Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Panel revokes the certificate of Medical Assessor Shen dated16 July 2024.
2. The Panel had diagnosed the claimant as having a Somatic Symptom Disorder.
3. The Panel has assessed the claimant as having 0% whole person impairment.

1. This is an application by the claimant for a review of a certificate and reasons of Medical Assessor Shen (the Medical Assessor) dated 16 July 2024.
2. The Medical Assessor assessed the claimant as having an Adjustment Disorder with anxiety and depressed mood which was caused by the motor accident and giving rise to a whole permanent impairment (WPI) of 5%.
3. This is a dispute between the claimant and the insurer about the degree of permanent impairment under Schedule 2, s 2(a) of the Act.
4. The following injuries were referred by the Personal Injury Commission (the Commission) for assessment:

(a) Psychological condition - psychological injury.

1. The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
2. The fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned - see WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46].The Panel is not required to "analyse every piece of information from every opinion contained in a document with which he [it] was provided" - see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel has come to its own conclusion and has taken its own history.
3. The Panel notes the High Court judgment in Gamestar Pty Ltd v Lockhart [1993] HCA 79. The Court observed in the absence of submissions referring to specific documents that a tribunal is not required to search for references within documents where the submissions do not specifically address the materials. The Panel also notes the comments of Bellew J in Bevan v Bingham [2023] NSWSC 19 concerning the obligation of legal practitioners to place only the necessary evidence before the decision-maker.

1. The accident occurred on 5 June 2020.
2. The claimant was a pedestrian in a car park. Initially he was an occupant of a car in the car park. Occupants of another car entered into an argument with the car in which the claimant was an occupant. The claimant exited his car and the driver of the other car reversed into him.
3. As a result of the collision, the claimant suffered a fracture of the right tibia. He was taken to hospital where he underwent surgery with internal fixation. He was discharged from hospital on 9 June 2020. The claimant's fixation was removed on 24 February 2021.

1. Prior to the subject accident, the claimant was involved in a motor vehicle accident on 8 December 2019, which led to him suffering a traumatic brain injury. This consisted of right frontal and frontotemporal subarachnoid haemorrhages, left parieto-occipital extradural haemorrhage and subdural haematoma overlying the right antero-lateral frontotemporal lobe and lateral right temporal lobe, as well as pneumocephalus of the left and midline posterior fossa, sella turcica and bilateral parasellar region, extensive calvarial and base of skull fractures.
2. Following the accident that occurred on 8 December 2019, the claimant returned to his studies at Western Sydney University.
3. The claimant was subsequently cleared to drive and has obtained his provisional driver's licence.

1. The claimant says the Medical Assessor fell into error for the following reasons:

(a) the Medical Assessor ignored and/or did not engage with relevant evidence;

(b) the Medical Assessor made wrong findings of fact in material respects;

(c) the Medical Assessor failed to provide any or any adequate reasons for various opinions which were integral to his ultimate finding that the claimant's whole person impairment exceeded 10%, and

(d) the Medical Assessor failed to properly apply the Psychiatric Impairment Rating Scales (PIRS) scale.

1. When considering the PIRS classifications, the Medical Assessor made the following assessments and classifications:

1. This gave rise to a WPI of 7%.
2. The Medical Assessor assessed the claimant's pre-existing impairment and made the following classifications:

1. This gave rise to a 2% WPI which was deducted from the assessment of 7% and leaving the claimant with a final WPI assessment of 5%.
2. Regarding the Social and Recreational Activities assessment, the claimant submits that the Medical Assessor erred in finding a mild impairment class 2. The claimant submits that the appropriate finding ought to have been moderate impairment, class 3.
3. The claimant submits that if he had been correctly assessed as class 3 moderate impairment for social and recreational activities, the list classes in ascending order would have been: 1, 2, 2, 3, 3, 4, which would give a medium class value of 2.5, rounded up to 3. The aggregate score would have been 15, which would then have given rise to a 15% WPI pursuant to Table 7.7. Deducting the pre-existing 2% WPI would then give a total of 13% WPI arising out of the subject accident.
4. Additionally, with the classification of Adaptation, the claimant submits that the Medical Assessor erred in finding severe impairment class 4 in category 6. The claimant submits the appropriate finding ought to have been total impairment class 5.
5. The claimant submits the Medical Assessor failed to consider and/or address evidence in the material before him and that such evidence is inconsistent with his opinion and ultimate assessment of whole person impairment.
6. In particular the claimant submits the Medical Assessor failed to engage with the claimant's statement dated 18 May 2023.
7. It is submitted that it was incumbent upon the Medical Assessor to properly engage with direct evidence of the claimant including his statement and explore this during the examination particularly where there are clear inconsistencies between the evidence in the claimant's statement and what is reported in the certificate issued to the parties.
8. It is submitted that had the Medical Assessor properly engaged with such material, that process would have been capable of causing a material difference to the eventual outcome based on the Medical Assessor's utilisation of the PIRS scale.
9. The claimant refers to his statement dated 8 May 2023. There it was noted that the claimant had intentions on returning to the workforce, prior to his accident. He also mentioned that he had not been able to return to any type of work due to his ongoing pain and restrictions. The claimant also referred to attempting to return to his studies. However, he said that due to the injuries he sustained and ongoing restrictions he could not attend class.
10. The claimant submits that noting that he provided a history of not being able to work, or continue his studies to completion following his accident, then he ought to have been categorised as class 5 - totally impaired.

1. The insurer submitted that a consistent thread through the Medical Assessor's certificate was the inconsistency of the claimant with regard to downplaying his pre-existing symptoms. The insurer says this is largely due to the effects of his traumatic brain injury sustained in a prior accident.
2. The insurer submits that the Medical Assessor determined the claimant's recount to be incongruous with the treating and medico-legal evidence before him, and, as a result, the Medical Assessor placed more weight on this evidence than on that of the claimant's subjective retelling.
3. Concerning the assessment for Social and Recreational Activities, the insurer referred to the claimant's submission that the Medical Assessor erred in finding a class 2, mild impairment. The insurer noted reference to the claimant's statement to the Medical Assessor that he rarely went out or saw friends and the claimant's contention that this should have seen him rendered him as class 3, "moderately impaired".
4. The insurer submits that as per the requirement of cl 6.14 of the Motor Accident Guidelines (the Guidelines), the Medical Assessor correctly questioned the veracity of the claimant's history where it was inconsistent with the documentary evidence before him.
5. The insurer says that the Medical Assessor recorded that the claimant still has regular outings with his family. He also noted that while the claimant rarely goes out with his friends, this is "partly due to their own busy life schedules unrelated to the injury."
6. The insurer submits this history as recorded by the Medical Assessor, particularly in light of the noted inconsistencies, is consistent with the Guidelines' description of a class 2 impairment.
7. The insurer refers to the Medical Assessors assessment of impairment related to adaptation as follows (Certificate pgs 12-13).

"He said he was studying normally, and I raised a reference from his records that he was doing part time studies. I asked if he was able to continue studying, and he said he was not able to persist with his studies after the leg injury. I asked why the letters from his treating doctor suggested he was studying up until January 2022, and he said that this was not the case.

Since the subject accident, he has not been able to work."

1. The insurer submits that the claimant's account was directly inconsistent with the treating evidence before the Medical Assessor. The insurer says that the Medical Assessor acted in accordance with cl 6.41 of the Guidelines by bringing the inconsistencies to the attention of the claimant during examination.
2. The insurer says that the claimant repeatedly made statements which contradicted the objective findings of multiple treating providers. The insurer submits the Medical Assessor was entitled to weigh up the apparent inconsistencies and use his clinical expertise to make a judgement as to their veracity.
3. The insurer noted that the claimant submitted that the statement dated 18 May 2023 contained information to the effect that the claimant had not returned to work since the accident and had been unable to attend class due to his injuries.
4. The insurer submits that the Medical Assessor clearly referred to and evaluated the objective evidence upon which he relied. In relation to adaptation, the insurer says that the Medical Assessor summarised the relevant reports as follows:

(a) "He has a compensation claim for the subject accident and no intention of working at this stage" - Letter of Dr Martens dated 11 September 2020;

(b) "He has finished semester one and has passed with no significant issues...He is not interested in working part-time, and would rather focus on his studies." - Letter of Dr Lam dated 3 June 2021;

(c) "He has commenced business studies and completed one semester, though he has dropped one subject. He intends to resume studies at full-time capacity." - Letter from Stephanie Lam , rehabilitation physician, dated 18 January 2022, and

(d) "...adaptation was moderately impaired" - Report of Dr Anderson dated 11 May 2023.

1. The insurer says that the Medical Assessor found the claimant sustained a class 4, severe impairment in relation to adaptation. The insurer submits that was a fair and correct assessment based on the history obtained from the claimant and that which was ascertained from review of the objective evidence before the Medical Assessor.

1. The claimant has submitted a statement of 8 May 2023.
2. The claimant said that following his accident in 2019 he continued to experience some hearing loss at high level frequencies and residual left cranial nerve VII palsy. He no longer experiences any urinary issues or coccyx pain.
3. This statement goes predominantly to the claimant's physical injuries and his economic loss.

1. The Medical Assessor provided a certificate, and reasons dated 15 July 2024.
2. The claimant denied drinking alcohol and said that he rarely used cannabis, though he would not mind being prescribed with medicinal cannabis. The claimant was reported to have repeatedly asked the Medical Assessor, during the course of the assessment, to prescribe medicinal cannabis.
3. The Medical Assessor reported that the claimant appeared to have understated his level of substance use. It was said that his responses were contradicted by the ambulance medical records, hospital records, neuropsychological reports, and his preoccupation with being prescribed medicinal cannabis in the assessment. The Medical Assessor said the claimant likely had a substance use disorder, which included cannabis, and may include opiates and benzodiazepines. The Medical Assessor said that it was unclear if this had remitted, though it more than likely contributed to his behaviours and cognitive disturbances.
4. The Medical Assessor said that the claimant provided a history of limited cognitive impairment from the pre-existing head injury, and attributed significant impairment to his concentration and memory to the subject accident. However he said that this was contradicted by the neuropsychological assessment, which clearly attributed significant impairment to the head injury and a possibility of pre-existing attentional weakness and contribution from substance use. The Medical Assessor said that this was a more plausible explanation of his current impairment.
5. While the claimant had said that he has developed significant psychological distress from the subject accident, the Medical Assessor said that this was contradicted by his mother on several occasions stating that his emotional state has returned to baseline, and this has been noted by his rehabilitation consultant on several occasions.
6. The Medical Assessor also noted that the claimant had claimed a limited ability to drive, and yet he had gone through significant lengths in order to be able to drive, including attending the neuropsychological assessment, undertaking multiple driving lessons with special driving instructors, and an occupational therapist driving assessment. The Medical Assessor said that this is not consistent with someone unable to, or restricted in capacity to drive. Furthermore, the main concern regarding his driving capacity was related to the pre-existing impairment. On this basis, the Medical Assessor said that it seemed the claimant may have understated his capacity to drive.
7. Regarding a diagnosis, the Medical Assessor concluded:

"I am not terribly convinced of a psychiatric injury from the subject accident, though I appreciate the severity of his injuries from the subject accident would otherwise likely meet criterion A for a PTSD diagnosis, though it is plausible that his intoxicated state may have prevented him developing this at the time. At most, he may have developed an adjustment disorder, due to emotional distress arising from the subject accident, though his distress appeared to have abated over time, and with some overshadowing from the emotional disturbances and impairment from the pre-existing injury.

He has a major neurocognitive disorder, from traumatic brain injury, un-related to the subject accident, evidenced by his cognitive impairment, as well as associated functional deficits with regards to his capacity to return to study or other social roles.

He has a pre-existing Substance use disorder, which has likely persisted".

1. The Medical Assessor diagnosed the claimant has having an Adjustment Disorder.

1. The Medical Assessor's PIRS assessment was as follows:

Since the subject accident, he said he is showering every day as he is not a grub, though he sometimes requires assistance from his mother on account of the pain and

As he can still self-care, with some reduction of his independence due to his physical injuries, which are not assessed in the PIRS, he has minor impairment.

Since the subject accident, he said he has friends, but they have moved on with their life. He said he rarely talks to friends and rarely goes out much.

Since the subject accident, he said he would go out to his sister's place, or grandmother's place, and go for movies sometimes.

As he is rarely going out with friends, but has regular outings with his family, he has mild impairment.

He said he is driving a little bit, and he said he can drive alone. He has invested significant effort in obtaining his driving licence.

Since the subject accident, he said his relationship with his family has been good, and they assist him a lot, including with his shower as his legs can become numb and painful.

Since the subject accident, he said he has friends, but they have moved on with their life. He said he rarely talks to friends and rarely goes out much.

As he has maintained a good relationship with his family, and has been more distant from friends, though partly due to their own busy life schedules unrelated to the injury, he has mild impairment.

Since the subject accident, he said his concentration has been poor, and he struggles to read anything.

He was alert, appeared grossly cognitively intact, though easily distractible throughout the assessment.

He had been able to study part-time in a Business Course after the subject accident, up to a year afterwards.

I note that he has been able to sustain his focus on driving safely under the supervision of several driving instructors and an OT.

He said he had enrolled in business at university, and he said he would attend university for his units until it was disrupted by COVID. He said he was studying normally, and I raised a reference from his records that he was doing part-

time studies. I asked if he was able to continue studying, and he said he was not able to persist with his studies after the leg injury. I asked why the letters from his treating doctor suggested he was studying up until January 2022, and he said that this was not the case.

Since the subject accident, he has not been able to work. He said has deferred his studies, though he was not able to tell me when.

He had been able to study part-time in a business course.

1. The claimant's pre-existing impairment was assessed as follows:

Evidence of significant impairment from his pre-existing head injury

He was able to study part-time in Business, after a deferment. He had not returned to work.

1. Deducting 2% pre-existing impairment from the post-accident impairment assessment of 7% gave the claimant a total 5% WPI.
2. An assessment of the claimant's need for psychological services following his trail bike accident on 8 December 2019 was prepared by Ms Leahy dated 19 October 2020. It is in part illegible or difficult to read.
3. Ms Leahy reported amongst other things that the claimant was "often preoccupied with taking about drugs. He also asked me to prescribe him medication such as Valium. When I explained this was not possible as I was not a medical practitioner, he told me he thought I could if I wanted to, but I did not want to do it for him. This presentation suggested some possible personality disorder features but due to lack of engagement, this was not able to be explored further."
4. In her report of 18 May 2020, Ms Leahy said that the claimant was in great need of support for various psychological problems. The accident of 8 December 2019 had serious impacts affecting his mood, and daily functioning. Ms Leahy reported that the claimant appeared paranoid, anxious and reported that he was tripping out, with some thought disturbances. Ms Leahy appears to be in practice with Dr Gertler and whose clinical notes have been seen by the Panel.
5. Dr Anderson provided a report and WPI assessment for the claimant. He assessed 17% WPI and concluded that the claimant had:

(a) Chronic Post-traumatic Stress Disorder, and

(b) Substance Use Disorder in remission (predominantly opiate)

1. Dr Anderson assessed 0% WPI for his pre-existing disability.
2. Regarding the claimant's motor bike accident**,** medical records indicated a Glasgow coma score of 10-13, LOC for 10 minutes, and post-traumatic amnesia duration of 23 days.
3. A neuropsychological report of Ms Massey, clinical neuropsychologist, of 12 August 2020 reported:

"While difficulties in attention and working memory, information processing speed, memory, and executive functions may be consistent with the severity and nature of the TBI Mr Ali sustained in December last year and his report of ongoing cognitive difficulties, broad reductions across intellectual domains and visuospatial areas are somewhat unusual, raising the possibility of additional factors impacting Mr Ali's results.

Firstly, the attentional and behavioural difficulties during his childhood reported by Mr Ali and his mother, as well as his current behavioural presentation, raises the possibility of a pre-existing attentional disorder. Secondly, Mr Ali's preinjury cannabis (and possibly alcohol) use, may have also contributed to his results. Regular cannabis use during adolescence can have significant effects on intellectual functioning, specific cognitive domains, and increases risk of mental ill health, which may further compound cognitive difficulties. His reported cannabis and alcohol use post-injury may have further added to difficulties in cognition, mood and behavioural regulation during his recovery. Additionally, Mr Ali's variable engagement across tasks, fatigue and reported anxiety symptoms may have contributed to variability in his performance, as well as impacting measures of attention and working memory, and information processing speed.

In light of all these issues, it is difficult to determine the relative contribution of each factor in accounting for Mr Ali's performance. Additionally, none of these factors alone would account for his current results therefore, it is likely that the cause of Mr Ali's difficulties are multifactorial. However, given the severity of his brain injury and his reported increase in cognitive changes following his injury, it is likely that his TBI has at least exacerbated pre-existing issues in attention and working memory, impulsivity, and mood (irritability and anxiety) and potentially contributed to additional cognitive difficulties".

1. Dr Synnott provided a report of 21 August 2023 for the insurer.
2. He reported that the extent to which the claimant's current psychiatric difficulties and presentation were related to the earlier traumatic brain injury on 8 December 2019 and how much was related to the subject accident on 5 June 2020 was difficult to confidently determine. Dr Synott said that he had no confidence in the accuracy and credibility of the claimants account.
3. Dr Synnott concluded that in his opinion, "there appears to be a causal relationship between his current psychiatric difficulties and the subject MVA - despite the fact he was a poor historian. That he has had little contact with medical professionals - be it a GP or mental health professionals - since the subject MVA gives cause for doubting the credibility of his history about experiencing psychiatric difficulties related to the subject MVA, and there is no objective evidence to support his current claims".
4. Dr Synnott concluded that the claimant had a diagnosis of a Major Depressive Disorder with prominent anxiety. No WPI assessment was provided. He said that to The extent to which his current psychiatric difficulties and presentation were related to the earlier traumatic brain injury caused by the motor bike accident on 8 December 2019 and how much was related to the subject accident on 5 June 2020, was currently difficult to confidently determine as he had no confidence in the accuracy and credibility of the claimants account.
5. General practitioner (GP) notes reveal limited complaint of any psychiatric disability following the accident. To Ms Leahy, psychologist, the claimant said he had not experienced psychiatric injuries. This was also expressed to Dr Lam, at the Westmead Hospital Brain Injury Service.
6. Professor Cameron in his report of 7 July 2023 said that, in regard to the first accident on 8 December 2019, the claimant had a significant past traumatic brain injury. His impression was that the claimant had residual cognitive and behavioural impairments related to that.
7. Dr Bosanquet in his report of 5 May 2022 was of the view that it was unlikely that the fracture of the tibia would "lead to any reduction in his capacity for future employment".
8. Dr Bodel in his report of 20 May 2022 also concluded that from an orthopaedic view, the prognosis for the claimant was that he would gradually return to his studies and work, over time.
9. Department of Neurosurgery records at Westmead Hospital, following the motor bike accident on 8 December 2019 record an admission from 8 December 2019 to

2 January 2020. The claimant had polytrauma including traumatic brain injury following a trail bike versus car accident. The claimant had a Glasgow Coma Score of 10 to 13 at the scene. There were brain imaging abnormalities, a fracture of the left parietal bone, pneumocephalus and other abnormalities. There was a ventricular drain inserted initially. There was said a left lower motor neurone facial nerve palsy. There were extensive calvarial and base of skull fractures. There was a collapse of the right upper lobe and right lower lobe lung. 10. Records from the Department of Education have been produced. The claimant's attendances and scholastic records might be considered not to be exemplary. His Higher School Certificate results cannot be found. 11. There are several reports in the respective bundles of documents of the parties which predominantly go to the claimant's physical injuries. These do not impact this assessment.

1. Following a meeting of the Panel on 27 October 2025, the Panel requested additional documentation from the claimant. A direction was made for the following material to be produced by the claimant:

"The Panel considers however that before the medical examination takes place it needs and requires the following; (a) All school and academic results of the claimant including his Higher School Certificate results (b) Western Sydney University records including acceptance into the transitional course to which the claimant has referred. (c) Centrelink records (d) a statement from the claimant providing details of i. what activities the claimant undertook a way of work or otherwise in the year 2019 to the date of his motorbike accident ii. whether the claimant made any claim for damages regarding his motorbike accident."

1. A statement was received from the claimant and records of Western Sydney University.
2. In the claimant's statement he says he was working as a labourer with a kitchen installation company for three months prior to the motorbike accident. The claimant did make a claim for damages but was regarded as the at fault driver and did not pursue the claim.
3. The claimant says that he obtained his Higher School Certificate but gave no other information.
4. Centrelink records have been requested but not produced.

1. The claimant was examined on 16 February 2026 by Senior Medical Assessor Mason and Medical Assessor Doris. Their report follows:

Mr Ali is a 23-year-old man who lives with his mother and younger brother in the family home in Granville. He said he is not in receipt of any form of income and specifically denied payments from Centrelink or from the CTP insurer. He stated he relies on his parents for money. He said he has not worked since the subject motor accident and is not in a relationship.

Mr Ali was born in Auburn hospital. His mother is 62 years of age and his father is 55 years of age. His father was a form worker who developed back problems 1 year ago. His mother was a child care provider and educator. He said they separated 2 months ago but was reluctant to provide details about the reasons. He is 1 of 10 children having 5 brothers and 4 sisters. He is the eighth of the 10 children. It was difficult to clarify but he indicated 7 of the children were born to his mother and father and 3 to his father's former relationship. He said currently he lives with his mother and younger brother; his younger sister recently married and moved out of the family home. He became defensive when asked about growing up in his family but eventually was able to describe it as a good experience in which he suffered no form of abuse.

He attended school at Auburn West primary school and Old Guilford primary school. He said he did some home schooling in year 7 because his mother wanted him to be a priest. He then attended an Islamic school, Salamah college, before going on to Ashfield boys high school where he completed year 12 while living with his family in Ashfield in 2019. He said he completed the higher school certificate at Ashfield boys high school with a good result. He denied behavioural and concentration problems while at school. When his school record of poor attendance, difficulty with concentration and frequent behavioural difficulties was raised with him he was reluctant to accept this was the case and said he did well.

After leaving school he said he went on to the University of Western Sydney to study business. The panel raised the fact that his HSC performance would not have gained him university entry. He then acknowledged he had commenced the Pathway program and hoped to gain access to university in the following year. However the transition to university was complicated by a traumatic brain injury sustained on 8 December 2019 in a motorcycle versus car accident after completing school. Further details are provided below under medical history.

When asked about relationships he initially said "I was a player", giving the impression that he was popular with the ladies. He then said he had 2 previous girlfriends. One relationship lasted for approximately 1 year while he was at school. The other lasted for about 2 months and did not continue after the subject motor accident because he could not walk.

With regard to work he said he did some form work during the holidays when he was in year 12 of high school. Following the HSC he worked installing kitchens and in cabinetmaking for a few weeks. Subsequent to that he worked on the NBN installation for approximately 3 weeks. This work was brought to an end by the pre-existing motorcycle accident on 8 December 2019.

Leisure activities prior to the motor accident consisted of going out with friends. He said he also enjoyed going to the gymnasium, doing Muy Thai martial arts training, boxing and playing rugby league football.

When asked about past insurance claims he said he did not receive a settlement for the motorcycle accident in December 2019.

Forensic history consisted of a fine for fighting in 2021 and a charge of possession of illicit drugs in 2023. Mr Ali was either unable or extremely reluctant to provide details of these events and it was not possible to be certain a complete history had been provided.

Past medical history consists of the aforementioned motorcycle accident on 8 December 2019 resulting in a severe traumatic brain injury. Injuries consisted of right frontal and frontotemporal subarachnoid haemorrhages (SAH), left parietooccipital extradural haemorrhage (EDH) and subdural haematoma (SDH) overlying the right antero-lateral frontotemporal lobe and lateral right temporal lobe, as well as pneumocephalus of the left and midline posterior fossa, sella turcica and bilateral parasellar region, extensive calvarial and base of skull fractures. He had been unconscious for 10 minutes and had a GCS score of 10 following the accident. He was maintained in a coma in ICU for 14 days, and suffered post-traumatic amnesia for 23 days. He was in hospital for 1 month, cared for by the Westmead brain injury unit and had been on the Lifetime Care and Support Scheme for 2 years. Neuropsychological testing indicated borderline impaired intellectual functioning in September 2020.

Mr Ali's memory for events following that motorcycle accident are unreliable. He indicated commencing Pathway studies at Western Sydney University in early 2020 and discontinuing them because of the subject motor accident. It is entirely unlikely that a person with a severe traumatic brain injury could participate in those studies. The panel note the records of Western Sydney University indicate enrolments in 2020, 2021 and 2022 with outcomes being non-completion or discontinuation.

When questioned about past psychiatric history Mr Ali denied ever having difficulties. Although not documented, an attention deficit hyperactivity disorder is likely to have interfered with his capacity to focus on his school studies. There were also behavioural difficulties in school involving aggression towards other students and teachers with multiple suspensions. He denied any family history of psychiatric illness.

With regard to substances he said he smokes 2 packets of cigarettes per day (40 cigarettes). He denied the use of alcohol. He acknowledged cannabis use at night but said "not much". He also denied the use of cocaine but then suggested he and I "should have a line together". He said he does not use other recreational drugs. However he does use analgesic medication obtained illicitly on Facebook marketplace, mainly Panadeine Forte and tramadol. He said his doctors will not prescribe as much as he needs for left leg pain. Mr Ali was reluctant to acknowledge a well-documented pre-existing history of diazepam, tramadol and cannabis use although made a vague acknowledgement when pressed.

Current medications consist of Panadeine Forte 2 tablets twice daily or occasionally 3 times daily. These are supplemented with tramadol "here and there". He is not using any psychotropic medications. He stated he had used Panadeine Forte the night before the interview and had not used any medication or illicit substance on the morning of the interview. He specifically denied using cannabis or diazepam.

With regard to pre-accident functioning Mr Ali was going through brain injury rehabilitation following the motorcycle accident. He required encouragement to attend to his personal hygiene and required assistance from his family in doing so. He had resumed contact with his friends and at the time of the subject motor accident was out with a group of friends. At that time he was unable to drive a motor vehicle because of the traumatic brain injury. He was able to travel as a passenger and could use public transport. He continued to live with his family and said a relationship with a girlfriend had ended because he could not walk. He had difficulty with his concentration because of the traumatic brain injury. He had not resumed work or study at that time because of the traumatic brain injury. The most likely psychiatric diagnosis prior to the subject motor accident was substance use disorder, although there is no clear clinical documentation of this.

Mr Ali said he was crushed between 2 cars. When asked to elaborate on the situation he said he hopped out of a car but was not sure if he had been seated in the front or the back of the car. He was reluctant to explain why he got out of the car. From his description he had moved behind the car when another vehicle moved forward and crushed his leg between the bumpers. He said the other car immediately reversed and took off. He said he was still standing but when he tried to walk his leg was like jelly and he dropped to the floor. He said his head did not hit the ground. He said he did not realise his leg had been broken. His friends picked him up and put him back into the same car and were transporting him to Auburn hospital when they were pulled over by police. An ambulance arrived, he was given the green whistle (analgesia) and he was transported to Westmead Hospital. Mr Ali was reluctant to provide this description and kept saying it was all recorded and we could see it on CCTV, implying that had been provided to the panel.

History of Symptoms and Treatment Following the Motor Accident

Mr Ali was admitted to Westmead Hospital 5 June 2024 and discharged on 11 June 2020. He underwent right tibial nail ORIF on 6 June 2020 with no immediate complications. Discharge medications were Endone, paracetamol and pregabalin. Screws were removed in August 2020 and the internal nail was removed in 2021.

Following discharge Mr Ali stated he was in severe pain and relied on increasing amounts of opioid medication. He also reluctantly acknowledged using illicit tramadol, Panadeine Forte, Valium and cannabis. When asked to describe events after the motor accident he said the pain became much more severe. He said he is currently still in pain and continues to use Endone, Lyrica and tramadol. He said he has to obtain these substances illegally because the doctors will not provide the amounts he needs. He went on to say he needs to keep up the habit the doctors caused. When asked how far he can walk because of pain limitations he said he does not know. He also stated he had never tried to run. He is able to stand for approximately 5 minutes before it becomes too painful. He said he spends most of his day sitting down or lying down. He continues to use Panadeine Forte 2 tablets twice or 3 times daily with intermittent tramadol for breakthrough pain.

Mr Ali said he had been unable to return to sport or socialising with friends because of pain. He has been unable to work because of pain. He said he cannot provide any assistance with household tasks because of pain. He said with great distress that he has been unable to attend the mosque to pray because he is unable to prostrate himself due to pain. As a consequence of the motor accident he said he is now significantly overweight because he cannot be physically active.

When asked about psychological injuries he said all his friends have been going forward with their lives. They have studied, found jobs, married and had children but he has been left standing still. He said he is living off his parents and feels ashamed of that. He said he is angry and frustrated with his circumstances. He experiences social anxiety because he cannot join his friends in their activities due to pain. His sleep is disrupted by pain when he moves around. When he is woken he has thoughts in his head about all the opportunities he has lost because of pain. He said he does get suicidal thoughts because of all these lost opportunities but he would not act on them. He said he feels traumatised by what the accident has cost him and he feels anxious, nervous and at times panicky.

He was asked if he had received any treatment for his psychological condition. He said he had seen psychologists following the motor cycle accident but not for the subject motor accident. He recalled the name of psychologist Ms Nerida Leahy but not Dr Paul Gertler who were both seen in 2020. He then added he had seen a psychologist called Sam a few months ago but he could not remember his last name. When asked for further detail about this treatment he said "forget it" and would not provide more information. He added he does not like talking about himself to other people.

Mr Ali confirmed he had not consulted a psychiatrist for treatment and had not been prescribed psychotropic medication.

Injuries or Conditions since the Motor Accident

Mr Ali denied any such injuries or conditions. He was specifically asked if there had been any further motor vehicle accidents which he denied. He also denied any other form of trauma in his life.

Mr Ali said he continues to struggle with pain in his leg. He continues to be socially avoidant because of that pain. He acknowledged low mood, frustration and some anxiety because he cannot participate in life as he did before the accident. He reports being deeply embarrassed by his circumstances.

Mr Ali is a 23-year-old right-hand-dominant man whose appearance is consistent with his stated age. He was located in a room in his home in Granville. He was accompanied by his older sister Ms Majeda Dib who was present throughout the interview. It became apparent as the interview progressed that his mother was intermittently present and he spoke with her in Arabic despite instructions not to do so. He was identified from his photograph on his NSW provisional driver license with the address of his father's home in Auburn. The interview was conducted via the Microsoft Teams application with a good internet connection. Mr Ali had difficulty joining the interview and was 10 minutes late. The interview commenced at 10:10 AM and concluded at 11:55 AM.

Mr Ali was neatly dressed and well presented. His hair was neatly done and his beard neatly trimmed. He was a difficult interviewee because he found it difficult to remain on topic. He complained he had not slept on the previous evening. He appeared to be disinhibited and over familiar with the interviewers. He denied use of illicit substances. He frequently swore throughout the interview and requested permission to smoke cigarettes, which he did. He was evasive and not to the point in his response to questions. He often challenged the interviewer by asking why it was necessary to answer certain questions. He was not able to see the relevance of the questions, such as why his parents had separated.

Mr Ali was neither depressed nor anxious in appearance. He displayed a full range of affect including humour, although this was inappropriate at times. His presentation was completely dominated by his concerns about leg pain. He indicated this prevented him from working, socialising, studying, praying and contributing to household tasks. He revealed significant embarrassment arising from his difficulties with pain. He was low in mood because all his friends had moved along with their life and he was stuck. He described passive suicidal ideation which he did not intend to act on. He was not tearful throughout the interview. He described some degree of anxiety arising from his awareness of the perceptions of other people regarding his condition.

He appeared to be fully oriented in time, person and place. There was no evidence of a psychotic disorder.

Self care and personal hygiene: Mr Ali said he showers approximately every third day. The main reason for this is leg pain and he said he does require help from his mother when he showers. He said he does not do any laundry, cooking or housework because of leg pain. He said his brother is a barber and comes to the house every month to cut his hair. He has gained weight because of inactivity. From a psychiatric point of view he is unimpaired.

Social and recreational activities: Mr Ali said he does nothing. He said he does not see any friends because of pain, but then added he does not like anyone. He said sometimes he goes outside to get some sun. He does not attend entertainment events because of pain and anxiety. When family members visit the home he does hang out with them. From a psychiatric point of view he is unimpaired.

Travel: Mr Ali has obtained his provisional driver license and is able to drive alone for 5 minutes to the shops in the local area to purchase cigarettes, et cetera. He said he is unable to use bus or train because he is unable to walk to the station. He travelled overseas to Thailand in December 2023 and to Egypt in 2024. He is mildly impaired.

Social functioning: Mr Ali maintains a good relationship with family members. They are especially supportive of him. A relationship with a girlfriend ended after the motor accident because he was not able to walk. He does not see any friends because of embarrassment regarding his inability to walk and run. From a psychiatric point of view he is unimpaired.

Concentration, persistence and pace: Mr Ali is able to watch movies on television. He is also able to do research on his phone. He seemed to be fascinated by the fact that the two interviewers were psychiatrists. He said he planned to research psychiatrists online and then find a movie about them which he will watch after the interview. The panel note that he was not able to persist with study prior to and after the subject motor accident. There is likely to be a significant contribution from his brain injury to any difficulties in this area. From a psychiatric point of view he is unimpaired.

Adaptation: Mr Ali is unable to work and unable to assist at home because of leg pain. From a psychiatric point of view he is unimpaired.

A number of inconsistencies were noted throughout the interview. These have been addressed above in the body of the report. Despite this the panel members were satisfied that Mr Ali provided a clear and honest description of his injuries to the best of his ability. His sister Ms Majeda Dib explained to the assessors after the interview that he was both anxious and distressed by his physical difficulties.

Mr Ali presents with a severe pain related condition which interferes with his daily functioning to an extreme degree. The physical injury of a comminuted fracture of the right tibia treated with ORIF could reasonably be expected to heal and result in little or no functional impairment. The psychiatrist members of the panel are not qualified to make such a determination and rely on the insurer's submission in a report by Professor Ian Cameron dated 7 July 2023 who noted the leg injury has not affected his capacity for work.

Diagnosis is therefore somatic symptom disorder with predominant pain. DSM-5-TR criteria are met as follows:

Criterion A. Mr Ali complains of severe right leg pain which is persistent 5.5 years after the subject motor accident.

Criterion B. Excessive thoughts, feelings and behaviour relate to the pain as follows:

1. There are disproportionate and persistent thoughts about the seriousness of the pain.

2. He displays a persistent high level of anxiety about the pain and his health.

3. He devotes excessive time and energy to the pain.

Criterion C. The pain has been continuously present for 5.5 years.

The Panel notes the pre-existing brain injury on 8 December 2019 which has left the claimant with multiple cognitive disabilities and difficulty in coping with life in general. It is not unlikely that this injury has contributed to his failure to respond to his fractured tibia in a positive way and to resume the normal trajectory of his life. Finally, the Panel notes the diagnosis of post-traumatic stress disorder by the claimant's instructed psychiatrist Dr Anderson. The panel accepts that DSM-5-TR criterion A for post-traumatic stress disorder is met by the subject motor accident. However the claimant did not report intrusion symptoms and avoidance phenomena arising from the motor accident. Therefore criteria for the diagnosis of this condition are not met.

Discharge summary of Westmead Hospital dated 11 June 2020 indicates the fractured tibia was caused by the subject motor accident. From Mr Ali's point of view the fractured tibia is the cause of his pain. The panel accepts that the motor accident did result in a fractured tibia which has in turn resulted in a somatic symptom disorder with predominant pain. Motor Accident Guidelines Version 10.1, which commenced on 12 December 2025, stipulate at 6.215 "The PIRS must not be used to measure impairment due to somatoform disorders or pain".

Mr Ali said he showers approximately every third day. The main reason for this is leg pain and he said he requires help from his mother when he showers. He said he does not do any laundry, cooking or housework because of leg pain. He said his brother is a barber and comes to the house every month to cut his hair. From a psychiatric point of view he is unimpaired.

Mr Ali said he does nothing. He said he does not see any friends because of pain, but then added he does not like anyone. He said sometimes he goes outside to get some sun. He does not attend entertainment events because of pain and anxiety. When family members visit the home he does hang out with them. From a psychiatric point of view he is unimpaired.

Mr Ali has obtained his provisional driver license and is able to drive alone for 5 minutes to the shops in the local area to purchase cigarettes, et cetera. He said he is unable to use bus or train because he is unable to walk to the station. He travelled overseas to Thailand in December 2023 and to Egypt in 2024. He is mildly impaired.

Mr Ali maintains a good relationship with family members. They are especially supportive of him. A relationship with a girlfriend ended after the motor accident because he was not able to walk. He does not see any friends because of embarrassment regarding his inability to walk. He does not attend the mosque for similar reason. From a psychiatric point of view he is unimpaired.

Mr Ali is able to watch movies on television. He is also able to do research on his phone. He seemed to be fascinated by the fact that the two interviewers were psychiatrists. He said he planned to research psychiatrists online and then find a movie about them which he will watch after the interview. The panel note that he was not able to persist with study prior to and after the subject motor accident. There is likely to be a significant contribution from his brain injury to difficulties in this area but this is not a psychiatric injury. From a psychiatric point of view he is unimpaired.

Mr Ali is unable to work and unable to assist at home because of leg pain. From a psychiatric point of view he is unimpaired.

Apportionment - pre-existing/subsequent impairment

There is no documented pre-existing psychiatric condition. Mr Ali did suffer a severe traumatic brain injury from which he was recovering at the time of the motor accident. This is a neurocognitive disorder. Treating psychologists noted a substance use disorder prior to the motor accident. The clinical record of Westmead Hospital indicates he was intoxicated, having smoked marijuana and taken Valium and tramadol immediately prior to the subject motor accident. School records indicate difficulties with concentration and behaviour in his final years. There were difficulties arising from the brain injury when he attempted the Pathway entry to University of Western Sydney. The panel psychiatrists concluded it was not possible to apportion for pre-existing impairment because there was no documented psychiatric condition. There is no record of subsequent impairment

There has been no substantive treatment. No treatment effect allowance is made.

Degree of permanent impairment caused by the motor accident

A finding of zero percent permanent impairment indicates that there was an injury caused by the motor accident and that there may be continuing symptoms, however, relevant Guides and Guidelines rate the associated impairment at 0%.

1. The Panel refers to the decision of Mandoukos v Allianz Australia Insurance Limited [2023] NSWSC 1023. This is a hearing de novo and the issues raised before the Medical Assessor and for determination by the Panel include consideration of a differential diagnosis.
2. The Panel has not sought alternative diagnoses to that assessed by the Medical Assessor. What was referred to the Panel was an assessment of a psychological condition-psychological injury. The Medical Assessor had found that the claimant had an adjustment disorder.
3. The Panel must examine the claimant and perform its assessment on the basis of its discussions with the claimant on the day of assessment. A psychiatric symptom might evolve over time and disappear over time for that matter. In this case, the Panel was not satisfied that the claimant had an adjustment disorder but was satisfied on the basis of the history provided by the claimant, and the clinical assessment of the Medical Assessors, that he was suffering a psychiatric disability of a Somatic symptom disorder with predominant pain.
4. The Panel met on 2 March 2026 to discuss the Medical Assessors findings on examination. The legal Member of this Panel did not participate in the medical examination but prior to the Panel meeting on 2 March 2026, the legal Member has had the benefit of reading and considering the Medical Assessors examination report. On 2 March 2026, the examination findings and the issues going to causation and assessment of WPI were all discussed. It is from this teleconference of the Panel that the Panel has agreed and reached its final conclusion and determination.
5. The Panel adopts the report of Senior Medical Assessor Mason and Medical Assessor Doris

1. The claimant suffered a serious leg injury resulting in a fractured tibia caused by the driver of the insured car deliberately driving towards and into him, pinning him between two vehicles.
2. The nature of the impact would have been sudden and unexpected. It is the finding of the Panel that it would not be unreasonable for the claimant to have suffered not only physical disabilities because of the accident on 5 June 2020 but also some psychiatric disabilities. Those psychiatric disabilities however are not on the finding of the Panel significant of continuing disabilities suffered by the claimant as a result of an incident and earlier accident on 8 December 2019. Because of the accident, the claimant has suffered a fractured tibia which on the finding of the Panel has resulted in a somatic symptom disorder with predominant pain.
3. Some of the differences of assessment between Dr Anderson, the Medical Assessor and the Panel are very much differences of opinion of classification. The Panel has assessed the claimant based on his responses during the examination and the clinical assessment at that time of the claimant by the Medical Assessors.
4. Regarding the earlier accident on 8 December 2019, the Panel is satisfied that the claimant suffered a traumatic brain injury and had been undergoing brain injury rehabilitation. Because of this injury, the claimant was not able to drive a motor vehicle at the time of the accident. He had difficulty with his concentration because of the traumatic brain injury, and at the time of the accident had not resumed work or study because of this. As the Medical Assessors assessed, the most likely psychiatric diagnosis prior to the subject motor accident was Subject Use Disorder but there is no clear clinical documentation of this. The Panel has therefore made no deduction for pre-existing psychiatric disability

1. The Panel is not satisfied that the claimant had a substance use disorder prior to the subject accident. There is insufficient evidence about that to have a conclusive diagnosis.
2. The claimant suffered a traumatic brain injury on 8 December 2019, prior to the accident the subject of this claim. The Panel has discussed the medical evidence about this and is satisfied that at the time of the subject accident, the claimant was still suffering from the effects of this disability, as well as from pain consequent on his injured leg from the subject accident.
3. The Panel has assessed WPI at 0% and that he has a diagnosis of a Somatic Symptom Disorder.

1. The Panel revokes the certificate of Medical Assessor Shen dated16 July 2024.
2. The Panel had diagnosed the claimant as having a Somatic Symptom Disorder.
3. The Panel has assessed the claimant as having 0% WPI.