Issued under s 7.23 of the Motor Accident Injuries Act 2017

(a) revokes Medical Assessor Nagesh's certificate dated 20 August 2024, and

(b) certifies that the degree of the claimant's permanent impairment as a result of psychological injury caused by the accident is 10%, being not greater than 10%.

A statement setting out the Panel's reasons for the assessment is included with this certificate.

1. On 4 November 2021, [CBC] (claimant) was driving on Punchbowl Road and in the process of merging between two lanes when his vehicle was rear ended (accident).
2. AAI Limited t/as GIO (insurer) is the relevant insurer for the purposes of the Motor Accident Injuries Act 2017 (NSW) (MAI Act).
3. These proceedings involve a dispute between [CBC] and the insurer about his degree of permanent impairment, for the purposes of the MAI Act, as a result of any psychological injury caused by the accident.
4. Medical Assessor Abhishek Nagesh assessed [CBC] and issued a certificate dated 20 August 2024. The Medical Assessor certified that [CBC]'s psychological injury caused by the accident, being major depressive disorder, has resulted in a permanent impairment of 8% being not greater than 10% for the purposes of the MAI Act.
5. [CBC] sought a review of Medical Assessor Nagesh's assessment. On 22 October 2024, the President's delegate determined there was reasonable cause to suspect Medical Assessor Nagesh's assessment was incorrect in a material respect, on the basis of the Medical Assessor's allocation of Class 3 for Social Functioning using the Psychiatric Impairment Rating Scale (PIRS).
6. On 14 May 2025 this review panel (Panel) was constituted to conduct a review of Medical Assessor Nagesh's assessment (Review).

1. The present dispute involves whether [CBC]'s "degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%". That is, whether it exceeds the "impairment threshold" for the purposes of the MAI Act.[1] This is relevant to [CBC]'s entitlement to damages for non-economic loss.[2]
2. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be made in accordance with the Motor Accident Guidelines (the Guidelines), stating:

(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.

(2) Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.

(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.

(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent."

1. The Guidelines are made pursuant to s 10.2 of the MAI Act. Version 10 of the Guidelines is effective from 15 September 2025 and replaced version 9.3, except for claims arising from accidents before 1 April 2023. For such accidents, such as the current accident, certain clauses of version 10 do not apply, and specific clauses from version 9 of the Guidelines continue to apply.
2. Part 6 of the Guidelines is based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). Part 6 of the Guidelines is definitive with regard to the matters it addresses but where it is silent on an issue, the AMA 4 Guides should be followed.[3]

1. Under the Guidelines, "impairment" is defined as "an alteration to a person's health status. It is a deviation from normality in a body part or organ system and its functioning. Hence, impairment is a medical issue and is assessed by medical means".[4]
2. The process by which impairment is evaluated is set out in cls 6.17 and 6.18 of the Guidelines. This provides a three-stage process which includes a review and evaluation of all available evidence, an interview and a clinical examination wherever possible, and preparation of a certificate using the methods specified in the Guidelines to determine the percentage of permanent impairment.
3. In respect of the third stage, the determination of psychiatric impairment is to be assessed in accordance with 'Mental and behavioural disorders' found in cls 6.201 to 6.228 of the Guidelines.[5]
4. Any psychiatric or psychological impairment must be assessed separately from any impairment resulting from a physical injury.[6] Accordingly, in determining [CBC]'s impairment resulting from his psychological or psychiatric injuries, the Panel must not take into account any impairment resulting from his physical injuries.

1. This is a medical dispute as defined in s 7.17 of the MAI Act and constitutes a medical assessment matter pursuant to Schedule 2, cl 2. It was referred to the Personal Injury Commission (Commission) for assessment under Division 7.5 of the MAI Act.
2. The Panel is to conduct the Review in accordance with s 7.26 of the MAI Act. Section 7.26(5A) of the MAI Act provides that the panel is to be constituted by two Medical Assessors, being specialist medical practitioners, and a Member assigned to the Motor Accidents Division of the Commission.
3. 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.[7]
4. The Panel is required to form its own opinion on the medical question in dispute by reflecting on the panel members' professional judgment and expertise; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[8]

1. On 5 August 2024, Medical Assessor Abhishek Nagesh undertook a medical assessment of [CBC] and, in his certificate dated 20 August 2024, determined that [CBC]'s psychological injuries caused by the accident give rise to a permanent impairment of 8%, which is not greater than 10%.
2. Medical Assessor Nagesh was referred the injuries of major depressive disorder and post-traumatic stress disorder for assessment.
3. Medical Assessor Nagesh assessed [CBC] via video conference.
4. [CBC]'s pre-accident and psychosocial history was recorded. It was noted that he had been diagnosed with opioid dependence, alcohol misuse disorder and gambling disorder prior to the accident. He was on methadone and had employment issues, which is why he was self-employed.
5. It was reported that he was together with his wife prior to the accident, but this was strained and there was no intimacy between them. It was also reported that he struggled with cooking, cleaning and shopping prior to the accident due to his alcohol misuse, depression and anxiety. He showered once every couple of days but was still capable of living independently and caring for himself and his children. His social life had also reduced, and he had a loss of enjoyment of life prior to the accident. He was able to drive and could travel without problem.
6. He was also diagnosed with depression and anxiety in around 2013 and was experiencing depressive and anxiety symptoms prior to the accident, but states he was managing reasonably ok. He had been diagnosed with post-traumatic stress disorder and major depressive disorder as a result of a quad bike accident in 2015.
7. It was noted that, after the subject accident, he was told he would need to have surgery and began to worry about getting addicted to opioids again. He said "everything changed after four to six months" and he was not able to return to work. He was in pain, which affected his mood and further exacerbated his depressive and anxiety symptoms. He was unable to sleep, he stopped enjoying things, his appetite fluctuated, and he lacked energy and motivation.
8. [CBC] is on medications and seeing a psychologist and psychiatrist.
9. In respect of current functioning, it was noted that [CBC]'s routine involves staying home the majority of the time. He is not working or studying. His mother does most of the cooking, although he can cook once a week and makes steak and a cup of tea. He sits on the lounge and watches a bit of television. He can go to the shops once a week on his own and shower once a week. A cleaner comes to do the cleaning.
10. [CBC] reported becoming socially withdrawn and continues to remain socially withdrawn, not partaking in any recreational activities. He has stopped socialising with friends and stopped attending family functions. He can travel up to 20 minutes an hour, but due to his pain he has to stop if he has to travel longer.
11. He has separated from his wife. He says she left due to his apathy and social withdrawal. He has lost contact with all his friends.
12. He says his concentration is poor and he can concentrate for a period of up to 30 minutes before starting to feel tired.

1. The Medical Assessor opined that [CBC]'s depressive and anxiety symptoms were exacerbated by the accident and that he meets the DSM-5 criteria for major depressive disorder based on the subjective report of [CBC], his mental state examination, and the contemporaneous records of his general practitioner (GP), psychiatrist and psychologist.
2. The Medical Assessor noted he did not consider a diagnosis of post-traumatic stress disorder as the accident was not severe enough to satisfy criterion A. The Medical Assessor also noted that [CBC] did not report any post-traumatic stress disorder symptoms to him.
3. In respect of causation, the Medical Assessor noted that [CBC] was experiencing depressive and anxiety symptoms prior to the accident. He found that [CBC]'s depressive and anxiety symptoms were exacerbated by the accident because of his physical inability, his inability to work, his loss of income, his pain, and the fact he had to undergo further surgery, which impacted him due to his fear of anaesthesia and fear of being further addicted to opioids.
4. The Medical Assessor opined that [CBC]'s symptoms have become treatment resistant, chronic, permanent and stabilised.

1. Medical Assessor Nagesh opined 13% whole person impairment caused by the accident, based on the following allocation in respect of each PIRS category:

(a) Category 1: Class 2. Medical Assessor Nagesh referred to his ability to cook steak once a week and his ability to shop independently. He showers once a week without prompting and changes clothes as and when required. Even though he struggles with activities of daily living, the Medical Assessor opined that [CBC] is still capable of living independently.

(b) Category 2: Class 3. [CBC] is socially withdrawn. He does not take part in any recreational activities. He has stopped attending social events, including family functions, weddings, dinner parties and anniversaries.

(c) Category 3: Class 1. [CBC] can drive for a period of up to 20 minutes to an hour. If he has to travel longer that this, he has to stop. This is stated to be entirely due to his pain and not due to any anxiety.

(d) Category 4: Class 3. [CBC]'s relationship was strained prior to the accident, but because of the accident and his depressive and anxiety symptoms, he has separated from his ex-wife and lost contact with the majority of his friends.

(e) Category 5: Class 2. [CBC]'s ability to concentrate is diminished, but he states he can concentrate for a period of up to 30 minutes where he can watch television. He was able to concentrate during the entire duration of the interview. He starts to feel tired when he has to concentrate beyond 30 minutes.

(f) Category 6: Class 3. [CBC] has not been able to work since the accident. His ability to handle stress has been reduced due to his ongoing depressive and anxiety symptoms. In the Medical Assessor's opinion, [CBC] can work up to 20 hours per week in suitable duties from a psychiatric perspective.

1. Medical Assessor Nagesh opined 5% whole person impairment due to [CBC]'s pre-existing major depressive disorder, based on the following allocation in respect of each PIRS category:

(a) Category 1: Class 2. [CBC] stated he was struggling with activities of daily living prior to the accident. However, he was still able to live independently, showered on most days, and changed his clothes when required.

(b) Category 2: Class 3. [CBC] stated he had no motivation to do things prior to the accident. He reported a loss of enjoyment of life and there was a decrease in social interaction. He had stopped attending social events, including group social events like weddings, family functions, dinner parties and anniversaries.

(c) Category 3: Class 1. There was no deficit. [CBC] was able to travel independently to local, familiar and unfamiliar places.

(d) Category 4: Class 2. [CBC]'s relationship with his ex-wife was strained but they had not separated. He had lost contact with most of his friends prior to the accident.

(e) Category 5: Class 2. [CBC] states he was able to concentrate for a period of up to 30 minutes but his memory was not the best. Beyond 30 minutes, he could not concentrate and would feel tired.

(f) Category 6: Class 1. [CBC] was working full-time as a self-employed electrician. His ability to handle stress had decreased from some extent due to his ongoing depressive and anxiety symptoms, hence a minor deficit.

1. The Medical Assessor made no apportionment for any subsequent impairment, and no adjustment for effects of treatment given the Medical Assessor opined [CBC]'s symptoms have not improved with treatment.
2. After deducting 5% for [CBC]'s pre-existing condition, the Medical Assessor opined 8% permanent impairment caused by the accident.

1. On 14 May 2025, the Panel was convened in this matter. Part 5 of the Personal Injury Commission Act 2020 (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. The Panel determines how it conducts and determines the proceedings.[9]
2. On 15 May 2025, the Panel issued Directions to the parties requiring them to each file a bundle containing submissions and the documents they relied on for the purposes of the Review.
3. On 20 August 2025, the Panel met. The Panel issued further Directions noting that, contrary to its directions dated 15 May 2025, neither party had filed submissions directed to the Panel or addressing causation. The Panel noted that the President's delegate had allowed the review and the Panel's task was to undertake a new assessment of all matters with which the medical assessment is concerned, per s 7.26(6) of the MAI Act.
4. The Panel also noted that the claimant's bundle was in excess of 1,500 pages with no specific submissions in respect of any of the documents said to be relied upon. A significant portion of the documents regarded [CBC]'s alleged physical injuries with no submissions as to how these documents are relevant to the Panel. The Panel noted rule 67D(2) of the PIC Rules, which states that the appropriate decision-maker for proceedings is not required to have regard to a document not specifically referred to in submissions made by a party to the proceedings. Accordingly, the Panel made directions for the parties to each upload and serve submissions directed to the Panel, and for the production of specific clinical records from [CBC]'s treating medical practitioners. The Panel also determined that a medical examination of [CBC] was required and made directions accordingly.
5. Despite the Panel's directions made on 15 May 2025 and 20 August 2025, the insurer did not provide any submissions directed to the Panel, nor any submissions addressing causation.
6. Following the medical examination of [CBC], the report of the Medical Assessors was provided to the legal member of the Panel. The Panel then re-convened on 5 November 2025 to discuss the examination findings and report, and determine the Review.

1. The Panel notes the size of the claimant's bundle and the lack of detailed submissions in respect of these documents. If reference is not made to a document contained in the bundles it should not be assumed that the Panel was unaware of that material or that the Panel failed to take the material into account.[10]

1. On 13 October 2025, the insurer filed an application to lodge additional documents (ALAD). This application was opposed by the claimant. Leave was refused for the reasons set out in the interlocutory decision dated 16 October 2025.
2. The Panel notes that the claimant's submissions in response to the insurer's ALAD dated 13 October 2025 attached an internal review certificate from the insurer. This was not accompanied by an ALAD, nor was it a document directed to be produced by the Panel. It was provided on 15 October 2025, being less than a week prior to the scheduled medical examination. The claimant's submissions merely state that the internal review decision is "of assistance to the Review Panel". There are no other submissions as to why this document is relevant to any issues before the Panel or otherwise necessary to facilitate the just, quick and cost effective resolution of the real issues in the proceedings. The document does not satisfy rules 67 or 67C of the PIC Rules, nor has the claimant made an application for leave to introduce the document under r 67C(3). Accordingly, this document has not been considered by the Panel.

1. [CBC] relies on submissions dated 12 September 2025. [CBC] also relies on submissions dated 17 September 2024 regarding his application for review of the certificate of Medical Assessor Nagesh. The Panel has considered these submissions in so far as they relate to the task of the Panel.
2. [CBC] submits that his psychological injuries of anxiety, major depression and post-traumatic stress disorder are all caused or materially contributed to by the accident. He further submits that the medical evidence supports that his permanent impairment arising from the accident is greater than 10%.
3. [CBC] submits that the accident caused or contributed to the worsening and exacerbation of his post-traumatic stress disorder, major depression and anxiety, such that it can be said to be caused by the accident.
4. He submits that all objective measures suggest that, whatever his emotional state before the accident, it has deteriorated. This includes moving from a position where he was able to work in a restricted capacity to now being unable to work at all and being unemployable. He submits that he had been able to look after himself, but now lives with his mother and is reliant upon her care. He now rarely leaves home, has lost relationships with friends and family, and his wife has divorced him.
5. He submits his medications have increased post-accident, including 25mg of Seroquel to 300mg in addition to Lorezepam for anxiety, and Sertraline has increased to 200gm. He has also commenced Duoloxetine 60mg.
6. He submits he has been admitted to hospital several times since the accident, being to Concord Repatriation General Hospital on 7 April 2024 for management of his mental health condition, and Matilda Nepean Hospital on 23 April 2024 for worsening depression and anxiety.
7. He submits he was reviewed by Dr Rajneesh Singh on 14 August 2025 who recommended a three-week in-patient programme at Matilda Nepean Private Hospital to monitor his anxiety and trauma. [CBC] submits that, in that report, Dr Singh notes [CBC] has gained a significant amount of weight since the accident despite the use of Mounjaro and that there has been a resurfacing of his nightmares and flashbacks, with the slightest triggers such as sudden noises or exposure to news or media related to an accident triggering his flashbacks. He reports feeling "hypervigilant and emotionally numbed".
8. [CBC] submits his permanent impairment arising from the accident is greater than 10%. He submits that his treating psychiatrist, Dr Singh, noted on 20 June 2024 that he had nil working capacity or earning capacity given his mental state. He submits that Dr Singh's report dated 5 March 2024 stated his mental state continued to decline and there were experiences of passive death wishes.
9. [CBC] submits that important matters of history were provided to the Medical Assessor during the examination and not recorded or alternatively were matters not enquired of by the Medical Assessor, including:

(a) [CBC]'s admissions to the Matilda Mental Health Facility and Concord Hospital for "detox";

(b) sensations of "oral callings" perceived from his daughter and mother;

(c) dreams since the accident involving either waking up crying and in hysterics, thinking he is buried alive in a coffin, or wakes up in tears with his pillows soaked and unable to determine why;

(d) that [CBC]'s medication prescriptions have substantially increased after the accident, and

(e) that [CBC] is reliant upon his mother and heavily reliant on a cleaner and gardener. He also had a period in March 2024 when he "completely spiralled out of control". He says that, due to his current psychological state, he would struggle to live independently without assistance.

1. [CBC] submits that, based on the history taken by the Medical Assessor, he ought to have classified [CBC] has class 4 for social functioning. [CBC] submits that the fact he has now separated from his wife takes him out of class 3, as class 3 "applies to 'severely strained relationships' whereas the relationship is now at an end". He also submits that he is unable to form or sustain a long-term relationship, he has lost his partner, and has lost his close friends. He is unable to care for his dependants; they are in the custody of his former partner. [CBC] further says that his regular in-patient admissions to mental health facilities mitigates against any finding that he is functioning at a class 3 and these matters put him "squarely within class 4 at a minimum".
2. In respect of adaptation, [CBC] submits that he has been unable to work since the accident, and is currently neither studying nor working. He showers once a week. He is socially withdrawn and does not partake in any recreational activities. He has separated from his wife as she could not stay with him due to his apathy and social withdrawal. He has lost contact with all friends. His attention and concentration are poor, and he can only concentrate for a period of up to 30 minutes, afterwards he starts to feel tired.
3. His routine involves staying at home most of the time, sitting on the lounge and "watching a bit of TV". He has stopped socialising, stopped recreational activities, and stopped attending family functions. [CBC] suggests he ought to have been assessed as class 5 as, at the time of the assessment, he was totally impaired and cannot work at all. [CBC] submits that no one would engage him to work on the basis of his level of current functioning. [CBC] submits that, at the very least, he ought to be assessed as class 4 as he cannot work more than one or two days at a time, less than 20 hours per fortnight.
4. [CBC] submits that anxiety symptoms are part of a post-traumatic stress disorder.
5. It is noted that the claimant's bundle is over 1,500 pages. In accordance with the directions of the Panel made on 20 August 2025 and r 67D(2) of the PIC Rules, [CBC]'s submissions dated 12 September 2025 list the material relied on by him. While most of these references are simply to a page number, rather than providing the Panel with substantive submissions as to the assistance that the material provides, the Panel confirms that it has considered the referenced material. This material is summarised below.

1. The insurer relies on its submissions to the President's delegate dated 8 October 2024. The Panel has considered the submissions in so far as they relate to the task of the Panel.
2. The insurer notes it is not in dispute that [CBC] had a pre-existing degree of permanent impairment as a result of pre-accident psychiatric conditions. The insurer relies on cls 6.220 and 6.217 of the Guidelines. The insurer submits that, in circumstances in which there was a trove of objective evidence of pre-accident impairment, the assessor was required to undertake a detailed history of [CBC]'s pre-accident functioning within the PIRS categories. He has done this.
3. The insurer continues that the Medical Assessor is not required to record every detail that was provided to him, and the entire assessment is geared towards an impairment of [CBC]'s functioning on the day of the assessment.
4. The insurer submits that a history of a particular time when [CBC]'s symptoms were aggravated cannot have any relevance to assessment of [CBC]'s impairment as it is on the day of the assessment, nor could a retelling of symptoms or medication changes.
5. The insurer notes that [CBC]'s application for assessment of permanent impairment totalled 1,420 pages in size and was not accompanied by any submissions or references to particular part of the documents.
6. In respect of categorising social functioning as a class 3, the insurer submits that cl 6.220 of the Guidelines emphasises that the descriptors are intended to be illustrative rather than literal. It is the clinical judgment which is considered the most important tool in undertaking the assessment.
7. The insurer submits that [CBC] had admitted his relationship with his wife was strained prior to the accident. This is entirely consistent with the pre-injury categorisation for social functioning within class 2. The insurer submits that a separation from a spouse does not indicate an incapacity to maintain relationships and, in any event, the category descriptions are not to be read literally.
8. In respect of adaptation, the insurer submits that [CBC] seems to be confusing the Medical Assessor's role of a psychiatric clinician with that of a vocational assessor. The insurer says [CBC]'s submissions suggest that the Medical Assessor should have categorised adaptation based upon [CBC]'s attractiveness as a potential employee rather than based upon his psychiatric capacity to engage in employment (whether or not that employment is in fact offered to him).
9. The insurer also submits that the Medical Assessor expressly disavowed a diagnosis of post-traumatic stress disorder caused by the accident on the basis that the accident was not severe enough to satisfy criterion A of the DSM-5 criteria.

1. [CBC]'s application for personal injury benefits dated 8 November 2021 has been considered by the Panel.
2. The accident is described as "I was stationary in my vehicle, in the process of merging between two lanes with my left indicator on, when my vehicle was struck from behind, with force".
3. [CBC] reports physical injuries but no psychological injuries.
4. In response to whether he received treatment at hospital after the accident, [CBC] has ticked "No".
5. In response to whether he was suffering an illness or injury affecting the same or similar parts of his body at the time of the accident, [CBC] has ticked "No".
6. In respect of employment details, the form states he was off work from 5 November 2021 to 22 November 2021.
7. The application notes that he made a CTP claim for an injury that occurred on 15 July 2019, when he was driving a hire car. He is unsure of the insurer and says he was not at fault.

1. The clinical notes of DMC Medical Centre, as at 5 June 2019, have been considered and evaluated.
2. Under "past medical history - active" it is noted "2015 - depression; 2015 - identified doctor shopper for Oxycodone".
3. On 19 November 2007, it is recorded "depressed 2/12; mental health care plan completed; commence Zoloft 25mg x 3/7; up to 50 if tolerated; R/V 1/52".
4. On 20 November 2007, a letter created regarding a Mental Health Plan. A K10 test administered by Dr Peter Davidson has a result of 38. The GP Mental Health Care Plan notes the presenting issue to be "depression - last 2 months, triggered by parental breakup and concerns re relationship".
5. On 4 December 2007, it is recorded "Tolerating Zoloft 50 [illegible]".
6. On 28 December 2007, Zoloft 50mg was prescribed. A reference to Sue Huxley is noted.
7. On 12 March 2008, it is recorded "been off Zoloft for 1 week. Had weird dreams with Zoloft. Has been depressed for 5 months. Been seeing Sue Huxley but not helpful. Counselling. Trial of Avanza 30mg. for review. Counselling".
8. An entry on 26 March 2008 records "used Avanza - got [illegible] & sleepy at work; Loval / Prozac [illegible]".
9. On 24 February 2015, the notes record [CBC]'s injuries resulting from his 2014 quad bike accident. Under "Actions" it is noted "has been depressed; has been on Lovan and Zoloft; counselling".
10. On 4 April 2015, it is noted "Early release of Super, forms completed for Depression; started taking Lovan 7-8 years ago, after stopping, restarted taking it recently". The reason for contact was listed as "depression". A K10 test administer by Dr Ali Kutlu dated 4 April 2015 has a result of 37. A GP Mental Health Care Plan was also prepared on this date, noting "started taking Lovan 7-8 years ago, after stopping, restarted taking it for chronic depression".
11. A referral letter from Dr Nese Sozen to Dr Munro dated 24 April 2015 notes that [CBC]:

"... was referred to me by Dr Ali Kultu for assessment and counselling. Since you are his ongoing GP, I am writing to request for [CBC] to get a referral letter to see our psychiatrist, Dr Anna Lee. My assessment is that [CBC] has ongoing dysthymic depression. Following his bike accident in January 2014, he lost his 22 month of daughter and developed symptoms of PTSD. Consequently he had a surgery and developed a dependence to Oxycodone. My professional opinion is that [CBC]'s depressive symptoms and anxiety are not stable yet. It would be beneficial for him to have a medication review since he is very keen to stop taking Ocycodone".

1. A referral to Dr Anna Lee dated 5 May 2015 is for "opinion and management of his anxiety disorder and possible depression".
2. On 6 May 2015, it is recorded:

"referral to psychiatrist; Dr Anna Lee; a psychiatrist for anxiety and PTSD from bike accident; ... has been prescribed Quetiapine 25mg daily; needs pain killers and withdrawals from Endone; advised on tapering Endone; switch to Panadeine Fort and to see Dr Anna Lee; counselling ++".

1. The Early Release of Superannuation on Specified Compassionate Grounds Report by registered medical practitioner dated 4 June 2015 completed by Dr Kutlu notes that the funds are required for "an acute or chronic mental illness", noting the condition as "depression" and notes the medical treatment is for "treatment of depression". It is recorded that [CBC] will require treatment for 52 weeks, being the maximum period.
2. A Prescription Shopping Program patient summary report for the period 1 January 2015 to 31 March 2015 notes that seven prescribers had prescribed [CBC] 11 items of Oxycodone and 1 item of Sertraline, meeting the prescription shopping program criteria.
3. There are WorkCover NSW Medical Certificates for an injury in 2005 and an injury in 2008.

1. The clinical records of Australian Health Care Centre as at 19 November 2018 have been considered.
2. These refer to [CBC]'s current medications as Seroquel 25mg, with the last script listed as 19 February 2017.
3. There are WorkCover NSW certificates of capacity regarding a hand laceration on 10 May 2013.
4. On 16 August 2013, it was recorded "admits to stress at work and family and relationships". A Mental Health Care and Assessment Plan was prepared. Temaze 10mg was prescribed. A GP Mental Health Care Plan addressed to Jacqueline Gerber diagnoses "mixed anxiety and depression" with a K10 result of 19. It notes "Yes" in response to "has the person ever received specialist mental health care?", and reports under "Family History" "Father and mother: depression". Under "main problems / diagnosis" it is recorded "lots of stress with work, relationship and family".
5. On 5 September 2013, it was noted that [CBC] failed to attend his appointment with Jaqueline Gerber.
6. On 22 October 2013, [CBC] requested a letter for sleep apnoea.
7. On 12 January 2014, it was noted "recent MVA treated in hospital. Notes added to file. Signs of pulmonary embolism".
8. On 11 February 2015, it was noted "Not feeling good for a while. Looks like he has been suffering from depression". Zoloft 50mg was prescribed. A referral was provided to Dr Govind Krishna.
9. On 26 March 2015 it was recorded that "On Zoloft since February this year. Feels better. Lost his child. MVA - January last year. Relationship issues. Form filled for insurance purpose. Discussed about depression management. Advised to continue same dose. Review if needed". Also on 26 March 2015, it was noted "Needs form completing re depression diagnosis. See above - seen by Dr MAK. .. Advised I can not complete a form about a diagnosis that I have not made or dealt with. Advised review with Dr MAK" [sic].
10. The clinical notes of 18 May 2015 record "Suffers from chronic right ankle pain. On analgesic. Needs specialist review. Suffers from depression on Zoloft 50mg". A Centrelink Medical Certificate completed by Dr Khan diagnoses "1. Depression since January 2015 (temporary), 2. Chronic pain from MVA March 2014 (permanent)". It certifies that [CBC] is unfit for work / study from 11 May 2015 to 11 August 2015 (inclusive).
11. The clinical notes of 29 June 2015 note "On Endone for his ankle pain. Now run out of same. On Quetiapine 25mg at night for his anxiety and depression".
12. The clinical notes of 10 August 2015 note "suffers from anxiety and depression as well as chronic right ankle pain".
13. Medical Certificates dated 10 August 2015, 29 November 2015, 17 February 2016, 25 May 2016, 14 August 2016 and 20 November 2016 state that [CBC] is a "regular patient in our surgery who has been suffering from anxiety and depression for [the] last few years", and certifies him unfit for full time duties from 10 August 2015 to 11 February 2017 (inclusive).
14. The clinical notes of 29 November 2015 note "Suffers from anxiety and depression in the past. Currently on quetiapine 25mg and stopped Zoloft". A referral to Dr Alex Pilsky dated 29 November 2015 states it is for opinion and management, noting [CBC] has been suffering from anxiety and depression.
15. Entries on 7 December 2015, 17 February 2016, 30 March 2016, 1 June 2016, 14 August 2016 and 21 October 2016 refer, inter alia, to prescriptions for Seroquel 25mg being issued.
16. A Medical Certificate dated 10 January 2016 certifies [CBC] as being fit for work four hours daily, five days a week from 11 January 2016 to 19 February 2016 (inclusive) due to a right ankle injury.
17. The entry on 8 February 2016 states "Psychologist - Jacqueline Gerber; Patient failed to attend today's appt with no notice given".
18. The clinical notes of 20 November 2016 record "Suffers from anxiety and depression". A prescription was issued for Seroquel 25mg.
19. The clinical notes of 19 February 2017 record "suffers from de[p]ression and anxiety. Needs MC and medication" [sic]. A prescription was issued for Seroquel 25mg. A Medical Certificate competed on the same date notes that [CBC] is a "regular patient in our surgery who has been suffering from anxiety and depression for [the] last few years", and certifies him unfit for full time duties from 12 February 2017 to 11 May 2017.
20. Throughout this period there are frequent attendances for chronic ankle pain and prescription of Endone. There are also several specialist referrals due to his ongoing ankle pain and other medical issues.

1. The clinical notes of Miranda Medical Centre as at 2 November 2020 have been considered and evaluated.
2. On 28 April 2015, it is recorded that [CBC] presented suffering from depression for six months. A K10 score was 32, with a diagnosis of mild depression. Temazepam 10mg was prescribed. It is noted "plan lexapro possible mental health plan and psychiatric review".
3. A letter of referral to Ms Dianne Aslin dated 28 April 2015 is for opinion and management regarding [CBC]'s anxiety and depression.
4. A GP Mental Health Care Plan dated 28 April 2015 diagnoses anxiety / depression.

1. The Discharge Referral from The Sutherland Hospital dated 7 June 2015 notes that [CBC] presented with a Mental Health Problem, and has "known PTSD/anxiety" for which he is currently on medication, with regular psychiatric review.

The University of Sydney Gambling Treatment Clinic

1. The notes from The University of Sydney Gambling Treatment Clinic have been considered. The intake form dated 22 August 2020 notes [CBC]'s principal gambling activity to be "horses aps" accessed via internet applications. It is noted he first experienced a problem with gambling "about 4-5 yrs ago". It was noted that he has another child coming, so funding is required. It was noted he is on a prescription drug reduction program and previously had some issues with anxiety. He had commenced Seroquel six months prior. It was noted that his business had a 60-80% downturn in the last three months, and that it made "$1m" last year.
2. It was noted that he drinks five to six drinks daily, which commenced in January 2020 to forget about his tax debt. It is noted he plans to get support for this.
3. It was recorded that [CBC] had 11 video-counselling attendances at the clinic between 22 August 2020 and 28 November 2020, and attended eight of these.
4. The sessions focused on gambling modules and strategies. It was noted that, while he had been gambling for a long time, it had only become problematic in the past four to five years. He "is getting into serious debt with some third parties and needs to stop gambling". He noted not to have any financial control at the moment, as he has given it to his wife after his last gambling binge.
5. It was also noted that there had been adjustments to having a newborn resulting in concerns about his mental health, and he has connected with Panda and BeyondBlue. He also reported invoices not being paid at work, which is adding stress. Issues around sleep and finances were discussed.

1. The discharge referral for Liverpool Health Service notes [CBC] attended and was discharged on 17 January 2020 after presenting with a hand laceration after cutting wood using a bench saw. It is noted he is a self-employed electrician and lift mechanic.
2. The Liverpool Health Service progress notes record that [CBC] was admitted to hospital on 2 March 2021 and discharged on 10 March 2021 after presenting for a generalised seizure secondary to alcohol withdrawal syndrome. It is noted:

"generalised seizure in context of sudden cessation of heavy ETOH today ... on average 1-1.2L of spirits or rum daily mixed with coke; heavy EOTH consumption started secondary to social and work/financial stressors". Under patient history, it is noted "opioid dependence following MVA - has been on methadone for >4 years since mx by GP MVA" and later on "placed on Methadone 5 years ago for prescription opioid dependence (oxycontin) following a quad bike accident 7 years ago".

1. It is noted that [CBC] lives with his mother, wife and two children, and works as an electrician (own company). It is noted he returns to work on 15 March 2021 and is "in debt - has to pay back by June 2021 to ATO". It is recorded:

"36 yo male, presenting with first presentation of alcohol withdrawal seizure after 14 months of excessive drinking due to inability to cope with unemployment during the pandemic and financial stress (currently in debt with ATO)"

1. It is noted that [CBC] was informed that he could not drive for three months following this seizure. It is also noted that [CBC] self-ceased Quetiapine 25mg that he was originally prescribed by a psychiatrist for anxiety five to seven years ago, however he reports he has not taken it for "months".
2. It was noted that [CBC] reported feeling he began to drink excessively in January 2020 due to financial stress, reporting he is in a significant amount of debt to the Australian Taxation Office (ATO) and is currently on a payment plan to pay it back. He advised he runs his own business as an electrician and his accountant is currently involved in helping him pay the money back to the ATO. [CBC]'s wife asked if he had also mentioned the bike accident, and [CBC] said he did not feel he needed to raise this however he did so after his wife's prompting. [CBC] and his wife explained he was involved in a quad bike accident and was in a wheelchair for some time, which is when his wife considers [CBC] became dependent on oxycodone and other pain relief. His wife also had a miscarriage around this time. [CBC]'s wife also noted that his parents are currently undergoing a divorce after 40 years and his grandmother died on Sunday. [CBC] reported the loss of his baby was the biggest loss yet and that both he and his wife have not dealt with that loss.
3. Doctors recommended mental health support and how counselling may assist.
4. The Ambulance Report dated 2 March 2021 notes [CBC]'s wife witnessed him have a two-minute tonic clonic seizure, and that he has no history of seizures. She reported that [CBC] had a 12-month history of alcohol abuse of approximately 1L of spirits per day, with a decreased amount of half a bottle the prior day and no alcohol yet that day.

1. The clinical notes of Allcare Carnes Hill Medical Centre as at 25 May 2022 and 30 July 2024 have been considered and evaluated.
2. On 6 March 2020 it is recorded "MVA July last year in Canberra; had whiplash; neck pain; back pain; also right ankle pain and swelling...".
3. On 6 May 2020 it is recorded that [CBC] is prescribed Seroquel to help him sleep by his psychiatrist.
4. On 7 May 2020 it is recorded "had X-rays done yesterday; MVA July last year in Canberra; had whiplash injury; constant neck pain, back pain and right ankle pain...".
5. On 23 March 2021 it is noted "h/o alcohol abuse; on campral and disulfiram by drugs and alcohol clinic in Liverpool; had a seizure earlier this month; attended LDH, Dr Chan; not driving ..." [sic].
6. On 5 November 2021 it is noted:

"yesterday at 2.30pm had RTA; his car was stationary; hit from another car from behind; in Punchbowl; works as elevator mechanic; self employed; pain in the neck, shoulder pain; taking pain killers, Panadol and Nurofen, regularly; pain is better; unable to work due to this pain".

"had RTA on 4/11/2021; his car was stationary; hit from another car from behind; in Punchbowl; works as elevator mechanic; self employed; pain in the neck, shoulder pain, right little finger is swollen, right ankle pain as his right foot was on the brake; taking pain killers, Panadol and Nurofen, regularly; pain is better; unable to work due to this pain; has spoken to a law firm and would like CTP" [sic].

1. On 22 November 2021, 20 December 2021, 1 February 2022, 15 February 2022, 1 March 2022, 15 March 2022, 29 March 2022, 19 April 2022 and 17 May 2022 it is noted:

"had another RTA on 13/11/2021, had RTA on 4/1/2021, he was not at fault, another car came infront of his car from side road, pain in the back of neck, right shoulder aggravated, deformity of right little finger with restricted movements, swollen right ankle area. taking pain killers, panadol and nurofen, regularly, waiting for MRI scan on neck, US of right shoulder, X-ray and U/S right little finger, X-ray right ankle western imaging in blacktown, U/S right shoulder ... unable to work due to pain ..." [sic].

1. Also on 22 March 2022 it is recorded "feeling very depressed, saking [sic] ref to psychiatrist".
2. A referral letter dated 29 March 2022 refers [CBC] to Dr Hock Yeoh for opinion and management of depression.
3. A referral to Ms Kerry Watson, psychologist, from Dr Hamayoun Siddiqui dated 5 May 2022 is "for opinion and management of de[p]ression following MVA, I think he will benefit from CBT" [sic].
4. On 23 June 2022, it is noted "discussed with patient of symptoms of anxiety and depression after MVA; insurance asked ref to psychiatrist".
5. The referral to Dr Rajneesh Singh, psychiatrist, from Dr Siddiqui dated 23 June 2022 is for "opinion and management of symptoms of anxiety and depression after MVA".
6. On 1 July 2022, it is noted "called psychiatrist; appointment in September; sleep issues; 3-4 hours at night; depression and anxiety; melatonin"
7. On 14 November 2022, it is noted:

"issues with his physical and psychological heath. He is on Methadone programme for drug addition and he is going to have three surgeries on his foot and ankle. Because of his physical and psychological health issues, he will not be able to work as a lift mechanic in future. This is going to be a permanent restriction."

1. There are attendances between November 2022 and April 2023 with Dr Siddiqui regarding [CBC]'s physical injuries said to arise from the accident, however there is no reference to psychological symptoms or injuries.
2. On 4 April 2023, [CBC] attended upon Dr Siddiqui. It is relevantly noted:

"...seeing Kerry Watson, seen psychiatrist Dr Singh, he increased Zoloft to 100 mg, also started Seroquel. He advised 3 weeks in-patient in Penrith to help his anxiety and mental health. Surgery has to be postponed till his mental health is better. Wake up crying some nights, gets very angry easily, has some fears that he may not wake up from anaesthesia, hitting hands on something in sleep..." [sic].

1. On 18 April 2023, it is noted that [CBC] saw Dr Singh two to three weeks ago, who suggested increasing Zoloft 50 to 100mg and advised Seroquel.
2. On 19 April 2023, [CBC] attended upon Dr Siddiqui for anxiety. It is noted that Dr Singh advised to increase Zoloft to 100mg and advised Seroquel 25mg. It is also noted that he advised [CBC] needs inpatient treatment to improve his mental health.
3. On 20 April 2023, [CBC] attended upon Dr Siddiqui for anxiety. It is again noted that Dr Singh advised to increase Zoloft to 100mg and advised Seroquel 25mg.
4. On 2 May 2023, 27 June 2025 and 25 July 2023, [CBC] attended upon Dr Siddiqui for ankle pain. The same block text that appears on 4 April 2023 is recorded.
5. On 15 August 2023, [CBC] attended upon Dr Siddiqui for anxiety. It is noted that Zoloft was increased from 100mg to 150mg. It is reported that his mood is low, energy level is low, and [CBC] is not enjoying things which he normally enjoys. His concentration is good, confidence is good, seep is not good. His appetite is down, he has low self-esteem, irrational fear, no delusions, no hallucinations, no suicidal thoughts.
6. On 22 August 2023, [CBC] attended upon Dr Siddiqui for ankle pain. Relevantly, the same block text that appears on 2 May 2023 is included but it is relevantly noted "...seen psychiatrist Dr Singh, he increased zoloft to 100 mg, I have increased it to 150 mg...".
7. On 19 September 2023, [CBC] attended upon Dr Siddiqui for ankle pain. The same block text with the addition from 22 August 2023 is noted.
8. On 10 November 2023, [CBC] attended upon Dr Siddiqui. It is recorded "asthma anxiety; depression; GORD; attended ED".
9. On 14 November 2023, [CBC] attended upon Dr Siddiqui for weight issues. The same block text with the addition from 22 August 2023 is noted.
10. On 24 November 2023, [CBC] attended upon Dr Siddiqui and requested a letter regarding his inability to work due to his current physical and psychological illnesses.
11. On 12 December 2023, [CBC] attended upon Dr Siddiqui for ankle pain. The same block text with the addition from 22 August 2023 is noted.
12. On 21 March 2024, [CBC] attended upon Dr Siddiqui for ankle pain. The same block text with the addition from 22 August 2023 is noted.
13. On 17 April 2024, [CBC] attended upon Dr Siddiqui for "obesity". The same block text with the addition from 22 August 2023 is noted. It is also recorded that [CBC] is going to be switched from ethadone to buprenorphine injection, is on a detox programme, and is going through separation with his wife.
14. On 22 April 2024, [CBC] attended upon Dr Muhammad Yaseen Memon. It is recorded "booked tomorrow with Nepean Mental Health; was in hospital 2 weeks - alcohol dependency, they have given some medication - 3 weeks; here with dc summary ... follow up psychologist and psychiatrist".
15. On 15 May 2024, he attended for ankle pain. The notes record the same block text and also note "...has been in Matilda for 3 weeks, under Dr Singh, will be discharged on 24/5/24..." [sic].
16. On 13 June 2024, the reason for contact is listed as "anxiety". It is noted he has been discharged from Matilda, and is on Seroquel, Eliva, Ativan and Lorazepam.
17. On 18 July 2024, [CBC] attended Dr Siddiqui with the reason for contact listed as "ankle pain". The same block of text appears as on 22 August 2023.

1. The clinical notes of Dr Beena Chaugule at Clinic 66 as at 21 March 2022 have been considered and evaluated. This lists [CBC]'s current problems to include opiate dependence, anxiety and depression.
2. A statutory declaration signed by [CBC] dated 15 December 2020 notes "I am going away to Port Macquarie within the dates of the 23/12/20-4/1/21. I will be driving and aware of possible drowsiness etc and side effects".
3. A statutory declaration signed by [CBC] dated 2 March 2021 notes "I am going away between the dates of 2/3/21-16/3/21 and will safely store my takeaway medicine in a locked container away from any children or other adults".
4. On 23 February 2021, it is recorded that there is a three-week shutdown period. [CBC] is planning on going away for one week. Has no income. A discussion occurred regarding [CBC]'s weight gain. He is not taking Seroquel and has quit smoking. He was previously smoking 25 to 30 cigarettes per day. He is recorded to drink four to five standard drinks on three to four nights per week, with three alcohol free nights.
5. On 6 March 2021, it is noted that he had been drinking up to half a bottle of spirits, but had ceased this since his seizure.
6. On 23 March 2021, it is recorded that he had an alcohol withdrawal seizure, has been drinking 1200mls of spirits daily, 6-8/12, triggered by financial pressures, now seeing Dr Hallinan and committed to continuing abstinence.
7. On 6 April 2021, it is recorded:

"weight - has lost 9-10kg - as no licence so incidental walking, cannot drive due to seizure; work fine - 40 hours per week but during daylight hours... business - planning to build a business with smaller lift, Otis has been difficult with paying invoices...".

1. On 20 April 2021, reference is made to his alcohol abstinence. It is noted he "challenged himself last week - lunch at the pub, did not succumb to the desire". It is also recorded "work busy; sleep - much improved - working 7.30 - 5pm; looking at longer term work like this".
2. On 4 May 2021, it is recorded "Mother well, sister lives with her; work fine".
3. On 18 May 2021, it is recorded "has been stable, is now on deadline to get job done, limited hours ongoing".
4. On 8 June 2021, it is recorded "last week, fall at work onto chest - has a rib injury; chest sore, gait bad, has taken codeine due to pain, cannot take deep breath without pain; now back to standard hors ..."
5. On 22 June 2021 it is recorded "has been well, chest injury settled, now back to full mobility".
6. On 10 August 2021, it is recorded "is not working at present due to being in a hot spot".
7. On 24 August 2021, it is recorded:

"still isolated and hotel closed, they are not opening for maintenance, chief engineer is not letting access to anyone from locked down LGA; is getting JobSeeker - 40% of payroll; has been having a routine daily, up early, looks after kids, gets them to school; doing modernisation of home; has gained 2kg in the last 8 weeks".

1. On 21 September 2021, it is recorded "has managed to getting a lot of jobs done at home; has made a point of getting a routine going in this time".
2. On 6 October 2021, it is recorded "work - may not have ongoing contract, relying on govt support, will look at getting some other work, might have to go back to Canberra".
3. On 19 October 2021, it is recorded:

"Westin job settled; not much work in relation to lift maintenance - work is dependent on use in the office; is having a little break from the longe hours; disc re work and life; discussion regarding pivoting life to something more family friendly - is thinking about starting another business re delivery; disc re working in an employed circumstance".

"sleeping well; walking early; doing a lot of home things - not bored took kids fishing; is starting a company as a courier delivery service". A subsequent entry on the same date notes "lift industry is in tatters; works in modernisation - so strata, hotels not keen to spend; is doing a small courier service".

1. On 16 November 2021, it was recorded that [CBC] had started operating a new business doing deliveries, and is planning on going to Port Macquarie in December.
2. On 30 November 2021, it is recorded that [CBC]'s business of delivery is going well. He is thinking of going away to Port Macquarie. He has not had a holiday for over a year. His mother is moving in with him for a couple of months. He is reported to brush his teeth twice a day.
3. On 11 January 2022, it is noted that [CBC] called from Port Macquarie regarding his Methadone dose given he had been a close contact.
4. A letter from Dr Chaugule dated 11 January 2022 notes that [CBC] is a longstanding patient of hers under the opiate treatment program, and that he has been on holiday in the north coast.
5. On 18 January 2022, it is recorded that [CBC] has returned from leave. He reported having a good break but due to weather did not get to do as much fishing. His business has started. His sleep has improved after ceasing lift work. He ceased Seroquel over the past few months. Noted "now sleeping well without meds".
6. On 1 February 2022, it is noted that [CBC]'s business in catering and food has picked up and he has another person doing deliveries while in hospital. His elevator business is active but there are no contracts at present.
7. On 15 February 2022 it is noted, inter alia, that [CBC]'s business is going well, he is sleeping well, his delivery food is going well.
8. On 1 March 2022, it is recorded that [CBC] has two businesses, however is earning less than while in his elevator business. He is considering returning to business in lift work in an employed capacity. He was advised Methadone causes drowsiness, so he should not drive while drowsy or operate machinery, and should not drive while intoxicated.
9. On 15 March 2022, it is noted that [CBC]'s business has cooled due to fuel costs and increased cost of delivery. It continues "is trying to try a few different things - has been looking at Facebook page and a lot of people looking for gardening work - so lawn work".

1. The clinical records of Doctors at Prestons printed on 27 September 2021 and 20 May 2022 have been considered and evaluated.
2. A consultation on 15 March 2021 records [CBC]'s alcohol dependence. It notes he is having issues with his wife and that his mother is looking after him. Diazepam 5mg was prescribed.
3. A consultation on 20 March 2021 records requirement for a referral to a neurologist and psychiatrist.
4. A referral letter dated 6 September 2021 to Dr Sujaya Sringeri regards "...opinion and management regarding his psychological issues. Considering his past medical and psychological history he needs a thorough assessment and psychological management".
5. An entry on 4 November 2021 records:

"was changing lane - got hit by another car at the rear of his car; his car was basically stationary; he was able to get out of the car by himself; nil head injury; states vision fine; he will try to find another GP for CTP - or he will return to me; advised Panadol/Nurofen prn - taken already - feeling a bit better - advised tds regularly; hosp if worse" [sic].

1. The notes of NSW Health Drug Health Services have been considered and evaluated.
2. On 17 March 2021, it was noted that [CBC] had only had one nip of vodka. His wife had moved out of their home and taken their children with her. He reported having no alcohol since then. He is back at work and is following the advice not to drive motor vehicles.
3. On 18 March 2021, it was reported that [CBC] attended with his mother but was interviewed alone. He noted he had drunk alcohol the prior day. His medications were discussed.
4. On 16 April 2021, it is recorded that [CBC] reports doing well with alcohol abstinence, has returned to work and is not driving. His wife and children are back at home, however tension was reported in the relationship.

1. The clinical records of Kerry Watson, psychologist, as at 15 September 2025 have been considered and evaluated.
2. The clinical notes dated 1 June 2022 regard an initial assessment. [CBC] is noted to have reported a persistent depressed mood, persistent anxiety, intrusive memories, fatigue and loss of energy, diminished interest or pleasure in previously enjoyed activities, sleep disturbances characterised by severe insomnia and recurred nightmares, reduced motivation, reduced socialisation, feelings of inadequacy and failure in material and parental role, feelings of hopelessness, helplessness and inadequacy, fear of being involved in another accident, avoidance behaviour characterised by avoidance of commuting by motor vehicle whenever possible and avoidance of the accident site.
3. Subsequent consultations between July and December 2022 record frustration and increased agitation arising from pain, as well as persistent depressed mood and increasing anxiety due to prolonged injury related symptoms. In August 2022 it was noted he had withdrawal from all social contact and communications with family members. The 15 August 2022 consultation reports a DASS 21 score of extremely severe in all categories, and a Beck Anxiety Scale of Severe, Concerning all levels. A Beck Depression Scale was recorded as severe.
4. There is a break in the notes between 5 December 2022 to 27 March 2023. On 27 March 2023, it was noted that [CBC] continues to avoid interactions with family members other than children or friends due to his irritability / frustration intolerance. He reported persistent variable pain between 70 to 100 out of 100. He described declining mental health and marital discord, which he attributed to his severe irritability. The clinical notes of 10 July 2023 note he remains extremely fearful of undergoing necessary surgery, and also described increased anxiety and increased depressed mood.
5. The notes of 13 November 2023 record no change in symptoms and no improvement, low motivation and depressive thought content, minimal functioning, feelings of anger, disagreements with his wife over their children and social withdrawal.
6. On 23 April 2024, it was reported that he had an increased pain state and was grieving his loss of physical functionality. He had increased alcohol use to manage his symptoms and aid sleep.
7. It was noted on 7 May 2024 that [CBC] was currently in private hospital doing a mental health program due to a recent relapse in wellbeing and excessive use of alcohol. Communications with his wife had recently broken down, and he reported being unable to see his children, causing him significant distress.
8. On 2 August 2024, it was noted that he demonstrated extreme depressive thought content and depressed mood, feeling numb with bouts of agitation, a loss of interest in almost everything, a perception of compromised functionality and focus, and being unmotivated to engage socially or with family.
9. Also on 26 November 2024, [CBC] reported exhibiting extremely pessimistic and depressive thought content, and prominent feelings of hopelessness and helplessness. On 13 June 2025, he reported feeling isolated and withdrawn from others. He had reached an agreement with his wife on child access, but also reported feeling minimal pleasure from this as he feels numb most of the time. He reported persistent pain and depressed mood, and persistent and severe anxiety.
10. On 6 August 2025, it is noted that [CBC] reported a recent alcohol relapse, increasing depressed mood, feelings of isolation, hopelessness and helplessness, and persistent pain. He had some passive suicidal ideation.
11. The notes included an allied health recovery request form dated 1 June 2022 for a psychologist was prepared by Dr Siddiqui and notes a diagnosis of adjustment disorder with depressed mood. Ms Watson was nominated as the service provider.
12. Subsequent allied health recovery request forms dated 8 July 2022 and 21 November 2022 for a psychologist prepared by Dr Siddiqui note a diagnosis of major depressed mood with anxiety and "PTSD".
13. Letters from Ms Watson to the insurer dated 10 July 2022 and 21 November 2022 refer to [CBC] receiving weekly then fortnightly psychological treatment and that he has consistent demonstrated significant psychological symptomology that has developed as a result of the accident. Ms Watson opined that [CBC]'s demonstrated psychological symptomology is consistent with the diagnostic criteria of post-traumatic stress disorder and a major depressive disorder with anxious stress, based on the DSM-5.
14. Letters from Ms Watson to Dr Siddiqui dated 28 November 2023 and 25 July 2024 note that [CBC] continues to receive psychological treatment, albeit on an irregular basis. In the July 2024 letter it is noted that he has missed or cancelled several appointments of late. Ms Watson notes he remains of the opinion that [CBC]'s psychological symptomology is consistent with the diagnostic criteria of post-traumatic stress disorder and a major depressive disorder with anxious stress, based on the DSM-5.

1. The clinical records of Dr Rajneesh Singh, psychiatrist, as at 17 September 2025 have been considered and evaluated.
2. The letter of Dr Singh to Dr Siddiqui, copied to the insurer, dated 7 July 2022 notes significant life role transitions since having the accident, noting [CBC] reported suffering from major physical injuries which required multiple operations and that he is unlikely to return to his previous career.
3. It was noted that he presents with "classical" symptoms of mixed anxiety depressive disorder including persistent low mood, marked levels of amotivation and disinterest in usual pleasurable activities, along with snappiness which is out of character. He states he has gained up to 18 kilograms over the past six months due to his lack of desire to engage in physical workout as well as pain. He also reported sudden onset panic attacks.
4. His quadbike accident and subsequent oxycodone addition were noted, and it was recorded he is currently on 37.5mg of Methadone. He reported seeing a psychologist on a regular basis and being prescribed Seroquel 25mg after the death of his newborn child after a premature birth.
5. He reported being married to his current partner for 14 years, and acknowledges relationship strain due to his psychological and physical health issues over the last six months.
6. Dr Singh diagnosed major depressive disorder with anxiety symptoms. It was recommended to commence on Duloxetine 30mg daily mane, increasing to 60mg in a week, and 2-4mg nocte of Melatonin for sleep disturbance.
7. A subsequent letter dated 15 November 2022 from Dr Singh to Dr Siddiqui notes that unfortunately not a lot has changed since his last review. [CBC] reported his ongoing life transitions have also brought about some significant financial issues along with his grapples with ongoing physical health issues. He reported potential side effects from Duloxetine and as a result, Dr Singh ceased Duloxetine and commenced Zoloft 50mg daily.
8. A letter dated 30 March 2023 from Dr Singh to Dr Siddiqui notes that [CBC] continues to experience ongoing anxiety manifesting in the form of intermittent panic attacks. He also reported nightmares causing ongoing sleep disturbance, feeling low in mood with ongoing amotivation, and remains preoccupied with life role transitions that he has experienced since the accident. Zoloft was increased to 100mg daily and Seroquel 25mg. A three-week inpatient program for Mood and Anxiety Disorder was suggested if his mental state continues to decline.
9. A letter dated 18 April 2023 from Dr Singh to Dr Siddiqui is in identical terms to the letter dated 30 March 2023.
10. A letter dated 5 March 2024 from Dr Singh to the insurer notes that [CBC]'s mental state continues to decline. Dr Singh noted he believed [CBC] would benefit from a three-week inpatient program for Mood and Anxiety Disorder to stabilise his mental state, optimise his medications and mitigate any further risks of decline in his mood.
11. A letter dated 3 May 2024 from Dr Singh to the insurer notes that [CBC] continues to present as dysphoric and low in his mood while acknowledging negative ruminations and fleeting suicidal ideations, though denies any intent or plan. Given his current mental state with no significant improvement, Dr Singh requested [CBC]'s admission for an extra ten days.
12. A letter dated 20 June 2024 from Dr Singh to Dr Siddiqui provides an update following [CBC]'s discharge from Matilda Nepean Private Hospital. [CBC] reported that his children continue to visit with him and his mother is now living with him. He acknowledges finding his motivation on the lower side with lack of focus, and being quite tired physically throughout the day. He reported some sleep related difficulties, mainly in terms of nightmares. He is maintaining regular contact with his psychologist. Dr Singh opined nil work or learning capacity given his current mental state.
13. A letter dated 10 February 2025 from Dr Singh to Dr Siddiqui notes that [CBC]'s mental state is largely unchanged. He continues to experience ongoing emotional upheavals that he attributes to his issues with the adjustment to his new life, being the life role transitions he has had since the time of his injury. He refers to the breakdown of his marital relationship. He acknowledges ongoing intrusive thoughts, negative ruminations and occasional sleep disturbance. An inpatient admission program was discussed as a potential option.
14. A letter dated 14 August 2025 from Dr Singh to Dr Shabana Bokhari notes that [CBC]'s mental state remains largely unchanged. He reported feeling quite debilitated with his chronic pain, which he usually manages with Panadeine Forte. He continued to report intermittent nightmares and waking with a severe dry mouth. He reported flashbacks, being hypervigilant at times and emotionally numbed. He blamed the happenings over the last few years in having caused the strain that led to the breakdown in his relationship. [CBC] reports having accumulated a significant amount of weight since the accident. He found Mounjaro helpful initially, however he is unable to continue it due to costs. Dr Singh requested a three week in-patient program at Matilda Nepean Private Hospital to attend the mood and anxiety and trauma program. [CBC]'s medications remained unchanged, noting the need to monitor the use of Lorazepam given the potential of Benzodiazepine dependence. It was noted that a sleep study may be required to rule out the possibility of underlying sleep apnoea given [CBC]'s current symptoms.

1. The patient summary dated 28 June 2024 has been considered and evaluated. These record an initial consultation on 10 February 2023, where it was reported that multiple surgeries were planned with Dr Viswanathan. [CBC]'s primary concern / fear was reported to be opioid addiction due to a previous history of this post-surgery. It is note he is currently taking Methadone, and has been for the past seven years, and Zoloft. It was recorded that he has a history of major psychiatric illness. It was recorded that he has major depression and anxiety, and is seeing psychologist Kerrie Watson and psychiatrist Dr Singh. It is noted that [CBC] has a high risk for developing chronic pain syndrome post-surgery.
2. The letter addressed to A/Prof Viswanathan, orthopaedic surgeon, from Dr Vahid Mohabbati dated 13 February 2023 refers to an initial consultation with [CBC] on 10 February 2023 regarding his ankle pain. It is noted that [CBC] is concerned with his post-operative recovery due to his previous history of opioid addiction following a quad bike accident. It was opined that [CBC] is highly at risk for developing chronic pain syndrome post-surgery, in particular complex regional pain syndrome and suggested pre-operatively switching his liquid methadone to a methadone tablet.
3. Notes from a case conference on 13 February 2023 record a discussion regarding clinical presentation with persistent ankle pain and opioid dependence, and a post-operative pain management plan was provided.

1. The Emergency Department discharge referral dated 7 April 2024 from Concord Repatriation General Hospital notes [CBC] presented to ED due to alcohol withdrawal. His primary diagnosis was alcohol dependence, with opioid dependence. The admission notes focus on [CBC]'s relationship with his family, and record that he was abstinent for two years until December 2023, when he was triggered by an event with his father. It is noted that he usually uses one litre of spirits daily. A detox in 2021 is noted. Upon admission, [CBC] commenced a methadone to Buvidal microtransfer.
2. He was noted to have been clinically stable on the day of discharge, being 18 April 2024. It was noted that [CBC] lives with his mother and is currently going through a divorce. He is said to be close with his mother and sister.

1. The discharge summary of Matilda Nepean Hospital dated 24 May 2024 has been considered. It was noted that [CBC] is recently separated and lives by himself. He last worked in November 2021 when he ceased work on account of injuries from a motor vehicle accident. It was noted that [CBC] presents with significant life role transitions since the accident in November 2021, and reports having suffered from major physical injuries around his ankle and knees.
2. It is noted that [CBC] was admitted with classical symptoms of mixed anxiety depressive disorder made worse in the context of a recent relationship breakdown. He also reported ongoing sleep disturbance and sudden onset panic attacks. The diagnostic impression is noted to be major depressive disorder with anxiety symptoms.
3. He was admitted on 23 April 2024 and discharged on 24 May 2024, being a stay of 31 days. It was noted that his mother would be moving in with him.
4. The progress notes dated 23 April 2024 note that [CBC] was admitted due to increased anxiety and depressive symptoms as a result of a recent separation from his wife. He reports having a supportive mother and will live with her after his discharge. The notes report that he was going through hard financial times which caused the separation, [CBC] started gaining weight and changing his physical appearance. It was also recorded that he was involved in a car accident in November last year.
5. The progress notes have been considered and evaluated. [CBC] is noted to report focusing on his ex-partner and his children, and reported financial and other psychosocial stressors such as accommodation given his recent separation.
6. On discharge, it was noted:

"[CBC] was admitted for worsening depression/anxiety symptoms in the context of a recent separation. He was admitted on 23/04/2024 and discharged 24/05/2024, a total of 31 days. [CBC]'s attendance to the group program was high for the first week of his admission but dropped due to deterioration in mood and motivation in the context of further family stress (e.g. not being told about decisions being made regarding his children). [CBC] continued to engage regularly in movement-based groups but reported he did not find much help from psychology-based groups...."

1. The report of Dr Stephen Allnut, forensic psychiatrist, dated 28 October 2020 has been considered. This report notes it has been prepared in respect of a potential medical negligence claim regarding [CBC]'s opioid dependence.
2. [CBC]'s 2014 quad bike accident and subsequent surgeries were referenced. It was noted that, in January 2014, he felt a bit depressed about not being able to do more for himself and his significantly increased dependency on his wife and mother, which he described as "100%". It is noted that his sleep was "erratic" and he had to sleep upright in a chair due to his physical injury. He had difficulty concentrating and could not pursue any interests except for sitting all day watching TV. He reported doctor shopping to obtain Endone and had withdrawal symptoms when he was unable to obtain it. It was noted that it affected his relationship with his wife, as she had increased anxiety and was fearful of the effect of Endone on his health and life. In around April 2015, he transferred from Endone to OxyContin.
3. In May 2016, after his second child was born, [CBC]'s wife told him he had to stop otherwise he was going to die. As a result, he attended Clinic 66 and started a Methadone program. He reported commencing drinking alcohol daily in January 2020, having about half to two thirds of a bottle of rum per day. He was working 40 to 60 hours per week, depending on demand. He had accrued a debt of around $700,000 due to a gambling addition. His gambling addition is noted to have emerged in August 2015 when he began gambling on horses.
4. It is noted that [CBC] had stopped his pre-injury recreational activities, such as hunting, fishing and socialising, because he felt he could not leave the house, and struggled to work due to a lack of motivation. He rarely did domestic chores and relied on his wife to do these. It was noted that he was unable to get a job due to being on the Methadone program as he would not pass the medical, and that while he was self-employed, he was unable to get insurance. It was noted his teeth were now rotten and falling out. It was reported that he believed his anxiety about his stressors and how he was going to get past his methadone addiction had contributed to his drinking and gambling debts. Sleep disturbances were noted.
5. It is noted he is only showering once to twice a week, and that he would not even do that if he did not have to go to work. He last reported going out to see a friend around six to eight months ago and avoided social contact. His relationship with his wife had deteriorated and he was concerned they were going to separate.
6. He had commenced seeing a psychologist for his gambling, but had not seen a psychiatrist since the 2014 accident and there had been no admissions to psychiatric hospitals or suicide attempts.
7. Dr Allnut opined that [CBC] presented with symptoms consistent with depression with associated anxiety, and would attract a diagnosis of persistent depressive disorder or chronic major depressive disorder with associated panic attacks. It was also noted that he would be diagnosed with a substance abuse disorder, as he has an opioid dependence disorder and alcohol use disorder, as well as a gambling disorder.

1. The independent medical examination report of Dr Patricia Junger, psychiatrist, dated 7 May 2025 has been considered. This notes that, at the time of the accident, [CBC] had a persistent depressive disorder with panic attacks, a polysubstance use disorder, and had had a qualitative deterioration of his mood disorder. It is noted that [CBC] described a deterioration in his physical functioning because of the accident, which has contributed to a qualitative deterioration in his mood state. It is also noted that [CBC]'s mood disorder in part may be more problematic because he is not working. Should he be able to return to meaningful occupational functioning, his mood disorder may improve.
2. Dr Jungfer diagnosed persistent depressive disorder with panic attacks, polysubstance use disorder in remission, and gambling disorder in remission. Her prognosis was guarded.
3. Dr Jungfer opined a pre-accident whole person impairment of 6% and a post-accident whole person impairment of 15%. Accordingly, Dr Jungfer opined 9% whole person impairment caused by the accident.

1. The independent medical examination report of Associate Professor Michael Shatwell, orthopeadic and accident surgery consultant, dated 19 May 2025 has been considered. A/Prof Shatwell examined [CBC] on 16 May 2025.
2. In summary, A/Prof Shatwell opined that the accident, which was a "low energy collision", would not have caused any significant injuries, nor could it have caused any significant aggravation of [CBC]'s right ankle problem which would have continued to cause him problems whether the accident described happened or not. A/Prof Shatwell notes that the subsequent follow up notes made by [CBC]'s GP showed there was no urgency in seeking medical attention for his acute injuries, with a face-to-face consultation not occurring until four days after the accident. There was no specific treatment aside from analgesia.
3. A/Prof Shatwell opined that the forces involved would be minimal as evidence by the damage to the motor cars observed on the photographs in the file. A/Prof Shatwell opined that [CBC]'s persistent right ankle and knee problems are due to the development of degenerative changes secondary to the severe disruption of the right ankle which was a major traumatic event in 2014. He opines that post-traumatic arthritis developing in this joint is inevitable, and problems with overload due to [CBC]'s build would have occurred even in the absence of any past accidents. A/Prof Shatwell opined:

"In my opinion, the original injury of 2014 is the cause of the ongoing problem and it is highly unlikely there was any aggravation of this by the minor low speed collision that occurred on 4 November 2021."

1. In respect of work capacity, A/Prof Shatwell opined:

"I do not consider that the accident in question which occurred on 4 November 2021 has changed the prognosis for [CBC]'s right ankle and knee problems.

These are the main factors limiting his capacity for work. The effects of the accident of 4 November 2021 would have settled within a day or so of the accident described or within a few weeks at the very most.

[CBC]'s limited capacity for work is the result of his pre-existing right lower limb injury and his longstanding high body mass index."

1. The certificates of fitness prepared by Dr Siddiqui certify that [CBC] has no current capacity for any employment. This is said to be due to pain. There is no reference to any psychological injuries or symptoms.

Medical Assessment - Permanent Impairment (Physical)

1. [CBC] underwent a Medical Assessment - Permanent Impairment (Physical). The assessment was undertaken by Medical Assessor Raymond Francis Wallace on 27 August 2024, who issued a certificate dated 9 September 2024.
2. Medical Assessor Wallace certified that [CBC]'s injuries caused by the accident, being cervical spine - musculo ligamentous injury; right shoulder - musculo ligamentous injury / subacromial bursitis; right ankle - aggravation of right ankle injuries and non-united fracture of medial malleolar; and right knee - interstitial tear of the ACL and right knee posterior horn meniscus tear, gave rise to a permanent impairment of 8%, which is not greater than 10%. Medical Assessor Wallce certified that [CBC]'s finger - right little finger, musculo ligamentous injury had resolved and gave rise to no assessable permanent impairment.
3. It was noted that [CBC] exhibited no pain behaviour at the time of review on 27 August 2024 and is currently undergoing no active treatment apart from the use of medications of Nurofen and Panadeine Forte.

1. The email from [CBC] to the insurer and his solicitors dated 23 June 2022 refers to a psychiatrist referral and seeks approval prior to making the appointment. [CBC] notes that his psychologist has recommended it will be of great assistance to him to start some medication to assist with his sleep and noting "the other very serious situations / thoughts I am experiencing in my head". He refers to a diagnosis of severe depressive disorder and tentative anxiety disorder form his psychologist, which he says is affecting "just about eery aspect of my life as much as the physical side of the injury is".
2. The notes of Benchmark Rehabilitation, which includes correspondence with [CBC] and the insurer, have been considered. These include references to [CBC]'s proposed surgery, home and gardening assistance, medication and treatment approvals, attendances on various doctors and specialists, and planned holiday with his mother to Port Macquarie.

1. [CBC] was examined on 21 October 2025 and 25 November 2025 by Medical Assessors Barrett and Singh. On both occasions he was assessed via videoconferencing. He was located at his home and was assessed unaccompanied.

1. [CBC] is a 40-year-old man who lives with his mother in a home he previously shared with his wife and children, up until his wife moved out in March 2024. He has daughters, aged 9 and 4, who live with their mother. He has regular contact with his daughters, every second weekend and half of the school holidays, although the arrangements have not been formalised. His CTP payments have ceased, and he is awaiting a Centrelink Jobseeker payment, whilst applying for a Disability Support Pension.
2. [CBC] was born in Sydney, as the eldest of two siblings. His birth was normal, and he reached milestones at expected ages. He described a happy childhood, free of adversity or trauma. He denied any difficulties with social relationships, concentration or behaviour at school, describing himself as a "good kid" and "happy go lucky". He attended a local co-ed catholic high school, where he achieved an above-average HSC result.
3. There is a family history of alcohol use disorder in his father, beginning later in life after the death of [CBC]'s paternal grandfather. His father also had a history of gambling on poker machines and horse racing, although [CBC] did not know the extent of his father's gambling. [CBC] is aware that his mother previously used an antidepressant, but he did not know the details of her history.
4. [CBC] began smoking in his 20s. He first used alcohol at 16 years of age, then not until he was 18 years of age, when he used three to four standard drinks, twice a month. He would gamble on horses, occasionally spending about $100 per week.
5. After completing high school in 2002, he started an apprenticeship with an elevator company and completed a TAFE Certificate 3 in Electroskills technology over three years, and a TAFE Certificate 4 in Industrial Electronics over one year. After completing his apprenticeship, he remained working for the same employer until 2015. He had one workers' compensation claim, after injuring his left hand with a saw, for which he had a few weeks off before making a complete recovery.
6. He had a two-year relationship, which broke up in his early 20s. Whilst he initially reported the break-up as amicable and that he coped afterwards, later in the interview he reported that he was low in mood for about a month, prompting him to see his GP, who referred him to a psychiatrist. He saw the psychiatrist only once, who prescribed quetiapine 25mg nocte, which he took daily for a few months, then up to about twice a week for six months.
7. By 22 or 23 years of age he formed a relationship with his former wife.
8. He denied a history of binge eating disorder, although he accepted that by 2014 he had reached a BMI of 54.8, where a BMI over 30 is defined as obesity. He was treated with weight loss surgery, a gastric sleeve gastrectomy in 2014, after which he lost about 60kg.
9. In January 2014, he was involved in a quad bike accident whilst pig hunting with a friend. His friend was driving, and he was the pillion passenger. When the accelerator became stuck, the bike reared up, he fell off the back of the bike, and the bike continued uncontrolled and ran over him. He suffered fractures to three ribs and a compound fracture of the right tibia. He was hospitalised for six days initially and had a total of three surgeries. As a result, had significant pain in his right leg for about four to six months, for which he was commenced on opioid analgesics in hospital. He subsequently developed an opioid use disorder, developing tolerance and dependence. He denied any symptoms of post-traumatic stress disorder after the quad bike accident.
10. In the meantime, he had married in 2015. After eight months off work, he returned to his employer but felt a changed attitude and was made to feel guilty about his sick leave. This, combined with his awareness of greater financial opportunities, led to his decision to start his own business in 2015, performing electrical work on elevators.
11. His business was successful, eventually having up to four staff. As a result, he had access to increased income and, in this context, in 2015, his gambling on horses increased in frequency, up to five times a week, and he began accumulating debt, including to the ATO. He acknowledged that his wife was never aware of the extent of his gambling. He could not recall when he stopped gambling.
12. By early 2016, his opioid use had escalated such that he was using 150mg oxycontin per day and over-the-counter Panadiene Extra 70 tablets per day (1,050mg codeine), daily. His eldest daughter had just been born, and his wife was dissatisfied with his opioid use. In June 2016, he self-presented to Liverpool Hospital Drug and Alcohol Service and was commenced on methadone replacement, which he remained on, at reducing doses, through till late 2023 or 2024 when he switched to buprenorphine long-acting injection, monthly, which he continues. He acknowledged that his methadone treatment would have prevented him from working with an employer, but it did not prevent him from working for himself in his own business.
13. He does not recall the date when his alcohol use increased, but he accepted the hospital discharge records, which recorded that this occurred in January 2020, as accurate. He heard through contacts that he had been seen leaving the methadone clinic, which had led to the loss of a few customers of his business. On the background of his accumulating gambling debts, he explained that the "financial issues got to me". In January 2020 he began using a third of a bottle of spirits per day, increasing to one bottle of spirits per day, about 22 standard drinks, by March 2021.
14. He then ceased alcohol suddenly and suffered an alcohol withdrawal seizure, resulting in an ambulance being called and transport to Liverpool Hospital Emergency Department. On discharge, he was followed up by the drug and alcohol clinic where he saw an addiction specialist and was prescribed disulfiram, "Antabuse", for about one year. He was then abstinent from alcohol from March 2021 until December 2024.
15. By 2021, he was $700,000 in debt to the ATO due to gambling. In the context of the financial stress, he experienced depressed mood and sleep disturbance. He could not recall his other symptoms at the time. He does not recall receiving any treatment, such as psychotropic medications.
16. His wife moved out of the family home after March 2021 due to her dissatisfaction with his alcohol use and arguments over finances. She later returned to the home during weekdays, as their eldest daughter attended the local school, although they remained separated under the same roof and she and the girls spent the weekends at her parents' home.
17. It was difficult for [CBC] to recall his functioning in the period before the accident. Initially, he provided an account that he loved cooking, that he shared cleaning and showered daily and saw friends for BBQs once or twice a month.
18. The Medical Assessors put to him that this was inconsistent with the description of his functioning contained in Dr Steven Allnutt's report dated 28 October 2020. He acknowledged that his memory of this period is limited. As best the Medical Assessors could understand, he was cooking twice a week. He would feed his dog and help with his daughters. He cleaned and showered four to five times a week. He would see a friend occasionally. He reported that he was driving without difficulty but could not recall when the driving suspension was lifted after the March 2024 seizure. He reports that he was working 40 to 60 hours a week in his own business. He handled all business invoicing and wage preparation.

1. On 4 November 2021, [CBC] was driving his Toyota Yaris, hatchback, stationary behind traffic, when he was hit by a car from the rear. His right knee hit the dashboard and his right ankle was pushed under the pedals. His airbags did not deploy. He self extricated, exchanged details and drove his car home. Emergency services were not called. He said, "I knew I was hurt, didn't know how bad".

History of symptoms and treatment following the motor accident

1. He had pain in his right shoulder, diagnosed with bursitis, pain in his right knee, diagnosed with a torn ACL tendon and meniscus, pain in his right ankle, diagnosed with an ankle fracture and a dislocated right little finger.
2. He experiences chronic pain, mostly in the right leg, at an average severity of four to five out of ten, and at worst eight out of ten most mornings.
3. Surgery has been recommended and approved by the insurer. Still, he is apprehensive about proceeding with surgery due to a fear of dying under anaesthesia and is concerned about the possibility of uncontrolled pain post-surgery.
4. He has been using Panadeine Forte, prn, two to four tablets, daily. He states that his opioid therapy prescriber is aware.
5. As a result of pain and physical restrictions, he cannot drive for more than 15 to 30 minutes, cannot sit for more than 30 to 60 minutes, he cannot stand to clean or wash dishes and he was unable to return to work because of his pain.
6. Due to reduced activity and less care with his diet, his weight increased by 30 kilograms.
7. His post-accident psychiatric symptoms began gradually, following the stressors of physical restrictions causing immobility and inability to work. His inability to work increased his financial stress, as the CTP payments were not equivalent to his business income.
8. At reassessment on 25 November 2025, the Medical Assessors put to [CBC] that his account of not working after the accident was inconsistent with the content of the clinical records of Dr Chaugule at Clinic 66. These records describe a delivery business, beginning prior to the accident due to COVID-19 pandemic related decline in his elevator business, and continuing until mid-March 2022 when it "cooled" due to increased fuel costs. According to Dr Chaugaule's records, [CBC] had additionally started a seedling business and considered alternate work doing lawns or returning to the elevator repair industry as an employee.
9. [CBC] provided a number of responses to this. First, he asserted that he had consultations with the GP only every month and that the relevant GP entries were not written on the basis of consultations, "I can guarantee those notes were not when I saw the doctor". Secondly, he asserted that the GP had recorded incorrect information, "I recall Dr Chaugule making notes and thinking they were incorrect and inaccurate".
10. In regard to whether his elevator business was operational at the time of the accident, he accepted that there was a contraction due to the COVID-19 pandemic related restrictions but asserted that he continued a contract with the hotel. After the accident he could not attend the hotel and was instead sending a trade's assistant, and for that reason the hotel terminated their contract.
11. It was put to [CBC] that according to Dr Chaugale's notes, he was performing other work roles. He stated that the entries do not accurately reflect the extent of his engagement. In regard to a delivery business, he denied having a delivery business. He stated that his ex-wife made cakes to sell and that before the accident he would help her "occasionally" to make the deliveries, locally, but that he did not continue after the accident due to the onset of pain and resultant gradual onset of psychiatric symptoms.
12. In regard to the seedling business, he explained that this was a fleeting idea, that he bought five plants but did not proceed.
13. In regard to his apparent plan to return to the elevator repair industry as an employee at entry 1 March 2022, about four months after the accident, and the apparent inconsistency between his plan and his stated incapacity to work due to accident related injuries, he responded that he may have had a number of unrealistic ideas, but he did not and could not enact them due to pain, and later, due to psychological symptoms.
14. Gradually, over time, his mental health "all snowballed". He reported sleep disturbance, initial and middle insomnia, due to "a lot of stress". With the aid of prescribed sedating medications, he achieves an average of five to six hours sleep each night. He has occasional nightmares, of being buried alive or trapped, occurring sporadically, causing him to wake crying. He describes low energy, rather than lack of interest, impacting his ability to take his children out. His energy is worse in the morning and evening.
15. He reports that he feels safe at home and avoids going out, stating that he feels exposed, judged and triggered because of his weight gain. He reports that he eats only one meal a day, at night. His weight has plateaued at 145kg, which at a height of 180cm, results in a BMI of 44.8. He snores, he has hypertension and his lipids are borderline. He is distracted when he watches rugby league games on television. He can enjoy seeing his children, but feels, "so horrible" that he can not do things with them. He denied any suicidal thoughts.
16. He had another motor vehicle accident in 2022. He could not recall many details but denied any injury in the accident.
17. He remained abstinent from alcohol after the accident up till December 2023. He had limited recall of the details of this relapse. When prompted by the hospital records, he agreed that the relapse occurred in December 2023. He attributes it to the stress of conflict in the home with his wife. Additionally, he accepted the account in the hospital records that a chance encounter with his father at a service station in December 2023 had led to their total estrangement. The relapse began with a few drinks a week, but increased to one bottle of spirits a day. He was waking at 5.00am, needing to use alcohol, and was vomiting daily.
18. His former wife left the family home in March 2024 due to their conflict. He reports that for the first three months afterwards, she prevented him from seeing his children.
19. He continued drinking until he presented himself to Concord Hospital requesting alcohol detoxification and management of withdrawal in April 2024. He was then transferred to Matilda private psychiatric hospital for a one month admission. He was discharged on daily thiamine. He has maintained abstinence since discharge, on acamprosate, a medication used to reduce alcohol cravings.
20. He continues to gamble on horses and NRL, spending $100 per week most Saturdays over the past few years using gambling apps.
21. He was referred to his treating psychiatrist, Dr Singh, in 2022, and continues to see him every few months. He is prescribed sertraline 200mg daily, quetiapine 200mg nocte, clonidine 150mcg bd, acamprosate 666mg tds, lorazepam 2mg daily and thiamine iii daily.
22. He considers the medications have helped "numb" him, such that emotionally he is "on a level playing field".
23. He has been seeing his psychologist, Kerry Watson, every two to three weeks since 2022. In addition to support, she has taught him some breathing control techniques, which he has found helpful at managing his anxiety.
24. He reports that he is awaiting an elective admission to Matilda private psychiatric hospital, as suggested by Dr Singh, to assist him re-establish routine and optimise his medications.

1. [CBC] was assessed via video conference on both occasions.
2. At the 21 October 2025 examination, he was sitting on a couch, wearing a soiled, pink t-shirt and shorts. He had short hair and beard, but it was not neat or styled. He lay on his side and rested his head in his hands. He was polite and pleasant and tolerated a lengthy interview and repeated clarifications with grace. There were no psychomotor changes. His speech was normal in rate, volume and rhythm.
3. His affect was reactive and appropriate to the content. He did not appear significantly anxious or depressed and could smile readily and laughed briefly at times, appropriate to the content. His mood was despondent and low.
4. He described poor self-esteem, "I hate the person I am". He was not hopeless and reports a desire to improve, "Inside me I want to be better", "I want to eat better", identifying his children as a strong motivator for recovery. There were no delusions, abnormal perceptions and was no formal thought disorder.
5. Objectively, there was no evidence of substantial concentration impairment. [CBC] displayed the capacity to focus on the questions asked of him and to provide detailed and goal directed answers.
6. He denied suicidal ideation. He did not report any risk to others.
7. He has some insight into his condition and is engaged in treatment with a psychiatrist, psychologist, psychotropic medications and voluntary hospitalisation.

1. The Medical Assessors accept that [CBC] made best efforts to recall his history accurately at the examination, but that his recollection of past events is impacted by the effects of past heightened emotion, opioid use and alcohol use upon memory formation. Therefore, where contemporaneous records exist, the Medical Assessors have preferred the history contained in those records.

1. [CBC] had pre-existing DSM-5 Opioid Use Disorder. He had a history of sustained daily use, indicative of dependence, and escalating doses, indicative of tolerance. This was causing difficulties in his marriage and impacting his ability to gain employment. He was subsequently on opioid maintenance therapy, initially methadone, then long-acting buprenorphine injection.
2. He had DSM-5 Gambling Disorder, persistent and recurrent problematic gambling, documented in the 2020 notes from the University of Sydney Gambling Treatment Clinic, with a history of escalating monetary amounts, concealing the extent of his gambling and jeopardising his relationship, causing significant financial loss and debt.
3. He had DSM-5 alcohol use disorder, with tolerance, a need for increasing amounts of alcohol, withdrawal, experiencing a documented alcohol withdrawal seizure, and impacting his relationship from January 2020, in the context of financial stress due to gambling debts, and contributed to by contraction of his business. At the time of the subject accident, the alcohol use disorder was in early remission, with [CBC] having been abstinent for eight months.
4. [CBC] had symptoms consistent with a DSM-5 diagnosis of adjustment disorder, with depressed mood, noting that in the context of his financial stressors arising from gambling debts, as well as loss of the relationship with his wife, he experienced depressed mood and impaired sleep. Further, there is evidence in the contemporaneous records of both the University of Sydney Gambling Treatment Clinic notes, as well as Dr Chaugule's notes, of a substantial downturn in his business due to the impact of the COVID-19 pandemic restrictions, stated as a 60 to 80% contraction in 2020 compared to the previous year. This would have been an important further stressor, exacerbating his symptoms, especially given his perilous financial situation. His engagement in cooking, socialising and self care was reduced.

1. The Medical Assessors are satisfied that [CBC]'s pre-existing DSM-5 opioid use disorder, on maintenance therapy, was unchanged after the accident.
2. The Medical Assessors are satisfied that [CBC]'s pre-existing DSM-5 gambling disorder, persists and was not impacted by the accident.
3. The certificate of Medical Assessor Raymond Francis Wallace confirms [CBC] suffered physical injuries in the subject accident, which are permanent and continue to cause impairment. Although not greater than 10%, the impairment was 8% and the Medical Assessors note that Dr Wallace found no pain behaviours on examination. The Medical Assessor thus accept [CBC]'s account that the accident related physical injuries caused pain and some pain related work restrictions.
4. The Medical Assessors accept that [CBC]'s pre-existing DSM-5 adjustment disorder with depressed mood was exacerbated as a result of the accident due to the stress of his physical restrictions, which impacts [CBC]'s mobility and his capacity to work. The accident related injuries were not the only reason his ability to generate income was impacted, but are a cause. This has caused a loss of hope of improvement of his pre-existing financial predicament. The Medical Assessors, exercising their clinical judgment and expertise, find that the accident could have and did cause an exacerbation of [CBC]'s pre-existing adjustment disorder.
5. The Medical Assessors are not satisfied that [CBC]'s December 2023 relapse of pre-existing alcohol use disorder was caused by the accident. [CBC] had a pre-existing alcohol use disorder, which had arisen in the context of pre-accident financial stressors arising as a consequence of debt accumulated due to gambling.
6. The Medical Assessors note that it is the typical natural history for alcohol use disorder, once established, to relapse and remit, especially if stressors thought to be relevant to its emergence continue. That is, were it not for the accident, there would have been a substantial risk of relapse.
7. The post-accident relapse of alcohol use disorder had occurred more than two years after the subject accident, and almost two years after the exacerbation of the adjustment disorder, first recorded in the treating GP's notes in March 2022.
8. The initiating trigger for alcohol use, gambling debts, persisted, and on that background, the contemporaneous records of Concord Hospital indicate that the relapse of drinking in December 2023 was immediately triggered by contact with his father.
9. Despite the persistence of the accident-related exacerbation of adjustment disorder, the December 2023 relapse of drinking has remained in remission since April 2024.
10. Therefore, the Medical Assessors opine that there is no temporal relationship between the onset of the accident related psychiatric condition and the relapse of drinking alcohol, nor of persistence of the accident related psychiatric condition and abstinence from alcohol use. The Medical Assessors determined that the accident was no more than a negligible cause of the relapse of alcohol use disorder.

Psychiatric Impairment Rating Scale (PIRS) Assessment

1. Exacerbation of pre-existing adjustment disorder with depressed mood

2. Pre-existing alcohol use disorder in late 2023, now in remission since April 2024

3. Pre-existing opioid use disorder, on maintenance therapy

He sees his treating psychiatrist, Dr Singh, every few months. He is prescribed sertraline 200mg daily, quetiapine 200mg nocte, clonidine 150mcg bd, acamprosate 666mg tds, lorazepam 2mg daily and thiamine iii daily.

He sees his psychologist, Kerry Watson, every two to three weeks and has done since 2022. In addition to support, she has taught him some breathing control techniques, which he has found helpful at managing his anxiety.

Excluding the physical restrictions to household chores, he takes less care with his diet, relying on his mother for meals, buying pre-prepared meals and no longer cooking more than a toasted sandwich. He showers only once a week. Objectively, he was mildly dishevelled. The Medical Assessors accept that, when his physical restrictions are excluded, his poor motivation attributable to his psychiatric condition results in him not independently meeting hygiene and nutritional standards, fulfilling the definition of a moderate impairment.

He feeds his dog, but has physical restrictions to washing or walking the dog, with the insurer paying for this service, once a month. He spends his day sitting on the couch, where he feels at ease and comfortable. He looks at social media and watches re-runs of NRL games. About once a month, he will take his children to the park for 1 hour, where he sits on a bench and feels regretful that he cannot join them in play. He will colour-in with his daughters and watch movies with them. He took his daughter out for a pub lunch for her birthday. His mother helps make celebratory foods and decorate for birthdays and Christmas. He does not go out otherwise, feeling self-conscious and negatively judged about his weight. Noting he can go out, occasionally, with family who are supports, there is a moderate impairment.

He can drive locally or to familiar places restricted due to pain and "nowhere to go". When asked specifically if he is anxious driving, he reported hypervigilance and increased cautious comments as a passenger, but not avoidance or restrictions. As there is no avoidance of driving, despite symptoms of anxiety driving, when the physical restrictions and lack of need to travel are excluded, there is no impairment.

His marriage has ended. He has not formed any subsequent relationships. Given his reported inability to meet his own minimum hygiene and nutritional standards, he would be unable to care for his children without his mother's assistance.

He becomes distracted when watching movies, looking at his phone or falling asleep. He is able to read and follow the form guide on gambling apps. At assessment, he was able to engage and attend for over 2 hours.

Therefore, applying their clinical judgement, the Medical Assessors assess a mild impairment.

[CBC] was very clear that his inability to work was initially and primarily due to his physical conditions, which must be excluded from assessment.

Isolating only the psychiatric condition, considering his psychiatric symptoms and functioning, in the Medical Assessors' clinical judgment, he would not be able to work in his pre-accident position and would need to work in a less demanding role. His avoidance of social situations would restrict his ability to work outside the home.

He does not manage his self-care to minimum standards independently.

However, he does manage his own personal finances and bill payments.

For about a year, from September 2023 to September 2024, he was buying specialty tools from a neighbour, who he believed had bought them from a warehouse, and reselling them on Facebook marketplace. He made about 15 to 20 sales over the year and made about $5,000 to $10,000. However, he ceased in September 2024 when the police charged him with possession of stolen property. He pled guilty and received a fine. He reported sales on average less than once a fortnight.

When impairment due to the psychiatric conditions is isolated, there is a moderate impairment.

[CBC] acknowledged that he has limited recall of this period. The Medical Assessors accept that his functioning by November 2021 may have substantially improved compared to that reported by Dr Steven Allnutt in his October 2020 report, noting that [CBC] had been abstinent from alcohol from March 2021. Based on [CBC]'s best recollection, and applying our clinical judgement, there was a mild impairment, noting he was cooking less frequently and not showering daily, but that he maintained the psychiatric capacity for full time work, which would indicate that he could live independently.

[CBC] was socialising with a friend occasionally, indicating that he could go out without a support person, feeding his dog and helping with his children, but his conditions had reduced his engagement in frequency of socialising. For these reasons, a mild impairment is assessed.

He was driving without any difficulty. Therefore, there was no impairment.

His wife had separated from him in March 2021, apparently due to his resumption of his drinking of alcohol. Although he was hopeful of reconciliation, there was no reconciliation of the relationship. His wife had returned to the home during weekdays in order to access their daughter's school, but they were separated under the same roof and did not have an intimate relationship. The Medical Assessors consider the marriage had ended, and that the relationship did not reconcile after March 2021, consistent with the definition of a severe impairment, "pre-existing relationships ended; for example, lost partner".

It is likely that the combination of anxious worrying about his gambling debts, depressed mood and regular buprenorphine injection, would have had some impact upon his concentration. Applying the Medical Assessors' clinical judgment, there was mild impairment.

He was restricted from employment by others due to his opioid use disorder maintenance therapy which would have rendered him unable to be successful when applying to work for an employer. He was however able to work full time in a different employment environment, self-employed, consistent with the definition of a mild impairment.

1. [CBC] reported a subsequent motor vehicle accident in 2022, however he could not recall any details of this accident. There is no evidence before the Medical Assessors in relation to this accident, nor did the parties make any submissions in respect of this accident.
2. There is no evidence before the Medical Assessors of any other unrelated subsequent event or injury, nor did either party submit that any subsequent impairment should be taken into account.
3. Accordingly, the Medical Assessors find no subsequent impairment.

1. While [CBC] reports that he is numbed and better able to manage his anxiety, there is no evidence of improvement in his functioning with treatment. His treating psychologist has recommended another voluntary admission to a private psychiatric hospital. Accordingly, the Medical Assessors opine that there should be no adjustment made for effects of treatment.

1. [CBC] has been attending his psychologist and psychiatrist since 2022. While there is a further planned admission to a private psychiatric hospital, the Medical Assessors note his previous in-patient admissions and current medications. The upcoming hospital admission is said to focus on daily routines. While this may result in some minimal improvement, the Medical Assessors are satisfied that his level of impairment is unlikely to change significantly, being more than 3%, within the next year, whether or not he undertakes further in-patient hospital treatment. Accordingly, the Medical Assessors are satisfied that his impairment is permanent for the purposes of its assessment.

1. The Panel agrees with and adopts the examination findings of its medical members, both of whom examined [CBC] on 21 October 2025 and 25 November 2025, assigned classes to each PIRS category, and provided reasons for their findings. The Panel also agrees with and adopts the reasons and diagnoses made by its medical members. The Panel provides the following further reasons.
2. The Panel has assessed the same classes as Medical Assessor Nagesh and Dr Jungfer with respect to social and recreational activities (class 3), travel (class 1), concentration, persistence and pace (class 2) and adaptation (class 3). In respect of the differences, the Panel notes that an assessment of [CBC]'s permanent impairment must be done as it is on the day of assessment. Further, the clinical judgment and expertise of the Medical Assessors is the most important tool in the application of the PIRS.[11]
3. The Guidelines provide that, in applying the PIRS, the Medical Assessor should assess the extent to which a claimant's pre-accident lifestyle, activities and habits have been changed as a result of the psychiatric injury.
4. Self-care and personal hygiene is part of activities in daily living.[12] Both the Panel and

Dr Jungfer assessed class 3. Medical Assessor Nagesh assessed class 2. The Medical Assessors have opined moderate impairment for the reasons set out above, including that [CBC] no longer cooks. The Panel notes that, at the time of the assessment by Medical Assessor Nagesh, the claimant was reported to have been able to cook once a week and shop independently. 5. Social functioning refers to the capacity to get along with others and communicate effectively.[13] The Panel assessed class 4. Both Medical Assessor Nagesh and Dr Jungfer assessed class 3. The Panel notes that [CBC] reports his marriage has ended. There have been periods since their separation where he has been unable to see his children. The PIRS definition of a severe, class 4 impairment, is of a pre-existing relationship having ended, rather than being severely strained such that there are merely periods of separation as described as occurring in a moderate impairment. The PIRS provides common examples, but does not require that each example is fulfilled.

1. Clause 6.5 of the Guidelines provides that a determination of whether the injured person's impairment is related to the accident is implied in all assessments. In addition to the relevant provisions of the AMA 4 Guides, the common law principles also apply in considering such issues. Accordingly, it is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychiatric condition.[14]
2. Clauses 6.6 - 6.7 provide:

"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.

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. In respect of the applicable common law principles, causation of injury is required to be established on the balance of probabilities. [CBC] is not required to establish causation to the level of medical certainty.[15]
2. The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining causation.[16] It is therefore necessary to consider whether the accident caused or contributed to the diagnosed psychiatric condition. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[17] As observed by Spigelman CJ (Davies AJA agreeing) in Seltsam Pty Ltd v McGuinness (2000) 49 NSWLR 262; [2000] NSWCA 29:[18]

"An inference of causation for purposes of the tort of negligence may well be drawn when a scientist, including an epidemiologist, would not draw such an inference".

1. The Panel has considered the medical evidence before it, including the clinical notes of Doctors at Prestons dated 4 November 2021 and Allcare Carnes Hill Medical Centre dated 5 November 2021. These notes refer to physical injuries and pain reported by [CBC] following the accident. The clinical notes of Allcare Carnes Hill Medical Centre thereafter contain numerous entries referring to [CBC]'s complaints regarding physical injuries said to have been caused by the accident. There are also referrals to specialists for management of his physical injuries and pain.
2. The Panel has considered the report of A/Prof Shatwell dated 19 May 2025. In the doctor's opinion, it was unlikely there was any aggravation of [CBC]'s persistent right ankle and knee problems due to the accident. The Panel notes that, in addition to his right ankle and knee, [CBC] also reported pain in his neck and shoulder, as well as a swollen right finger, as a result of the accident.
3. The Panel notes that certificates of fitness prepared by [CBC]'s GP dated 14 June 2022, 12 July 2022, 10 August 2022, 7 September 2022, 5 October 2022, 2 November 2022, 30 November 2022, 19 December 2022, 7 February 2023, 7 March 2023, 4 April 2023, 2 May 2023, 30 May 2023, 27 June 2023, 25 July 2023, 22 August 2023, 19 September 2023, 17 October 2023, 14 November 2023, 12 December 2023, 24 January 2024, 20 February 2024, 21 March 2024, 17 April 2024, 15 May 2024, 13 June 2024 and 18 July 2024 certify that [CBC] is unfit for work due to his physical injuries caused by the accident. These injuries are certified include pain in the neck, shoulder pain, a swollen right little finger, and right ankle pain.
4. The clinical notes of Allcare Carnes Hill Medical Centre following the accident note frequent attendances by [CBC] due to his reported physical injuries and record that [CBC] is "unable to work due to pain". On 14 November 2022, it is recorded that "...Because of his physical and health issues, he will not be able to work as a lift mechanic in the future. This is going to be a permanent restriction".
5. The Panel has considered the clinical records from [CBC]'s treating practitioners and the diagnoses made by those doctors. The Panel has also considered the certificate of Medical Assessor Wallace, which certified that [CBC]'s reported injuries were caused by the accident. On balance, and based on its reliance on those documents, the Panel is satisfied that [CBC] suffered physical injuries as a result of the accident.
6. [CBC] had a complex pre-accident physical and mental health history and, in this regard, the Panel refers to its summary of the documentation provided by the parties. It also refers to the pre-accident diagnoses by the medical members of the Panel of an opioid use disorder on maintenance, gambling disorder, alcohol use disorder in early remission and adjustment disorder with depressed mood.
7. The Panel has considered the role of the accident in causing the exacerbation of [CBC]'s adjustment disorder with depressed mood, noting that the accident does not need to be the sole cause as long as it is a contributing cause, which is more than negligible. Exercising their clinical judgment and experience, the medical members on the Panel have determined that the accident could have caused an exacerbation of [CBC]'s adjustment disorder with depressed mood. The Panel finds that [CBC]'s pre-existing adjustment disorder was aggravated following the accident due to its impact on his capacity to work his usual job. This impact is persisting based on [CBC]'s evidence and the Medical Assessors' clinical judgment.
8. Accordingly, based on the above documentation and the findings of its medical members following their examination of [CBC], the Panel finds that the accident did cause or materially contribute to the worsening and exacerbation of [CBC]'s adjustment disorder with depressed mood.
9. The Panel notes [CBC]'s significant gambling problem prior to the accident, including his treatment at The University of Sydney Gambling Treatment Clinic, where he received treatment in 2020. In 2020 and early 2021, he is reported to have significant debts to the ATO as a result of his gambling. There is no evidence before the Panel that [CBC]'s gambling was aggravated by the accident. Noting his pre-existing Gambling Disorder, and the evidence before it, the Panel finds that [CBC]'s Gambling Disorder has no relationship to the accident, and therefore the accident did not cause or contribute to his pre-existing Gambling Disorder.
10. The Panel notes [CBC]'s severe alcohol use disorder prior to the accident. The evidence before it demonstrates that [CBC] was drinking significantly prior to the accident. He is reported to have commenced drinking excessively in January 2020 and was consuming an average of 1 to 1.2 litres of spirits daily at the time of his hospital admission in March 2021. He was reported to be abstinent from alcohol from March 2021 to a period significantly after the accident. His admission in April 2024 for alcohol withdrawal following a subsequent relapse clearly states that this relapse was due to an event with [CBC]'s father. The Panel finds that there is no causal link between the accident and [CBC]'s alcohol use disorder or relapse. In any event, the Panel notes that [CBC] has reported that he is currently abstinent from alcohol and therefore the Panel has found his alcohol use disorder is in remission.
11. The Panel notes its diagnosis of pre-existing opioid use disorder on maintenance therapy. [CBC] was prescribed Methadone at the time of the accident and is reported to currently be on monthly buprenorphine injections. There is no evidence that the accident caused or contributed to [CBC]'s opioid use disorder. The Panel finds this was completely pre-existing and is unchanged post-accident.
12. In evaluating [CBC]'s permanent impairment, the Panel is conscious that the PIRS must not be used to measure impairment due to [CBC]'s physical injuries or pain. Accordingly, the Panel has only assessed [CBC]'s impairment as a result of the accident caused adjustment disorder.

Degree of permanent impairment caused by the motor accident

1. Clause 6.218 of the Guidelines provides that in order to measure impairment caused by a specific event, being the accident, the 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 the "mental and behavioural disorders" part of the Guidelines.
2. The Medical Assessors on the Panel have estimated [CBC]'s pre-existing impairment as 7% (see above). Accordingly, the Panel has found that there is a 10% permanent impairment caused by the accident, being [CBC]'s current impairment of 17% minus his pre-existing impairment of 7%.

1. For the above reasons, the Panel finds that [CBC] has a permanent impairment of 17% as a result of the adjustment disorder with depressed mood which has been exacerbated by the accident. For the reasons given by the medical members of the Panel in their re-examination findings, the Panel has deducted 7% due to [CBC]'s pre-existing impairment. The Panel finds [CBC] has a 10% permanent impairment as a result of the accident caused psychological injury.
2. The Panel notes that, while it has reached the same substantive conclusion as Medical Assessor Nagesh that [CBC]'s degree of permanent impairment as a result of the psychological injury caused by the accident is not greater than 10%, it has otherwise reached different conclusions.
3. The Panel revokes Medical Assessor Nagesh's certificate dated 20 August 2024 and issues a new certificate that reflects its finding that the degree of permanent impairment of [CBC] as a result of the psychological injury caused by the accident is not greater than 10%.

1. On 10 November 2025, [CBC] confirmed that he would like to make an application to de-identify the decision pursuant to r 132 of the PIC Rules. The Panel requested the insurer confirm its position on the proposed de-identification direction. No response was received from the insurer.
2. These reasons contain sensitive personal information. Having weighed the matters referred to in r 132(4) of the PIC Rules, including the safety, health and wellbeing of [CBC], 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 identified before it is published.
3. Accordingly, balancing the matters in sub-rule 132(4), the Panel is satisfied that a de-identification order is appropriate and directs that its decision be de-identified before it is published pursuant to sub-rule 132(1).

[6] Clauses 6.36 to 6.37 of the Guidelines.

[8] Insurance Australia Group Ltd t/as NRMA Insurance v Keen [2021] NSWCA 287 and Insurance Australia Ltd v Marsh [2022] NSWCA 31.

[9] Rule 128 of the Personal Injury Commission Rules 2021 (PIC Rules).

[10] The Panel refers to Roger v De Gelder [2015] NSWCA 211 and Dunbar v Allianz Australia Insurance Ltd [2015] NSWSC 119.

[14] Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75].

[15] Briggs v IAG Ltd (t/as NRMA Insurance) (2024) 106 MVR 203; [2024] NSWSC 3 at [43]- [44].

[17] Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50].

[18] Cited with approval by White JA (Macfarlan and Payne JJA agreeing) in Metro North Hospital and Health Service v Pierce [2018] NSWCA 11 at [138]. See also the discussion of Stern JA (Mitchelmore and Ball JJA Agreeing) in Insurance Australia Ltd (t/as NRMA Insurance) v Le [2025] NSWCA 121 at [34].