REVIEW PANEL ASSESSMENT OF DEGREE OF PERMANENT IMPAIRMENT

Certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017

1. The Review Panel revokes the certificate dated 26 October 2023 and issues a new certificate determining that:

(a) the following injuries caused by the motor accident give rise to a permanent impairment of 7% and IS NOT GREATER THAN 10%:

1. adjustment-like disorder with a permanent response to trauma with post-traumatic stress disorder like symptoms, and
2. alcohol use disorder.

1. On 16 May 2019, Melinda Doreen Bradley (the claimant) was driving her Honda CR-V on the Princes Highway and was waiting to turn into her street when the insured vehicle collided with the right front side guard and front door of the claimant's vehicle. No airbags deployed in the claimant's vehicle but did so in the other vehicle. The claimant had to exit through the passenger door as the driver's door was jammed. Ambulance, paramedics and police officers attended the scene. The claimant was taken to hospital. The claimant's vehicle could not be repaired. The claimant maintains she suffered physical and psychological injuries as a result of the accident.
2. The insurer indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay the claimant any damages and/or statutory compensation benefits under the Motor Accident Injuries Act 2017 (the Act). The insurer conceded that the claimant's psychological and chest injuries sustained in the accident are not minor injuries as defined in the legislation. The insurer accepted liability for statutory benefits beyond 26 weeks from the date of the accident.

1. The parties have each presented their respective bundles of documents upon which they rely. The Review Panel (Panel) has read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel, or a Panel Member, has not read it, nor taken it into consideration, in much the same manner as parties not referring to, or not specifically relying upon, a document in their own bundle and submissions.
2. The fact that evidence is not referred to in these reasons does not mean it has been overlooked. It is not required that each piece of evidence be mentioned.[1] The Panel is not required to "analyse every piece of information from every opinion contained in a document with which it was provided".[2] The Panel has come to its own conclusions and has taken its own history.

1. There is a dispute between the parties about the degree of permanent impairment under Schedule 2, cl 2(a) of the Act. The dispute was referred to Medical Assessor Glen Smith for assessment of depression, anxiety, post-traumatic stress disorder.
2. Medical Assessor Smith certified on 26 October 2023 as follows:

The following injuries caused by the motor accident give rise to a permanent impairment of 9% and IS NOT GREATER THAN 10%:

• Aggravation of post-traumatic stress disorder (PTSD)
• Alcohol-induced depressive disorder
• Alcohol use disorder

Medical Assessor Smith found there was a pre-existing history of those three conditions which have been aggravated by the motor accident. He assessed 17% whole person impairment from which he deducted 8% whole person impairment for the pre-existing conditions.

1. The claimant sought a review of Medical Assessor Smith's certificate on the basis that the assessment was incorrect, within the meaning of s 7.26 of the Act, in a material respect. The claimant brought the application within the time prescribed by s 7.26(10)(a) of the Act and cl 34 of Procedural Direction PIC 7 (28 days).
2. The claimant submitted that Medical Assessor Smith's deduction for pre-existing impairment is incorrect and, but for his error in assessment of pre-existing impairment, the outcome of the assessment would have been different.
3. The claimant submitted there is a reasonable cause for suspicion that Medical Assessor Smith's certificate was incorrect in a material respect for the following reasons:

(a) failure to give relevant consideration to materials and/or failure to engage with the claimant's submissions;

(b) failure to disclose path of reasoning and/or failure to provide adequate reasons, and

(c) failure to accurately apply the psychiatric impairment rating scale (PIRS).

The claimant submits there was no evidence available to Medical Assessor Smith to indicate that the claimant had any significant pre-existing impairment at the time of the accident.

1. The claimant submits that the history taken by Medical Assessor Smith (pages 3 to 5 of his Certificate) largely relates to events which did not result in a functional impairment at the time of the accident, including a prior motor vehicle accident in 1999, and sexual abuse she experienced as a child some 50 plus years ago. Particulars are given in support of that submission.
2. The claimant further submits that Medical Assessor Smith's certificate contained numerous examples of factual errors which are material to the assessment of permanent impairments, particularly with respect to the findings relating to the claimant's pre-existing/subsequent impairment. Particulars are given in support of that submission.
3. In relation to the alleged failure to disclose path of reasoning/failure to provide adequate reasons, the claimant submits that Medical Assessor Smith failed to explain why he determined that the claimant had the same level of impairment prior to the accident, and following the accident, in five of the six PIRS categories including the following:

(a) Self-care and Personal Hygiene;

(b) Travel;

(c) Social Functioning;

(d) Concentration, Persistence and Pace, and

(e) Adaptation.

Particulars are given in support of that submission.

1. Similar submissions are made in relation to Medical Assessor Smith's alleged failure to accurately apply the PIRS. Factual particulars are given in support of those submission. It is not necessary to repeat those particulars.
2. The claimant's review application was opposed by the insurer on various grounds. It is not necessary to repeat those submissions in detail as they were not accepted by the President's delegate. Briefly, those submissions can be summarised as follows:

(a) the insurer does not agree that Medical Assessor Smith erred in relation to the assessment of pre-existing impairment;

(b) the insurer submits that any factual errors recorded by Medical Assessor Smith do not alter the PIRS class rating for pre-existing impairment and current impairment and are not material to the outcome of the assessment. Factual particulars are given in support of that submission;

(c) the insurer submits Medical Assessor Smith provided sufficient reasoning for his class ratings in relation to the current impairment and pre-existing impairment;

(d) the insurer submits Medical Assessor Smith provided a clear path of reasoning for each category for current impairment and pre-existing impairment and has assessed the class rating correctly, and

(e) the insurer submits Medical Assessor Smith correctly determined that the psychological injuries caused by the accident give rise to a permanent impairment of less than 10%.

1. President's delegate Jeremy Lum issued a Determination of an Application for Review of a Medical Assessment on 7 February 2024 which stated the satisfaction of the President's delegate that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The basis of that decision was stated to be the absence of any clarifying reasons from Medical Assessor Smith for his finding that the claimant's pre-existing diagnoses of post-traumatic stress disorder and associated impairment were present at the time of the subject accident.
2. Accordingly, the review application was accepted and was referred to the Panel, which is to reassess the psychological injuries that were referred to Medical Assessor Smith, as previously identified.

1. A medical assessment matter is determined in accordance with s 63 of the Act. The matter is determined at first instance by a Medical Assessor pursuant to and, on review, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
2. Part 5 of the Personal Injury Commission Act 2020 (the PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a Panel, reviewing a decision of a Medical Assessor.[3]
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written Application.[4]
4. The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[5]
5. All members of the Review Panel had no previous involvement with the claimant or with this matter.

1. The claimant relied upon the following material which the Panel has considered:

These submissions do not address the claimant's psychiatric injuries.

Report of Dr Richa Rastogi, consultant psychiatrist, to the claimant's lawyers

Dr Rastogi assessed the claimant remotely through Telehealth. Dr Rastogi diagnosed persistent post-traumatic stress disorder with anxiety caused by the subject accident.

Dr Rastogi found no pre-existing mental health conditions. The claimant's prognosis is stated as follows:

"Her prognosis is guarded with persistent psychological impairments particularly with fear and arousal with driving, physical deconditioning and loss of ability to do pre-injury activities. The avoidance with anxious laminations and fear. She holds a poor prognosis leading to encroachment in her independent living with risk of deterioration given she is emotionally vulnerable."

Dr Rastogi says that the claimant's psychiatric injuries are permanent and that her psychological impairments are persistent causing social and vocational limitations.

Dr Rastogi assesses the claimant's WPI under the PIRS as follows:

Mild impairment as she lacks routine, lost weight and structure, not eating properly, missing showers and lacks motivation.

Moderate impairment with social isolation and she does not get to involve in social activities. She is isolated and reclusive, and not engaging in social events. Stopped walking and lost friendships.

Mild impairment as she can drive for short distances and is triggered, avoids accident site, extreme fear of having an accident, anxiety with concentration difficulties.

Mild impairment as relationship with daughter and granddaughter estrange, feeling of burden on her loss of friendships.

Moderate impairment as she feels tired and exhausted and has short attention span and has difficulty with retention. She can barely manage day-to-day activities due to inclusive thoughts and agitation, gets a brain fog and frazzled easily.

Total impairment as has no capacity to work in suitable duties. The psychological barriers with erratic phase, cognitive deficits and poor stress coping and pain are barriers to her functioning.

Aggregate score impairment: 17 which converts to 19% WPI

Report by Dr James Bodel, orthopaedic surgeon, to the claimant's lawyers

This report is relevant to the claimant's physical injuries. Dr Bodel reported that the claimant's complaints, at the time of his assessment, were as follows:

• pain and stiffness at the base of the neck;
• pain and stiffness over the top of the left shoulder;
• left shoulder and arm pain with numbness and tingling into the hand to all five digits;
• right shoulder girdle pain;
• pain in the lower part of the back aggravated by prolonged sitting, bending, twisting or lifting, and
• cramping in the left forearm and hand.

Dr Bodel opined that the claimant suffered damage to the disc at C4/C5 above the fusion at C5/C6 and C6/C7. He found rotator cuff pathology in both shoulders and a musculoligamentous injury to the lower back caused by the motor accident. Dr Bodel found a combined 17% WPI.

Report by Christine Stranger, psychologist, to the claimant's lawyers

Ms Stranger is the claimant's former treating psychologist who is now retired. Ms Stranger records as follows:

"Melinda Bradley suffers from a Post-Traumatic Stress Disorder with associated Anxiety and Depression. The original diagnosis was approved for psychological treatment by NRMA and consistent investigations by the writer have established criteria for PTSD on many assessments. Ms Bradley had one prior recorded Mental Health difficulty in her history on a prior MVA twenty years earlier. This event occurred at the same intersection, again not her fault. Ms Bradley sought a couple of sessions of counselling at GP recommendation. There is a personal history before the 1999 accident, with evidence Ms Bradley had a successful working background, that she is a resourceful lady of some independence and strength of character, hobbies and a family life, friends and grandchildren.

There are criteria for Post-Traumatic Stress Disorder (DSM) and documented clinical notes to support how Melinda Bradley consistently meets these criteria."

Under the heading Prognosis, Ms Stranger says as follows:

"In summary, PTSD is often a diagnosis reflecting an accumulation of similar traumatic events. For Ms Bradley, at the same corner twenty years ago, a MVA had some repercussions. Dislocated ribs, a fractured neck and a metal plate in her head had to be adapted into her life. She recovered her functioning then. However, the legacy of the 2019 trauma has much more severe physical and emotional impact. Final psychological prognosis is unknown at this stage, but Ms Bradley has shown resilience, a positive attitude and sufficient intellect to try to reframe his goals. Whilst recovery and improvement has already been recorded, there are still hurdles medically and a continued loss in physical capability. As her prior psychologist, I believe the foundations of her personality and intellect are her strength so psychological prognosis is optimistic for her to cope. What is unknown is, if medical complications continue to create barriers for her, which will test her mood, recovery and relationships in the future."

Report by Dr Frank Machart, orthopaedic surgeon, to the insurer

Under the heading Diagnosis, Dr Machart says as follows:

"Injury to ribs now healed. There was a soft tissue to fragile cervical spine subjected to previous 2 level fusion and degenerative changes above the fusion. Radiculopathy is not evidence."

Dr Machart says that the claimant's cervical injury requiring fusion was not totally asymptomatic at the time of the subject accident. Dr Machart assessed 5% WPI for the cervical spine and 2% WPI for each shoulder giving a Combined WPI of 9%.

CT cervical, thoracic and lumbar spine reported by Dr Lau

(a) The claimant does not dispute the Medical Assessor's findings with respect to her current level of impairment, but his findings with respect to her level of pre-existing impairment.

(b) The claimant submits that neither the treating medical evidence available to the Medical Assessor, nor the history provided by the claimant to the Medical Assessor during the assessment, indicate that the claimant had any significant pre-existing impairment at the time of the subject accident.

(c) In particular, the claimant submits that the Medical Assessor's deduction for pre-existing impairment is clearly incorrect in a material respect and, but for the Medical Assessor's error in assessment of pre-existing impairment, the outcome of the assessment would have been different.

(d) The claimant submits that her pre-existing capacity for employment was more related to her physical incapacity and other medical conditions than her psychological symptoms which were largely in remittance/non-existent at the time of the subject accident.

(e) The claimant submits that in the years immediately preceding the subject accident, she experienced very few symptoms warranting any level of psychological impairment.

The claimant then makes further submissions in relation to Medical Assessor Smith's findings under the various categories of the PIRS which it is not necessary to repeat or summarise.

1. The insurer relied upon the following material which the Panel has considered:

Insurer's index of documents in relation to review application

1. The report of Medical Assessor Thomas Newlyn and Medical Assessor Atsumi Fukui is as follows:

The following injuries caused by the motor accident give rise to a permanent impairment of 7% and IS NOT GREATER THAN 10%:

• Other Specified Trauma and Stressor-Related Disorder - Adjustment-like disorder with a persistent response to trauma with Post-traumatic Stress Disorder-like (PTSD-like) symptoms
• Exacerbation of Alcohol Use Disorder

The claimant was 63 when assessed on 14 March 2025 using Microsoft Teams Videoconferencing. The claimant was alone at home in Narooma. She preferred to be addressed as Mel.

Soon after beginning the assessment, she reported that her phone had sent a message saying it was too hot. Her video and audio feed occasionally froze, but the medical assessors could review the missing audio with the claimant.

When the assessment ended, the video and audio feed froze again, so the medical assessors closed the link and conferenced by telephone.

The claimant reports she had several Motor Vehicle Accidents (MVA).

She specifically mentioned accidents when she was 8 and 17.

She said there were a few others but the one that was most traumatic before the 16 May 2019 MVA occurred on 18 September 1999. That accident was at the same intersection as the 16 May 2019 MVA.

Because of the September 1999 MVA she needed a cervical fusion at C5, C6 and C7 in 2002. She reported that a metal plate was inserted that had six screw holes but there was only enough bone for five screws.

She reported "a little bit of counselling," and once her neck had recovered, she could travel and work. She had no driving difficulties and no later mental health problems.

In the workup for her cervical fusion surgery, she was diagnosed with Hepatitis C.

She has assumed that she was infected while working in hospitality because she had cuts from broken glass that would have had blood contamination.

She waited for treatment until 2016 when it was available on the PBS. She said that after treatment the virus was undetectable.

She was diagnosed with hypertension in 2016 and received treatment before the 2019 MVA.

The only surgical procedure she recalled was her cervical fusion.

She attended 13 schools and left high school after completing year 10.

Her stepfather travelled for work and the family moved with him.

She said she has a TAFE certificate in Training and Assessment. From her work experience she had many certificates.

From age 13, the claimant helped her stepfather, a baker, in the kitchen and shop.

After high school she worked in casual positions until the 1999 MVA.

After her Hepatitis C diagnosis, she was placed on the Disability Support Pension (DSP) in 2009 because of the effects of the infection.

She said she worked casually as a hotel manager until 2017.

She cleaned houses with cash in hand, was paid for her photography and sold goods and preserves at a market stall.

She was building a shed at her home with the help of a friend.

Based on her description of her activities this would not have averaged more than 20 hours a week.

After the 2019 MVA she stopped all work reporting that her difficulties with concentration and focus did not allow her to work.

Her mother is 'going on' 84, lives nearby but is not seen regularly. The claimant said her mother did not appreciate her 'fussing over her'.

Her mother managed the local NRMA franchise for 20 years.

Father died on 24 September 1993. He was in the bakery industry.

Her mother re-partnered and her stepfather lived with her mother until he died 10-12 years ago.

Her stepfather was in the bakery industry and travelled for work.

He was physically and emotionally abusive to his stepchildren.

The claimant's older brother has asthma. He lives 40 km away. She reported seeing him when he visited their mother or when she went to the hospital for checkups because he lived nearby.

Her 12 years younger half-brother has an Alcohol Use Disorder and has had two marriage breakdowns.

The claimant wondered if this history was relevant to the 2019 MVA.

From age five to age nine a family friend sexually abused her.

She denied that her stepfather sexually abused her.

She said that she blocked memories of the sexual abuse. She said she did not have dreams about it, and it had not affected her relationships.

The only effect was that she worried about what people did in the privacy of their homes.

She reported that her stepfather was physically and emotionally abusive.

She was married for 10 years to the father of her children.

She married at age 20 and left her husband when he became violent and moved with her children to Kingscliff, eventually returning to live in Narooma.

Since her marital breakdown, she has been in several relationships.

A 10-year relationship that began before the 1999 MVA broke down 4 or 5 years after that accident. She stated that the relationship breakup was unrelated to the MVA.

Her partner didn't want to help with the rent, and she felt that because he was noncommittal, she was a 'convenience'.

She said he could not handle her depression and lack of cooking.

They have remained in touch, and she says that he now lives in the back of his truck to avoid paying rent.

Her son is 44 and has two children, while her daughter is 42.

She had been in a relationship for 5 years before the 2019 MVA that broke up 5-6 months later when she lost her sex drive after that MVA. They had not lived together.

The claimant smokes an average of 10-15 cigarettes daily.

The claimant said she began drinking alcohol in her late 20s or early 30s but did not drink daily.

She did not drink before her pregnancies and stopped drinking spirits.

After arguments with her noncommittal partner, who was a heavy drinker, she was charged with two DUI offences approximately 30 years ago. One was high-range, the other mid-range.

She stopped drinking in 2016 before her Hepatitis C treatment.

In the years before the 2019 MVA, she could drink four bottles of white wine on weekends with friends at various social settings, such as barbecues and dinners.

When she was with a partner, she would have wine with dinner.

After the 2019 MVA she began to drink daily and said it was hard to estimate how much she drank.

She described filling a glass with ice and pouring in wine.

She said that drinking settled her and eased tension.

She did not think she drank to get rid of thoughts of the accident.

She reported drinking six glasses of wine the day before the assessment interview and said she questioned if she had an alcohol problem.

She disputed Assessor Smith's diagnosis of an Alcohol Use Disorder before and after the 2019 MVA.

She reported beginning marijuana use at age 16. She now occasionally smokes small amounts in the evening because it helps her sleep and relaxes her.

She said she drank two coffees a day and more milk than wine.

The claimant said that she was angry because of the effect of the 2019 accident and that the at-fault driver continued to drive dangerously.

Apart from the two DUI charges, she had received two speeding tickets.

She said that she had not claimed compensation other than for the 1999 and 2019 MVAs.

The claimant recalled attending three group counselling sessions around 1993 about Childhood Sexual Abuse but could not remember why she had attended as she said she had blocked the memory of the abuse.

She denied persistent mental health symptoms after the 1999 MVA.

The claimant said she was in a good place and not limited in her activities.

She lived alone and had a positive relationship with a partner.

She supplemented her DSP with casual jobs and a market stall.

The claimant began her history of the 16 May 2019 MVA by saying that she relived the accident every day.

She said she was driving on the Princess Highway following two other vehicles when the at-fault driver came out of the street she was planning to turn into and ploughed into her car's right front and right door.

She thought, 'Here comes an accident,' but she could not get the thought of 'accident' before the crash.

She recalled watching the airbags go off in the other car.

The claimant said this was not the first accident that her neighbour had had.

She could not open the driver's door and exited the passenger door.

She talked to emergency services and directed traffic until the police came.

She took photos of the accident, then sat in the gutter and cried.

She felt pain in her chest, neck and left shoulder.

She worried the metal plate in her neck from the 1999 accident would be damaged.

The ambulance personnel assessed her but she did not go to hospital.

She sent the friend who was helping build her shed to get painkillers from her home.

She had physiotherapy for her neck and shoulder until the insurer stopped payments.

She treats herself with heat packs, heat creams, and over-the-counter painkillers.

History of Symptoms Following the Motor Accident

The claimant began by describing her feelings after the accident and thoughts about her neighbour, the at-fault driver.

"She was drugged out and shouldn't have been driving.

She is on prescription meds and takes ice and whatever she can get.

The accident happened at the same place 20 years before.

The nightmares were immediate and about being crushed and in pain. I wake up thinking something has hit me. They have not changed.

I will have a nightmare about backing out of my driveway. They are there a couple of times a week. At the start they were nightly.

The flashbacks come day and night. When I turn into the street, it flashes back to then.

I drive two kilometres to avoid the intersection.

I don't really drive the new car I bought. In 6 years I put 6000 km on it.

I am not the person I used to be. I can't enjoy anything, and my whole life is affected.

I'm not good at eating. I have lost about 5 kg. I have weighed the same for 18 months.

I fall asleep watching TV and doze off in the lounge. From midnight to six in the morning, I wake three or four times, getting anywhere from four to seven hours of interrupted sleep.

I have lost interest in hobbies, but I just live with it.

If I need to see a specialist the nearest hospital is 40 km away.

I avoid driving distances. I am petrified that another accident will happen.

When it happened, I did not think I would die. I saw there was no blood.

Now I have a dreadful feeling that I will die in a car accident.

Driving, I may have to pull off the road and be sick.

When I am behind a truck, I am worried the load will fall off and hit me.

People have noticed I'm not my usual outgoing perky self.

I haven't been to a hairdresser since the accident. I have long hair.

I used to do wedding and birthday photography and stopped it. My garden is a mess."

History of Treatment Following the Motor Accident

The claimant said she refused to take antidepressant medicines. She was not interested in taking them and had never taken them when they were prescribed.

She explained that the woman who ran into her takes those medicines.

She reported that after the 16 May 2019 MVA, she was prescribed 'strong pain medicines' that she stopped as soon as she could.

• The GP records list prescriptions on Panadeine Forte [the combination analgesic medication codeine and paracetamol].

When Panadeine [the combination analgesic medication codeine and paracetamol] was an over-the-counter medicine she used that and now uses Panadol [the analgesic medication paracetamol], Dencorub [a cream containing methyl salicylate, camphor, menthol and eucalyptus oil] and heat packs.

She has been prescribed the antihypertensive medicine Reaptan [combined perindopril arginine and amlodipine besilate] since 2016.

She began to have psychological counselling on 4 July 2019.

When that psychologist, Ms Kathleen Troup, retired the claimant began to consult Ms Christine Stranger until she moved from the area.

She explained that in her small community, there were few psychologists. After the MVA, there were bushfires and then COVID, so the other psychologists in the area were busy and she had no access to further face-to-face psychological treatment.

Physiotherapy was prescribed until the insurer did not fund it.

Details of Any Relevant Injuries or Conditions Sustained Since the Motor Accident

No relevant injuries or conditions have been sustained since the motor accident.

The claimant believes that her symptoms are worse and that her anxiety and depression have 'not gone anywhere'.

The claimant is prescribed Reaptan for her blood pressure and no medicines for her mental health symptoms.

She does not receive psychiatric or psychological care. She said she has tried writing her thoughts on paper to get them out. Talking about the accident, she was not far from crying.

The claimant did not expect a change in her current treatment.

Appearance: Her appearance was consistent with her age.

Grooming: Her long hair was pulled back from her face. She did not wear makeup, but she did wear glasses.

Activity: She did not demonstrate pain behaviours. No psychomotor retardation or agitation was observed.

Aggression: No hostile acts towards peers and property reported.

Impulse control: Impulse control was average. Not accident-prone.

Interaction: She was cooperative throughout the interview, but editorialised on her anger that the at-fault driver could still drive and had no consequences for the 2019 accident.

Facial expression is appropriate to verbal content.

Speech: The rate was appropriate, and the volume was average. Her answers were goal-directed with frequent digressions into her distress over the behaviour of the at-fault driver and the contents of the certificate of Assessor Smith.

Affect: Anxious. She reported being stressed by the assessment process.

Dissociative: No behaviour was observed or reported.

Preoccupations: None reported. No recurrent self-injurious behaviour patterns.

Memory: No short-term or long-term deficit. She reported an inability to remember dates but was firm in recalling significant incidents in her life.

Concentration: Although she reported problems with focus and concentration, she could recall past events and focus on the assessment questions during the 120-minute Teams assessment.

Abstraction: She used abstract concepts without difficulty.

Knowledge: Her fund of information was as expected.

The claimant lives alone in a Housing NSW house in Narooma. She is self-sufficient.

The claimant said there were no problems with Self-Care and Personal Hygiene before the 16 May 2019 MVA. However, her cooking has been limited, and her appetite has reduced since then.

She showered daily before the MVA and but now had to force herself to shower. If she was not going anywhere she might not shower. She dressed daily.

She does not complete chores to her satisfaction. After the 2019 bushfires, she said she had not been able to clean up the aftermath of the ash on the property or inside the house. She shops independently weekly for groceries.

She said she had isolated herself from friends because she did not like them turning from the highway into her street. The day before the assessment, she had walked across the road to visit a neighbour. Friends bring her meals.

Before the MVA she would go fishing, listen to music and go up the river in a boat. She has stopped these outings.

Her interactions with her mother have not significantly changed since the MVA, in that her mother did not like her daughter fussing. Because her son lives far away, she does not see him often. She took her grandchildren to swimming lessons and found that enjoyable. Her granddaughter is ten and her grandson is eight.

She is a member of the Narooma Sports & Services Club. She said that she could go to the club on the courtesy bus but did that rarely. She was invited on average every 2 weeks.

She reported travel restrictions consequent to the 16 May 2019 MVA.

She reported reading books before the MVA but not after because of difficulties in focus. She said she could not focus on TV because her mind wandered.

The claimant continued to receive the DSP and had not returned to casual employment or market stall selling.

The claimant often focused her replies to questions about her life and symptoms on the behaviour of the at-fault driver and the dangers of the turnoff from the highway to her street.

Her answers sometimes confused the 1999 and 2019 MVA's, although later questioning would sort out the timelines.

She found the assessment anxiety-provoking and often remarked on her discomfort.

However, overall, there was consistency between the history of current psychiatric symptoms, presentation at the assessment interview and findings on examination.

The review panel considered the question of stabilisation and regarded the claimant's psychiatric disorders from the accident had stabilised.

F43.8 Other Specified Trauma and Stressor Disorder - Adjustment-like disorder with a persistent response to trauma with PTSD-like symptoms

Other Specified Trauma and Stressor Disorder - Adjustment-like disorder with a persistent response to trauma with PTSD-like symptoms,

This diagnosis applies to presentations in which symptoms characteristic of a trauma and stress-related disorder cause clinically significant distress or impairment in social, occupational, or other important areas of functioning but do not meet the full criteria for any of the disorders in the trauma- and stressor-related disorders diagnostic class such as PTSD.

However, many individuals who have been exposed to a traumatic or stressful event exhibit externalising anger.

The review panel did not diagnose PTSD caused by the 16 May 2019 MVA because the claimant did not meet criterion A because she did not fear for her life and actively directed traffic after leaving her car. Other PTSD criteria are subsumed in the Other Specified Trauma and Stressor Disorder diagnosis.

Her pre-existing Alcohol Use Disorder was exacerbated from a mild to a moderate disorder after the 2019 MVA.

The review panel did not diagnose an exacerbation of Alcohol-Induced Depressive Disorder because there was no evidence in the documents of such a disorder and the claimant denied depressive symptoms in the years before the 2019 MVA. The review panel assigned the depressive symptoms reported by the claimant after the 2019 MVA to Other Specified Trauma and Stressor Disorder.

The claimant's history and provided documents show a deterioration in functioning immediately after the 16 May 2019 MVA with trauma symptoms that met diagnostic criteria for Other Specified Trauma and Stressor Disorder.

She reported anxiety and depressive symptoms, re-experiencing, sleep disturbance, social withdrawal and changes in arousal caused by the MVA.

The claimant increased her alcohol use, so she now met the criteria for a Moderate Alcohol Use Disorder.

Her symptoms have continued and were observed at the 14 March 2025 assessment.

• Other Specified Trauma and Stressor Disorder - Adjustment-like disorder with a persistent response to trauma with PTSD-like symptoms.
• Alcohol Use Disorder.

Degree Of Permanent Impairment Psychiatric Impairment Rating Scale

The determination as to permanent impairment is made in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Motor Accident Guidelines.

Other Specified Trauma and Stressor Disorder - Adjustment-like disorder with a persistent response to trauma with PTSD-like symptoms.

Other Specified Trauma and Stressor Disorder - Adjustment-like disorder with a persistent response to trauma with PTSD-like symptoms.

Mild impairment. She had mild personal neglect and sometimes did not shower daily. She dressed daily and was able to maintain her home by herself although she did not believe she cleaned and tidied adequately. She cooked for herself and despite weight loss in the years after the 16 May 2019 MVA her weight had stabilised in the past 18 months. She lived independently without support.

She had mild impairment. She was able to go alone to events when invited, although she did not always accept. She reported that she would go to a wedding if invited. She sometimes went to the Narooma Sports & Services Club using the club courtesy bus. She enjoyed taking her grandchildren to their swimming lessons.

Mild impairment. Anxiety about the possibility of another accident resulted in her driving less. Still, she can drive in the Narooma Area, drive to hospital appointments 40 km away and travel by courtesy bus.

Mild impairment. Overall, she has maintained contact with her family. She takes her grandchildren to swimming and has regular contact with her son and daughter. She has had reduced contact with her mother since before the MVA related to her mother's dislike of fussing. She has less frequent contact with friends and no longer sees them for barbecues or dinners. Her partner of five years, who did not live with her, stopped contact five or six months after the MVA because she lost her sex drive. The ending of the relationship was more a loss of friendship than partnership.

Mild impairment. She can play solitaire. She watches some TV. She cannot focus on reading for long. Despite complaints that the assessment interview was stressful, she maintained focus for 120 minutes and could recap audio-visual 'freezes' for the medical assessors.

Moderate impairment. She continues to receive the DSP granted because of Hepatitis C symptoms. She is not motivated to return to the part-time pursuits she did before the MVA. These activities would average less than 20 hours a week.

Psychiatric Impairment Rating Scale ‑- Pre-existing/subsequent impairment

No deficit was reported in this domain of functioning. The claimant lived alone. There were no difficulties in self-care or personal hygiene.

No deficit was reported in this domain of functioning. She described active social and recreational activities with family and friends. Her Alcohol Use disorder did not result in impairment.

No deficit was reported in this domain of functioning. The claimant reported no difficulties with car driving or travel related to the 1999 MVA.

No deficit was reported in this domain of functioning. She had a positive relationship with her family, although she visited her mother less often because her mother did not like her daughter fussing over her. She had a positive interaction with her friends. Her partner did not live permanently with her.

No deficit was reported in this domain of functioning, and the claimant reported that she enjoyed reading books and doing craft activities.

There was no deficit reported in this domain of functioning from mental health symptoms. She was in receipt of the DSP because of her diagnosis of Hepatitis C. She supplemented her DSP with part-time pursuits that would have taken less than 20 hours a week.

The claimant denied PTSD symptoms in the years before the 16 May 2019 MVA saying that she had blocked memories of the sexual abuse.

Her brief group treatment was in 1993, and she did not recall why she attended.

She did not describe the onset of PTSD symptoms because of her adult partner's abuse.

Her alcohol use history was one of binge drinking that, in the years before the MVA, met the criteria for a diagnosis of Mild Alcohol Use Disorder. However, there was no impairment in functioning caused by her alcohol use.

There was no confirmation that she had developed an Alcohol-Induced Depressive Disorder before the MVA.

Her Tobacco Use Disorder was evident before the MVA.

Her marijuana use would have been a focus of concern but not a clinical disorder.

There is no adjustment needed as there is no measurable treatment effect, and she is receiving no treatment for her mental health symptoms that are not in remission.

Determination regarding the degree of whole person impairment of the claimant due to the injuries caused by the 16 May 2019 MVA.

The total percentage whole person permanent impairment for assessed psychiatric injuries caused by the motor accident is 7%. Therefore, permanent impairment is not greater than 10%.

The claimant's solicitors submitted that Assessor Smith's assessment of pre-existing impairment was in error. The Review Panel found there was no pre-existing impairment in functioning in the PIRS despite an Alcohol Use Disorder. There was no confirmation of an Alcohol-Induced Depressive Disorder. Her childhood sexual and physical abuse and adult partner abuse had not resulted in recorded or reported PTSD symptoms.

The review panel did not find a pre-existing impairment of 7%, as suggested by the insurer.

In reviewing the WPI effects of the 16 May 2019 MVA, the review panel found no more than mild impairment in five of the six domains of functioning in the current Psychiatric Impairment Rating Scale.

The review panel agreed with Assessor Smith that there was a mild impairment in Self-Care and Personal Hygiene. The claimant lived independently without support and with mild personal neglect.

The review panel did not agree with Assessor Smith's Social and Recreational Activities assessment, finding the claimant had a mild impairment because she could socialise at the Narooma Sports & Services Club, attend weddings if invited, and enjoyed taking her grandchildren to swimming lessons.

The review panel did not agree with Assessor Smith's assessment of social functioning, which found that the claimant had a mild impairment. Overall, her social functioning with her family had been maintained, but there had been a loss of contact with her friends. Clinically, the breakup of her relationship resulted in more loss of friendship than partnership.

The review panel agreed with Assessor Smith's Travel, Concentration, Persistence and Pace assessment.

The review panel did not agree with Assessor Smith's Adaptation assessment, finding that her stopping part-time pursuits while receiving the DSP caused a moderate impairment in Adaptation.

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[6] The Panel adopts the examination findings and reasons of Medical Assessor Fukui and Medical Assessor Newlyn.
2. The Panel is not required to choose between competing medical opinions and is required to form its own opinion.[7]
3. The Medical Assessors have explained the bases for their assessments and diagnosis which are different to those of Medical Assessor Smith, Dr Rastogi and Ms Stranger. In relation to their ratings under the various Categories of the PIRS, the Medical Assessors have scored differently to Medical Assessor Smith under the categories of Social and Recreational Activities, Social Functioning and Adaptation, for the reasons stated. The medical assessment of permanent impairment is made at the time of the examination. In that respect, the previous assessments are somewhat outdated, and do not reflect current symptomatology, in the Medical Assessors' opinion.
4. The Panel accepts the claimant's submissions that it is not appropriate to make a deduction for any pre-existing psychiatric impairment at the time of the assessment.

1. For the above reasons, the Panel concludes that the certificate issued by Medical Assessor Glen Smith on 26 October 2023 should be revoked. The new certificate appears at the commencement of these reasons.

[1] _WAEE v Minister for Immigration and Citizenship [_2003] 75 ALO 630 at (46).

[2] Farr v Insurance Australia Limited t/as NRMA Insurance Limited [2014] NSWSC 1435 at (46).

[7] Allianz Australia Group Limited v Keen [2021] NSWCA 287 and Insurance Australia Group Limited v Marsh [2021] NSWCA 31.