significant evidence base for treatment of psychological injury and is not causally related. Sertraline was noted to be indicated for the injury, however is not reasonable and necessary as it has been trialled with little effect and is now taking Pristiq which should not be taken with Sertraline.
6. In respect of Diazepam it was noted to be causally related however, should only be used in the short term and is not reasonable and necessary given the chronicity of her condition.
7. Cleaning assistance was found to be related to functional impairment caused by the psychological injury, however, was not reasonable and necessary given that she can function at work on a full-time basis.

Claimant's review submissions dated 14 May 2024

1. The claimant submits that the findings of Medical Assessor Chew in respect of the psychiatric impairment rating scale (PIRS) categories is not consistent with the evidence and is not compliant with the assessment criteria set out in the AMA 4 Guides and the Guidelines. It is submitted that the Medical Assessor failed to take an adequately detailed pre- and post-accident history of symptoms from the claimant.
2. It is submitted that a "primary example" is the Medical Assessor "...not taking anything close to an adequate history is the fact that he failed to ask and to properly record that the claimant was no longer working at the time of the subject assessment."
3. It is submitted that in respect of "self-care and personal hygiene" a class 3 impairment ought to have been assessed given that she showers once a week prompted by her husband and struggles with energy and motivation. In addition, her husband had taken over the performance of chores and childcare duties.
4. In respect of concentration, persistence and pace it is submitted that a class 2 impairment ought to have been found, noting that the claimant was not in fact working at the time of the assessment and she struggled with concentration and her work performance had declined.
5. In respect of adaptation, it is submitted that the Medical Assessor recorded an incorrect history that the claimant was working.
6. The submissions also suggested that the Medical Assessor failed to put his "inconsistent PIRS assessment findings" to the claimant and therefore failed to afford procedural fairness.

1. The insurer submits that the claimant's submissions regarding the fact the claimant as no longer working was the first they had heard of such situation and there was no information as to why she ceased work. It was noted the claimant had been the subject of a management issue in 2023 with no suggestion this had anything to do with the motor accident.
2. It is submitted that "the claimant's solicitors do not say whether she told Medical Assessor Chew that she had ceased working. If she had and it was a permanent situation, then presumably she would have informed him of that fact." The insurer notes there is no independent evidence to show the claimant had ceased work, and it is noted the Medical Assessor took a history of the claimant driving to work.
3. The insurer submits that if the review is to proceed, the assessment of a class 3 impairment for social and recreational activities is too high on the evidence.

1. The Panel made interim directions requiring the parties to lodge a single bundle of all documents relied upon. The Panel has considered the material within the bundles lodged in compliance with these directions. This includes a bundle lodged by the claimant on

9 May 2025 consisting of 500 pages - "250530-026103" and a bundle lodged by the insurer on 30 May 2025 consisting of 77 pages - "insurer's final review bundle." 2. Whilst not every document has been referenced within these reasons, the certificate and reasons have been prepared in the context of all material having been considered. 3. We have noted the report by Kerry Watson, psychologist, dated 17 August 2024. Throughout the course of counselling, Ms Al-Obaidi has consistently demonstrated significant and increasing psychological symptomatology without any notable resolution which developed following the motor vehicle accident in which she was involved on 6 March 2021. She was of the opinion that Ms Al-Obaidi's demonstrated psychological symptomatology is consistent with a diagnosis of a post-traumatic stress disorder and a major depressive disorder with anxious distress. Ms Al-Obaidi's psychological treatment has incorporated a cognitive behavioural therapeutic approach. 4. A report of Kasim Abaie, psychologist, of 26 April 2021 is noted. The claimant is recorded as suffering severe physical pain and during sessions she displayed symptoms of severe anxiety with panic attacks. It was noted the claimant is suffering from anxiety disorder, anger management problem, learning difficulties and low confidence in addition to post-traumatic stress disorder and sleeping disturbance. 5. We have noted the independent medical examination report by Dr Aman Suman, consultant psychiatrist dated 1 August 2022. He diagnosed a post-traumatic stress disorder with persistent depressive disorder caused by the accident. He felt that the injury had not stabilised at that time. In a further report of 21 March 2024, Dr Suman assessed a 17% WPI as a result of a post-traumatic stress disorder with persistent depressive disorder caused by the motor accident. 6. We have noted the reports by Dr Rajneesh Singh, consultant psychiatrist. In a report dated 23 May 2023 stating that Ms Al-Obaidi has been diagnosed with following mental health conditions, post-traumatic stress disorder, major depressive disorder with anxious distress. In relation to the functional neurological disorder diagnosis, he wrote:

"Please note that the diagnosis of functional neurological disorder was made by neurology team at Bankstown Hospital. Functional neurological disorder is a disorder that has biological, psychological and social risk factors and events that trigger it... In Ms Al-Obaidi's case, the diagnosis of functional neurological disorder (FND) reflects her worsening mixed anxiety depressive illness that she has developed since the time of MVA."

1. In a further report dated 4 December 2023, symptoms were noted to be ongoing and the option of trialling SNRI class of antidepressants was discussed in view of the lack of therapeutic effect with other classes of antidepressant medications. His plan is noted to be:
   • "reduce Zoloft to 100 mg daily for three days & cease;
   • once Zoloft stopped, commence of tab Pristiq - 50mg daily, after breakfast - consider increase dose to 100mg in next two to four weeks;
   • tab Diazepam - 5mg/day PRN for anxiety for short term use over next four to six weeks, and
   • tab Prazosin - 1 mg nocte (monitor BP) as before. "
2. In the most recent report of 4 February 2025 to the claimant's general practitioner (GP), Dr Singh, reports that not a lot had changed with the claimant "continuing stalemate around her work cover issues." She was noted to be continued to remain employed in a nursing job as before but certainly has experienced ongoing negative and anxious ruminations along with evidence of enduring low mood. The claimant is noted to think that her work offered her some level of healthy distraction.
3. Dr Sidrak, GP, in a report dated 14 October 2023 to Ms Watson, notes the claimant as suffering from ongoing depression and could not manage work related stress and may lose her job.

1. This documents the claimant presenting to the hospital with chest pain, dizziness and weakness when driving to the physiotherapist having had a panic attack. The subject motor accident was noted. She was discharged with a recommendation to continue taking regular medications and follow up with her GP in a few days.

1. The claimant's injuries allegedly caused by the motor accident have been the subject of a number of previous medical assessments/certificates through the Commission. The Panel has considered all such certificates. It is noted that a Review Panel on 19 December 2024 revoked a certificate of Medical Assessor Cameron and found a 9% WPI due to soft tissue injuries to the cervical and lumbar spine and a left shoulder injury. It was found that injuries to the arms and foot, hands, knee. legs, right shoulder, wrists and stomach were not caused by the motor accident.
2. We have noted the certificate by Medical Assessor Louis Izzo, dated 14 March 2024. The following treatment and care: Whether the request for reimbursement for IUD, gynaecologist, termination of pregnancy, and associated costs related to the injury caused by the motor vehicle accident, does not relate to the motor vehicle accident. Injuries that

Ms Al-Obaidi complained of, appeared to be very exaggerated considering that it was a minor accident, minimal damage of the car, and no X-ray or other evidence of any trauma. There appears to have been a great deal of distress with depression and anxiety consequent upon the termination of pregnancy. 3. We have noted the medical assessment certificate by Medical Assessor Alan Home dated

7 June 2023. The certificate stated the diagnosis was aggravation of the underlying symptomatic lumbar discopathy with chronic back pain. It further found that a request for reimbursement of ambulance costs on 19 June 2023 did not relate to the injury caused by the motor accident and was not reasonable and necessary in the circumstances. 4. We have noted the review of medical assessment certificate of determination by the medical review panel. The certificate dated 8 April 2025 stated the review panel affirms the certificate of Medical Assessor Izzo dated 14 March 2024. Accordingly, on the basis of the certificate and reasons provided by the review panel in the related review, the Panel is not satisfied, on the balance of probabilities, that the claimant's lumbar spine injury caused by the motor accident is of such a severity that it can be found that the treatment in dispute to be causally related to the motor accident, particularly in light of pre-existing lumbar spine complaints. Further, the Panel finds that the disputed treatment is not reasonable and necessary in the circumstances. The review panel certified the claimant to have suffered soft tissue injuries to the cervical and lumbar spine and a left shoulder injury. 5. The Panel noted the certificate by the Commission's Medical Review Panel dated

19 December 2024. 6. A certificate of Medical Assessor Mason dated 2 September 2024 found that certain psychological treatment was not related to an injury caused by the motor accident and is not reasonable and necessary in the circumstances. Medical Assessor Mason stated

"In my opinion, Ms Al-Obaidi does not have a genuine psychiatric illness as a consequence of the subject motor accident. Because of this, she does not require the prescription of anti-depressant medication Pristiq (desvenlafaxine) and does not require a four-week admission to the anxiety and mood disorder treatment programme at South West Sydney Private Hospital."

1. The following is the clinical examination findings of the Medical Assessors following their examination of the claimant on 13 August 2025.

1. The assessment was conducted by Medical Assessors Christopher Canaris and Himanshu Singh. The assessment was done over a video conference. Ms Al-Obaidi was present at her home and attended the appointment through a MS Teams meeting. The Medical Assessors were present in their respective offices.

1. Ms Al-Obaidi was born in Iraq. She grew up with her parents and three sisters and two brothers. She has a twin sister. Her other sister is three years older to her and has two brothers one is six years older and the other one is nine years older to her. She had a very good childhood. She left Iraq when she was 14 to 15 years of age. She studied in Iraq up until Year 9 or 10. She then moved to Syria and finished Year 12 in Syria and was there for around four years as a refugee. She denied any trauma. She denied negative experience in Iraq and Syria and denied being exposed to a war situation. Her oldest brother lives in Sweden and the other brother lives in Australia. Her twin sister lives in Australia and the oldest sister lives in Sweden. She met her husband in Syria and they got married in Iraq.
2. Ms Al-Obaidi stated a happy childhood. When they moved to Syria they lived in Damascus for four years and she enjoyed her life there. She met her husband in Syria.
3. Ms Al-Obaidi stated that her father was quite older than her mother, and he was often sick and was a heavy drinker. He was on medications and died of heart attack. Her father died when she was 11 to 12 years old. She then grew up with her mother.
4. Ms Al-Obaidi stated that she moved to Australia in 2014. She initially studied language and then did a foundation in nursing and gained entry to the University of Western Sydney. She was accepted into a Bachelor of Nursing degree which started in February 2017 and completed in October - November 2019 and got her AHPRA registration. She started to work at a medical centre in Liverpool in 2020 and worked there more than a year. She stated then the accident happened. After the accident she wanted to change to another medical centre so she moved her job to Cecil Hills Medical Centre from 2021 and was there for almost two years. She stated that there were two other nurses with her, to help her and the work was more manageable. She then started to work at Fairfield Heights in the GP Clinic and worked all through the last year, 2024 in a full-time position. She took a lot of breaks. She stated that she cannot leave work due to the financial reasons. She also at times reduced her hours and days on the advice of her GP, psychologist and psychiatrist.
5. Ms Al-Obaidi denied any previous mental health issues. She did not give a history of consulting a psychologist or a psychiatrist before the motor vehicle accident.
6. Ms Al-Obaidi stated that she has history of back pain in 2015-16 when she saw her GP and had to see a neurologist which did not cause any impairment. She was good and she later travelled to Iraq and Dubai without any issues. She did not have any surgeries and was not taking any regular medication.
7. Ms Al-Obaidi denied any family history of psychiatric illness.
8. Ms Al-Obaidi denied a history of smoking cigarettes. She would drink alcohol very occasionally when she would go out. She denied use of illicit substance use. She had started to vape in the last year.
9. Ms Al-Obaidi stated that her husband joined her in Australia in 2019 though they got married before this and she used to travel to see him to Iraq. She had her first child in 2019. Before her husband joined, she used to live by herself. She managed her studies and worked on her own. She was working and studying. She was initially studying and later working full-time and had an amazing relationship. She was living by herself. She denied any issues with her physical or mental health. She was able to drive freely. She would regularly socialise and go out and see her friends and had a happy life.

1. Ms Al-Obaidi stated that the accident was in March 2021. She could not remember the date of the accident. She stated that she did not want to talk about the accident. On being told by the Panel that it is important to know what happened in the accident, but again it is her choice and her decision as to if she wants to talk about the accident, to which Ms Al-Obaidi stated that she does not want to talk about the accident and it is all mentioned in the documents.
2. We noted from the previous documents and certificates Ms Al-Obaidi was involved in a motor accident on 6 March 2021. She was stationary behind another vehicle waiting for traffic lights to change to turn right when she was hit from behind by a big car a four-wheel drive. She was not pushed into the car in front. The vehicle behind did move off and collided with the rear of her car. This was a low-speed, low impact collision, seat belts were worn but airbags did not deploy. There was no head strike or loss of consciousness. Police and ambulance were not called. She took photos of the other vehicle and other driver's licence. After moving off the road she said she stopped 30 minutes to rest because she was shocked. She then drove home but then 30 minutes later, she developed pain in the lower back and both shoulders. She said the back pain radiated down into her left leg and she developed headaches. She attended her GP, Dr Sidrak, two days later who ordered X-rays and an MRI scan and referred her for physiotherapy. She was also referred to a neurosurgeon Dr Abraszko and consulted with her on three or four occasions. She requested another MRI scan and at the last consultation surgery was suggested. Ms Al-Obaidi said she was too distressed to listen but her husband was with her and was able to follow what she said. She went back to her GP who referred her to another neurosurgeon Dr McKechnie. She said he advised against surgery, in the end she did not undergo surgery.
3. Ms Al-Obaidi said that by the time she had become pregnant and, on the advice of Dr Abraszko, decided to have a termination because she did not believe she would be able to cope with the back pain involved. We questioned Ms Al-Obaidi about the fact that there was no such recommendation in the documents provided by Dr Abraszko. She said she has seen the documents and knows this is the case but nonetheless insisted that she had been advised to have a termination of pregnancy. Her GP referred her to obstetrician Dr Nadir Bakhit who performed the procedure. At this point in the interview Ms Al-Obaidi became extremely distressed and said she felt very guilty about it and continues to be distressed.

History of symptoms and treatment following the motor accident

1. Ms Al-Obaidi stated that she had injuries in the accident and developed low back pain, pain in both the shoulders, both wrists and neck. The pain goes down to her left leg. She also has numbness and heaviness in her legs. She stated, "no one believes I have pain, I am incontinent of urine and have urge incontinence. I lost control of my urine. After the accident I never realised that I had mental issues until my husband told me."
2. Ms Al-Obaidi corroborated that she did not go to the emergency department and went home after the accident. Later, she was in severe pain and saw her GP after two days.
3. Ms Al-Obaidi stated she saw her GP later for her mental health and told her GP that she was not feeling well. She was not engaging and feeling angry. She was having a lot of nightmares which have been less with the medications. She could not remember the nightmares. It was not clear for her. One of them was about the car accident, pregnancy and having birth in the car. She would wake up screaming or crying. The nightmares may or may not be related to the accident. She was very easily agitated. She would feel depressed and go to her room and close her room. She would close the light and stay alone in the room and does not enjoy anything. She would often be anxious and worried about everything and was not the same person as before. She also started to have panic attacks. She was not able to drive, as she would have palpitations, heart pain and restrictions in her movement. She would think that there was something inside her. She did not want to go anywhere. She had thoughts of suicide. She had a plan. She wanted to take all her pills, so she does not have her medications with her now. She did not make any attempt to end her life.
4. Ms Al-Obaidi stated that her husband tried to take her to Kiama once but it was the worst experience. She was anxious and had to often go to the toilet and felt worse after that. She can hear and see the things around her after the accident. She could hear someone talking to her or calling her and she would go and ask about if they were calling her name which was not the case. She also had panic attack in the doctor's room where she saw someone in the room. Following the panic attack, she was checked at the practice and then her ECG and blood pressure were fine. She was unable to sit and she could not feel her legs. She tried to get off the bed and fell. The doctor said that she needed to go to the hospital but she phoned her twin sister who came and put her in the car and took her to see her GP, Dr Sidrak. He was shocked, called an ambulance and arranged for her to go to Bankstown Hospital. She did not know what happened but confirmed that she did recover over four days at Bankstown Hospital with only physiotherapy. She attributed the event to panic attacks and stated that the neurologist said it has a psychological basis.
5. Ms Al-Obaidi was working after the accident at the medical centre as a registered nurse. She stopped driving for few months. The medical centre was close by and her husband used to pick her up and drop her off. She would go with her husband if she was going anywhere else as well. She later started to drive once she received psychological therapy from her psychologist Kerry Watson.
6. Ms Al-Obaidi stated that she continued to feel depressed and was unable to enjoy anything. She also stopped reading and would not go out. The relationship with her husband became quite strained and she started to feel frustrated and irritated all the time. Her mother was involved at one point where she was helping her with cooking and cleaning and her sister would also help her with housework and cooking. She started to drive around six to seven months after the accident with the help of her husband and her psychologist. She would mostly drive in the local area.
7. Ms Al-Obaidi continued treatment under the care of her GP and was referred to psychologist Kerry Watson. She would mostly use her mental health care plan and would see her every two to three weeks. She was referred to psychiatrist Dr Rajneesh Singh and saw him every two to three months. Her psychiatrist wanted her to get her admitted to the hospital but it was declined by the insurance company. Her medications were also changed.

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

1. Ms Al-Obaidi denied any relevant injuries or conditions sustained since the motor accident.

1. Ms Al-Obaidi stated that she took Diazepam today before the appointment to help her with her anxiety. She is in pain all the time. The pain goes everywhere in her body. She reported numbness and heaviness and burning sensation. She often has to take breaks. She needs to stand up or sit down or change her posture to the right or left. She needs help in the shower as she cannot reach her legs.
2. On being asked about her symptoms if she was not in pain, she stated, "I do not know how I will function if I was without pain."
3. Ms Al-Obaidi stated that she takes Olanzapine 2.5mg on alternate days as it makes her tired. It does help her to sleep and she may sleep for six to seven hours and wakes up mostly by

7.00 - 7.30 in the morning. Her appetite is also low. If she will remember, then she will eat once a day and she may feel sick and vomit. Her weight has increased she does not know why and has gained around 10kg since the accident. On some days, she may not eat the whole day. She does not feel hungry and forgets to eat. She may drink water. She does not enjoy anything. She moved to Tasmania and people say it is beautiful, but nothing looks beautiful to her. 4. Ms Al-Obaidi stated that she has stress incontinence and urge incontinence and she is always wearing pads. She also got assessed for her incontinence and got a WPI rating. She has been told she had a urinary tract infection and has taken antibiotics for it. She is in constant feeling of anxiety. She feels aggression at times and cannot handle the stress. 5. Ms Al-Obaidi stated that she continues to feel low and has low motivation and energy. She is currently working. She is employed full-time but she will take days off. She is not able to do any housework. She will spend time with her daughter but does not do much and her husband will do most of the things. She will sit next to her and watch her play. She does not give her daughter food or shower her. She will give her water or juice when she asks. She may sit with her daughter when she studies. 6. Ms Al-Obaidi stated that she moved to Tasmania to live with her husband. She moved around three to four months ago. Her husband used to work in security, and he is now a GP at a medical centre. They had separated at one point and were living separately. She did not have a sexual relationship with her husband for more than one and a half years. While they were living in Liverpool, they were in the same house but they had separated for almost eight months and by the end of last year, they moved to different houses. She moved out to live at her mum's house and left her daughter to stay with her husband as she is quite close to her father. Since moving to Tasmania, they are living in the same house but they live in different rooms. She was at her mum's house from roughly October-November 2024 until April 2025. Her GP Dr Sidrak advised her to go with the family and to work full-time as a trial period to help with her mental health. Her husband is currently a GP at a medical centre in Tasmania and she is a registered nurse in a full-time contract at the same centre.

1. Ms Al-Obaidi continues to receive treatment under the care of her GP, psychologist and psychiatrist. She has psychology sessions with Ms Watson under the mental health care plan every two to four weeks. The psychologist bulk bills her, and Allianz does not pay for it. She also sees psychiatrist Dr Rajneesh Singh every six to eight weeks now online and that is also not supported by the insurance company, and her psychiatrist will bulk bill her. She continues to take following medications:

(a) Pristiq 200 mg;

(b) Lamotrigine 25 mg;

(c) Hiprex and Oxybutynin 5mg twice a day for incontinence;

(d) Minipress 1mg for nightmares;

(e) Panadeine Forte for pain;

(f) Diazepam for panic attack;

(g) Gaviscon;

(h) Voltaren gel;

(i) Stemetil, and

(j) Olanzapine 2.5mg every alternate day and that helps her to sleep.

1. Ms Al-Obaidi was seen over a video conference. She attended the appointment on her own. She was dressed appropriately and well-presented. She was identified from her Tasmanian driver licence. There were no signs of agitation or retardation. She had a spontaneous speech with normal rate, tone and volume. She described her mood as low and anxious. Her affect was reactive and she was teary at times when talking about the accident. She had full range of emotions which were appropriate to the situation. She would cry talking about the accident and about her inability to function. She reported nightmares but was not able to remember them. She did not describe any grandiosity, racing thoughts or increased energy levels. She denied having any active or passive suicidal thoughts, intents or plans and there were no thoughts, intents or plans of harming others. There was no evidence of formal thought disorder, no delusional pattern of thinking and no perceptual abnormalities. She was orientated to time, place and person and there was no cognitive dysfunction. She struggled with recall and was only able to recall two or three words and was not able to do serial subtractions after two steps. Her judgement was intact though she appeared to have limited insight into her issues

1. The Medical Assessors noted the seeming inconsistency in her report of showering twice a week and working every day pointing out that she would need to have acceptable self-care and hygiene to be working. She insisted that she had provided us with an accurate history of her functioning. The Medical Assessors also noted that her vulnerable background of losing her father at the age of 11 and then going as a refugee to Syria due to the threat of her life in a high traumatic environment pointing out that all this could have had an adverse impact on her. She again insisted that this had not impacted on her mental health.
2. The Medical Assessors raised the issue of her previous work situation as Medical Assessor Chew had apparently failed to note that she was in fact not working. She responded saying that she was not working at the time of examination by Medical Assessor Gerald Chew for a period of four to six weeks but that her employers paid her. She then changed her job from Cecil Hills Medical Centre to Fairfield Heights GP clinic in April 2024. She said that did not work for that period of around four to six weeks however she was working most of the last year but would take days off often from work.
3. The Medical Assessors also noted the inconsistency between her report of her concentration, persistence and pace in that she stated she cannot reply to emails and her husband or her sister will write for her. She cannot do her CPD and her husband will help her or will do on her behalf which was inconsistent with her ability to work as a registered nurse in a medical centre. She responded by denying that she had had denied any issues or limitations in her work at the medical centre or in her previous role and denied any notification to the nursing board. The Medical Assessors also noted the inconsistency between her performance on simple test of memory and concentration and her capacity to work full-time albeit with days off and making mistakes at work again, when this was put to her, she contended that she had accurately represented her difficulties and limitations with concentration.

1. Ms Al-Obaidi is currently living with her husband and her daughter working as registered nurse at a medical centre. She was involved in a motor accident on 6 March 2021. It was a minor motor accident in which her vehicle was rear-ended while stationary. She was not pushed into the vehicle in front. She did not require to go to the emergency department and there were no police or ambulance in attendance. She drove home from the site of accident. She developed pain symptoms following the accident for which she has received treatment in the form of medications and physiotherapy. Ms Al-Obaidi continues to present with symptoms which meet the DSM-5-TR criteria of a persistent depressive disorder and somatoform pain disorder. Ms Al-Obaidi meets the criteria of persistent depressive disorder as per the DSM-5-TR:

(a) she represented with depressed mood for most of the day for more than days than not for at least two years;

(b) she presented with following symptoms, poor appetite, insomnia, low energy, poor concentration and feelings of hopelessness while being depressed;

(c) during the two-year period, she never been without symptoms in criteria A and B for more than two months at a time;

(d) while criteria for major depressive disorder may be continuously present, this is not essential to the diagnosis;

(e) there has never been a manic or hypomanic episode and she has never met criteria for cyclothymic disorder;

(f) the disturbance is not better explained by psychotic disorder;

(g) the symptoms are not attributable to physiological effects of a substance or another medical condition, and

(h) the symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

1. She presented with somatic symptom disorder with predominant pain as per the DSM-5-TR as:

1. one or more somatic symptoms, in her case pain, that are distressing or result in significant disruption of daily life; 2. excessive thoughts, feelings or behaviours related to pain symptoms or associated health concerns due to disproportionate and persistent thought about seriousness of her symptoms, persistently high level of anxiety about health symptoms and excessive time and energy devoted to these symptoms or health concerns, and

1. the state of being symptomatic is persistent and has been more than six months with predominant pain.

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) (AMA 4 Guides).and Part 6 of the Motor Accident Guidelines.

2. Somatic symptom disorder with predominant pain (not assessable for whole person impairment)

Ms Al-Obaidi showers around twice per week. She changes clean clothes daily. She tried to make a tea but she burned herself. She forgets to turn off the gas. She is not cooking. Her husband will cook or her sister going to come to help her to cook. She used to cook before. She is not vacuuming and not cleaning the house. She does not have a motivation and no energy and feel tired and exhausted and just sits in the room. She is not good with her self-care and her husband will complain about it.

The Panel noted that there is inconsistency on her account and her ability to work daily with the amount of dysfunction she reported in her self-care while noting her response when this inconsistency was pointed out to her. The Panel was of the opinion that she will be able to live independently and look after herself adequately though may look unkempt occasionally.

The Panel excluded limitations attributable to pain which are not assessable for whole person impairment.

Ms Al-Obaidi stated she does not have many friends in Tasmania. She does not go out to see her friends. She did not use to go to see her friends and would not speak to them even while she was in Sydney. She does not go to school events of her children.

Her husband will drive her daughter to school. She has cut off all her friends. Her husband has friends here in Tasmania and invited her but she did not go. She will make excuses not to go out. She went to her husband's nephew's wedding once and was there for an hour and left. She has been mostly staying at home.

Ms Al-Obaidi stated that she has been driving. she drives only locally about 8 to 10 minutes. She can drive by herself if it is not busy. She has not been on any holidays. The only holiday she had when her husband tried to take her to Kiama but it did not go well. She has not been on any overseas travels since the accident, and she came to Tasmania to stay with her husband.

Ms Al-Obaidi stated that her relationship is not good. She is dependent on her husband and earlier on her mother. She is not intimate with her husband and they are living in separate rooms and they had separated for a while last year up until now when she moved to Tasmania. She denied any periods of domestic violence.

Ms Al-Obaidi stated that she is not good with focus.

She could not write emails, and her husband will help her or assist her. She cannot do her CPD. Her husband will assist her on behalf of her and open her login and will do the webinar instead of her to meet her basic CPD requirements. At work as well she tends to make mistakes and often forgets things. She does not watch TV at all. When asked to do the serial sevens test, she started with 100 then 93 then started to make mistakes.

She could only recall two out of three words. She was not able to do simple calculations like 22 - 15.

The Panel considered her apparent impairment in this category as incompatible with being able to work as a nurse in a medical centre even if reportedly making mistakes and having days off while noting her response when this inconsistency was put to her. It concluded that there was evidence of symptom amplification. Using clinical judgement, it rated her as Class 2.

Ms Al-Obaidi is currently working in a new medical centre in Tasmania after she moved. She forgets a lot. She has to have stickers around her to help her remember tasks. She may forget to take the blood pressure and just gives injections when asked by the doctor. She is not allowed to give vaccines unless the doctors are around and have checked her.

She has not made any serious mistakes so far causing any serious incident or harm to the patient. There has been no AHPRA complaint. She will often check her schedule to make sure that she does not get too overwhelmed with work. She was working last year apart from a month when she changed her job but would take days off.

The Panel is of the opinion that she is able to work full-time but in a different environment from that of pre-injury job requiring comparable skills and intellect as those of the pre-injury job. She is working as a registered nurse.

1. There is no pre-existing impairment or subsequent impairment, hence no apportionment is made.

Psychiatric Impairment Rating Scale - Pre-existing/subsequent impairment

1. There is no significant effect from the treatment received so far hence no apportionment is made for the effects of treatment.

1. Degree of permanent impairment caused by the motor accident is 7%.
2. Permanent impairment ratings take symptoms into account, however the percentage permanent impairment is not a direct measure of disability.

1. The Panel discussed the above clinical examination findings at the preliminary conference of 27 August 2025, along with the documentary evidence, and it was collectively agreed by all Panel members that the clinical examination findings would be adopted as part of these reasons.

1. There is a direct temporal relationship to the accident and onset of the psychological symptoms. Her ongoing pain from the accident has maintained her psychological distress and pain symptoms. She attributes her pain to the accident and the injuries as per has sustained in the accident. Her symptoms have been ongoing and are directly and temporarily related to the motor accident. Her symptoms have continued despite her receiving treatment from a GP, psychologist and psychiatrist. She has received sufficient psychological sessions and has been on combination of various psychotropic medications.
2. Ms Al-Obaidi does not present with post-traumatic stress disorder. She does not meet Criterion A of post-traumatic stress disorder as she was not exposed to actual or threatened death or serious injury in the accident. It was a minor collision which did not require attendance by police or ambulance and did not require her to attend the emergency department immediately. The symptoms of trauma experienced by her such as nightmares, repeated thoughts about the accident and the initial avoidance of driving could be explained by the ongoing depressive disorder which has resulted following the accident.
3. The following injuries were caused by the motor accident:
   • persistent depressive disorder, and
   • somatic symptom disorder.

1. The Panel noted that there were no submissions in relation to Medical Assessor Chew's findings in relation to treatment and care. It finds, however, that Valerian does not have a significant evidence base for treatment of her psychological injury and is therefore not causally related. The Panel finds that Sertraline was indicated for treatment for the claimant's psychiatric injury and therefore causally related. It agreed also that Diazepam was causally related, as was cleaning assistance.

1. The Panel finds that Sertraline was not reasonable and necessary as the claimant had trialled this with little effect and was now on Pristiq (desvenlafaxine) and that the two drugs should not ordinarily be taken together. It agreed also that Diazepam was indicated only for short term use and was not reasonable and necessary for treatment of a chronic condition. Similarly, cleaning assistance was not considered reasonable and necessary given the Panel's assessment of mild impairment in self-care and personal hygiene.

1. The Panel's findings on diagnosis and the percentage assessment of WPI differs from that of Medical Assessor Chew. Accordingly, the original medical certificate is revoked and a new certificate is provided at the beginning of these reasons.