1. The Review Panel revokes the certificate of Medical Assessor Mason dated

13 September 2024 and certifies that the degree of permanent impairment of the claimant that has resulted from the psychological injury caused by the acccident on 30 May 2017 is greater than 10%.

1. BLP (claimant) was injured in a motor vehicle accident at North Ryde on 30 May 2017 (accident). She subsequently made a claim for damages under the Motor Accidents Compensation Act 1999 (MAC Act) on the insurer of the other vehicle involved in the accident, Allianz Australia Insurance Limited (insurer).
2. There is a dispute between the claimant and the insurer about whether, for the purposes of s 131 of the MAC Act, the degree of her permanent impairment as a result of psychological injury caused by the accident is greater than 10% (dispute). The dispute is a medical assessment matter for the purposes of Part 3.4 of the MAC Act: s 58(1)(d) MAC Act.
3. The dispute was assessed by Medical Assessor Mason. On 13 September 2024 the Medical Assessor certified that all the injuries referred to him for assessment had been determined to be secondary to a somatic symptom disorder (pain) and that assessment of the degree of permanent impairment of these injuries was therefore not required.
4. The claimant applied to the President of the Personal Injury Commission (Commission) to refer the medical assessment to a review panel for review in accordance with s 63 of the MAC Act. On 25 November 2024 a delegate of the President accepted the application and referred it to a review panel. This panel (Panel) was subsequently constituted to conduct the review of Medical Assessor Mason's assessment (Review).

1. The Panel is to conduct the review in accordance with s 63 of the MAC Act. Section 63(3) provides that the review panel consists of two Medical Assessors and a member assigned to the Motor Accidents Division of the Commission.
2. The review 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 63(3A) MAC Act. Although styled a "review", the Panel is determining afresh the medical assessment matters referred to it: Frost v Kourouche (2014) 86 NSWLR 214; [2014] NSWCA 39 at [9] per Leeming JA (Beazley P and Basten JA agreeing).
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128.
4. Version 5 of the Medical Assessment Guidelines (Assessment Guidelines), effective from

12 February 2021, apply to this review as does version 1 of the Motor Accident Permanent Impairment Guidelines effective from 1 June 2018 (Impairment Guidelines).

1. In accordance with directions made by the Panel on 11 June 2025 the parties each filed bundles containing the documents they relied on in the Review.
2. At a case management conference held on 25 August 2025 additional directions were made with respect to the filing of further submissions and documents by the parties.[1]

1. An application to lodge additional documents filed by the claimant was the subject of a decision by the Panel on 10 September 2025.[2] An application to lodge additional documents filed by the insurer was determined by the Panel on 17 September 2025[3].
2. The claimant filed a further application to lodge additional documents on 20 January 2026. These documents were received by the Panel on 21 January 2026, after the claimant had been re-examined by the medical members of the Panel on two occasions. The documents the subject of the application are 40 separate certificates of capacity (the documents).
3. Despite what is recorded in the application, the documents were not provided in accordance with the directions made by the Panel on 23 October 2025. Those directions required the claimant to file the clinical records of Drs Majumder and Usmani on or before

28 November 2025, prior to the second re-examination that took place on

10 December 2025. 4. As already recorded, the documents were not available to the Panel prior to either of the re-examinations taking place. The Rules stipulate that an additional document must not be introduced for the purposes of a medical assessment after the medical assessment has taken place: rule 67C(5). 5. Admission of the documents would delay the determination of the proceedings; the parties would need to be afforded an opportunity to file submissions addressing the documents and a further re-examination may be required to address the documents with the claimant. 6. The Panel is not satisfied the introduction of the documents is necessary to facilitate the just, quick and cost effective resolution of the real issues in the proceedings. 7. For the foregoing reasons the application is refused.

1. The Panel convened on 20 August 2025 and discussed the issues in dispute and the evidence. It was determined that a re-examination of the claimant was required. The Panel agreed the re-examination would be conducted by its medical members on 1 October 2025.
2. The medical members of the Panel re-examined the claimant on 1 October 2025. When the Panel convened on 22 October 2025 it determined that the records of a number of treatment providers referred to by the claimant when she was re-examined were relevant to the matters in dispute. The claimant was directed to file additional records from her treatment providers, and the parties were given an opportunity to file submissions addressing those records.[4] A further re-examination was appointed to take place by MS Teams on 10 December 2025 to allow the medical members of the Panel to discuss the records with the claimant.
3. The Panel re-convened on 21 January 2026. The members of the Panel discussed the re-examination findings and agreed on the outcome of the Review as recorded in the certificate and these reasons. The Panel also determined that the claimant's application to lodge additional documents dated 20 January 2026 would be refused for the reasons earlier recorded.

1. No damages may be awarded for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%: s 131 MAC Act.
2. Section 132 of the MAC Act deals with the assessment of impairment. If there is a dispute about whether the degree of permanent impairment of an injured person is sufficient for an award of damages for non-economic loss, such damages may not be awarded unless the degree of permanent impairment has been assessed by a Medical Assessor under Part 3.4.
3. The method of assessing the degree of impairment is dealt with in s 133. Permanent impairment is to be assessed in accordance with the Impairment Guidelines. Clause 1.3 of the Impairment Guidelines states that they apply to the assessment of the degree of permanent impairment that has resulted from an injury between 5 October 1999 and

30 November 2017. 21. Clauses 1.5 - 1.7 of the Impairment Guidelines address causation of injury. Impairment caused by mental and behavioural disorders is assessed in accordance with cl 1.201 - 1.228 of the Impairment Guidelines: cl 1.35 of the Impairment Guidelines. 4. In order to measure impairment caused by a specific event, Medical Assessors must, in the case of an injured person with a pre-existing psychiatric diagnosis or diagnosable condition, estimate the overall pre-existing impairment using precisely the method set out in cls 1.201 - 1.228 of the Guidelines, and subtract this value from the current impairment rating: cl 1.218 of the Impairment Guidelines. Clause 1.34 of the Impairment Guidelines deals with subsequent injuries. 5. Chapter 11 of the Medical Assessment Guidelines sets out the assessment procedure including, at [11.1]-[11.5], the Medical Assessor's role.

1. Causation of injury is addressed at cl 1.5 of the Impairment Guidelines as follows:

1.5 An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues.

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

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

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

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

1.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. In Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 (Owen) Campbell J held at [27] that:

"Given that the task of the Medical Review Panel in determining the causation question is not solely a medical determination within the expertise of the assessors constituting the Panel, the position has, with respect, been aptly put by Johnson J in Ackling at p. 500 [87] that the Assessors will derive practical assistance from this part of the permanent impairment guidelines. But it is well to emphasise that the question to be assessed is one of legal causation involving mixed questions of fact and law arising principally from the law of negligence as modified by Civil Liability Act 2002, s.5 D.(See s.3B(2))."

1. In general terms, subject to 5D Civil Liability Act 2002, it is sufficient if the injury was caused or materially contributed to by the motor accident. The motor accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen at [50].

1. Prior to undertaking the assessment the subject of this review, Medical Assessor Mason assessed the claimant on 2 April 2024 and issued a certificate dated 5 April 2024. That certificate records the Medical Assessor declined to make an assessment under s 132(3) of the MAC Act because persistent somatic symptom disorder (with predominant pain) was "not yet permanent". It is also recorded in the certificate that the "permanent impairment of these injuries should be capable of assessment 12 months after decompressive surgery."

1. In his reasons the Medical Assessor recorded details of the claimant's pre-accident psychological history. In this regard, it is recorded that she experienced symptoms and received treatment after her first marriage came to an end. She reported that "while it was emotionally draining, she recovered and was able to move on with her life." The separation from her second husband following the accident "added to her sense of distress" following the accident.
2. The claimant gave a history of being involved in a motor vehicle accident in 2012 and reported that there was no claim for compensation. She could not remember why she was prescribed fluoxetine in 2011 or whether she used it.
3. The Medical Assessor's reasons contain the following history:

"...they were rear ended at speed by another vehicle and she did not see it coming. She said it was a big shock and the vehicle was pushed a few metres forward.

She said she opened the door of the vehicle and waited for the driver of the other vehicle. She described him as abusive and aggressive and wondered if he was drunk. She asked if she could see his driver's licence and he was reluctant to provide it. When she said she wanted to call the police she said he started yelling and swearing and went back to get his license and then sped off. Another motorist who had pulled up urged her to move the car because it was in danger of a further collision..."

1. The claimant experienced ringing in her ears and headaches, pain in the neck and lower back. She said she was shocked. Subsequent symptoms, treatment and investigations related to her physical complaints are recorded. Cervical decompressive surgery was recommended by Dr Pope, neurosurgeon. The claimant reported that Dr Pope had informed her she could be paralysed if she experienced another bump such as a motor accident or even being jostled in a crowd. She said this set off an intense fear of paralysis. She questioned Dr Pope about the likely success of surgery and was told there was no guarantee that all the pain would be relieved. She said this frightened her and she consulted other specialists. There was a further anxiety arising from the fact that brain scans revealed a small intracavernous right internal carotid artery aneurysm which was a pre-existing incidental finding.
2. The claimant reported that:

"...because of her physical symptoms and her fear of further injury resulting in paralysis she was unable to go out, she withdrew from friends, her relationship went downhill and she was not able to participate in any sporting activities. She said prior to the accident she had been living with her husband for 3 months and when that relationship broke down she moved back with her family. She said she did not like herself and did not want to be around. There were almost daily suicidal thoughts."

1. The reasons record the claimant's reported physical and psychological symptoms. The psychological symptoms included fear of further injury causing paralysis, ongoing depression, chronic pain and sleep apnoea. She saw a psychologist and had been prescribed an antidepressant.
2. The reasons also include a description of the claimant's functioning by reference to each of the areas of functioning in the psychiatric impairment rating scale (PIRS).
3. The Medical Assessor diagnosed a major depressive disorder with anxious distress and persistent somatic symptom disorder with predominant pain. As to causation, the Medical Assessor expressed the following opinion:

"[The claimant] was involved in a relatively minor motor accident. Neither police nor ambulance were called and subsequently she was able to drive to the city. She did not develop a trauma-related condition such as post-traumatic stress disorder as a result of the accident because DSM-5 Criterion A was not met. Nor did she become depressed directly as a result of the accident. She subsequently developed physical symptoms which included both cervical and lumbosacral spinal pain. This resulted in difficulties in coping at work and restriction of her activities. Eventual consultation with a neurosurgeon (Dr Pope) resulted in extreme fear of further neurological damage resulting in paralysis and further restriction of her activities. Secondary to pain and the restriction of her activities she developed a major depressive disorder with anxious distress. Because the condition is entirely secondary to physical injury the most appropriate diagnosis is Persistent Somatic Symptom Disorder (with predominant pain) which was caused by the subject motor accident."

1. Because the claimant had decided to proceed with cervical decompressive surgery and was awaiting insurer approval, the Medical Assessor determined it would not be possible to arrive at a final diagnostic conclusion and assessment of impairment until 12 months after surgery. He stated that the "current diagnosis of somatic symptom disorder (pain) does not allow for the calculation of whole person impairment."

MEDICAL ASSESSOR MASON'S SECOND ASSESSMENT - THE ASSESSMENT UNDER REVIEW

1. On 13 September 2024 Medical Assessor Mason certified that "[a]ll the injuries referred to [him] for assessment have been assessed and determined to be secondary to a Somatic Symptom Disorder (Pain)." As a result "[a]n assessment of the degree of permanent impairment of these injuries is therefore not required."
2. In his reasons the Medical Assessor recorded that the claimant's circumstances had not changed since the assessment conducted in April 2024. Various matters recorded in the Medical Assessor's earlier reasons are repeated and referred to. When asked about her current symptoms the claimant stated, "she was too scared to proceed with surgery because of fear of becoming paralysed." She said she did not want to be more dependent upon her parents but then stated that she would maybe consider surgery in the future if she had no choice.
3. The claimant reported her sleep had deteriorated and that she is unable to tolerate CPAP. She is woken frequently by pain and gets between one and three hours sleep a night, and this results in excessive somnolence throughout the day. The claimant described daily headaches, ongoing neck and back pain, a swollen right upper arm due to holding her head up, and other physical symptoms.
4. Psychological symptoms reported by the claimant included poor concentration, depression, "flashbacks", anxiety, and difficulty with memory. When questioned about the use of the term "flashbacks" the claimant said she was always alert and frightened when she is in a car. She said a couple of times she has woken up from dreams of an accident and that she is always hypervigilant on the roads. She is afraid of another accident because "one more jerk and I will be paralysed". The claimant continued to see her GP and a psychologist. She used the antidepressant Lexapro 10 mg.
5. The Panel has evaluated the description of the claimant's current functioning addressed by reference to the PIRS domains. The Panel notes that the Medical Assessor found the claimant's presentation to be internally consistent, consistent with the documentation provided and consistent with the diagnosis he made.
6. Medical Assessor Mason found that the claimant's condition had not changed substantially since she was last assessed. She presented with similar symptoms consisting of significant ongoing pain arising from the cervical spine and lower back. Decompressive cervical surgery was recommended but had been declined because of the risk associated. The "pain picture" was complicated by the presence of headache and/or migraine, vertigo, obstructive sleep apnoea, weight gain and bladder and bowel dysfunction. The Medical Assessor recorded that:

"The most debilitating feature of her condition is her constant fear of paralysis if she suffers further cervical spine injury; this has resulted in significant impairment of all activities. As a consequence of the physical symptoms she has developed a major depressive disorder with anxiety. It is clear that if pain was to resolve she would fully resume work, social and recreational activities."

1. The Medical Assessor found that the claimant continued to suffer from a major depressive disorder with anxiety secondary to her chronic pain condition and a somatic symptom disorder with predominant pain. With respect to causation, he found that the accident resulted in significant psychiatric symptoms secondary to pain.
2. No assessment of permanent impairment was made by the Medical Assessor because he had determined major depressive disorder with anxiety arising secondary to somatic symptom disorder is not assessable using the psychiatric impairment rating scale.

1. Each party filed a bundle containing the evidence relied on for the purposes of the Review. Much of the material relates to the claimant's physical complaints. Each party made an application to lodge further documents. As recorded earlier, those applications were the subject of separate determinations by the Panel. The claimant was given leave to rely on a statement of CFN dated 30 May 2024, a report of Grant Johnston dated

20 December 2024, and Mr Johnston's handwritten notes dated 19 June 2024. The insurer was given leave to rely on a supplementary report of William Bailey dated

2 September 2025. 2. In addition to this material the Panel was provided, at its request, with clinical records from Macquarie Medical Centre for the period 22 October 2012 - 27 November 2025 and Greenacre Medical Centre for the period 7 September 2020 - 27 November 2025. The parties were given an opportunity to file written submissions addressing this material. The claimant filed submissions addressing these records dated 5 December 2025. The insurer did not file any submissions with respect to this additional material.

1. On 20 November 2023 Medical Assessor Garvey certified that gastro-oesophageal reflux, gastritis, irritable bowel syndrome (IBS) and faecal incontinence caused by the accident give rise to a permanent impairment of 0% and that the impairment is not greater than 10%. The Medical Assessor's reasons make it clear he did not think the gastro-oesophageal reflux and gastritis were caused by the accident. In his opinion the gastro-oesophageal reflux was caused by a pre-existing small hiatus hernia, and the gastritis was caused by Helicobacter pylori. The Medical Assessor thought that any anal symptoms were mild, very intermittent, and not evident on examination. In his opinion, the likely diagnosis was IBS. Any history of faecal incontinence "is on the balance of probabilities consequent on [i]rrritable [b]owel syndrome." In the Medical Assessor's opinion, the IBS and faecal incontinence were caused by the accident.
2. On 8 February 2024 Medical Assessor Grainge certified there was a 5% permanent impairment of the claimant's respiratory system caused by the accident. In his reasons, the Medical Assessor recorded the claimant "has multi-factorial sleep disorder with contributing factors of obstructive sleep apnoea, depression and ongoing pain...". Medical Assessor Grainge was of the opinion that but for the accident and consequent weight gain, the claimant would not have developed obstructive sleep apnoea requiring therapy.
3. On 28 March 2024 Medical Assessor Steiner certified that injury to the claimant's visual system was not caused by the accident and that, as a result of that finding, assessment of permanent impairment was not required. In his reasons the Medical Assessor recorded:

"As she did not have glaucoma and as her narrow chamber angles are a constitutional condition merely descriptive of the anatomy of the inside of her eyes it is my opininion [sic] that the following injuries were not caused by the motor accident accident [sic] and that is 'visual system - drug induced narrow angle glaucoma triggered by amitriptyline and lyrica medication prescribed for her motor vehicle accident injuries'".

1. On 28 June 2024 Medical Assessor Gorman certified that soft tissue injuries to the claimant's lumbar and cervical spine caused by the accident gave rise to a permanent impairment of 5% and is not greater than 10%. In his reasons the Medical Assessor recorded his opinion that the accident had aggravated "a developmental issue" in the lumbar spine. Left leg and knee injuries were not caused by the accident. The accident caused cervical spine injury gave rise to an impairment of 5%. The lumbar spine injury did not attract any permanent impairment.

1. Medical Assessor Gorman issued a combined certificate dated 2 July 2024 wherein he certified that the injuries caused by the accident give rise to a permanent impairment which is not greater than 10%.

1. Dr Harbison, orthopaedic surgeon, reported to the insurer on 25 September 2018. The doctor recorded a history that the claimant developed back and neck pain after the accident. Her main problem was neck pain. She sometimes experienced right and left upper limb symptoms. The claimant had pre-existing changes in her spine. She demonstrated "some features of illness behaviour". In the doctor's opinion the claimant sustained soft tissue strain of her cervical and lumbar regions as a result of the accident. There were, in his opinion:

"...some inconsistencies such as the neck range of motion...but there was also illness behaviour. These findings indicate that there is a psychological component to the present problems...".

1. Dr Harbison did not think the claimant required any specific treatment. The injuries sustained may have caused her to be unfit for work for a short period following the accident. In a separate report of the same date the doctor assessed 0% impairment of both the claimant's neck and her lumbar spine.
2. Dr O'Neill, neurologist, reported to the insurer's solicitor on 6 June 2022. The claimant reported that symptoms in her neck and lower back regions were "equally bad". She also experienced symptoms in her arms and legs. On examination there were "marked abnormalities of a non-organic nature." In the doctor's opinion:

"...the current diagnosis is a major psychosomatic reaction to the relatively minor motor vehicle accident in a patient with pre-existing and largely asymptomatic degenerative disease of the cervical spine and a developmental spondylolisthesis at

1. The claimant had shown she had the capability of working for at least 20 hours a week, albeit from home in her capacity as a senior manager in digital commerce. Her inability to work longer hours "would primarily be as a consequence of the adverse psychological response to her pain". Given it had been five years since the accident, and given the claimant's symptoms were worsening, it was in the doctor's opinion highly unlikely the claimant will be able to increase her working hours or return to pre-accident employment. In the doctor's opinion the claimant "should be given the benefit of the doubt that the accident ... did cause some mechanical neck pain with restriction of movement in the setting of someone with pre-existing but largely asymptomatic prominent cervical spondylotic degenerative disease." Similarly, "it might be construed" that the accident did result in development of mechanical low back pain in a person with pre-existing but largely asymptomatic developmental spondylolisthesis. The doctor assessed a 5% impairment of both the cervical and lumbar spines.
2. Dr Sethi, gastroenterologist and hepatologist, reported to the insurer on 16 November 2022. The claimant reported developing gastrointestinal symptoms "around 3 months" after the accident. The Panel has considered the symptoms recorded by the doctor. In the doctor's opinion the claimant developed gastro-oesophageal reflux disease (GORD), irritable bowel syndrome (IBS) and faecal incontinence "of her own accord". Dr Sethi recorded that the accident and the analgesic medications the claimant subsequently received did not play any causative role and they have developed regardless. His reasons for arriving at this conclusion have been considered. In the doctor's opinion, the prognosis for the GORD and IBS is good. They will likely remain stable and are unlikely to worsen or progress. The prognosis for her faecal incontinence was guarded. It will likely persist and is unlikely to improve or resolve. In Dr Sethi's opinion, "to no extent whatsoever" do the claimant's accident-related injuries impact her ability to obtain, engage in and maintain employment.
3. Dr Courtenay, orthopaedic surgeon, reported to the insurer's solicitor on 23 November 2022. In the doctor's opinion pre-existing neck pathology had been aggravated by the accident. The claimant's low back pain was not related to the accident and was attributable to a pars defect of the lumbar spine. The report records:

"This claimant has also suffered extensively from anxiety and depression and that goes right back to all the documentation provided and right back to at least 2012. I also note it has come up in other reports and the patient gets very focussed on her condition and unfortunately, I think that is the current situation. She has been recommended to have spinal surgery in her neck and in her low back but even though there is certainly pathology in the cervical spine and some of that pathology is related to the motor vehicle accident, I do not believe from a psychological point of view she is ready for that, and I also do not believe she is going to get the improvement she suspects. Again, there is no radiculopathy, and the condition has been stable. The low back I do not believe is related to the motor vehicle accident and it is related to a previous pars defect. I do not believe she will benefit from surgery to that."

1. Dr Courtenay though that there were "some discrepancies, particularly with previous injuries and also the severity of the accident." Surgery was not going to help. In the doctor's opinion there was an impairment of the claimant's work capacity. Part-time work in a different environment was appropriate. The doctor assessed a 5% permanent impairment of the claimants cervical spine.
2. Dr Jungfer, psychiatrist, reported to the insurer's solicitor on 20 February 2023. The doctor recorded a history that the claimant had completed a return to work program but was never able to achieve a return to full time work. The claimant reported that she could not return to the office due to pain and the issues with driving. The dizziness and nausea made it hard for her to be in an office environment. The claimant had changed jobs and reported that she was struggling in the role of her current job and does not have the physical ability to carry out the role.
3. The claimant reported headaches, vertigo, constant neck pain, mid to low back pain, pain in both knees that can be so severe she thinks she needs to call an ambulance, urinary incontinence, waking from sleep with pain. She experiences anxiety and stress, a fear of her future, fear of surgery as well as fear of her job stability. She reported nightmares of having an accident, being injured or not being successful. When in a car she felt stress, anxiety and worries about having another injury. The claimant reported flashbacks and panic attacks.
4. In the doctor's opinion the claimant's background history indicated an underlying generalised anxiety disorder and a somatic symptom disorder. These conditions predated the accident and made her more vulnerable for "psychiatric dysfunction" following an accident. In response to the accident, the claimant developed a chronic adjustment disorder with mixed emotional features secondary to the chronic pain she reports. Post-traumatic stress disorder was not diagnosed because the doctor did not consider criterion A was satisfied. The doctor recommended that the claimant undergo psychometric testing for effort testing/ symptom validity so that aspects of her diagnosis could be clarified. In her opinion there were non-organic factors influencing the claimant's presentation. These symptoms are a component of her pre-existing somatic symptom disorder. In Dr Jungfer's opinion it is probable the condition deteriorated in response to the accident, "although it cannot be excluded that external factors such as secondary gain are influencing this deterioration". The adjustment disorder with mixed emotional features would impact upon her employment, predominantly the reliability of her employment and her endurance. Physical factors appeared to be the predominant limiting factor. In the doctor's opinion the best form of management would be under a chronic pain model. Dr Jungfer assessed a 5% permanent impairment as a result of the adjustment reaction to her chronic pain.

1. Dr Jungfer recorded that there were references in medical records that were not consistent with the history the claimant provided when assessed and not all aspects of these discrepancies could be clarified.
2. Dr Burrow, orthopaedic surgeon, provided a medico-legal report dated 8 November 2021. He recorded a history of the accident, the claimant's symptoms and treatment. The claimant reported visual symptoms, headache, neck pain, bilateral upper extremity and low back pain and lower extremity pain. She also had intermittent dysaesthesia. In the doctor's opinion the accident caused an aggravation of pre-existing degenerative changes in the cervical, thoracic and lumbar spine. The prognosis was poor, particularly in relation to the cervical spine where there is "quite dramatic" cord impression. While the claimant reported significant radicular-like complaints in the upper extremity from the cervical spine and on occasions in the lower extremity, on examination there was no evidence of radiculopathy.
3. Dr Guirgis reported on 30 March 2021. The claimant reported symptoms in her neck, shoulders, back and legs. In the doctor's opinion the claimant suffered injuries to her neck and back as a result of the accident. The material annexed to the report has been reviewed, including the doctor's assessment of permanent impairment.
4. In a medico-legal report dated 28 November 2022 Dr Berry, general surgeon, diagnosed gastritis arising from a sliding hiatus hernia, Helicobacter infection and medication intake, and "anal dysfunction", the cause of which was not known. In the doctor's opinion the claimant's upper gastrointestinal condition is likely to be due to her medication intake. The doctor could not "explain her incontinence in terms of her spinal injury". Dr Berry assessed a 7% permanent impairment.
5. Dr Herald reported on 24 January 2022. The doctor diagnosed cervical disc prolapse at C4/5, C5/6 and C6/7 levels with radiculopathic symptoms to upper limbs and secondary headaches, L5/S1 spondylolisthesis with associated radiculopathic symptoms to both lower limbs, recent left knee fracture as a result of a fall one week before, secondary reflux from chronic medications, temporary increase in glaucoma pressure as a result of medications, post-traumatic stress disorder, and chronic pain syndrome. In his opinion:

"She definitely had a pre-existing area of pars defects in the lumbar spine and cervical spondylosis. It may have begun from previous injury in 2012 for which she had a good recovery. However as a result of the motor vehicle accident she has had a permanent aggravation of these conditions and the motor vehicle accident was the main contributing factor to her current pain and neurological deficit."

1. In Dr Herald's opinion the claimant was fit for sedentary "type" duties. She probably required surgical decompression of her cervical spine. In a separate report the doctor assessed a 10% permanent impairment as a result of her cervical and lumbar spine injuries.
2. In his reported dated 7 March 2022 Dr Herald comments on Dr Harbison's report.
3. Associate Professor Wong, general surgery consultant, reported on 18 May 2022. The doctor was asked to assess the claimant's digestive system. In his opinion the claimant's upper gastrointestinal tract has consequential impairment due to NSAID medication. Her lower gastrointestinal tract has consequential impairment of intermittent faecal incontinence to the spinal cord injury. The doctor assessed a 15% permanent impairment.
4. Dr Rastogi, psychiatrist, reported on 18 January 2023. The doctor recorded that there was "no known previous psychiatric history." The doctor diagnosed major depressive disorder with anxiety and chronic pain disorder. The claimant's prognosis was guarded. She was incapacitated to work in preinjury employment permanently. In a separate report the doctor provided an assessment of the claimant's permanent impairment. The doctor's assessment, and her reasons for the class she assigned to each domain of functioning, have been evaluated by the Panel.

1. The material from treatment providers includes a large number of radiological reports. The reports relate to the claimant's spine, brain, head and left knee. There are also whole-body bone scans, nerve conduction tests and a sleep study report. The Panel has considered this material.
2. Extracts from the clinical records of Campsie Medical Centre relied on by the insurer were printed on 30 June 2021. The past medical history in the patient record has been considered.
3. The first entry in the patient notes is dated 25 October 2012. In that note Dr Abouzeid recorded that the claimant had been involved in a motor vehicle accident the week before and that "she hit a truck and had mild neck pain...". She subsequently felt pain in her right and left calf. On 30 October 2012 the doctor recorded:

"...She sent multiple messages on the weekend concerned about multiple symptoms.

She was provided with lenghthy [sic] counselling session about her problem, anxiety and fear of serious medical problem..."

1. The clinical notes from this practice also include reference to various illnesses and ailments together with the following:

(a) 9 November 2012 - "Long counselling session about anxiety.";

(b) 22 November 2012 - "Long counselling session: Major anxiety about her DVT, ovarian cysts and DDx... strongly advised that she should re start clexane until the INR is under control. She refused and had a panic attack about the thoughts of having another needle...";

(c) 27 November 2012 - "...Long counselling session about resultas [sic], causes, short term long term. Counselling about her anxiety [sic] neurosis and how to deal with her fears...";

(d) 21 December 2012 - "...Displaying a great deal of anxiety neurosis and fear of needles...";

(e) 8 January 2013 - "...She still have fears and anxiety about her condition...";

(f) 7 May 2013 - "...Migraine since last night affecting right frontal area. Also experienceing [sic] aura with visual disturbances since this morning at work...";

(g) 6 October 2013 - "...Rx options discussed in detail: Pradax or clexane. We discussed her risk factors. This trigger her anxiety and fear of side effects and triggered avoidance with delaing [sic] with issues. Counselling +++++";

(h) 3 April 2014 - "Mechanical low back pain";

(i) 16 September 2014 - "...She suffers from anxiety, lack of confidence and making decision [sic].. She had suidal [sic] thoughts...";

(j) 10 June 2015 - "...Neck pain, started mon, no PI, ole ROM reduced when streching [sic] the L trapezius. Neck muscles and trap are tender to palpation [sic];

(k) 5 April 2016 - "Neck and R & L trapezius pain, couldn't get out of bed, returned from She is tarvelling [sic] to USA on Friday o/e pain and swelling over L Trapezius, neck ROM tender...";

(l) 1 June 2017 - "Tues MVA: hit from the back twice and described whiplash injury, headache and dizzy, o/e ROM are limited in all directions be of the pain. Extension limited to 5-10 degrees. Palpation severe pain in all neck muscles and trapezius muscles Back ROM normal.", and

(m) 14 June 2017 - "...Examination: Left shoulder higher than right at rest, trapezius tender bilaterally on palpation, warm to touch, Cervical spine: ROM limited by pain, especially on extension Shoulders: full ROM Forearms: pain in right forearm UL neruo: reflexes equal bilaterally, power 5/5, pain along nerve IMP: whiplash grade 2..."

1. The post-accident notes refer to neck, low back and arm symptoms, intermittent headaches, blurred vision, dizziness, and crying. On 16 April 2019 it was recorded the claimant was tearful, stressed and had "too much health issues". Other psychological symptoms were recorded. A note recorded on 7 November 2019 refers to the claimant being "very stress, work going thr [sic] redandecy [sic]". On 24 June 2020 it was recorded she "has a lot of anxiety". On 10 August 2020 Dr Rao recorded "...Psych: Poor sleep. Depressed mood. Low self esteem. Irrational fear...". The last entry in the notes is dated 10 June 2021 and records that the reason for contact was "[n]eck and lower back pain".
2. The claimant's bundle includes reports from her treating doctors[5], including Dr Assaad, Dr Pope, Dr Abouzeid, Dr Ooi, Dr Rao, Dr McKechnie and Dr Freiberg. With respect to this material, the claimant's submissions dated 22 September 2023 only refer to Dr Frieberg's report of 17 March 2023, Dr Cordato's report dated 9 April 2021, Dr Assaad's report dated

23 January 2018, and Dr Diwan's report of 29 January 2018. The references made to these reports was in the context of physical impairment and not the claimant's psychological impairment. 3. The claimant was referred to Dr Assaad, neurosurgeon, by Dr Majumder. She was first reviewed by Dr Assaad in August 2017. The doctor recorded a history of the accident and the development of neck and back pain three to four days later. Significant neck pain was her main symptom. Pain radiated into her arms. The most significant radiological findings included multiple protrusions in the cervical spine. There was evidence the protrusions are calcified but may have been recently aggravated. The doctor diagnosed an aggravation of asymptomatic cervical and lumbar changes. Further investigations and treatment were recommended. 4. In a report dated 3 October 2017 Dr Assaad recorded the claimant felt she was gradually improving. She still had neck and back pain. Treatment options, including surgery for the cervical spine, were discussed. In his report dated 23 January 2018 the doctor stated that the MRI of the spine again demonstrated three levels of cervical stenosis with disc protrusions. The radiologist reported the findings were worse than on the previous imaging "although it is difficult to be sure". As far as the cervical spine was concerned, the claimant remained a candidate for surgical decompression and fusion. 5. In a report dated 28 August 2018 Dr Assaad recorded there had been some improvements. The MRI performed in July 2018 demonstrated a stable appearance of the cervical disc protrusions. In comparison to the year before there may have been some slight improvement in the protrusions. The L5/S1 and the thoracic disc remained stable. Given the claimant was improving and she was gradually increasing her work hours, continuing conservative measures were suggested. 6. A report from Dr Assaad dated 17 April 2020 records the claimant reported continuing symptoms including headaches, neck pain, lower back pain, and bilateral intermittent leg pain. An MRI scan performed in November 2019 showed several cervical disc protrusions, without cord compression that appeared stable or "slightly improved." There was a thoracic disc protrusion. There were also findings in the lumbar spine. The low back symptoms were worsening. Surgery was discussed. In a report dated 21 August 2023 the doctor recorded the claimant continued to experience neck and low back symptoms. She was referred for further investigations. The claimant reported her symptoms were severe enough that she would consider surgical intervention. 7. The claimant was also referred to Dr Pope, neurosurgeon, who reported on 8 September 2017. She reported neck pain, right upper limb pain and back pain following the accident together with functional limitations. On examination the claimant had fear avoidant behaviour and was "hunched over with pain, clutching her neck and right arm". In the doctor's opinion the claimant had three ruptured discs in her neck at C4/5, C5/6 and C6/7 with musculoskeletal and discogenic neck pain, right C6 and probable C7 radicular pain and radiculopathy. She was getting worse and "failing" nonsurgical measures. She should see a pain specialist and consider surgery to decompress the spinal cord to prevent cord injury, to help with her chronic pain syndrome and chronic denervation and "to help her move forward from this problem." The claimant was working four hours a day, three days a week, mainly from home. The doctor was "happy for that to occur". 8. In a report dated 9 May 2018 Dr Pope noted complaints of neck, upper limb, and back pain. There was fear avoidant behaviour. The findings were consistent with the accident. The claimant had been referred to a pain specialist to help her deal with pain. She was "in a chronic pain syndrome". The doctor stated that "[t]he fact she is working part time, 4 hours a day, 3 days a week, mainly from home, is encouraging but that needs to increase as well as her work away from home." Stabilisation had not occurred. Symptoms and signs continued. The role of surgery should be discussed. 9. The claimant reported neck and back pain to Dr Sheh, a consultant physician in pain and rehabilitation medicine. The doctor made various recommendations with respect to treatment[6]. In a report dated 4 April 2019 Dr Pope recorded the claimant's complaints of deteriorating symptoms "over the last few years". She continued to work 20 hours a week mainly from home. Her symptoms were predominantly in the neck. She demonstrated fear avoidant behaviour. The claimant had chronic disc herniations with discogenic and musculoskeletal neck pain, cervicogenic headaches and bilateral radicular components mainly from the C5/6 level. She was not coping with her symptoms. Surgery was proposed. There was a "good chance" she will be able to return to her job after the operation. 10. Dr Diwan, spinal surgeon, reported on 29 January 2018. The claimant reported neck and lower back pain with symptoms in her limbs. The claimant reported she was getting much better. There was "quite some limitation of various activities of daily living." Because back pain was not a "predominating concern" a non-operative strategy was suggested. In terms of her neck, the claimant's anxiety with respect to myelomalacia[7] was noted. If her neck or upper arm symptoms increased the doctor was "happy to review her" for a three-level anterior cervical decompression and stabilisation. 11. In a report dated 8 January 2020 Dr Cordato recorded there had been discussion about surgery but it had been agreed "at this stage" that a non-operative approached would be best. The claimant had been working part-time but was made redundant in December 2019. The claimant reported headaches, numbness in her arms, back and neck pain. In a report dated 9 April 2021 the doctor recorded that there was significant cervicogenic pain. 12. Dr Rao, neurosurgeon and spinal surgeon, reported on 12 August 2020. The claimant reported severe neck and radicular pain following a motor vehicle accident. She also reported ongoing back pain and radicular pain down both legs. The scans over the previous three years showed worsening rather than improvement. There was significant spinal cord compression with signal change and neurological deficit. The natural history is progression and would most likely lead to surgery over the next few years. In the interim there was a small risk of quadriparesis or plegia if there was a fall. The doctor thought surgical management was the best option. The details of the proposed surgery recorded in the doctor's reports have been noted as have the matters recorded by the doctor in the "NTD case management review" dated 8 September 2020. 13. Dr McKechnie, neurosurgeon, reported on 17 February 2021. The claimant reported headaches, pain in her neck, back and limbs following a motor vehicle accident. The investigation findings were noted. In the doctor's opinion, given the investigation findings and the claimant's symptoms it would be reasonable for her to consider cervical spine surgery. If her back and leg pain was not manageable decompression and fusion surgery "would also be a reasonable option". 14. Dr Liu, neurosurgeon, reported to Dr Usmani on 27 May 2021. Lower back pain was worsening. The claimant found it difficult to walk up stairs and her sleep is interrupted by the physical symptoms. She also has constant neck pain and bilateral upper limb paraesthesia. A posterior decompression and fusion for her lower back and limb pain "is a reasonable option." 15. A document dated 16 January 2021 described as an "OT ADL Assessment" relates to an assessment carried out on 17 December 2021. The medical history recorded in the report, together with the reported functional tolerances have been considered. Various limitations are reported due to pain. The claimant reported she experiences anxiety when she has to go out into the community due to fear of being bumped or injured in a crowd. She was working from home completing administrative tasks. She was independent with showering and dressing. She reported difficulties with toileting due to pain and difficulties with work due to her physical injuries. Various limitations performing home duties and home maintenance were recorded and result from the claimant's physical injuries and symptoms. The recommendations made in the report have been considered. 16. Dr Freiberg's reports[8] deal with difficulties the claimant experienced with her sleep and the results of a sleep study. The doctor noted the claimant reported depression and anxiety. 17. Dr Reitz, orthopaedic surgeon, reported to Dr Usmani on 28 August 2023. The claimant reported stumbling in a car park due to her unsteady gait. Since the fall she had pain in both knees. She was referred for MRI scans of her hips and knees. 18. Clinical notes from Access EAP are handwritten and difficult to read. There is reference to chronic pain that impacts on mood and sleep.

1. The records from the Centre for Digestive Diseases relate to gastroenterological issues and include reports addressing various procedures and findings.
2. An AHRR dated 28 May 2020 relates to a psychological referral. The diagnosis recorded is mixed anxiety and depression and chronic pain. The following signs and symptoms were recorded:

"Low mood, loss of pleasure, sleep disturbance, anxiety and avoidance

Chronic Pain from head, migraines, headaches, pain in neck goes to arm, clumsiness and loss of strength

Pain that goes down leg, 2 types chronic pain that's constant, then sharp pain that if unrelieved within a few minutes requires energy

care at hospital. On occasion leg jams seizes up and she requires help to go to hospital

Sleep deprivation, due to pain and emotional distress".

1. The AHRR records that the claimant's work capacity was "4 days a week, 4 hours, can work from home". She had very limited functioning with respect to self-care, domestic caring, and was "[s]cared of sitting in a small car, hit one more time will be paralysed which causes anxiety and panic in vehicle".
2. Dr Ooi's clinical notes are handwritten. The first entry in the doctor's notes is dated 25 February 2020. The notes relate to treatment of the claimant's eyes. The doctor's reports have been considered as have the symptoms reported by the claimant. In a report dated 11 June 2020 the doctor recorded the claimant described symptoms consistent with narrow angle closure, and that she described headaches, especially upon waking in the morning and sunlight sensitivity. He stated that "[i]t is a little bit of a confusing picture, as she also is with a neck injury and does get referred pain." In the doctor's opinion the claimant "may be on the cusp of developing narrow angle closure glaucoma."

1. Records from Macquarie Medical Centre include a patient health summary. The first entry relates to a consultation on 24 November 2020. On that occasion the claimant reported neck, right arm and low back pain. Notes recorded on 19 December 2020 refer to similar complaints. The certificate of fitness dated 24 November 2020 is difficult to read. The diagnosis recorded includes depression and anxiety. As recorded earlier, the various radiological and investigation reports[9] have considered.
2. The claimant has also filed the clinical records from Macquarie Medical Centre for the period 22 October 2012 - 27 November 2025 and Greenacre Medical Centre for the period 7 September 2020 - 27 November 2025.
3. The Macquarie Medical Centre clinical notes (22 October 2012 to 9 November 2020) include reference to the following:

"22 October 2012 MVA 5/7 ago - ongoing neck pain ++ shooting pain both legs

14 November 2017 Suffers from C5/C6 disc protrusion severely compressing thecal sac and cord and compressing (R) C6 nerve and mid to low back pain

6 January 2018 gets stressed, frustrated as she cannot do her usual thing and she is in pain

need referral to see psychologist as under stress since she met with any accident.

-finding hard to face all these ongoing health issues

- husband not understanding , feels parents are more supportive.

she has discussed with employer , they asked her to present referral to see psychologist.

16 January 2018 Under lot of stress RE: Her neck and back pain and also worried about if she has to go for operation

2 March 2018 Under stress because of work related injury Will see psychologist soon P/ Counselling

3 April 2018 Also work related stress, anxiety Refer to Carol Hayek (Psychologist)

20 April 2018 Also suffers from Stress, anxiety due to work related injury

22 May 2018 Saw Psychologist last wk , Feels much better

28 September 2018 Feels pain on lower back and (R) side neck Feels stress about operation

23 April 2019 Saw Psychologist , Will continue counselling Under lot stress of at work and family issue

9 July 2019 Stress and anxiety sx is still the same

15 September 2019 Still feels work injury related stress and anxiety

24 May 2020 feels stress and anxious sees psychologist

5 July 2020 Suffers from anxiety and major depression

1. August 2020 Stress, anxiety, depression".
2. These records also include a referral Dr Diwan dated 27 January 2018, a psychological/counselling management plan dated 18 September 2018, the reports from Dr Assaad to Dr Majumder about neck and other symptoms, Dr Cordato's report dated

8 January 2020 that deals with physical symptoms post-accident, and Carol Hayek's report dated 16 July 2020 that includes reference to the claimant's presentation being complex and pervasive further compounded by ongoing medical issues. 3. The second set of Macquarie Medical Centre clinical notes cover the period 9 November 2020 to 27 November 2025. On 25 October 2023 Dr Cordato's report refers to post-traumatic migraines since the accident. On 13 March 2024 Dr Heim reported the claimant continued with severe neck and lumbar pain. 4. Clinical notes from the Greenacre Medical Centre include reference in a note recorded on

7 September 2020 to neck pain and lower back pain "secondary to MVA". On 15 March 2021 it was recorded the claimant "c/o right sided lower back pain radiating down the right leg". On 9 March 2023 a note refers to a history of depression "doing well". On 17 August 2023 reference was made to "chronic pain". An entry recorded on 23 April 2024 records:

"Major depressive disorder diagnosed by a psychiatrist ... Undergoing IVF treatment, adding to stress levels ...Provided information on managing stress and anxiety related to the legal process and IVF treatment. "

1. There are complaints of neck, back and knee pain in entries made between

January and May 2025. The last clinical entry in the patient notes was recorded on 21 November 2025.

1. In her claim form dated 6 June 2017 the claimant provided the following version of the accident:

"I was stationary at the Red lights and the other vehicle crashed into the back of me. He was travelling at a high speed lost control and hit me. I felt the impact twice as he clipped into my vehicle then pulled out and smashed it again..."

1. It is recorded in the claim form that the claimant suffered injuries to her neck, upper and lower back, legs, forearm and arm. Attached to the claim form is a certificate completed by Dr Majumder dated 19 July 2017. The claimant's injuries were described in the certificate as being "pain on back of neck + upper back + tender over muscle + neck movements [illegible]".

1. Mr Bailey, mechanical and biomedical engineer, reported to the insurer on 13 June 2023. Among other matters, Mr Bailey expressed the opinion that: the accident occurred at low speed; the insured driver's vehicle was unlikely to be travelling significantly faster than

8 km/hr at the instant of contact; and the claimant's vehicle was unlikely to have undergone a change in velocity of more than approximately 5 km/hr, with corresponding acceleration of approximately 1.7g (mean) and 2.7g (peak). 2. In Mr Bailey's opinion, the risk of musculoskeletal injury was no greater than during sudden heavy braking or during activities of daily living with "at most" the potential for minor bumps and short-term discomfort to soft tissue as a consequence of unexpected postural movements or incidental cabin contact. He stated that it is not clear how the collision caused or contributed to the aggravation of previously asymptomatic pathology in the cervical and lumbar spine that the claimant reports. 3. Mr Bailey accepted there was the potential for short term minor soft tissue injuries associated with sudden movement and postural changes. He did not accept there were loads on tissue that could cause significant injury that: was not detected in reasonably contemporaneous medical imaging; and caused changes that did not begin to cause symptoms until three to four days after the event. The photographs in the report depicting damage to the vehicles driven by the claimant and the insured driver have been considered by the Panel. 4. Mr Johnston reported to the claimant's solicitors on 20 December 2024. The report is 86 pages in length. The claimant's further submissions dated 1 September 2025 record that she relies on Mr Johnston's report with respect to the following:

(a) that the insured driver's vehicle was travelling "most likely around or possibly slightly higher than the 10-15 km/hour estimated by the insured driver";

(b) his note that the claimant had her foot firmly on the brake, and

(c) his opinion that the claimant was at increased risk of sustaining a neck injury as her head was turned at the time of impact.

1. Mr Johnston's handwritten notes are relied on to the extent they confirm he took a history that the claimant had her neck turned with her foot on the brake and was talking to CFN at the time of the collision. The claimant relies on Mr Johnson's opinion to support her submission that the accident was "not a minor and insignificant collision and that the collision was a significant collision."
2. Mr Bailey's supplementary report dated 2 September 2025 responds to Mr Johnston's report, in particular Mr Johnston's opinion that Mr Bailey had "significantly underestimated the severity of the impact" and not "adequately considered two risk factors." Mr Bailey maintained the opinion he expressed in his 13 June 2023 report. In his opinion the additional photographs of the claimant's vehicle prior to and during repair, and the accompanying repair quotation, confirmed the analysis contained in his earlier report that indicated the accident involved a minor impact.
3. Mr Bailey did not agree with Mr Johnston's criticism that he had "significantly underestimated the severity of this incident". In his opinion, the additional photographs "show the type and extent of damage that [he] had anticipated based on the damage to the holden and the analysis set out in [his] report." In Mr Bailey's opinion there is no possibility the insured driver's vehicle collided with the claimant's vehicle whilst travelling at 28 km/hr because a collision at that speed would have produced substantial damage to both vehicles well beyond the visible damage in photographs of both vehicles. He accepted there was the potential for short term minor soft tissue injuries associated with sudden movement and postural changes. He stated:

"The issue of pre-existing asymptomatic changes of a degenerative nature becoming symptomatic is for the clinicians but should be understood in the context of biomechanical evidence indicating loads on the neck in this event were of low severity and comparable to loads in everyday activities including during heavy braking and when 'dropping' into a firmly padded lounge chair."

1. In Mr Bailey's opinion, sudden unexpected movements do have the potential to cause muscle strain and:

"...this appears to have been the predominant symptom reported by the claimant in contemporaneous descriptions. There is no report of muscular or tendon related injuries that could cause ongoing symptoms and cause of the claimant's ongoing symptoms cannot be related to the application of forces to the neck or lumbar spinal regions during the reported incident."

1. The photographs contained in and annexed to the both the supplementary report and Mr Bailey's earlier report have been considered by the Panel as have the photographs in Mr Johnston's report.

1. The claimant relies on a statement from CFN, a former colleague, dated 30 May 2024. CFN stated that before the accident she found the claimant to be a very motivated and positive person. She was usually "joyful and talkative". She often laughed and joked.
2. CFN states she was the front seat passenger in the car being driven by the claimant when the accident occurred. She describes the vehicle coming to a stop at red lights, hearing a braking sound followed by a loud "collision sound", and being pushed forward suddenly. She states that "[t]he force of the collision was so strong that it felt like our vehicle also moved forward and backward." She states that the claimant "appeared to be visibly in pain and shocked after the collision." She said the impact was "very forceful". CFN states that although the car was driveable after the accident, she observed it to be "badly damaged". She described the claimant as having "obvious signs of being in pain" when she drove from the scene.
3. CFN states that after the claimant returned to work following the accident her movements were "slower and guarded." She saw the claimant taking pain killers and observed that "she was still visibly affected by the accident and visibly still in pain. Her movements were slower and guarded." She also observed that the claimant's "persona changed"; she was often quite negative, less talkative, more closed in and more reserved.
4. CFN states that the claimant has visited her twice since she moved to Canada. She stated at [30]:

"...It was very obvious when I met up with [the claimant] in Canada that she was a very different person to the woman I knew and worked with before the accident. She appeared to be in constant pain. The pain appeared to be severe a lot of the time. She told me she was having difficulty sleeping. She certainly looked tired and worn out when I saw her. She moved slowly and with obvious difficulty. She didn't appear comfortable in any position for very long. She was not very talkative and appeared very withdrawn and far from the fun outgoing person she was before the accident. She also told me she had experienced significantly increased pain travelling on the plane and how she wasn't looking forward to the return flight on both occasions I saw her in Canada."

1. The claimant's written submissions dated 22 September 2023 address permanent impairment arising from her accident caused physical and psychiatric injuries. With respect to her psychological impairment, the submissions record:

"Dr Richa Rastogi, psychiatrist, in her report dated 18 January 2023 assed [sic] the claimant as having 15% whole person impairment in relation to the claimant's psychological injuries sustained as a result of the motor vehicle accident.

1. Other than the sentence reproduced above, the 22 September 2023 submissions do not address the claimant's case that her accident caused psychological injury gives rise to a permanent impairment that is greater than 10%.
2. The claimant also relies on written submissions dated 14 October 2024. Those submissions address purported "errors" in Medical Assessor Mason's assessment and aspects of the assessment she argues were incorrect in a material respect. As recorded earlier, the Panel is determining afresh the medical assessment matters referred to it. The claimant argues that the Medical Assessor: failed to disclose or explain his path of reasoning in various respects; applied the wrong test of causation; applied incorrect criteria; and made a demonstrable error by requiring a psychological injury to be a primary psychological injury in order to give rise to an assessable impairment.
3. The claimant argues the Medical Assessor wrongly applied the test for causation. In her submission, a "psychological condition and/or psychological injury does not need to be a primary psychological injury to give rise to an assessable permanent impairment. The psychological injury or condition only has to be causally related to the motor vehicle accident."
4. The claimant refers to cls 1.3, 1.6, 1.7 and 1.9 of the Guidelines, together with Nelkovska v Motor Accidents Authority of New South Wales [2012] NSWSC 819 and Peet v NRMA Insurance Ltd [2015] NSWSC 558. She argues that by requiring a psychological injury to be a primary psychological injury in order to give rise to an assessable impairment, Medical Assessor Mason applied incorrect criteria and made a demonstrable error.
5. The claimant submits she should be re-examined by a member of the Medical Review Panel as a re-examination "will assist the Medical Review Panel reach its findings."
6. In her written submissions dated 1 September 2025 the claimant argued that, on the basis of the opinions expressed by Medical Assessor Mason, Dr Rastogi, and Ms Hayek, she has "depression with anxiety" as a result of the accident. Her submissions record that as a result of the accident her vehicle was pushed forward into an intersection and that she was observed to be in shock immediately following the accident. Her case is that she experienced both a primary psychological injury from the shock of the accident and a secondary psychological injury, presenting as depression, due to pain and symptoms arising from the physical injuries she sustained in the accident.
7. The claimant argues that in not assessing her permanent impairment Medical Assessor Mason "has erred and applied incorrect criteria and made a demonstrable error in his medical assessment certificate." The claimant relies on Dr Rastogi's opinion that she has a 15% permanent impairment as a result of her accident caused psychological injuries.
8. The claimant's submissions compare the PIRS findings made by Dr Rastogi and Medical Assessor Mason. She argues that her degree of impairment in relation to concentration, persistence and pace, and adaptation is moderate rather than mild.
9. The claimant relies on CFN's observations of her before the accident, immediately after the accident, and subsequent to the accident. She relies on Mr Johnson's opinion that the accident was "not a minor and insignificant collision and that the collision was a significant collision." She also relies on his handwritten notes to confirm he had taken a history that she had her neck turned with her foot on the brake and was talking to CFN at the time of the collision.
10. In her written submissions dated 12 September 2025 the claimant noted there is a disagreement between Mr Bailey and Mr Johnston. She further notes that both experts agree there was a collision between the two vehicles, and the force of the collision caused damage to the two vehicles. She argues that the opinion of Mr Johnston should be preferred as he has considered the position of her body when the impact occurred. She also argues that the opinions of the two experts "have limited value in assessing [her] psychological injuries". The claimant submits that a psychological injury can be sustained without any direct physical injury.
11. The claimant's written submissions dated 5 December 2025 were filed in accordance with directions made by the Panel on 23 October 2025. The submissions address the clinical notes from Macquarie Medical Centre and Greenacre Medical Centre that were filed in response to a direction from the Panel.
12. These submissions note that the clinical records include reference to the claimant experiencing stress and anxiety due to a work related injury (entry on 10 January 2018). The claimant submits: the accident occurred when she was travelling to work; she had entitlements under both the MAC Act and the Workers Compensation Act 1987; and that the "work related injuries" referred to in the clinical notes are references to the subject accident.
13. Reference is made to entries in the notes that record symptoms of "stress and anxiety and or depression" and psychological intervention on March 2018, 20 April 2018, 5 February 2019, 23 April 2019, 6 August 2019 19 June 2020, 24 June 2020, 5 July 2020. She also refers to entries made on 19 October 2020, 26 May 2021, 7 March 2023, 13 June 2023, 4 July 2023, 7 August 2023, and 19 February 2024.
14. The claimant submits that as a result of the accident she has required medical treatment to reduce her levels of stress and anxiety "as recorded in the clinical notes". She also notes that "depression is also recorded in the clinical notes".

1. The insurer's submissions dated 31 August 2023 address the severity of the accident. In this regard the insurer relies on Mr Bailey's report dated 13 June 2023 in support of its submissions that:

(a) the claimant's allegation of being rear-ended at high speed cannot be accepted because it is inconsistent with the physical evidence and expert mechanical and biomedical evidence which indicates the rear-end impact was in the low range of severity, and

(b) in light of the low speed impact, there was no potential for significant injury, "consistent with the claimant's self-report of not developing any symptoms until

3-4 days after the accident".

1. The submissions refer to an earlier accident in 2012 following which the claimant reported neck, leg and left heal pain.
2. The insurer notes there is a pre-accident history of anxiety, particularly in relation to health concerns, and in this regard refers to the report of Dr Jungfer dated 20 February 2023. Reference is made to the history that the claimant required pharmacotherapy and attended a psychologist.
3. The insurer's submissions at [15] - [25] address inconsistencies in the claimant's evidence. Among other matters, the insurer refers to reference by Dr Jungfer in her report to the assessment of the claimant being challenging due to her refusal to explore her developmental history and inconsistencies in her history which were contrary to the medical records. Reference is also made to the claimant's denial of a pre-accident psychiatric history of depression, anxiety, adjustment difficulties and stress and her denial that she had attended a psychologist or requiring any pharmacotherapy.
4. The insurer's submissions refer to Dr Jungfer's opinion that there are non-organic factors influencing the claimant's presentation, including inconsistent symptoms, seeking multiple opinions from "treaters" and then "failing to pursue or comply with treatment", and withholding information. Reference is also made to the doctor's recommendation that the claimant undergo psychometric testing "to assist in clarifying the diagnosis."
5. The insurer refers to cl 6.41 of the Guidelines, and "urges the medical assessor to carefully consider the claimant's self-report and clinical presentation. In the absence of corroborative evidence, the insurer submits the claimant's subjective evidence ought not to be accepted."
6. The insurer's submissions address the claimant's physical injuries and impairment. The insurer: notes Dr Jonathan Herald diagnosed post-traumatic stress disorder and submits this diagnosis is "plainly outside his area of expertise as an orthopaedic surgeon and cannot be accepted"; relies on the reports of Mr Bailey and Dr Jungfer; argues that criterion A for post-traumatic stress disorder is not met; submits that Dr Jungfer's diagnosis of adjustment disorder with mixed emotional features giving rise to 5% permanent impairment should be preferred, and notes there was a longstanding history of somatic symptom disorder which continued post-accident.

1. The insurer's case is that the evidence demonstrates the claimant's physical and psychological injuries do not exceed the s 131 threshold.
2. The insurer's submissions dated 6 November 2024 address the claimant's submissions filed in support of her application for review of Medical Assessor Mason's assessment. The insurer opposed the application and argued it should be dismissed because the claimant had not demonstrated a material error and that it was open to the Medical Assessor to determine the claimant's psychiatric injury did not exceed the s 131 threshold. In the insurer's submission Medical Assessor Mason's path of reasoning in relation to causation is clear, and his failure to assess impairment was open to him given his findings. Further, the insurer submitted the "materiality requirement" has not been satisfied for the reasons advanced at [24] - [27].
3. In its submissions dated 5 September 2025 the insurer raised at [4] a number of issues in relation to CFN's statement. The Panel has considered the matters the insurer has raised and has given the statement weight to the extent recorded later in these reasons.
4. The insurer also addressed the reliance it placed on the opinion expressed by Mr Bailey in his two reports.

1. The claimant was re-examined by Medical Assessors Canaris and Friend (Medical Assessors) on 1 October 2025 and again on 10 December 2025. The re-examinations took place by AVL. The Medical Assessors' findings following the re-examinations are set out below.

1. The claimant currently lives with her parents. Before the accident, she had been a digital manager. She had worked with the same employer since 2008 in a range of roles, initially as a national account manager and was progressively promoted within the company. She had been doing e-commerce for about five to seven years. She has one younger sister living overseas. Her parents are retired. Her mother ran a business while her father had been senior quality assurance manager.
2. The claimant denied any history of psychiatric illness. She described herself as "very career driven" and motivated. She enjoyed cooking, shopping, and travelling for work. She worked long hours. She reported that she had been hitherto medically well apart from laser eye surgery and surgery for endometriosis.

1. She was asked about the motor vehicle accident in 2012. She said she was a passenger and that there had been no serious injuries or claim. She had also had deep venous thromboses in both legs in 2012. She is not on anticoagulation medication.
2. She does not drink alcohol, does not smoke, does not use drugs and does not gamble.
3. She knew of no family history of psychiatric problems.
4. The claimant grew up in India until she was 4 years old and immigrated to Australia with her family in 1984. She recalls her family being targeted as Sikhs following the assassination of Indira Ghandi. She recalls memories of her parents' businesses and shops being destroyed. Her recall of these events is fragmented but her awareness of these events is part of being a Sikh.
5. She remembers that schooling was hard in India and enjoyed being in Australia where schooling was much easier. The claimant completed year 12 and went on to university. She completed a Bachelor of Business. She worked throughout university as a recruitment consultant. She worked for a range of firms before joining the company she was employed by when the accident occurred.
6. Her first marriage "didn't work out". Her first husband wanted to relocate to India which she could not do. She was in a long-term relationship a couple of years after that and was living with her partner at the time of the accident.

1. On the day in question, she was driving to the city with a colleague for the Vivid festival where her employer had a stand. She was stationary at a red traffic light. A following vehicle collided with the rear of her vehicle. The airbags did not deploy. She was able to get out of her vehicle but felt in "complete shock".
2. The other driver, a male "was yelling and swearing at [her]" which she found disconcerting. She suggested telephoning the police. The other driver continued to yell at her and refused to give her his driver licence. She told him she would have to telephone the police. He got into his vehicle and drove off. She telephoned the police. She had to move her vehicle which was in a dangerous position. She had to drive slowly through a tunnel. Following drivers sounded their horns at her.
3. After the accident she arrived at her employer's stand with her colleague. She continued to feel in shock. They were both sent home by a manager.

History of symptoms and treatment following the motor accident

1. The claimant consulted her doctor the day following the accident after waking with pins and needles in her arms. She woke in a sweat and was in pain. It was difficult to see the computer screen.
2. She developed nightmares. She consulted an EAP counsellor for one appointment.
3. She was referred to Carol Hayek, psychologist whom she continued to consult. Ms Hayek's letter dated 18 September 2018 confirms the claimant was referred in 2018.
4. She was referred to various specialists including Dr Diwan, Dr Pope, Dr Rao, Dr Assaad and Dr McKechnie regarding ongoing pain in the neck, back and upper and lower limbs. Their reports refer to degenerative spinal disease and recommend surgery. The claimant stated that she was too scared of being paralysed to have surgery on her neck or back.
5. The claimant had 4 months off work and then commenced working from home. She was working about 2 days each week from home in December 2017.

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

1. She has not had any further accidents of any kind. She had egg freezing in 2019 according to the report of Associate Professor Lam dated 14 August 2020. The same report says that she previously had severe endometriosis excised and she had severe pelvic adhesions and adenomyosis in 2012.
2. She had laparoscopic excision of stage 4 endometriosis, extensive adhesiolysis, left ureterolysis, bilateral ovarian cystectomy, chromotubation, anterior rectal shaving, hysteroscopy and polypectomy and a cystoscopy according to the report of Associate Professor Lam dated 2 September 2020.
3. She was referred to Dr Freiberg, consultant physician respiratory and sleep medicine, whose report dated 31 January 2023 states she has a diagnosis of sleep apnoea and hypersomnolence. It recommends that she use a CPAP machine. The claimant was unable to tolerate the face mask for this therapy. She is a side sleeper and has not wanted to use a full-face mask.
4. She had also contended with the breakdown of her marriage towards the end of 2019. The breakup of her marriage appears to have been predominantly in the setting of accident-related problems including inability to be physically intimate because of pain and to participate in activities together. The breakup of the marriage was upsetting but did not cause a decrease in daily functioning beyond what she was experiencing arising from her injuries.

1. The claimant reported that she is "not so well" physically and has "a lot of pain". She is much troubled by her ongoing pain and her physical limitations saying she was once very active and fit. She is also much troubled by bladder problems with incontinence for which she has to wear pads. She complains also of bowel problems including faecal incontinence. She also complains of dizziness and headaches.
2. She is very depressed at times. "I get frustrated." "I wake up with panics and I'm sweaty". She feels she is very much "not the person [she] was before" saying, "You want to do things mentally - your brain is going at 100 miles per hour - I don't want to see people ...".
3. She feels very overwhelmed and finds herself getting very easily distracted. She admitted to feelings of hopelessness. She struggles with bad dreams and wakes up with her body jerking. Her dreams or nightmares are "very vivid and strong". She has dreams of herself falling or of being in motion and someone hitting her or a ball in a park hitting her "and I often see accidents in my dreams".

1. The claimant takes Panadol Osteo, an injection for migraine and headaches, Lexapro 10 mg daily, and Pariet "and when the pain is extreme, I have Endone". She had trialled Endep and Lyrica but has had problems with anticholinergic side effects which caused raised intraocular pressure. Lexapro was prescribed by Dr Usmani, her GP at Greenacre Medical Centre.
2. She was having physiotherapy, and hydrotherapy with exercise physiology, but the insurer has ceased payments for these treatments.
3. She has asked to see a psychiatrist but has not been able to find a psychiatrist who will treat CTP matters.
4. She has been advised to have spinal surgery on her neck, as described above, but is fearful of being paralysed after the surgery, despite being told that she has severe degenerative spinal disease, exacerbated by the injuries sustained in the accident.

1. The claimant was re-examined on both occasions by Microsoft Teams. A good audiovisual connection was established on both occasions. She was at her home. The Medical Assessors were in their respective offices and saw her head and shoulders.

1. The claimant presented as a woman of appearance consistent with her stated age and Indian ethnicity. She provided the history documented above. Her speech was somewhat pressured and overinclusive. She struggled to describe symptoms. She was anxious throughout often stating that she felt "overwhelmed". She was very teary at several points in the assessment. There was no evidence of psychosis or cognitive impairment.

1. The claimant spends most of the day on her own or sleeping if not attending appointments. She said that she used to drive everywhere and "I don't want to go in the car - even as a passenger, I start taking deep breaths...".
2. She limits herself to local journeys by car and said "if I can walk to the GP, I'll walk to the GP". She is very distrustful of drivers of other vehicles even when travelling as a passenger. Driving is also limited by the neck pain which particularly causes difficulty with reverse parking. She finds it very stressful to be behind the wheel and said "I just don't have the energy or stamina to deal with that".
3. She had been twice to Canada since the accident - she used to go every year. She has not been for several years. She did not enjoy the journey. She tended to stand at the back of the aircraft because of her back and neck pain. She also worries about travelling by aircraft because of her history of DVT, even though she takes prophylactic medication when she flies.
4. She moved back to live with her parents in 2017 or 2018 saying she was struggling physically, emotionally, and financially and said "I didn't want to be around".
5. She was struggling financially because she was working shorter hours. She has a property with a mortgage which is rented. Her parents deal with the real estate agent.
6. Her mother helps her with showering. She does not shower for several consecutive days because she lacks the motivation. She brushes her teeth. She has difficulty washing her hair because of pain. Her mother helps wash her hair or she has it washed by a hairdresser.
7. She needs to be reminded to take her medication.
8. Her appetite is "all over the place". She has been given a low FODMAP diet with which she finds it hard to comply. She has gained weight from 55 to 72 kg. She blames this in part on inactivity.
9. She does very little by way of chores around the house but will put her clothes in the laundry to be washed. She does not do any gardening or laundry because her hands are now very clumsy. She readily drops things which break. She believes that she could do the cooking and cleaning if she were physically better. Getting out of bed in the morning is a challenge because of pain. Bending is painful.
10. Her mother makes her breakfast and other meals. The pain in her arms and lack of strength and sensation makes meal preparation a problem. She has cut herself and is not allowed to do any chopping. She cannot change her bedsheets. She cannot lift more than 2 kg. Pain is the major obstacle to chores at home.
11. She goes out "very rarely" and said "now I completely avoid gatherings - we have a big family - they have lots of things on, but I won't go... I'm not mentally there and it takes a lot out of me to go to these things".
12. She prefers to stay at home on her own. In the last 3 months, she has been out once to dinner with her parents. She recalls she just wanted to go home once she went out. She would not go out on her own. Her overall anxiety is the major obstacle to going out.
13. She finds it very hard to focus on things and said "mentally I'm very exhausted" and "sometimes I tune out of the conversation... things that normally take me 10 minutes take me an hour... chores and things...".
14. She is forgetful and has left the stove on and now her mother does not want her doing things in the kitchen. She has caused the smoke alarms to activate.
15. As noted previously, she needs reminders to take her medicines. She finds herself "living in a panic state a lot of the time". She does not read, saying she would "really struggle to read". She watches very little TV, saying the noise bothers her and can spend only a few minutes with a program "and most of the time it's very stressful". When in front of the TV, she often flicks channels. If her family are watching something, she might spend only a few minutes with them.
16. After the accident she worked in a limited capacity for several years. She was put on "special projects" and was allowed to work from home. Following a restructure, she was made redundant around December 2019. She worked 15 to 20 hours each week.
17. She found work with another employer 11 or 12 months later where she worked for a year and a half but struggled. She worked in e-commerce and was required to report around the world and this required her to work unusual hours. She had problems with concentration and also found it difficult to manage with her neck. She worked 15 to 25 hours each week "and I was doing 2- or 3-people's roles". She recalled making a lot of mistakes.
18. She subsequently had other jobs with which she did not cope. She has been certified as having no work capacity. She tried several jobs after being made redundant, "but most of the jobs ended up in agreeing to separate... some of them required me to travel and I couldn't... I couldn't concentrate on spreadsheets...". She last worked two years ago with a software company. She did not make it to the end of the six-month probation. She spoke of not sleeping properly, not being alert, and of her neck "playing up.
19. The claimant struggled day to day both at work and at home because of physical and psychiatric/psychological symptoms. She had pain in her neck and arms, bladder problems, and headaches. She thinks she would be "better" if she were free of pain. She also reported difficulties with concentration and focus. She has a depressed mood, is tearful and has a lack of motivation.
20. She finds it difficult to deal with people at work especially if they ask her about herself and her personal life. She feels diminished as a person because she has worked in lesser roles since the accident.

1. The Medical Assessors questioned the claimant in relation to material in the documentation. She was asked about entries in her medical file in December 2017 referring to a flight to India. She said that she had wanted to go to see her family but did not travel because she was stressed and anxious. She spoke of breaking down, having sweaty hands, getting very agitated, and "also having all these injuries - thinking that if I have another jolt, I could be paralysed... I was having this battle facing what was going on... I had sleepless nights... waking up suddenly..."
2. The claimant was asked about her panic attacks. She described having "sweaty hands - you're breaking down crying - you have all these emotions - I would break down - cry - shake - it happens quiet often - I'd get really irritated"...back then I'd get a lot of suicidal thoughts... I had thoughts when I was driving home, I'd think of crashing my car into a tree or drinking poison or hurt myself with a knife...".
3. She has not made any attempt to harm herself apart from one incident when she thought about drinking a bottle of methylated spirits which she found in the bathroom. She did not proceed because her mother knocked on the door.
4. She was asked about the lack of psychiatric symptoms in her records until 2018. She said she did not know why her doctor had not written it down but said she had made her doctors aware of all her symptoms.

1. The Medical Assessors noted that Ms Hayek's report dated 2 September 2018 and the Psychological/ Counselling Management Plan dated 18 September 2018 state that the symptoms were stress, anxiety and pain. There was no mention of nightmares or difficulty driving. The claimant was adamant she had these symptoms from soon after the accident.
2. The claimant was asked about being too scared to have the recommended spinal surgery but having surgery for endometriosis in 2024. She replied that she had not proceeded with the spinal surgery because there was no guarantee about the outcome and a doctor had told her that another patient had woken up paralysed. She had parents who "depend on [her]".
3. She coped with the endometriosis surgery in 2024 because it was keyhole surgery and quite different from surgery that might impact on her spinal cord.
4. She was asked about her travel overseas in 2022. She said she could not remember where she had travelled to but recalled that she had been to Canada that year. It was a long journey, and she was anxious about the risk of a DVT but had been encouraged to go by her psychologist and to connect with family. She took prophylactic medication and wore compression stockings. She added that she often requested a wheelchair. She was very stressed, just wanted to stay home, and had arrived exhausted during that trip to Canada.
5. It was pointed out to her that there was no mention of psychological symptoms in the Greenacre Medical Centre notes in 2025 apart from medication. She said her doctors were aware of her symptoms and that it would be on her certificates of capacity.
6. She was asked about the reference in 2024 to IVF treatment. At the time of her endometriosis surgery, it was suggested she freeze eggs. She was given injections to stimulate ovulation which was stressful because she did not like injections. She wanted to maintain the possibility of having children. She had never liked injections or seeing blood and she equally found going to the dentist stressful including the injecting of local anaesthetic.
7. The claimant stated that the pre-existing psychological symptoms described in the supplied documentation had resolved prior to the motor accident. She had not required referral to a psychologist or psychiatrist or prescription of psychotropic medication for those pre-existing symptoms.

1. The Medical Assessors considered all the available information and the account of the claimant. The diagnosis of post-traumatic stress disorder was considered. The Medical Assessors determined the accident did not conform to a Criterion A event in accordance with the DSM-5-TR description of this condition.
2. In the opinion of the Medical Assessors the claimant's overall presentation was consistent with a diagnosis of persistent depressive disorder (dysthymia) with a persisting major depressive episode and anxious distress.
3. In terms of DSM-5-TR criteria, we noted the presence of depressed mood for most of the day for more days than not (Criterion A) with poor appetite, insomnia, low energy, poor concentration, and feelings of hopelessness (Criterion B). She has never been without the symptoms for any significant period (Criterion C). She has in the past satisfied criteria for major depressive disorder (Criterion D). There had never been a manic, hypomanic, or cyclothymic presentation (Criterion E) nor was there evidence of a schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorder (Criterion F). Her symptoms were not attributable to the physiological effects of a substance or to another medical condition (Criterion G) and cause her clinically significant distress and psychosocial impairment manifest in her distress at interview, her social withdrawal, her limitations with travel, the breakup of her relationship and inability to embark on another relationship, difficulties with concentration, and inability to work (Criterion H).
4. In relation to major depressive episodes, the Medical Assessors noted evidence in the documentation of her having satisfied the following DSM-5-TR criteria with periods in which there was evidence of depressed mood most the day nearly every day, markedly diminished interest and pleasure in almost all activities, poor appetite, insomnia, visible psychomotor agitation, and diminished ability to concentrate equating to six out of the nine symptoms cited in Criterion A of which a minimum of five was required. Her symptoms caused her clinically significant distress and psychosocial impairment as outlined above (Criterion B) and were not attributable to the physiological effects of a substance or to another medical condition (Criterion C). The anxious distress specifier captures her manifest anxiety and agitation as well as post-traumatic symptoms.
5. The Medical Assessors considered the diagnosis of somatic symptom disorder with predominant pain. It was noted that the claimant was excessively concerned in relation to the physical symptoms, the risks of spinal surgery and the risks of not having spinal surgery. She had documented degenerative spinal disease, exacerbated by the injuries sustained in the accident and various spinal surgeons had recommended surgery.
6. The Medical Assessors considered that she did not reach the criterion for the condition of somatic symptom disorder with predominant pain. Her chronic pain very clearly was distressing and highly disruptive to the life as per Criterion A of the DSM-5-TR description of this condition. Her symptoms had also been continuously present over many years (Criterion C). However, it was not clear to the Medical Assessors that her distressing symptoms were manifestly excessive. She had been found to have impairment arising from her physical injuries and had been referred for cervical disc decompressive surgery (which she had declined to undergo because of the fear of an adverse outcome, particularly paralysis). As such, she did not satisfy Criterion B for the diagnosis. There was evidence also of considerable anxiety around other somatic symptoms but again the Medical Assessors did not consider her anxiety to be manifestly excessive.
7. There was evidence of pre-accident psychological symptoms that appear to have been self-limiting. Those symptoms were associated with the breakup of her first marriage for which she saw a psychologist for six sessions and had been briefly on medication. There was evidence also in the Campsie Medical Centre notes of anxiety focused on her history of ovarian cysts and DVT. She had anxiety about side-effects of treatment including from injections and the risk for further DVTs when travelling. There were references to her anxiety in 2013. In 2014 she was noted to be anxious, lacking in confidence, and indecisive with suicidal thoughts.
8. She appears to have met criterion for a diagnosis of a generalised anxiety disorder. In terms of DSM-5-TR criteria, there was evidence of intermittent excessive anxiety and worrying (Criterion A) which she found difficult to control (Criterion B) and associated with feeling keyed up and on edge coupled with some loss of concentration manifest in her lack of confidence and difficulty making decisions (Criterion C). There was evidence of clinically significant distress in social, occupational, or other important areas of functioning (Criterion D). Her symptoms were not attributable to the physiological effects of the substance or to another medical condition (Criterion E) and were not better explained by another mental disorder (Criterion F).
9. The generalised anxiety disorder appears to have fluctuated in intensity since 2012. In the opinion of the Medical Assessors the condition was self-limiting and did not give rise to a permanent impairment.

1. The claimant has been continuously unwell since the accident. She has been on an antidepressant. Her condition has taken on an entrenched character. Her level of impairment is unlikely to change substantially in the next year with or without medical treatment.

Degree Of Permanent Impairment Psychiatric Impairment Rating Scale

1. Persistent depressive disorder with anxious distress

No deficit. The claimant's difficulties in this category are attributable to her pain. Her mother helps her with showering, and she could miss showers for a couple of days in a row saying she lacks the motivation. She brushes her teeth but has trouble washing her hair. She needs to be reminded about her medicine. Her appetite is "all over the place". She has been given a low FODMAP diet with which she finds hard to comply. She has been gaining weight. She blames this in part on inactivity. She does very little by way of chores around the house but would put her clothes in the laundry to be washed. She does not do any gardening or washing saying her hands are now very clumsy, and she readily drops things which break. She believes that she would do the cooking and cleaning if she were physically better.

Washing her hair is very difficult because of her pain - her mother helps her or she sees a hairdresser. Getting out of bed in the morning is a challenge because of pain. Bending is painful. Her mother makes her breakfast. Pain in her arms and lack of strength and sensation makes meal preparation a problem. She has cut herself and is not allowed to do any chopping. She can't change her bedsheets - she can't lift more than 2 kg. Pain is the major obstacle to chores at home. There is no deficit as a result of her psychological injury.

Moderate Impairment. The claimant goes out "very rarely" and said "now I completely avoid gatherings - we have a big family - they have lots of things on, but I won't go... I'm not mentally there and it takes a lot out of me to go to these things". She prefers to stay at home on her own. In the last 3 months, she has been out once to dinner with her parents. She recalls she just wanted to go home once she went out. She would not go out on her own. Her overall anxiety is the major obstacle to going out.

The impairment of functioning in this domain as a result of her psychological injury is moderate.

Mild Impairment. The claimant used to drive everywhere and said "I don't want to go in the car - even as a passenger, I start taking deep breaths...". She limits herself to local journeys by car. She said "if I can walk to the GP, I'll walk to the GP". She is very distrustful of other vehicles even as a passenger. Driving is limited by her neck and the difficulty in reverse parking. She finds it very stressful to be behind the wheel and said "I just don't have the energy or stamina to deal with that". She had been twice to Canada - she used to go every year. She has not been for several years. She did not enjoy the journey. She tended to stand at the back of the plane because of her back and neck. She also worries about travelling by air because of her history of DVT. She is able to travel without a support person in her local area. Her impairment in this domain as a result of her psychological injury is mild.

Moderate impairment. She had a partner at the time of the accident but afterwards she "wasn't the same person - I'd be waking up with panic attacks and be stressed". She "was saying I wanted to kill myself - I was going into a black hole - losing my career... I was on the edge and snapping" and they broke up a few months after the accident. She has not been in a relationship since breaking up with her partner in the aftermath of the accident. While she acknowledged that pain contributed to the disruption of her sexual relationship with her partner, the breakup was predominantly the result of her mood.

Her social withdrawal has led to arguments with her parents.

In the clinical judgment of the Medical Assessors the claimant's psychological injury gives rise to a moderate impairment in this domain.

The claimant described finding it very hard to focus on things and said "mentally I'm very exhausted" and sometimes I tune out of the conversation... things that normally take me 10 minutes take me an hour... chores and things...". She is forgetful and has left the stove on and now her mother does not want her doing things in the kitchen with smoke alarms going off. She needs reminders to take her medicines. She finds herself "living in a panic state a lot of the time". She does not read saying she would "really struggle to read". She watches very little TV saying the noise bothers her and can spend only a few minutes with a program "and most of the time it's very stressful". When in front of the TV, she often flicks channels. If her family are watching something, she might spend only a few minutes with them.

The claimant was re-examined on two occasions and remained focused and able to answer questions for periods of two hours for the first examination and one hour for the second. She responded to questions without hesitation or delay.

In the clinical judgment of the Medical Assessors she has a mild impairment as a result of her psychological injury.

Moderate Impairment. She worked at limited capacity for several months after the accident. She was put on "special projects" and was allowed to work from home. Following a restructure, she was made redundant around December 2019. She worked 15 to 20 hours per week. She managed to find work 11 or 12 months later where she worked for a year and a half but struggled. She worked in e-commerce and was required to report around the world hence making for odd hours. She had problems with concentration and also found it difficult to manage with her neck.

She recalled making a lot of mistakes. She described other jobs with which she did not cope. She sees jobs coming up on her phone on the internet but feels she cannot do them. She has been certified with no capacity. She tried several jobs "but most of the jobs ended up in agreeing to separate... some of them required me to travel and I couldn't... I couldn't concentrate on spreadsheets...". She last worked two years ago with a software company. She did not make it to the six-month probation. She spoke of not sleeping properly, not being alert, and of her neck playing up.

She admitted to a lot of problems emanating from pain as well as bladder issues and headaches. She thinks she would be "better" if she were free of pain, but she felt equally impeded by her difficulties with concentration and focus. She spoke of finding it hard to deal with people at work especially if people want to ask her about herself and her personal life. She spoke of the stigma working in significantly lesser roles.

The claimant cannot work. When the impact of her physical injuries, including pain, is excluded from consideration and consideration given only to the impact of her psychological injury, it was the clinical judgement of the Medical Assessors that the claimant had a moderate impairment in this domain. She could not work in the position she held at the time of the accident. She could, however, perform less than 20 hours a week in a different position that was less stressful or required less skill.

Psychiatric Impairment Rating Scale - Pre-existing impairment

Psychological counselling and brief period on psychotropic medication.

No deficit. There was no impairment in this category.

No deficit. There was no impairment in this category.

No deficit. There was no impairment in this category.

No deficit. There was no impairment in this category. She was living with her partner and enjoyed a good relationship with her parents. She had had some anxiety around whether to accede to her partner's wish to marry but this was within the bounds of normal variation in the general population.

Her marriage had broken up following the accident but this was a consequence of her physical and psychological injuries

No deficit. There was no impairment in this category. An entry in the Campsie Medical Centre notes refers to lack of confidence and indecisiveness but this did not equate to evidence of impairment as described in the examples provided by the PIRS.

No deficit. There was no impairment in this category. She was working fulltime in a responsible and demanding position.

Apportionment - pre-existing/subsequent impairment

1. The pre-existing generalised anxiety disorder had resolved prior to the accident. There was no evidence of impairment of functioning at the time of the accident. There was no subsequent impairment.

1. There was no evidence of benefit from the treatment. No allowance is made for the effect of treatment.

Degree of permanent impairment caused by the motor accident

1. The claimant's permanent impairment as a result of the psychological injury caused by the accident is 13%.

1. In its submissions, the insurer notes that there is a pre-accident history of anxiety, particularly in relation to health concerns, and in this regard refers to the report of Dr Jungfer dated

20 February 2023. 2. The Panel has given weight to the records from treatment providers that refer to pre-accident psychological symptoms. In particular, the Panel has given weight to Dr Abouzeid's clinical notes that refer to psychological symptoms in 2012, 2013 and 2014. These records also refer to the claimant receiving counselling during this period. 3. For the reasons given by its medical members in their re-examination findings, the Panel is satisfied the claimant suffered from generalised anxiety disorder prior to the accident. 4. The Panel is not satisfied that at the time of the accident the claimant was experiencing ongoing symptoms attributable to the generalised anxiety disorder. She told the medical members of the Panel that her symptoms had resolved. There is no reference in the clinical notes to the claimant reporting psychological symptoms or seeking treatment for such symptoms in the 12 months prior to the accident. CFN stated that before the accident she found the claimant to be a very motivated and positive person; she was usually "joyful and talkative" and often laughed and joked. The claimant was working in a managerial role at the time of the accident, had been working for the same employer for many years, and had been promoted over that time. The medical members of the Panel have assessed the claimant's pre-existing impairment by reference to the PIRS and found that she had no deficit in each of the PIRS areas of functioning and no impairment. For the foregoing reasons, the Panel is not satisfied there is objective evidence of a pre-existing symptomatic permanent psychological impairment. 5. There is a dispute between the parties about the severity of the accident and the nature and extent of the claimant's physical injuries. Each relies on an expert opinion, the claimant on Mr Johnston and the insurer on Mr Bailey. The Panel has considered the opinions expressed by these experts.

1. There is no dispute the vehicle insured by Allianz collided with the vehicle being driven by the claimant. The claimant made contemporaneous complaints of neck and back pain to her treatment providers following the accident.
2. The Panel has given weight to the opinions of Drs Harbison, O'Neill, Burrow, Guirgis and Herald, all of whom found the claimant suffered neck and back injuries as a result of the accident. Dr Courtenay accepted the claimant suffered injury to her neck as a result of the accident and assessed a permanent impairment of her cervical spine.
3. The Panel gives weight to the opinion of Medical Assessor Gorman, who certified that as a result of the accident the claimant suffered soft tissue injuries to her lumbar and cervical spine and that the cervical spine injury gave rise to a permanent impairment.
4. Weight has also been given to the opinion of the claimant's treating specialists, including Drs Assaad, Pope, Rao, and McKechnie, each of whom found that the claimant suffered physical injury as a result of the accident.
5. The Panel has considered the opinion expressed by a number of medico-legal specialists such as Drs Harbison and O'Neill, the first of whom found there were "some features of illness behaviour" and the latter described "marked abnormalities of a non-organic nature." Despite their reference to this behaviour, both doctors were satisfied the claimant suffered physical injury as a result of the accident.
6. On the evidence before it, the Panel is satisfied the claimant suffered injury to her neck and back as a result of the accident and that she continues to experience physical symptoms that are attributable to these injuries.
7. The claimant relies on Dr Rastogi's opinion that she has a major depressive disorder with anxiety and a chronic pain disorder as a result of the accident. In the alternative the claimant relies on Ms Hayek's diagnosis of mixed anxiety and depression and chronic pain.
8. The insurer does not dispute that the claimant suffered a psychological injury as a result of the accident. The insurer relies on the opinion of Dr Jungfer, who found that as a result of the accident the claimant has an adjustment disorder with mixed emotional features.
9. On the basis of: the symptoms reported by the claimant when she was re-examined by the medical members of the Panel; the changes in the claimant's presentation after the accident recorded in CFN's statement; the complaints and symptoms recorded by the claimant's treatment providers; the opinions of Ms Hayek and Drs Jungfer and Rastogi; and the opinion of its medical members, the Panel is satisfied the claimant suffered a psychological injury as a result of the accident.
10. The Panel agrees with and adopts the opinion of its medical members, both of whom are psychiatrists, that the claimant satisfies the diagnostic criteria for persistent depressive disorder with anxious distress. The Panel is satisfied the accident could have caused a persistent depressive disorder and finds that the accident was a necessary condition of the occurrence of the persistent depressive disorder.
11. For the reasons given by its medical members in their re-examination findings, the Panel is not satisfied the claimant meets the diagnostic criteria for post-traumatic stress disorder. In particular, the Panel is not satisfied Criteria A is met. Nor is the Panel satisfied the claimant has a somatic symptom disorder for the reasons given earlier by its medical members in their re-examination findings.
12. The clinical judgement of the medical members of the Panel is the most important tool in the application of the PIRS: cl 1.217 Impairment Guidelines. The Panel notes that the evaluation of impairment should only consider the impairment as it is at the time of the assessment: cl 1.21 Impairment Guidelines.
13. The Panel agrees with and adopts the precise examination findings and conclusions of its medical members based on their examination of the claimant, and their specific findings with respect to each PIRS category and permanent impairment. The Panel finds the claimant has a permanent impairment of 13%.
14. The Panel revokes the certificate of Medical Assessor Mason dated 13 September 2024 and certifies that the degree of permanent impairment of the claimant that has resulted from the psychological injury caused by the accident on 30 May 2017 is greater than 10%.

1. These reasons contain sensitive personal information. Having weighed the matters referred to in rule 132(4) of the Personal Injury Commission Rules, including the safety, health and wellbeing of the claimant, and whether the public interest in giving the direction significantly outweighs the public interest in open justice, the Panel is satisfied that its decision should be de-identified before it is published.
2. The Panel directs that, pursuant to Rule 132 of the Rules, the decision be de-identified prior to publication.

[1] See directions issued in writing by the Panel on 25 August 2025.

[6] Report of Dr Sheh dated 25 January 2018.

[7] Softening or degeneration of the spinal cord, leading to neurological dysfunction.

[8] Dated 17 March 2023 and 31 May 2023.