Issued under ss 7.23(1) of the Motor Accident Injuries Act 2017

The issue determined by the Review Panel is whether the injury caused by the motor accident is a threshold injury.

The Review Panel revokes the certificate of Medical Assessor Doron Samuell dated 31 October 2024 and certifies that the injury caused by the motor accident - adjustment disorder, is a threshold injury for the purposes of the Motor Accident Injuries Act 2017.

A statement of the Panel's reasons for the assessment is attached to this certificate.

1. On 10 December 2022, the claimant, Adam Alsabahi was involved in a motor accident when the vehicle he was driving was T-boned by a vehicle insured by Allianz Australia Insurance Limited.
2. As a result of the accident, the claimant claimed that he sustained physical injuries as well as a psychological injury.
3. The insurer accepted liability to pay the claimant statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act) for the first 26 weeks. At the time that the accident occurred, statutory benefits by way of loss of earnings and treatment and care expenses cease after 26 weeks if "the person's only injuries resulting from the motor accident were threshold injuries".[1] An injured person otherwise cannot recover damages under the MAI Act if the "only injuries resulting from the motor accident were threshold injuries".[2]
4. The insurer decided at the expiration of 26 weeks, that it would cease to make any further payments of statutory benefits on the basis that the claimant's psychological injury caused by the accident, was a threshold injury for the purposes of s 1.6 of the MAI Act. The insurer's decision was confirmed after an internal review.
5. To resolve the dispute, the claimant made an application for a medical assessment of the matter by the Personal Injury Commission (Commission) pursuant to Division 7.5 of the MAI Act.
6. According to schedule 2, cl 2 of the MAI Act, the issue of whether an injury caused by the motor accident is a threshold injury for the purposes of the Act is declared to be a medical assessment matter.
7. 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,[3] and pursuant to s 7.26 of the MAI Act, on review, by a review panel.

1. The dispute was referred at first instance to Medical Assessor Doron Samuell. The injuries referred for assessment were "psychological/psychiatric injuries caused by the motor accident."
2. The Medical Assessor stated that at the time of his assessment on 23 October 2024, and prior to the accident, the claimant had no psychological difficulty and no family psychiatric history.
3. The claimant reported that he came to Australia from Iraq as a refugee at the age of 14. The claimant reported that he faced challenges in Iraq due to the war. He remembered being depressed "most of the time." He remembers seeing bullets and hearing weapons discharged. He stated that he lost his childhood and would frequently think he was going to die.
4. The claimant reported that following the accident and since he was discharged from hospital on the day of the accident, he had "mental difficulty." He has not been treated by a psychiatrist or psychologist as he said he was "scared to be called a psycho."
5. Following his assessment, the Medical Assessor considered that the claimant described symptoms of anxiety and avoidance of driving. He believed that the claimant's symptoms were clinically significant and caused disability. The Medical Assessor was of the opinion that the symptoms satisfied the diagnostic criteria for a specific phobia and that the accident was a plausible cause of the condition. He concluded that the claimant has therefore sustained a non-threshold injury as a result of the accident.

1. On 3 December 2024, pursuant to s 7.26 of the MAI Act, the insurer made an application to the President of the Commission to refer the medical assessment to a review panel for review. The application was accepted by the Commission as having been made within the time prescribed by s 7.26(10) of the MAI Act.
2. The President referred the application to a review panel for review, being satisfied that there was reasonable cause to suspect that the medical assessment was incorrect in a material respect, having regard to the particulars set out in the application.[4]

1. According to s 7.26(5A) of the MAI Act, the Panel consists of two Medical Assessors and a Member of the Motor Accidents Division of the Commission. On this occasion, the review panel is constituted by Medical Assessor Rikard-Bell, Medical Assessor Singh and Member Castagnet (Panel).
2. Part 5 of the Personal Injury Commission Act 2020 (the PIC Act), enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor.[5]
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act and they provide that the Panel determines how it conducts and determines the proceedings. The Panel may determine the proceedings solely based on the written application.[6]
4. The review is not limited to only that aspect of the assessment that is alleged to be incorrect and is by way of a new assessment of all the matters with which the medical assessment is concerned.[7]

RELEVANT STATUTORY PROVISIONS, GUIDELINES AND LEGAL PRINCIPLES

1. A threshold injury is defined in s 1.6(1) of the MAI Act:

"(1) For the purposes of this Act, a threshold injury is, subject to this section, one or more of the following -

(a) a soft tissue injury,

(b) a psychological or psychiatric injury that is not a recognised psychiatric illness."

1. Section 1.6(4) of the MAI Act provides that regulations may be made to exclude or include a specified injury from being a soft tissue injury or a psychological or psychiatric injury for the purposes of the Act.
2. Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the Regulations) further provides that the following injuries are included as a threshold injury for the purposes of the MAI Act:

(a) acute stress disorder, and

(b) adjustment disorder.

1. Part 1, cl 4(3) of the Regulations provide that "acute stress disorder" and "adjustment disorder" have the same meanings as in DSM-5.[8]

1. Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the Act. Version 10.1[9] of the Guidelines relevantly provide:

"5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a psychological or psychiatric injury caused by the motor accident.

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

5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.

5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:

(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions

(b) a review of all relevant records available at the assessment

(c) a comprehensive description of the injured person's current symptoms

(d) a careful and thorough physical and/or psychological examination

(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the diagnosis of psychological injury. These clauses provide:

"Threshold psychological or psychiatric injury assessment

5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.

5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5TR), published by the American Psychiatric Association.

5.12 Where the symptoms associated with the injured person's psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury."

1. Sections 5D and 5E of the Civil Liability Act 2002 apply to the MAI Act.[10]
2. In Raina v CIC Allianz Insurance Ltd Campbell J stated:

"One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002 (NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely."[11]

1. The parties filed a joint paginated and indexed bundle of documents comprising 393 pages.
2. The Panel considered all this material.

1. The insurer submitted that the Medical Assessor's diagnosis of specific phobia did not comply with the requirements of DSM-5-TR and cl 5.11 of the Guidelines_._
2. The Medical Assessor considered that the claimant described symptoms of anxiety and avoidance of driving, his symptoms are clinically significant and cause disability, and these symptoms satisfied the diagnostic criteria for a specific phobia. However, there was no engagement with the actual diagnostic criteria set out for specific phobia in DSM-5-TR. In particular, there was no engagement with Criterion E, where a specific phobia diagnosis requires that the "fear, anxiety or avoidance is persistent, typically lasting for 6 months or more".
3. The insurer submitted that there was no objective evidence before the Medical Assessor in the available documents to suggest that the claimant's asserted symptoms had been present for a period of six months or more.
4. The claimant submitted that the claimant's psychological injury met the criteria for a determination of a non-threshold injury and that the Panel should confirm that finding.

1. The evidence relating to the injury being assessed may be summarised as follows.

1. According to the records of NSW Ambulance Service, ambulance officers attended the claimant's home at about 12:30pm on the day of the accident, after they received a call that the claimant was unconscious. The following notes were recorded:

"called to 21yo male at home for unconsciousness. [o/a] Pt was supine on couch; unconscious, nil alert, nil responsive and breathing. Pt only reactive to eyelashes being touched. Nil reaction to trap squeeze. Pts family states that he was in a t-boned MVA at approx 1130 today where he complained of chest pain,? hit head on steering wheel and was amnesic to events. Pt refused ambulance transport at time. Pts family states he went home, sat on couch and became unconscious at approx. 1210. Nil nausea, nil vomiting, nil diarrhoea, nil back or abdo pain at the time... OPA attempted but pt resisted with jaw. Pt transported to Liverpool hospital R1 with code 3 passed for further review and assessment. O/A to hospital, pt was responding to Drs and was a GCS14."

1. According to the clinical records of Liverpool Hospital, the claimant presented to the Emergency Department for treatment on the day of the accident.
2. The following symptoms were recorded:

"?headstrike, complaining CP post, amnesic to events

refused CDA transport went home last seen conscious at 1210hrs

PT non responsive GCS 3/15 at home sitting in chair

1. Following an examination by the Registrar in emergency medicine, Dr Chirstopher Loupos, it was recorded that there were some concerns about memory deficits; however, the claimant had passed the post-traumatic amnesia testing. A CT scan of the head and neck showed no abnormalities.
2. The claimant was discharged on the same day.

1. The clinical records of Hoxton Park Medical centre for the period March 2016 to July 2023 was before the Panel. The records showed no evidence of any prior treatment for any psychological or psychiatric condition.
2. On 14 December 2022, the claimant was seen by general practitioner (GP), Dr John Zeyad Abraham. The following notes were recorded:

1. On examination, Dr Abraham noted that there was no neck tenderness, and there was a good range of movement.
2. In his application for personal injury benefits dated 2 February 2023, the claimant described his injuries arising from the accident in the following terms (errors in original):

"the injuries I received from this accident, my head, my neck, my chest and I had psychological shock affected on my health and also stopped me from driving again - all this injuries happened of the accident."

1. The re-examination was conducted on behalf of the Panel by Medical Assessor Rikard-Bell and Medical Assessor via a video conference from 11am to 1pm on

11 November 2025. The claimant attended alone via audio-visual link from his home.

1. The claimant is a 24-year-old man who is the carer of his father, aged in his 60's and resides with both parents. His mother is aged in her 60's and is the carer for the maternal grandmother, aged 88. There are two older married sisters and an older brother, also married.
2. The claimant was born in Iraq and arrived in Australia as a refugee at the age of 14. His early years may have been somewhat unstable due to the war. His family relocated to Syria at age five in 2006, where they remained as refugees for 10 years. His family were unable to work and he was unable to attend school. The claimant stated it was like a war zone. The building they were living in was damaged and people died. His mother taught him how to read and write and there was no formal schooling. The family migrated to Australia in 2015 and the claimant attended Lurnea High School. After Year 10, he left school and became the carer of his father. His older brother was previously his father's carer; however, he married and the claimant took over the care of his father.

1. Before the accident, the claimant enjoyed playing soccer and going out with friends, as well as socialising with his cousins. He was able to focus well and there were no issues with self-care. He was not working, but he was able to care for his father. He was able to socialise and interact well with family and friends.

1. The claimant presented as a pleasant man of stated age who was approximately 30 minutes late for the assessment due to difficulties managing the video technology. However, he engaged well with the interview process. He wore a beard with shaven temples, neatly coiffured hair and neatly groomed eyebrows. He wore a green T-shirt. His eye contact was good and he cooperated well. At times, he seemed to lack confidence when describing his symptoms. Nevertheless, he was able to provide an adequate account of his experiences. His speech was normal in tone and volume. There was no abnormality of perception. The claimant's affect was reactive. There was no depression or anxiety noted. His cognitive function appeared normal, and his thoughts were logical. His English was competent, and he spoke with a slight Middle Eastern accent. The claimant explained that his grandmother is a pensioner, his mother is her carer and he is the carer for his father.

1. There is no history of serious illnesses, injuries or conditions. There is no current medication. There is no family history of psychiatric illnesses and no history of drug or alcohol issues. The claimant denied issues with alcohol or intoxication and will occasionally have a celebratory drink, although there has been no excessive alcohol use.

1. The claimant stated there is no history of psychological issues; however, he stated he had previously consulted with a psychologist at times of stress but did not need to continue treatment for more than one session. The Medical Assessors of the Panel enquired whether there was currently psychological treatment (as apparently reported to Medical Assessor Cameron in an assessment of his physical injuries). The claimant replied that he was unsure whether he had seen a psychologist. He then confirmed he had seen a psychologist once before the motor accident for issues related to stress; however, he has not consulted with a psychologist since the motor accident.

1. Initially, the claimant denied a history of motor accidents, workers' compensation claims, insurance claims or legal issues, then stated that there was a motor accident several months before the subject motor accident. He said he was not injured in this accident and denied any ongoing physical or psychological symptoms, and he did not submit a claim. He stated his father's vehicle was damaged and could not be repaired. The family then utilised the claimant's vehicle, which was a Toyota Corolla and was the vehicle involved in the subject motor accident and has not subsequently been replaced.

1. On 10 December 2022, the claimant was involved in a motor accident as the sole occupant at approximately 11.30am on Flowerdale Road, Liverpool, when another vehicle merged into his lane, causing a head-on collision. The claimant stated he lost consciousness and was unaware of what happened from the time of the accident until he woke up at Liverpool Hospital at approximately 3am the next morning, approximately 15 hours after the accident.
2. The claimant later stated he recalled the events up to the accident when travelling on Flowerdale Road towards a set of lights. There was a Keep Clear section of the road, and he slowed down, then a vehicle pulled in front of him and collided with the front of his vehicle. He was unaware whether the airbags deployed. He said the front of the vehicle was damaged and the vehicle could not be repaired.

1. The claimant was informed that his father had driven to the accident site and transported him home. Once at home, he was confused and unable to function. He was then was transported to Liverpool Hospital, where he was investigated. He said, _"_I blacked out". After he woke up at approximately 3am, he was discharged home.
2. After the accident, the claimant suffered chest discomfort presumably from the seatbelt, which continued for three weeks, which then subsided and completely disappeared. The claimant's main concerns currently are with travelling too fast and he is risk averse, whereas previously he enjoyed fast driving. The Medical Assessors of the Panel enquired whether he lost his licence or if there were any issues driving, and the claimant indicated that initially he lost his licence a year ago for three months, then corrected this statement and said he lost his licence before the subject motor accident. The claimant stated he has always been able to continue caring for his father and was unable to explain why he blacked out for over 12 hours with no memory, even though there was no evidence of a serious head injury.

1. Currently, the claimant sleeps about nine hours each night and stated, "I wake up a lot." He will go back to sleep and often when he gets up in the morning, he is tired. Nevertheless, he assists his parents in the morning and if required, he will return to bed. Otherwise, he washes his face, eats breakfast, helps his mother with cleaning and moving furniture or provides assistance with other tasks if she requires help around the house.
2. The family vehicle was not replaced following the subject motor accident; therefore, the claimant takes his father to appointments by Uber, public transport, or he contacts a friend to drive them. At times, he will accompany his mother when grocery shopping if she needs help, although primarily, the claimant focuses on assisting his father, who suffers from memory problems. It was unclear whether his father had received a formal diagnosis; however, he appeared to have a poor short-term memory. The claimant will sometimes see friends in the evening, or sometimes friends may visit and take him out.

1. The claimant stated there are no nightmares or flashbacks as he does not remember the accident. His appetite is reasonable, although he does not eat a great deal and his weight is stable. The claimant's mood is generally happy, and he denied any suicidal feelings or depression. There is no excessive anxiety except at times when in the car, when he can feel anxious if the vehicle is travelling too fast.
2. The claimant continues to take care of his father and provide support. He will act as his father's interpreter and assist him at appointments.
3. At home, he will listen to audiobooks as he does not particularly like to read.
4. The claimant stated that after the accident, he was unable to drive and he did not own a vehicle; therefore, he has not driven since the accident and the vehicle was not replaced. He stated that when he gets into the car, he feels panicky, and he is fearful of driving. He is fearful of travelling too fast and is fearful of travelling on the motorway. His friends have been picking him up, although occasionally he said he would drive his friend's car and they have been attempting to encourage him to return to driving, as he previously enjoyed driving. He could travel fast and he enjoyed taking risks.
5. For several months after the accident, the claimant stayed at home and did not go out a great deal; however, he was still able to care for his father and take him to appointments.

1. The claimant is able to dress, feed and manage his self-care well. Therefore, there is no impairment of self-care and personal hygiene.
2. In terms of social functioning, the claimant relates well to his parents, siblings, grandmother and cousins. Therefore, there is no impairment of social functioning.
3. In terms of concentration, the claimant is able to listen to audiobooks and watch movies. Therefore, there is no impairment of concentration, persistence and pace.
4. In terms of adaptation, the claimant is not working and is caring for his father, which is unchanged from before the motor accident. Therefore, there is no impairment of adaptation.
5. In terms of travel, the claimant does not currently own a vehicle; however, he is able to drive a friend's vehicle. He is hopeful that he will purchase another vehicle in the future and be able to drive to sporting venues with friends. Therefore, there is no impairment of travel.

1. The claimant is a 24-year-old man who arrived in Australia as a refugee from the Middle East at the age of 14. He left school after Year 10 and has been the carer of his father since the age of 17 and for the past seven years. Before the accident, he stated he was happily caring for his father and was active socially. After the accident, Medical Assessor Cameron found soft tissue injuries and it was reported to the Medical Assessor that there had been psychological treatment received; however, the claimant reported to the Medical Assessors of the Panel that there had been no psychological treatment received since the accident. The claimant continues to care for his father and organises public transport, an Uber ride or relies on friends to transport his father to appointments, as he did not replace the vehicle after the accident. The claimant is able to drive a friend's vehicle and there are no issues with travelling.
2. Following the motor accident, the claimant's anxiety increased with fearfulness about driving, driving near motorways or travelling too fast. Therefore, it was the view of the Medical Assessors of the Panel that, on balance, there is enough evidence to suggest the claimant developed an adjustment disorder. His vehicle was written off and resulting in hospital attendance. There was a loss of memory of over 12 hours duration, which remains unclear; however, there was increased anxiety with some panic symptoms, fearfulness of driving, reluctance to go out and some avoidance behaviours. Gradually, the condition has improved, and the claimant is now able to drive short distances.
3. The claimant continues to care for his father, and he maintains good relationships with friends and family. There was some pain in his chest for several weeks after the accident that has resolved and there are no ongoing physical symptoms.
4. The criteria according to DSM-5-TR are outlined below:

Criterion A - The development of emotional or behavioural symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s).

Criterion B - These symptoms or behaviours are clinically significant, as evidence by one or both of the following:

1. Marked distress that is out of proportion to the severity of the intensity of the stressor, taking into account the external context and the cultural factors that might influence symptom severity and presentation.
2. Significant impairment in social, occupational, or other important areas of functioning.

Criterion C - The stress-related disturbance does not meet the criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder.

Criterion D - The symptoms do not represent normal bereavement and are not better explained by prolonged grief disorder.

Criterion E - Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional 6 months.

1. The Medical Assessors of the Panel did not find sufficient evidence for a diagnosis of specific phobia, as there were no fear of driving and no fear or avoidance of vehicles.
2. The Panel reconvened to deliberate on the re-examination findings. The Panel's conclusion is that on the balance of probabilities, the claimant is suffering from an adjustment disorder which was causally related to the motor accident. This is a threshold injury.

1. The review is a comprehensive assessment of all matters related to the medical assessment. The original medical assessment related to whether the injuries sustained in the motor accident were or were not threshold injuries, as defined under the MAI Act.
2. The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: See Insurance Australia Group Ltd v Keen[12] and Insurance Australia Ltd v Marsh.[13]
3. The Panel adopts the examination findings and conclusions of the Panel's Medical Assessors.
4. The Panel finds that the claimant suffers from an adjustment disorder caused by the motor accident. This is a threshold injury for the purposes of the MAI Act.

1. For these reasons, the Panel revokes the certificate issued by Medical Assessor Samuell on dated 31 October 2024 and issues a replacement certificate which is at the commencement of these reasons.

[1] 1.Sections 3.11 and 3.28 of the MAI Act. For motor accidents occurring on or after 1 April 2023, the period of 26 weeks has been amended to 52 weeks by the Motor Accident Injuries Amendment Act 2022.

[8] DSM-5 is the document entitled Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, with a Text Revision (DSM-5-TR), published by the American Psychiatric Association in March 2022.

[9] Version 10.1 of the Guidelines came into effect on 12 December 2025.

[10] See s 3B(2) of the Civil Liability Act 2002.

[11] [2021] NSWSC 13 (Raina) at [65].

[12] [2021] NSWCA 287 at [40], [41] and [45].

[13] [2022] NSWCA 31 at [11], [21] and [64].