Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017

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

10 October 2024 and issues a new certificate as follows:

(a) the Review Panel certifies the following injury was caused by the motor accident:

(i) persistent depressive disorder, and

(b) the Review Panel finds that the above injury is NOT a threshold injury for the purposes of the Motor Accident Injuries Act 2017,

1. Geoffrey Meilak (the claimant) was involved in a motor accident on 2 June 2023. He was driving his wife's car and was stationary when he was hit from the rear. As a result of the motor accident, he says he suffered physical injuries to his neck and lower back as well as psychiatric injury.
2. The claimant made a claim for statutory benefits with Allianz Australia Insurance Limited (the insurer), the third-party insurer of the vehicle that he says caused the motor accident.
3. A medical dispute arose about whether the claimant's psychiatric injury is a threshold injury or not a threshold injury and the matter was referred to the Personal Injury Commission (Commission) for medical assessment.
4. On 10 October 2024, Medical Assessor Matthew Jones diagnosed the claimant's psychiatric condition as post-traumatic stress disorder which was caused by the motor accident and was not a threshold injury.
5. The insurer lodged an application with the Commission seeking review of the Medical Assessor's decision. This was allowed by the President's delegate (Ms Tajan Baba) and this Panel was convened to conduct the review.

1. Under the Motor Accidents Injuries Act 2017 (the MAI Act), there is a scheme for statutory benefits (under Part 3) for persons injured in motor accidents in New South Wales. Such benefits can include treatment and care and weekly payments.
2. For injured persons who have "threshold injuries", they cannot receive statutory benefits beyond 52 weeks after the accident and cannot recover damages.[1]
3. Version 10 of the Motor Accident Guidelines (Guidelines), effective from 15 September 2025, applies to the review. Part 5 deals with the assessment of threshold injury for psychiatric injuries.
4. The general provisions for medical assessment are contained in cl 5.6 of the Guidelines and are in the following terms:

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

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

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

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

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

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

1. Specifically, in relation to threshold psychological or psychiatric injury assessments, cls 5.10-5.12 provide as follows:

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

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

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

1. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition. The provisions regarding causation of injury are contained in cls 6.5 to 6.7 of the Guidelines and apply to both permanent impairment and threshold injury disputes. [2]
2. The provisions state:

"6.5 An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 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 the Personal Injury Commission) in considering such issues.

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

Causation means that a physical, chemical or biological 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 the 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.

6.7 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. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

1. Medical Assessor Jones was referred the following injury for medical assessment:
   • post-traumatic stress disorder.
2. The Medical Assessor determined that the claimant fulfilled the DSM-5-TR criteria for post-traumatic stress disorder. Specifically, with respect to criterion A, it was found:

"Mr Meilak reported a narrative and presented at assessment as consistent with satisfying diagnostic criteria for post-traumatic stress disorder. Although the accident was relatively minor, it would appear that he was quite shocked at the time and considered that he was at risk of serious injury and at one point thought that he may have died."

1. The Medical Assessor accepted that the claimant was previously psychiatrically well. Causation was accepted on the basis that the timing and nature of the development of symptoms was consistent with the motor accident being the cause of the claimant's post-traumatic stress disorder.
2. As post-traumatic stress disorder is a recognised psychiatric illness it was determined, by definition, to be a non-threshold injury.

1. The claimant relies on the report of anaesthetist and interventional pain specialist, Dr Sushama Deshpande dated 16 September 2023 who diagnosed the claimant with "adjustment disorder with anxiety and PTSD".
2. The claimant also relies on the report of psychologist, Mr Andrews dated 21 October 2023 who stated that the claimant met the criteria for post-traumatic stress disorder under DSM-5.

1. The insurer acknowledges that the claimant's treating psychologist, Mr Andrews, diagnosed post-traumatic stress disorder in his reports of 21 October 2023 and 11 April 2024. The insurer however relies on the opinion of biomechanical expert, Professor Anderson, who opined that the accident was low speed and that the only plausible injury would have been a neck strain that would have persisted for no longer than a few weeks. It is contended that the nature of the motor accident would not be of sufficient enough to satisfy criterion A of being a "traumatic event" with "actual or threatened injury".
2. The insurer also disputes the satisfaction of criterion C "avoidance" as the claimant refused to engage with arranged therapy to address any phobia/fear associated with driving. It is submitted that the claimant resumed driving immediately after the motor accident and as such, driving cannot be considered as being "distressing trauma-related stimuli".
3. The insurer says the claimant's psychiatric diagnosis related to the motor accident is an adjustment disorder, as diagnosed by Mr Berry on 24 July 2024, which is by definition a threshold injury.

1. On 26 June 2025, the Panel issued a direction to the parties requiring indexed and paginated bundles of the information they relied upon. The Panel stated that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The parties responded with the lodgement of bundles - the insurer's bundle comprising of pages 1-235 and the claimant's bundle comprising of pages 1-208.
2. The Panel has read and considered the information contained in the parties' respective bundles.
3. The documentation relevant to the issues to be determined in the threshold injury dispute is summarised below and also referred to in the Panel re-examination report and the findings made.
4. Dr Bushra Waheed clinical note entry dated 10,16 October 2022 - ongoing back pain, Panadeine Forte dispensed. Mr Meilak states can't work full time as back pain worsens after 20 hours of work. Is doing physio therapy.
5. Dr Bushra Waheed clinical note entry dated 23 April 2023 - Mr Meilak advised not to do heavy lifting. Pain "has improved completely in back as per pt req to go back now at work". Medical Certificate generated.
6. Application for personal injury benefits dated 7 June 2023 - completed by Mr Meilak. Lists injuries to neck, back, left shoulder and psychological injury.
7. Certificate of capacity/fitness dated 7 June 2023 - Dr Bushra Waheed confirms neck, back and left shoulder pain post motor accident on 2 June 2023.
8. Dr Bushra Waheed clinical note entry dated 7 June 2023 - claimant was stationary on Hume Highway when car behind was stationary and car came and rammed from behind. Neck, back and left shoulder pain ongoing. CTP forms filled out.
9. Mr Alex Berry, psychologist, initial consult dated 24 July 2023 - clinical impression of "adjustment disorder with mixed depressive/anxiety symptoms" as potentially appropriate for claimant, noting onset of stable symptoms following recent motor accident and persisting to present day.
10. Mr Ramsay Andrews, psychologist, report dated 21 October 2023 - diagnosed "post-traumatic stress disorder". Criteria A satisfied "as [Mr Meilak] was directly exposed to serious injury". Other criterion B to H considered satisfied also.
11. Dr Tim Ho, pain specialist, report dated 8 November 2023 - impression of chronic low back pain with pathology in radiology noted. Neck and shoulder pain also noted. Supportive of ongoing psychology and physiotherapy treatment.
12. Professor Robert Anderson, biometrics report dated 16 January 2024 - noted claimant was the driver of the lead vehicle in a three-vehicle chain collision. Crash speed considered no higher than 50 kph with change of velocity of the claimant's vehicle no higher than 15 kph. Reasonably expected of claimant to have some symptoms of neck strain to persist for several weeks. No risk of shoulder injury or lower back injury.
13. Mr Ramsay Andrews, psychologist, letter dated 11 April 2024 - considered Mr Meilak to be suffering from post-traumatic stress disorder as a result of the motor accident. Weekly psychological therapy noted but with continued symptoms including disrupted sleep, consistent fatigue, irritability, constant flashbacks, heart palpitations, hypervigilance, reduced memory and concentration and constant worried thoughts.
14. Dr David Kumagaya, psychiatrist, report dated 16 December 2024 - diagnoses post-traumatic stress disorder. Satisfied Mr Meilak reported direct exposure to serious injury and threatened death from motor accident (criterion A). Other diagnostic criteria considered satisfied (criterion B-H). Impairment rated under psychiatric impairment rating scale at 19% whole person impairment.
15. Commission Panel Certificate dated 23 May 2025 - The Panel noted that the claimant initially complained of pain in the neck, left shoulder, back of the head and lower back. There was also some referral of symptoms into the left leg. At the time of the Panel re-examination, current symptoms comprised of pain in the claimant's lumbar spine with radiation down the left leg. The neck and shoulders were asymptomatic. The Panel noted MRI radiology showing an L5/S1 disc protrusion which was considered to be not a threshold injury.

1. The Panel determined that the claimant be re-examined by Medical Assessors Rikard-Bell and Singh on 18 November 2025. The re-examination report is below:

The appointment was attended by Mr Meilak over a video conference. He was located at his home. he was assessed by medical assessor, Christopher Rikard Bell and Himanshu Singh over a Microsoft Teams meeting.

Mr Meilak was born in Australia. He grew up with his parents and his three brothers. His father worked at telecom, and his mother was a stay-at-home mom. He described a good childhood. He attended school up until year 10, he then started to work with his brother as a mechanic, later he had a few other jobs in pizza delivery as a sales representative. He also owned a cafe and worked at a video shop. Mr Meilak stated that he has always worked. He enjoyed working, but he denied taking time off work for a long period apart from going on holidays. He denied any trauma or abuse growing up and described a good childhood.

Mr Meilak stated that before the accident, he was working for himself for four years and was doing deliveries for Amazon and another company. He enjoyed doing career and delivery and was on the road all the time. He would work 60 to 65 hours in a week and drove his van. He would also work on the weekends for Amazon. Before this job, he had worked as a truck driver and drove car carrier trucks.

Mr Meilak denied any history of mental illness; he never saw anyone in the past for his mental health problems. He never had mental health problems and was never referred to a psychologist or prescribed psychotropic medications.

Mr Meilak did not report a family history of mental illness.

Mr Meilak did not report any medical issues before the accident. He reported that he has a history of high blood pressure and high cholesterol. I have noted from the documents that after the COVID-19 vaccination, he had pain in his chest and was told that he had a small blockage in his arteries. He also had a hernia operation 20 years ago, which was uncomplicated.

Mr Meilak also has no significant drug use history. He has been a non-smoker. He would drink alcohol, maybe one or two drinks, once in a blue moon, on special occasions and in social situations. He stated "I may have a beer on a hot day after mowing the lawn."

Mr Meilak denied any issues with the police or any pending court cases or charges. He denied any criminal history. He denied history of work-related injury or previous motor vehicle accident-related personal injury claims.

Mr Meilak did report that a long time ago, he had an accident while he was working as a delivery driver; however, he stated that he did not sustain any personal injuries, there was no claim, and he was fine. He had been working as a courier for about 6 months before the accident. He was not able to work after the accident and has not returned back to work since then.

Mr Meilak was born in 1975 and is currently 50. He lives with his wife, who is not working and his daughter, who is 14. He stated that he has been married for a while on being asked about the specific year, he was unable to tell and said that it has been a while and he has been married for more than 15 years. He again stated that he used to work and everything changed after the accident, which occurred two years ago and has ruined his day-to-day forever. He cannot seem to get over it and just cannot seem to get better.

Mr Meilak stated that he was on his day off work and was going to the shops on 2nd June 2023, he was driving his wife's car which was a small Corolla and was wearing the seatbelt. He was sitting in the traffic and was stationary. There was a bus in front that had to cross, so everyone stopped. Then he heard two big bangs. He stated "I heard the bang and it was so quick, I felt it and it happened quickly." A car had hit another car behind him and that car hit him. He did not hit the car in front. The lady from the front car came and said that he did not hit her car, and she would call the ambulance.

The police and ambulance later arrived at the accident scene. He stated that he heard the big bang and saw black, that is all he remembers and keeps thinking about it. He again stated and spoke about hearing the bang and saw the big black. When asked about the big black, he stated it was the dash mat from the front that flew over his face. He was not sure, but he said that he may have hit his head from the back. He was able to get out of the car, and a man came and spoke to him. Someone asked him to sit, and then he was in the ambulance. He denied having any bruises or blood.

He denied loss of consciousness. He stated that it was quick, and he could not get the bang out of his head. The ambulance paramedics checked him, and his blood pressure was up and down, and they asked him to go to the hospital. He did not want to go to the hospital, so he asked them to wait. The ambulance paramedic gave him tablets, he called his wife, and his wife came to pick him up. The ambulance gave him tablets, and he was asked to see his GP. He went to see his GP with his wife and left the scene of the accident. He never got the car back.

History of symptoms and treatment following the motor accident

Mr Meilak later saw his GP, Dr Bushra, as he had a sore neck. His neck was in pain along with his lower back. He was given tablets and was asked to come back if it gets worse. He went back to see his doctor on Monday and was sent to do X-rays for his neck and his sore lower back. Mr Meilak stated that he has done many things since the accident. He was also referred for an MRI and was told that his lower back disc is pushing against his nerves. He also started to have physiotherapy one to two weeks after the accident.

He denied having any surgeries following the accident, he started to take pain medications which included Panadeine Forte and Nurofen plus. There were other medications as well which he cannot remember. He also saw a specialist who advised cortisone, but he was scared to have cortisone injections and was also advised surgery. He was worried about the surgery, as he did not want to have one. He felt that he was still walking, though he was in pain when he would walk, then asked his GP to send him for a second opinion to another specialist. He then saw another specialist, who again advised the same to have surgery and cortisone injections. He has not had surgery so far as he is scared of surgery.

Mr Meilak stated that when he would get up, he would get dizzy spells, so he saw his heart specialist, who did tests and stated that everything was fine. He also had an MRI of the head and was told that there was something wrong with the bone which was affecting his middle ear.

Mr Meilak stated that following the accident, he has always been in pain. He does not want to have cortisone injections or surgery. The pain always wakes him at night, when asked by Mr Meilak, that he has a past history of back pain, as well as documented in his records. He stated that he never had issues with the pain, and this is a new level of pain and concern for him. He stated that before, it was a pain like when he would get tired after work, but now this pain is all the time, and some days it does not go away. It keeps veering him down a lot and is always scared about what might be happening.

On being asked about his mental health following the accident, he stated that he was not himself. He started to isolate himself; he was not going out. He could not sleep due to the pain and was not comfortable. He began to have nightmares following the accident. His wife would tell him that he was often jumping in his sleep, and then she would ask him what had happened the night before. He would not remember at times, but he would keep on jolting in his sleep and would wake up. At times, he did remember the nightmares, and he would see the bang and the black in his nightmares. He was scared to get back in the car for a while.

He would also often think about the accident and felt that he was reliving the accident. He could not get it out of his head and would keep thinking about it. He would get triggered if he read something or watched something on TV about a car accident. He would get distressed on hearing a loud noise as well apart from seeing an accident. He would always want it to go away, he was never like this before, and he would have always wished that the accident had not happened.

Mr Meilak then spoke to his GP and was referred to a Psychologist, Ramsey Andrews, whom he began seeing every week. On being asked about the session, he stated "we do things, we talk and the sessions stopped for a while and then restarted. He would ask me to push myself to do things, such as going out and driving, to try to make me relax. We have done something with the ice. He agreed when I asked him whether it was EMDR. He may feel good after the therapy and may have some good taste, but then again, his symptoms would come back. He continued to take painkillers every day. He also developed a constant ringing in his ears. He would get frustrated with the ringing in his ears and had to put some noise in the background and was also prescribed a tablet for the ear ringing; however, this tablet was waking him up in the middle of the night, so he started to take Melatonin for sleep. He has also been referred to see a Psychiatrist and is still waiting for an appointment at a clinic in Campbelltown.

Mr Meilak stated that he thought that he would die when the accident happened, but it was so quick that he could not understand what happened. He noted damage to the back of his car and under the front. He was told that his front of the car may have hit the curve in the front and was a right off.

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

Mr Meilak stated that he had an infection following the motor accident around after one month. He said he got some bug and was in Campbelltown Hospital for four to five days. He was discharged home after that, and he felt better. He also stated that he had developed a kidney stone on his left side, and he had been given medication for that as well, which controls his symptoms. He denied any other relevant injuries or conditions sustained since the motor accident.

Mr Meilak currently receives payment from the insurance company. He is currently not working, nor studying, he lives with his wife and his 14-year-old daughter. He continues to experience pain in his lower back. He has left leg numbing pain. His pain can be 10/10 on certain days and would settle down with more tablets. He has started to do hydrotherapy at the swimming pool; most days, his pain is 5/5 and it can be 6 to 7 as well. If he overwalks himself, then the pain gets worse, so he does not want to do anything. He also gets some payment for his daughter, something from Centrelink. He was not able to tell the exact details and his wife is also on disability support pension.

Mr Meilak added all I remember is the bang, I wish that it never happened. He would like to do things, but then he would have the pain and would lose the motivation. He cannot see properly and has to take painkillers. He has received physiotherapy every week. He also developed tinnitus in the ear, like a ringing noise, after the accident. It is constant and does not go away, and it is more when it is quiet and he is sitting by himself.

He reported having good days and bad days. On a good day, he would get up and do things but then the pain kicks in and he starts remembering the accident. It may last for one or two days, it is mostly after having a physiotherapy session or hydrotherapy and talking to his psychologist. If he gets good sleep, then he also has a better day.

On a bad day, his sleep is disturbed, he will have nightmares about the accident and he cannot sleep due to the nightmares and the pain.

Mr Meilak stated that the pain is a big barrier in returning to work and getting back to his life. If he was not in pain, he will feel comfortable again, he has this shit feeling every day and has very few good days. There is not much that makes him happy and he often wants to be left alone. If he was not in pain of course things will change for him he added later. He stated "I could do things that I used to do and things that I used to enjoy, now I cannot do anything."

Mr Meilak reported a lowered appetite he may only have one meal in a day and it depends when he is hungry. He has gained weight, he stated that he probably has gained weight because of medications and not being active physically. He has also been prescribed weight loss injections Mounjaro and that has helped him a bit. Mr Meilak was often upset and teary talking about the accident during the assessment. He kept on saying repeatedly "I heard a bang and it was black." He also said "I wish that it never happened and if I can change that day."

Mr Meilak stated that he is flat in his mood and does not feel like doing anything. He has to put up with the pain and he wants to be left alone on his own and then if it is quiet, he starts to hearing the buzz in his ear. He may watch a bit of TV but has no interest in it. He continues to have couple of nightmares on certain nights and he cannot sleep, even if he was watching TV and if something comes about the accident, he starts thinking about it, it comes out of the blue and he has no control over it. He mentioned some tablet for his nerves and that was also giving him more nightmares so he had to stop it.

He again added I think about the accident as I cannot do things, he would get anxious, at the same time he also gets angry and irritable with his wife. He reported that he finds it hard to concentrate, there is not much to do but even if he is doing something he gets distracted and has no interest. He also reported a lack of connection with his wife and his daughter and there is no sexual desire and no intimacy. He avoided the accident site as much as possible after the accident. He then started to live in a different area with his wife and his daughter. Mr Meilak did not report any self-harm or suicidal thoughts; he did not report any attempts at self-harm or suicide; he denied any symptoms suggestive of mania or psychosis.

Mr Meilak continues to receive treatment under the care of his GP and his Psychologist. The psychology sessions have been on and off due to funding from the insurance company. He takes Panadeine Fort and Nurofen Plus. He was recently prescribed Valium, which helped him to sleep, and he felt better the next day. He is on medications for his high blood pressure and a blood thinner, and is also on another medication for his ear issues. He stated that he has been on many medications and he does not remember the name. He has hydrotherapy sessions and has on-and-off physiotherapy sessions as well.

Mr Meilak was seen over a video conference. He was wearing a vest, he appeared unshaven, though his hygiene was maintained, and he appeared an overweight man of his age. He maintained intermittent eye-to-eye contact and was often looking away from the camera while talking. He was teary and distressed when talking about the accident; there were no signs of agitation or retardation. He reported his mood as flat and low, and his affect was restricted with a reduced range. He described a low level of motivation and energy.

He reported a lack of pleasure in the activities that he used to enjoy. His speech was spontaneous with normal rate, tone and volume. He reported a disturbed sleep with nightmares and a lowered appetite and weight gain. He reported nightmares and avoidance of certain area where the accident happened. He also reported being at times angry and irritable. He denied having any active or passive suicidal thoughts, intents or plans and there were no thoughts of harming others.

He did not describe any grandiosity, racing thoughts or increased energy levels. There was no evidence of formal thought disorder, no delusional pattern of thinking and no perceptual abnormalities. There is no cognitive dysfunction, he expressed his wish that the accident never happened and if he could change that day, he had a reasonable insight and his judgement was intact.

Mr Meilak will shower on his own, he sometimes may shower daily or every second day depending on how he feels and his pain. He may forget to brush and skip brushing his teeth then his wife will prompt him and remind him. He goes to the pool for hydrotherapy sessions every week and that helps him with the pain. He wants to try to stop all the medications as it is affecting his stomach. In the morning, he may wake up sometimes at 6 a.m. and when he will hear his daughter going to the school he will then go in his room if he has not slept well, he will again lie down and get up at 10 a.m.

He does not do much, he stated that he does nothing at home. His wife will ask for help and then she gets angry. She has got her own problems, he used to help her but now he cannot. He will spend most of the time sitting in his room. He is not cooking, not doing his laundry, does not do cleaning at home and his daughter now helps his wife. If he gets the pain when he tries to do something he has to stop. If wife will tell him to eat, him to shave, he may go for a coffee if he feels all right, but he may come back if it is busy and will not sit there, but if it is quite then he may sit in the cafe for some time.

He does not worry to eat anything. He does not go out socially and stays at home. He denied going out to any parties or functions. He does not contact his friends they may message him, but he does not want to go out with them. He has couple of friends who may come every now and then. He may speak to them briefly, but does not enjoy that time and will ignore them sometimes when they contact him.

Mr Meilak stated that he will push himself to drive, a lot of times his wife will do the driving. His wife drove when they went to the city for his appointment or he may catch a train with his wife. He does not go far on his own. He feels uncomfortable, earlier while working he used to go everywhere before the accident and go out to travel. He is comfortable if he knows the area even if his wife is driving, they need to stop and take a break if it is more than 30 minutes. He may drive in the local area up to the shop, but does not go any further mostly for 15-20 minutes and then he starts to have pain and has to come back home. There are days when he does not go anywhere and does not leave his house.

Mr Meilak stated that he has arguments with his wife as he does not have patience. He does not deal well with his daughter as well. He was never like this, he denied any period of separation or domestic violence, but then there are days he will just go and sit at his mother's place. He will jump in his car and go to his mother's place or will go to a par but will not leave his car and sit in his car as he does not want to be around people. He may not care to mow the lawn and if he does do that after 15 minutes, he is in pain then he cannot sleep very well at night. The insurance may send someone to mow the lawn even if he sits for too long or walks a bit far it starts to ache. He tries to push himself and walk in pain but then it disrupts his whole day and night.

Mr Meilak again stated that he has not returned back to work since the accident and he would wish that he could go back to his normal self and it never happened. His father has passed away and his mom lives locally and he would visit her at times. He also keeps in touch with his brother over the phone.

Mr Meilak stated that he never had back problems like this before the accident. He did not need time off work for his back issues. He may have a day off here and there sometimes if he was in pain and then he would get back to work.

The Panel Medical Assessors brought Mr Meilak's attention stating that there are GP notes before the accident which suggested that he was having pain and was struggling with the pain, there are GP notes suggesting that the pain was causing issues at work.

Mr Meilak again stated that he did not have any problems with the pain and he was happily working. The Panel Medical Assessors noted that this history was consistent with the GP entry of April 2023 which stated that Mr Meilak had returned to work.

The Panel Medical Assessors noted that this is a bit inconsistent, as the GP note suggests that he was in quite a bit of pain in the past, and there was an indication that he did not want to work due to the pain prior to the accident. However, the Panel Medical Assessors noted that there were no gross inconsistencies in his presentation and his presentation during the assessment and the mental state examination was consistent with the previous assessments and other documents provided to the Panel."

1. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[3]
2. The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[4]
3. The Panel refers to the above re-examination report of Medical Assessors Rikard-Bell and Singh. The Panel reconvened on 3 December 2025 and discussed the re-examination report findings before collectively making the below determinations.

1. The Court of Appeal in Mandoukos v Allianz Insurance Australia Ltd [2024] NSWCA 71 stated (at [78]): "... the medical dispute 'about a medical assessment matter' will, in each case, be a question of fact depending upon the ambit of the dispute between the parties at the relevant time having regard to the competing claims made."
2. What has been referred for assessment in these proceedings is whether the claimant has post-traumatic stress disorder as a result of the motor accident of 2 June 2023.
3. As stated in clauses 5.10 to 5.12 of the Guidelines, the Panel must assess the claimant and determine whether a psychiatric illness is present by applying the DSM-5-TR.
4. It is the experience of the Panel that psychiatric diagnoses may not remain static throughout the lifecycle of the claim and may change depending on various factors including treatment received, the claimant's fortitude/ vulnerabilities or the general progression of the initial illness.
5. That is why Medical Assessors may, in their clinical judgement, diagnose a condition that is the same as, or different to, the diagnosis of the original Medical Assessor or the diagnoses of the treating doctors, the medico-legal experts or how the injury is worded in the application or reply forms.
6. Having made a diagnosis, the Panel will then proceed to undertake an assessment of the whole person impairment or, as in the present case, whether the diagnosis is a threshold or non-threshold injury.

1. Mr Meilak is a 50-year-old married male with no significant previous psychiatric history. There is no significant family history and no significant drug and alcohol history. He was involved in accident on 2 June 2023 where he was rear-ended by another car while stationary in the traffic. Mr Meilak developed sore neck and lower back pain following the accident. He also developed psychiatric/psychological symptoms following the accident and the symptoms have continued. He has received treatment with psychological intervention. He has not seen a psychiatrist and not been on any psychotropic medication.
2. He continues to present with significant bout of lower back pain and the psychiatric symptoms which currently meet the DSM-5 TR criteria of a persistent depressive disorder. He meets the criteria of persistent depressive disorder as follows:
   1. depressed mood for most of the days than not;
   2. present of other symptoms while being depressed as poor appetite, insomnia, low energy, poor concentration and feelings of hopelessness;
   3. during the two-year period he has never been without symptoms;
   4. the criteria for major depressive disorder has been continuously present;
   5. there is never been a manic, hypomanic or he has never met criteria for cyclothymic disorder;
   6. the symptoms are not attributable to the physiological effects of a substance or another medical condition, and
   7. the symptoms cause clinically significant distress or impairment in social, occupation or other areas of functioning.

1. Mr Meilak does not meet the criteria for post-traumatic stress disorder, he does not meet the criteria A for post-traumatic stress disorder as it was a minor car accident where he was rear-ended and received the second impact from the car behind. He was not exposed to actual or threatened death or serious injury in the accident. Nor was the Panel satisfied of the perception of actual or threatened death or serious accident. The history Mr Meilak gave to the Panel was that he heard two loud bangs and he saw a big black, likely from a dash mat being dislodged and covering his face. He reported to the Panel about everything happening very quickly and he gave no history of a fear of dying as was reported to Medical Assessor Jones.
2. Following the accident, the ambulance visited and asked him to go to the hospital however he did not feel the need and instead called his wife and saw his GP later. He reports symptoms of trauma following the accident, such as nightmares and flashbacks, or dense behaviour, being hypervigilant, and emotionally distressed due to reminders of the accident; however, he does not meet the full criteria to make the diagnosis of post-traumatic stress disorder.
3. The Panel accepts that Mr Meilak likely had an adjustment disorder following the accident as diagnosed by Mr Berry in July 2023 with his symptoms progressing to meet the criteria of persistent depressive disorder as described above. This is now ongoing and has become chronic with episodes of major depressive disorder.

1. Mr Meilak denied any previous history of a psychiatric diagnosis or treatment. Mr Meilak did not report any psychological/psychiatric symptoms before the accident. There is a direct temporal relationship between the onset of his psychiatric symptoms and the car accident. The psychiatric symptoms are caused by the pain symptoms as well. There is a significant worsening of pre-existing pain that has led to the development of a depressive disorder. The pain is causing the dysfunction in his level of functioning and also the depressive disorder, his depression is also contributed by his inability to return to work and the impairment in his functioning due to the pain.
2. The Panel was therefore satisfied that the effects of the motor accident contributed to the development of the persistent depressive disorder.

1. The following injuries WERE caused by the motor accident:
   • persistent depressive disorder.
2. The following injuries WERE NOT caused by the motor accident:
   • post-traumatic stress disorder.

1. The following injuries are non-threshold injury persistent depressive disorder.
2. Section 1.6(1) of the Act states that:

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

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

"A Threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness."

"2) Each of the following injuries is included as a threshold psychological or psychiatric injury for the purposes of the Act

3) In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5)"

1. The assessment of whether the injury is a 'threshold injury' is not a direct measure of symptoms or disability. A finding that the injury is a 'threshold injury' indicates that there was an injury caused by the motor accident and that there may be continuing symptoms, however the injury satisfies the definition of a threshold injury under the Act and the Regulation.

1. The following injuries are not threshold injuries:
   • persistent depressive disorder.
2. The following injuries have been assessed and determined to be not caused by the motor accident:
   • post-traumatic stress disorder.
3. A decision as to whether these injuries are a threshold injury is not required for the purposes of the Act.
4. As the Panel has made a different finding as to diagnosis of injury, the Panel revokes the Certificate of Medical Assessor Jones. A new Certificate is issued at the front of the Panel's determination.

[1] The terminology for accidents that occurred before 1 April 2023 was "minor" injury and statutory benefits were only paid for up to 26 weeks.

[2] Briggs v IAG Limited Trading as NRMA Insurance [2022] NSWSC 372 per Wright J at [35].