MOTOR ACCIDENTS - Motor Accident Compensation Act 1999; claimant suffered injury in a motor vehicle accident when he was struck by a car whilst walking at a pedestrian crossing; original Medical Assessor (MA) determined the claimant's whole person impairment (WPI) as a result of the accident was 8%; claimant made an application under section 63 for referral of assessment to the Review Panel; Review Panel conducted its own examination and found as a result of psychiatric injuries sustained in the accident the claimant suffered a total WPI of 5%; Held - Certificate of original MA was revoked; de-identification direction made pursuant to rule 132 of the Personal Injury Commission Rules 2021.

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

24 April 2024 and substitutes the following determination that as a result of the accident, the claimant sustained the following injuries which gave rise to a permanent whole person impairment of 5%: * adjustment disorder with mixed anxiety and depressed mood, persistent (chronic).

1. On 13 September 2012, the claimant, ([CED]), was involved in a motor vehicle accident when he was crossing at a pedestrian crossing when a vehicle hit him from behind resulting in alleged physical and psychological injury (the accident).
2. On 27 July 2020, [CED] lodged a Personal Injury Claim form in respect of the accident. Gordian RunOff Limited (the insurer) was the relevant third-party insurer.
3. The claim is governed by the provisions of the Motor Accidents Compensation Act 1999 (MAC Act).
4. A medical dispute about the degree of [CED]'s whole person impairment (WPI) in respect of the alleged psychological injuries has arisen in connection with his claim. This constitutes a medical assessment matter under s 58(1)(d) of the MAC Act.
5. A medical assessment matter is determined in accordance with Chapter 3, Part 3.4 of the MAC Act.
6. The dispute was referred to the Personal Injury Commission (Commission) which then assigned it to Medical Assessor Christopher Canaris for assessment. Medical Assessor Canaris then assessed [CED] on 24 April 2024 and certified on the same day that the following psychological injuries caused by the accident had given rise to a permanent impairment of 8%:
   • persistent depressive disorder (dysthymia) with anxious distress, and
   • somatic symptom disorder with predominant pain.

1. [CED] sought a review of the medical assessment under s 63 of the MAC Act (the Review).
2. On 19 June 2024, a delegate of the President of the Commission determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect and referred the matter to the Panel.
3. The review provisions provide that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission: s 63(3) of the MAC Act. Accordingly, the President's delegate has convened this Panel to conduct the review of the medical assessment.
4. Part 5 of the PIC Act enables the Commission to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor: s 41(2) of the Personal Injury Commission Act 2020 (PIC Act).
5. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect. The review is by way of a new assessment of all matters with which the medical assessment is concerned: s 63(3A) of the MAC Act.
6. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the Rules.
7. On 17 February 2025, the Panel directed the parties to lodge with the Commission an indexed and paginated final bundle on which they relied in the Review.
8. On 13 May 2024, the Panel informed the parties that it considered a re-examination of

[CED] was required. Arrangements were made for him to be re-examined by Medical Assessor Gerald Chew and Medical Assessor Samson Roberts by video link (MS Teams) on 25 September 2025

1. Section 3 of the MAC Act defines 'injury' to mean a personal or bodily injury and includes a pre-natal injury; a psychological or psychiatric injury; and damage to artificial members, eyes or teeth, crutches or other aids or spectacle glasses.
2. [CED]'s claim and entitlements to compensation are governed by the provisions of the MAC Act. An injured person can make a claim for both economic losses and non-economic loss damages.
3. However, s 131 of the MAC Act provides that no damages for non-economic loss may be awarded in respect of injury unless the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%.

1. Section 44(1)(c) of the MAC Act says Motor Accidents Medical Guidelines may be issued in respect of the assessment of the degree of permanent impairment of an injured person as a result of an injury caused by a motor accident.
2. The relevant Motor Accident Permanent Impairment Guidelines are effective from

1 June 2018 (the Guidelines). The Guidelines were developed for the purpose of assessing the degree of permanent impairment arising from the injury caused by a motor accident, in accordance with s 133(2)(a) of the MAC Act: cl 1.1 of the Guidelines. 3. The Guidelines adopt the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive in respect of the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed: cl 1.2 of the Guidelines. They apply under the MAC Act to the assessment of the degree of permanent impairment that has resulted from an injury caused by a motor accident occurring between 5 October 1999 and 30 November 2017 inclusive: cl 1.3 of the Guidelines. 4. Causation of injury is addressed in cls 1.5, 1.6 and 1.7 of the Guidelines. 5. Clause 1.6 of the Guidelines notes:

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

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

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

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

"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."

"The assessment of mental and behavioural disorders must be undertaken in accordance with the psychiatric impairment rating scale (PIRS) as set out in these Guidelines. Chapter 14 of the AMA 4 Guides (pages 291-302) is to be used for background or reference only."

"The impairment must be attributable to a psychiatric diagnosis recognised by the current edition of the Diagnostic & Statistical Manual of Mental Disorders (DSM) or the current edition of the International Statistical Classification of Diseases & Related Health Problems (ICD). The impairment evaluation report must specify the diagnostic criteria on which the diagnosis is based."

1. The current edition of the DSM is the fifth edition text revision (DSM-5-TR).
2. In respect of the psychiatric impairment rating scale (PIRS), cl 1.219 of the Guidelines states that the behavioural consequences of psychiatric disorders are assessed on the following six areas of function, each of which evaluates an area of functional impairment:

(a) self-care and personal hygiene (Table 11 of the Guidelines);

(b) social and recreational activities (Table 12 of the Guidelines);

(c) travel (Table 13 of the Guidelines);

(d) social functioning (relationships) (Table 14 of the Guidelines);

(e) concentration, persistence and pace (Table15 of the Guidelines), and

(f) adaptation (Table 16 of the Guidelines).

1. Tables 11 to 16 of the Guidelines identify the five classes of assessment within each of the six areas of function.
2. Clauses 1.225 to 1.228 and Table 17 of the Guidelines address the three step procedure involved in calculating psychiatric impairment.
3. Clauses 1.222 to 1.224 of the Guidelines address the adjustment for the effects of prescribed treatment to the assessment of WPI.
4. Clause 1.218 of the Guidelines states:

"In order to measure impairment caused by a specific event, the medical assessor 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 this part of the Guidelines, and subtract this value from the current impairment rating."

1. Pre-existing impairment is addressed in cls 1.31, 1.32 and 1.33 of the Guidelines.
2. The evaluation of the permanent impairment may be complicated by the presence of an impairment in the same region that existed before the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value. If there is no objective evidence of the pre-existing symptomatic permanent impairment, then its possible presence should be ignored: cl 1.31 of the Guidelines.
3. Pre-existing impairments should not be assessed if they are unrelated or not relevant to the impairment arising from the motor accident: cl 1.33 of the Guidelines.
4. Subsequent injury is addressed in cl 1.34 of the Guidelines which states:

"The evaluation of permanent impairment may be complicated by the presence of an impairment in the same region that has occurred subsequent to the relevant motor accident. If there is objective evidence of a subsequent and unrelated injury or condition resulting in permanent impairment in the same region, its value should be calculated. The permanent impairment resulting from the relevant motor accident must be calculated. If there is no objective evidence of the subsequent impairment, its possible presence should be ignored."

1. Medical Assessor Christopher Canaris examined [CED] on 24 April 2024 and certified on the same day that the following injuries were caused by the accident and gave rise to a WPI of 8%:
   • persistent depressive disorder (dysthymia) with anxious distress, and
   • somatic symptom disorder with predominant pain.
2. The Panel summarises Medical Assessor Canaris' findings below.
3. At [2] of his certificate, Medical Assessor Canaris noted that post-traumatic stress disorder with major depressive disorder was the injury referred by the Commission to him for assessment.
4. Medical Assessor Canaris summarised the submissions of the parties at [3]-[4] of his certificate, noting that [CED] claims he has sustained psychological injury with a WPI greater than 10% as a result of the accident, whilst the insurer contends that [CED] has had a history of anxiety disorder and has been on antidepressants before.
5. At [5]-[6], Medical Assessor Canaris noted that he considered the documents contained in the Application and Reply as well as the listed late documents in his assessment.
6. Medical Assessor Canaris took a psychosocial and pre-accident history at [8], noting that

[CED] saw psychiatrist, Dr Stuart Saker, in 2012 before the accident and was noted to have had a history of anxiety from 2008 onward and been on escitalopram (an antidepressant) 10mg daily from 2010. Dr Saker had subsequently increased his dose of Escitalopram. He was somewhat vague as to the reasons beyond talking about the need to have medication adjusted. He has been married since 2015. He has two young children aged five and seven years. His son was diagnosed with autism around 2020 when he was two years old. He is in a special class and has NDIS support. He is getting on well at school. He has a younger sister. 7. [CED] came to Australia when he was young and had a group of Latino friends and played soccer and did karate. 8. He went back to Argentina for three years and came back and did his engineering certificate in welding. 9. He has always been "an introvert" and "never very loud and talkative". Before the accident, he "was playing drums - I played in my band - I had sports - gym - I had friends calling from work". 10. He did boxercise, football, and surfing. He worked as a contractor mainly as a welder and fabricator. 11. He denied any significant issues with concentration and memory, seeing himself as "more optimistic" and one to try and find solutions to problems ("I sort of had goals"). He claimed to look after himself and denied any difficulties with travel. 12. He has not worked since 2019, going onto the disability support pension around 2022. He says he cannot see himself working because of "concentration - memory - physical" issues saying, "It's difficult to get things done". He has problems with "pain in my back - my knees - picking up things". 13. The Medical Assessor then took a history of the accident at [9], recording that [CED] was wheeling a bicycle and leading two dogs on a leash across a pedestrian crossing when a vehicle hit him from behind causing him to fall on the bonnet, going forward about 20m. He fell off the bonnet when the vehicle onto the road landing on his knees and elbows. He was told he had to get off the road which [CED] said he could not do. The driver at fault then "carried me". There seems to have been some kind of argument. An ambulance attended and he was taken to the Bankstown Lidcombe Hospital. There again seems to have been some sort of discussion at the hospital. Staff seemed to think that he had fallen over. He was tested for drugs and alcohol - he was there for less than two hours. He was told to go to the waiting room and rang his father to pick him up - however, his father had to wait for police who apparently never attended. He was discharged later that day and taken home by his father, consulting with his general practitioner (GP) the following day. He had been physically well before the accident. 14. At [10], Medical Assessor Canaris recorded the history of symptoms and treatment following the accident, current symptoms, and current and proposed treatment. 15. As to relevant injuries sustained since the accident, the Medical Assessor noted at [11] that in 2014, [CED] hit another car. He was driving at the time. He does not seem to have sustained any injuries and he does not believe it impacted on him psychologically. 16. The Medical Assessor performed a clinical examination at [14]-[16] which the Panel reproduces below:

"I interviewed [CED] at his solicitor's office by Microsoft Teams. Despite a couple of brief interruptions, a good audiovisual connection was established. [CED] was sitting at a boardroom table looking up towards the camera. He presented as a dark-complexioned man wearing a grumble looking plaid shirt and jeans. He provided the accounts documented above. Although his overall narrative was coherent and consistent, he was at times vague in his description of his emotions and functioning. His demeanour was depleted and his affect restricted. I elicited no evidence of psychosis or of cognitive impairment."

This section of the certificate is not reproduced by the Panel.

"Although he was at times vague, there was no fundamental inconsistency in his presentation."

1. At [17], the Medical Assessor provided a thorough summary of the medical reports, imaging and other documentation that he relied on during his assessment of [CED].
2. Medical Assessor Canaris provided his diagnosis and reasons at [18], noting that

[CED]'s overall presentation is consistent with a diagnosis of persistent depressive disorder (dysthymia) with anxious distress. Medical Assessor Canaris considered a diagnosis of post-traumatic stress disorder and while he noted some symptoms suggestive of the diagnosis, the precipitating event would not qualify as a "Criterion A" event. In terms of DSM-5-TR criteria, he noted the presence of depressed mood for most of the day for more days than not over many years (Criterion A) with evidence of fluctuating appetite, insomnia, low energy, and poor concentration (Criterion B). He has never been without the symptoms for any significant time and certainly not for more than two months (Criterion C) although whether he met criteria for a major depressive episode over this time is open to question but this is not an essential criterion (Criterion D). He has never had a manic or hypomanic episode and there is no evidence of cyclothymic disorder (Criterion E) and there is no evidence of a schizoaffective disorder or schizophrenia spectrum, or other psychotic condition (Criterion F). His symptoms are not attributable to the physiological effects of a substance or to another medical condition (Criterion G) and cause him clinically significant distress and impairment in social and occupational functioning (Criterion H). Symptoms reminiscent of post-traumatic stress disorder are captured by the anxious distress specifier. There is evidence also of a somatic symptom disorder with predominant pain. The diagnosis is not in any way imply that his symptoms are without pathophysiological basis but reflects merely the extent to which they seem to dominate his life. Medical Assessor Canaris noted evidence of a pre-existing social anxiety disorder. 3. The Medical Assessor then set out his causation and reasons at [19], recording that both his persistent depressive disorder (dysthymia) with anxious distress and his somatic symptom disorder with predominant pain are attributable to the motor vehicle accident. His symptoms are generally specific to the subject accident. His pre-existing social anxiety disorder may have contributed to psychological vulnerability at the time of the accident. 4. At [20], the Medical Assessor determined that the following injuries were caused by the accident: * persistent depressive disorder (dysthymia) with anxious distress, and * somatic symptom disorder with predominant pain. 5. Medical Assessor Canaris provided his opinion on WPI through the PIRS at [22] which is reproduced below:

1. Persistent depressive disorder (dysthymia) with anxious distress

2. Somatic symptom disorder with predominant pain (not assessable for WPI)

Venlafaxine 75 mg daily, mirtazapine 30 mg at night, consultations with a psychologist

His wife will insist on him showering when he starts to smell, and he sometimes does not want to shower because he feels too depressed and "I have to be reminded". His wife would sometimes buy him clothes in an effort to get him into something new. He sometimes does not eat and sometimes overeats ("it's a bit all over the place") and his weight has been steady. I asked him how he thought he would manage if he lived on his own. He replied, "I don't think I would go out anyway". I put the question to him again. He responded, "I'm not too sure".

He does not go out socially but would have gatherings with his parents at his home which might be once a week. He does not always enjoy their visits especially "if I'm not well - if I've got a bit of stress - a bit of anxiety". Every few months, he might go out to dinner.

He does drive and can manage a 15-to-20 minute journey ("maximum would be half an hour") and he does not want to be anywhere he does not know or try to experience something new though he could not explain why other than that he was "more comfortable - it's what I can manage".

He finds it "a bit of a juggle with the kids" and while "I try my best, there's some things I don't react to properly - my wife she has patience for me I guess - she helps a lot... there's sometimes my frustration and my limits to things - it get difficult for us" and the intimate side of life has gone by the board.

He spends his days with "just pretty much just [going] for a walk - not every day - I get to a park - just sit down somewhere - try to do something outside... honestly, most of the time I'm in my shed... like meditation - just being in a quiet area - just think - be calm". He does not watch much TV saying, "I feel like I can't concentrate". He reads "a little" and would "read mainly for the kids - read them books". If he reads a book, he would if questioned about it later "sometimes remember - most of the time I forget". He blames his poor concentration on "a lot of thinking... it's like thinking or stress - just worry - what am I worried about - I'm not too sure what I'm worried about..." and he has accepted it as normal that he should worry although he does not like it. He would "just forget things - where they are - misplace things - I mightn't find things for several days - also trust". He recalled that when working at Coles, he would be "looking up what people are doing... if they're not working or working". He was not sure how the latter related to the accidents saying, "It's hard to explain but it's trust - being defensive" and he felt as though people might be having a go at him or that he would be "triggered" saying, "Just going out - people might be laughing - it's hard to explain - it's hard to go into detail - it's not that you don't have complete trust - it's just that you have to be wary".

He has not worked since 2019 going onto the disability support pension around 2022. He says he cannot see himself working because of "concentration - memory - physical" issues saying, "It's difficult to get things done". He has problems with "pain in my back - my knees - picking up things". Comment: Although he is not employable in his current condition, I have rated him as Class 3 or moderately impaired because of the contribution of physical issues.

1. The Medical Assessor addressed pre-existing WPI at [23], noting evidence of a pre-existing social anxiety disorder. This was manifest mainly in his shyness and he was documented as finding it difficult to socialise. However, he claimed to be functioning well in a range of areas of his life and on balance the Medical Assessor thought there was insufficient evidence from the history he provided or from the documentation on hand to make a deduction for pre-existing impairment.
2. The Medical Assessor noted at [25] that it would be reasonable to add 1% by way of adjustment for treatment effects.
3. Medical Assessor Canaris concluded at [26] that the injuries caused by the accident gave rise to a WPI of 8%.

1. In its assessment, the Panel relies on the following documentation and medical reports and summarises same below.

Report of Dr Rikard-Bell, psychiatrist, dated 20 September 2023

"On 13 September 2012 [CED] was involved in a motor vehicle accident as a pedestrian when he was struck by a vehicle while crossing the road. It would appear the accident was relatively mild in that there were no serious injuries, although he did complain of pain in his lower back and right knee. On 10 December 2020 Dr Walker found the pain in his right knee could not be explained on MRI and on 13 July 2021 Chaf Awit diagnosis chronic pain syndrome. Dr Jonathan Herald, orthopaedic surgeon, noted 12% whole person impairment with pain in the right knee, neck and lower back on 6 June 2022. Dr Suman, psychiatrist, noted pre-existing anxiety on 21 November 2021. On 27 August 2020 Dr Verma, psychiatrist, noted social anxiety in 2008 and diagnosed post-traumatic stress disorder and major depressive disorder. Dr Rikard-Bell formed the view [CED] has a pre-existing anxiety disorder which was temporarily exacerbated following the accident on 13 September 2022. There were no serious injuries from the motor vehicle accident and although there is some anxiety when crossing the road, after 6-12 he recovered and returned to his previous state. [CED] has developed chronic pain syndrome in relation to his right knee, neck, lower back and thoracic back. Therefore, on balance, there is no diagnosable psychological injury attributable to the subject motor vehicle accident. The anxiety disorder is pre-existing and the chronic pain syndrome does not qualify as a psychological injury according to the Act."

1. Prior or subsequent injuries, illnesses or conditions:

"There was previously diagnosed social anxiety disorder. Subsequently, he has developed chronic pain syndrome and the anxiety disorder has continued even though it may have been exacerbated somewhat after the accident"

"There is no diagnosable psychiatric condition attributable to the subject motor vehicle accident. There is pre-existing social anxiety disorder, which was temporarily exacerbated following the motor vehicle accident, however, has since resolved. He was away from work for 12 months after the accident; however he returned to full-time work over several years until 2020 when he stopped work due to pain symptoms."

"The prognosis in relation to the pre-existing anxiety disorder is guarded and dependent on treatment received, however the prognosis in terms of any exacerbation of the anxiety disorder after the accident is good as he has now recovered. He receives the Disability Support Pension in relation to chronic pain and the pre-existing anxiety."

"[CED]'s presentation since 2012 indicates towards him experiencing post-traumatic stress disorder with depressive symptoms following him being involved in the road traffic accident. He received treatment (details unclear) under the care of a psychiatrist for approximately one year following the accident although he ceased the medication shortly. [CED] had continued to struggle with post-traumatic stress disorder with depressive symptoms since 2013. The depressive symptoms have gradually worsened. [CED]'s presentation since around 2017 indicates towards him experiencing pervasive biological and psychological symptoms of depression. He experienced worsening in terms of his mental health by the end of 2019/early2020 when he gave up his last job working at Coles. He has experienced a gradual decline (with fluctuations) in terms of his mental health and functioning from 2013 onwards. [CED] described experiencing mild social anxiety in terms of interacting with women prior to the accident. Despite mild anxiety, he used to socialise well. [CED] did not experience any pervasive anxiety or depressive symptoms adversely affecting his functioning or general wellbeing prior to the accident. There has been a marked deterioration in terms of his functioning and general wellbeing post-accident secondary to his psychological injury. [CED] has used cannabis and smokes cigarettes since 2013 onwards. He has decreased his reliance on the above substances since he started receiving input from the psychiatrist, Dr Verma, since mid-2020. [CED]'s recent presentation indicates towards a slight improvement in terms of his mental health although he continues to struggle with major depressive disorder symptoms which is adversely affecting his functioning in general. Dr Suman was of the opinion that [CED]'s presentation/symptoms satisfy the criteria of: Post traumatic stress disorder; and Major depressive disorder. His current mental health stressors are a result of him being involved in a road traffic accident in 2012."

"Dr Suman was of the opinion that [CED] has suffered a psychological injury, i.e. post traumatic stress disorder with major depressive disorder as a result of being involved in a road traffic accident in 2012. Going into details of the specific criteria for post traumatic stress disorder: Criterion A. [CED] was involved in a road traffic accident which was a life-threatening experience for him. Criterion B. [CED] has experienced recurrent intrusive memories of the traumatic event including nightmares immediately following the accident. He has experienced significant distress in the context of any exposure to the triggers related to the accident. Criterion C. [CED] told me that he gave up driving for approximately six to eight weeks following the accident. He continues to drive independently although remains anxious at the traffic lights. [CED] told me that he has avoided the accident site. Criterion D. [CED] has experienced feelings of anger and fear since 2012. Any triggers would worsen his mental health symptoms. [CED] has lost interest in activities he used to enjoy previously. His relationship with his friends and family is strained. He has experienced significant negative emotions. Criterion E. [CED] told me that he continues to experience irritability and anger. He had previously experienced exaggerated startle response although symptoms have since diminished. [CED] does struggle with his concentration and insomnia. Criterion F. [CED] has experienced the above symptoms since 2012. His symptoms have gradually decreased in intensity and frequency over time although the depressive symptoms have become more progressive in nature. Criterion G. [CED] has experienced significant distress and impairment in terms of social, occupational and general functioning secondary to his psychological stressors. Criterion H. [CED]'s current presentation cannot be attributed to the use of illegal substances and cannot be solely explained on the basis of him suffering from pain symptoms."

"Dr Suman was of the opinion that [CED]'s psychological injury is a result of him being involved in the road traffic accident in 2012."

"Considering [CED]'s presentation since 2012 and limited response to the assertive treatment and input he has received from his psychiatrist and psychologist, Dr Suman remained guarded in terms of his recovery and return to work prognosis in the medium to long-term."

Statutory Declaration of [CED] dated 4 May 2021

1. He grew up in Argentina and completed high school in Sydney then worked as a welder and in other roles. From 2007 to 2010 [CED] resided in Argentina and would visit Australia. He returned to Australia in January 2012 and commenced a full-time position at Plan B Engineering, which was his father's engineering company as a welder where he worked until 13 September 2012 when the accident occurred. Prior to the accident, [CED] was well, apart from some problems with his left eye. He was diagnosed with anxiety prior to the motor vehicle accident and was taking escitalopram 10 mg since February 2012. He was under the care of Dr Saker, psychiatrist. When the accident occurred, [CED] struck the bonnet of the vehicle and travelled a short distance before the driver applied the brakes and he fell off the bonnet onto his knees and elbows onto the road. There were witnesses and an ambulance attended which transported him to Bankstown Hospital then discharged the same night. He was given Panadeine Forte for pain. On 14 September 2012 [CED] attended Dr Argueta, GP, in Bankstown who referred him for some scans. There was no previous history of insurance claims or other claims. In 2013 he saw Chaf Awit at Bridges Psychology in Belfield, as well as Dr Saker. On 14 November 2013 [CED] was involved in a subsequent motor vehicle accident which caused pain in the left side of his neck, although there was no claim lodged for this accident. [CED] worked for Australia Post between 2013 and 2015 when he sustained an injury to his Achilles whilst playing soccer which took three months to heal after surgery. [CED] spent a year in China from December 2015 and returned to Australia in October 2016. He recommenced work with Australia Post until October 2017. In November 2017 he began work at Fencing Warehouse in Revesby as a welder for a year, although he was in a lot of pain. In December 2018 he worked at Coles as a trolley collector for 10 months. There was further pain on 27 March 2019 and he consulted Dr Howe, GP. On 28 March 2019 there was lower back pain as noted by Dr Woo. In July 2022 [CED] lodged a claim, however there was a time limitation.

Report of Dr Verma, psychiatrist, dated 27 August 2020

1. Dr Verma noted that social anxiety was diagnosed in 2008 and [CED] takes Escitalopram 20 mg. In 2008 he was treated with antidepressants. [CED] was involved in a motor vehicle accident when he fell onto the bonnet of a vehicle then to the ground. He was taken to hospital and there was no loss of consciousness. After the accident, there was a fear of going on the road and there was ruminating about the motor vehicle accident. There was ongoing lower back pain and he continued to feel aggrieved. He saw a psychologist in 2012 and 2015 and was treated with Cymbalta. [CED] continues to ruminate about the accident and becomes easily stressed. Dr Verma diagnosed post-traumatic stress disorder and cluster C personality with secondary depression. Treatment included quetiapine, mirtazapine, Lexapro, Epilim and treatment with EMDR at St John of God. On 1 October 2020 Dr Verma noted there was initial insomnia and there was suicidal ideation. There were no nightmares.

Consultation notes of Chafic Awit, psychologist, dated 31 July 2020 - 2 May 2023

1. These consultation notes document inter alia scores on the DASS 21 at an "extremely severe" level for depression, anxiety, and stress. Apart from symptoms of anxiety and depression, there is evidence that his marriage is undergoing considerable strain, and there was a comment to the effect that his son was "clearly on the spectrum". There was a diagnosis of social anxiety disorder. Otherwise, there is not enough information to discern levels of impairment.

Application for Personal Injury Benefits Form dated 27 July 2020

1. [CED] described the accident as "I was crossing Sphinx Ave at a Zebra Crossing. As I was walking, all of a sudden, a white ute hit me on the right side. I fell onto the bonnet and travelled a short distance. When the driver applied the brakes, he skidded and I fell off the bonnet onto my knees and elbow." [CED] reported injuries to his "upper back, lower back, right knee, psychological (PTSD/depression/anxiety/agoraphobia), Radiculopathy".

ED discharge referral of Bankstown Hospital dated 13 September 2012

1. The discharge referral noted that [CED] had been in a "low-speed 10 k/hr" motor vehicle accident following which he was noted to complain of lower thoracic backpain.

Clinical records of Campsie Healthcare Medical Practice (various dates)

1. The earliest entry is on 9 April 2013 when he is described as having a long-term depressive illness with fear of rejection, resentment of both his parents, and that he had been single for a number of years with a serious relationship at the age of 20 years which is not going well after interference from parents. He is noted to have minimal social support as his sister and mother live overseas. However, he is noted to be working full time. There is reference to a range of stressors including social isolation and a large debt to the tax office as well as the lack of motivation. However, there appears to be no mention of the accident. He was referred to Chafic Awit and a number of sessions are documented. Medication included Escitalopram and Duloxetine (both antidepressants).

Patient Health Summary from Revesby Family Clinic (various dates)

1. On 5 August 2020, a consultation is recorded relating to a history of post-traumatic stress disorder said to be in 2014 for which he was seeing his psychologist and requesting a referral to Dr Saker whom he had seen previously. There are references to him seeing a psychiatrist, Dr Verma, and to have been prescribed venlafaxine. There are also references to his anxiety flaring up when he heard noise and car noises at night. Elsewhere, there are references to "backflashes" and lack of sleep with problems with attention and concentration as well as lack of energy and motivation.

Clinical records of Bankstown Clinic (various dates)

1. The notes record history of anxiety going back for years on a background of always having been shy and quiet. He was noted to find it difficult to socialise and to be in crowded places and to be very self-conscious if he has to go to the shops. He was noted to have been on Escitalopram 10 mg daily. He was noted to have been sexually abused as a child from a relative, to have had separation anxiety, and to have been bullied and teased at school. His affect was noted to be flat and his mood "nervous but good". He came under the care of

Dr Stuart Saker who recommenced him on escitalopram and suggested that he continue seeing his psychologist for cognitive behaviour therapy. On review on 29 March 2012,

Dr Saker recommended an increase in his Escitalopram dose to 15 and then 20 mg daily.

1. The Panel reproduces the submissions of [CED] dated 11 September 2025 by reference to paragraph numbers:

[2] Pursuant to the Panel's directions, [CED] has made all reasonable efforts to obtain and provide the following:

(a) Directions 1(a) - "tax records":

(i) [CED] encloses his tax records from 2012 to 2024.

(b) Directions 1(b) - "passport":

(i) [CED] encloses a copy of his passport issued on 21 October 2015. He does not have in his possession his previous passport covering the period of 2012 to September 2015.

(c) Directions 1(c) - "CTP claim form":

(i) [CED] encloses a copy of his CTP claim form.

(d) Directions 1(d) - "prior or subsequent accidents":

(i) [CED] has instructed that, other than the motor vehicle accident on

15 November 2013 (for which no CTP claim was lodged), he does not recall being involved in any other motor vehicle accidents since 2010, and

(ii) to ensure completeness, a request has been made to SIRA for confirmation of any relevant claims. The Panel will be updated once thus information has been received.

(e) Directions 1(e) - "workplace injury":

(i) [CED] has instructed that he does not have in his possession the claim form in respect of the 2019 work accident and does not recall further details relating to same, and

(ii) as provided above, a request has been made to SIRA to obtain records of any relevant claims, and the Panel will be updated upon receipt

(f) Directions 1(f) - "names of CTP and WC Insurer":

(i) [CED] does not recall details of the CTP insurer and Workers Compensation Insurer in respect of accidents or workers compensation claims since 2010, and

(ii) a request has been made to SIRA to assist in identifying any relevant insurers, and the Panel will be updated once this information is available.

(g) Directions 1(g) - "medico-legal reports":

(i) all medico-legal reports provided to the CTP insurer, including those of

Dr Herald and Dr Suman, have already been provided to the Panel.

1. The Panel summarises the submissions of the insurer dated 12 June 2024 by reference to paragraph numbers:

[1] The insurer submits that [CED] seeks Review of the Certificate of Medical Assessor Canaris dated 24 April 2024.

[2] In summary, the Review Application alleges:

(a) the PIRS 'Adaptation' finding is incorrect;

(b) findings are inconsistent with treating and medicolegal evidence;

(c) procedural fairness was denied, and

(d) Reasons are inadequate.

[3] The insurer submits that, for the reasons set out below, no error is demonstrated in the certificate.

[4]-[5] The insurer submits that [CED] alleges the Adaptation findings are incorrect and inconsistent with instructions and medicolegal evidence. It further submits that no error or inconsistency is demonstrated and that the findings accord with the available evidence.

[6] In the PIRS table (pp 13-14), the Medical Assessor adopted Class 3, noting:

• "He has not worked since 2019... cannot see himself working because of concentration, memory and physical issues... problems with pain in his back, knees and picking things up."

Comment: "although he is not employable... I have rated him Class 3 because of the contribution of physical issues."

[7]-[8] The insurer submits that [CED], on his own evidence, reports both physical and psychological factors contributing to work incapacity. This accords with both medicolegal experts:

(i) Dr Suman (29 November 2021) - the presentation reflects "biological and psychological symptoms" causing him to stop work, and

(ii) Dr Rikard-Bell (20 September 2023) - he "decided to stop work... due to pain" and there is "no impairment of adaptation... attributable to the accident."

[9]-[10] The insurer submits there is no evidence that incapacity to work is primarily psychological. It submits that the Medical Assessor provided a clear reasoning pathway consistent with Stanizzo v AAI Ltd t/as GIO [2021] NSWSC 1077, including the explanatory comment under "Reasons for Decision".

[11] The insurer continues that it was open to consider all factors contributing to lifestyle change and conclude that physical injuries contributed to incapacity, supporting Class 3 rather than Class 5.

[12]-[14] The insurer submits that the differing PIRS classifications between Medical Assessor Canaris and Dr Suman reflect a difference of medical opinion and that more than a mere difference of opinion is required to demonstrate error or inconsistency (Ferguson v State of NSW [2017] NSWSC 887).

[15]-[16] The insurer submits that [CED] alleges substantial inconsistencies with treating and medicolegal evidence and that no explanation is provided beyond noting a different opinion from his own expert.

[17]-[18] A differing opinion as to Class 2 or Class 3 does not amount to demonstrable error (Parker v Select Civil Pty Ltd [2018] NSWSC 140). The insurer submits that alleged inconsistent findings relate to three categories:

[19]-[21] The Medical Assessor adopted Class 2, noting: reminders to shower, fluctuating appetite, ability to manage if living alone, and uncertainty when questioned further. The insurer submits this is consistent with Class 2 as Class 3 requires inability to live separately without regular support, and no evidence was provided demonstrating this.

[22] The insurer submits the assessment aligns with medicolegal evidence:

(i) Dr Bell - he presents as caring about appearance; able to dress, feed, wash, and care for children, and

(ii) Dr Suman - "casually dressed and kempt."

[23]-[24] Even his own expert does not suggest inability to live independently. The insurer submits Class 2 is appropriate.

[25]-[28] The insurer submits [CED]'s own evidence (occasional dinners, family gatherings, driving) is consistent with Class 2 as Class 3 requires inability to go out without support, and no evidence supports this. He did not attend social activities before the accident due to pre-existing anxiety. The insurer relies on pre-accident records from 2012 documenting long-standing social anxiety, avoidance, and CBT referrals.

[29]-[32] Dr Rikard-Bell confirmed a pre-existing anxiety disorder. The insurer submits his pre-accident functioning mirrors his current difficulties. [CED] told the Medical Assessor he rarely went out socially even before the accident. The insurer submits Class 2 was, if anything, generous.

[33]-[36] The insurer submits the reasons for Class 2 are clear: strained relationships, difficulty in the household, and reduced enjoyment of gatherings. The Medical Assessor accepted strain, tension, and loss of friendships. There is no evidence of severe impairment (e.g., separations, domestic violence, child protection involvement) required for Class 3 and therefore Class 2 was appropriate.

[37]-[39] The insurer submits there were no inconsistencies requiring clarification. No psychiatric inconsistency was identified requiring notification under cl 1.41 of the Guidelines. The Guidelines require inconsistencies between clinical findings and observed behaviour to be put to [CED] for comment.

[40]-[43] The Medical Assessor expressly stated: "there was no fundamental inconsistency in his presentation." The insurer relies on SZGUR [2011] HCA 1 at [9]: procedural fairness does not require exposing thought processes unless a critical or adverse issue is raised. The Insurer submits no adverse conclusions were made beyond material already known, only a different medical opinion supported by reasons and therefore this ground must fail.

[44] The insurer submits that the Medical Assessor:

(i) demonstrated methods and reasoning across the 14-page report;

(ii) provided detailed PIRS reasoning consistent with AMA4 and the Guidelines, and

(iii) satisfied the requirements in Rodger v De Gelder [2015] NSWCA 211.

[45]-[47] [CED] does not explain how reasons were inadequate beyond preferring the views of Dr Suman. The insurer submits, consistent with [CED]'s own submissions, that PIRS descriptors are illustrative and the Medical Assessor must exercise clinical judgment and that this ground must fail.

[48]-[50] A certificate is "incorrect in a material respect" only if the error is not trivial or immaterial. The insurer submits no material error is demonstrated affecting whole person impairment to the threshold for non-economic loss and the application must fail on this basis alone.

1. The Panel summarises the submissions of [CED] dated 27 May 2024 by reference to paragraph numbers:

[1]-[3] [CED] sets out the background to the dispute and submits that Medical Assessor Canaris erred in his assessment.

[4] [CED] sets out Medical Assessor Canaris' PIRS table findings.

[5] Medical Assessor Canaris certified the injuries caused by the accident gave rise to 8% WPI.

[6]-[7] [CED] sets out s 7.26 of the Motor Accident Injuries Act 2017 (NSW) and notes the onus of proving the medical assessment is incorrect lies with

[8] The claimant relies on the following grounds of review:

(a) the Medical Assessor's PIRS "Adaptation" findings are demonstrably incorrect and inconsistent with [CED]'s instructions, treating evidence, and both parties' medico-legal evidence;

(b) the Medical Assessor's findings are substantially inconsistent with the preponderance of treating and medico-legal evidence regarding the psychological injuries;

(c) the Medical Assessor failed to put inconsistent findings to [CED], denying procedural fairness and resulting in material error, and

(d) the Medical Assessor failed to give adequate reasons regarding the WPI assessment of psychological injury, contrary to Rodger v De Gelder [2015] NSWCA 211.

[9] [CED] submits that these failures render the overall assessment materially incorrect and justify referral for review by the Proper Officer.

[10] It is submitted that the Medical Assessor erred in applying Class 2 where Class 3 is plainly more appropriate, given his own findings and the criteria in the Permanent Impairment Guidelines.

[11] Page 11 of the report records significant deficits in self-care, including a lack of motivation to shower, dependence on reminders, inconsistent eating, and inability to manage independently.

[12]-[13] Dr Suman (psychiatrist) applied the Guides correctly in 2021 and assessed Class 3 for equivalent symptoms. [CED] submits the evidence supports a Class 3 rating, amounting to a material error requiring review.

[14] It is submitted that the Medical Assessor erred in applying Class 2 rather than Class 3 based on his findings and the relevant criteria.

[15] Page 11 records severely restricted social engagement, rare outings, and avoidance due to anxiety.

[16]-[17] Dr Suman assessed Class 3 in 2021 for the same type of deficits. [CED] submits the evidence supports material error in applying only Class 2.

[18] No dispute arises regarding the Class 2 rating.

[19] It is submitted that the Medical Assessor erred by applying Class 2 instead of Class 3, given his own findings and the relevant criteria.

[20] Page 11 records significant functional impairment in parenting, intimate relationships, frustration tolerance, and interpersonal functioning.

[21]-[22] Dr Suman assessed Class 3 for comparable deficits. [CED] submits the evidence supports material error and the inappropriateness of a Class 2 rating.

[23] There is no dispute regarding the Class 3 rating.

[24] It is submitted that the Medical Assessor erred by applying Class 3 rather than Class 5, which is plainly more appropriate on the evidence and the criteria.

[25] The report confirms [CED] has not worked since 2019, is on DSP, cannot see himself working due to concentration, memory and physical issues, and is not employable. The Medical Assessor nevertheless reduced the classification due to physical contributions.

[26]-[27] Dr Suman assessed Class 5 in 2021 for these same deficits. [CED] submits the evidence supports a Class 5 rating, and the Class 3 finding constitutes a material error.

[28]-[30] [CED] submits that this reflects a demonstrable misapplication of the Permanent Impairment Guidelines, constituting material error requiring review. Guideline 1.220 expressly resists literal application of criteria and requires consideration of all circumstances. This aligns with Dr Suman's 2021 assessment, which properly applied the Guides and resulted in WPI above 10%. The applicant, [CED], has discharged the statutory onus, and the matter should be referred for review.

[31] [CED] relies on Elliott v Insurance Australia t/as NRMA Insurance [2014] NSWSC 1848. Justice Campbell held that the Proper Officer must assess whether there is reasonable cause to suspect material error and should consider the totality of the criticisms rather than isolated points.

[32]-[33] His Honour held at [59] that a "state of unease" is sufficient to enliven the power to refer a matter for review. [CED] submits that this threshold is satisfied here: the errors produce a clear state of unease regarding correctness.

[34] Correct application of the PIRS Categories would exceed 10% WPI, consistent with Dr Suman's 2021 calculations.

[35]-[44] [CED] sets out the cases upon which his submissions are based, including Dogon v Redmond & Ors [2010] NSWSC 1329 (reasonable cause), Farache v Motor Accidents Authority of NSW & Ors [2011] NSWSC 446 (causation, applying the guides), and Meeuwissen v Boden & Motor Accidents Authority of NSW [2010] NSWCA 253 (reasonable cause to suspect material error exists)

1. The Panel summarises the submissions of the insurer dated 28 September 2023 by reference to paragraph numbers:

[1]-[8] The insurer sets out the background to the dispute and sets out a list of the medical reports/materials it has received and relies upon.

[9] The insurer submits that [CED] sustained several subsequent injuries:

• 2013 motor vehicle accident;
• 2015 Achilles tendon tear while playing soccer, and
• 2022 motor vehicle accident.

[10]-[13] The insurer submits that immigration records show significant periods overseas before the subject accident. It is recorded that [CED] again lived overseas for almost a year (2015-2016). The insurer submits that absence of Argentine treatment records prevents a complete understanding of pre-accident history.

[14]-[22] These submissions are in respect to physical injury and are not reproduced by the Review Panel.

[23]-[32] These submissions are in respect to physical injury and are not reproduced by the Review Panel.

[33]-[51] These submissions are in respect to physical injury and are not reproduced by the Review Panel.

[52]-[55] These submissions are in respect to physical injury and are not reproduced by the Review Panel.

[56]-[58] These submissions are in respect to physical injury and are not reproduced by the Review Panel.

[59]-[66] These submissions are in respect to physical injury and are not reproduced by the Review Panel.

[67] The insurer submits that [CED] had a substantial pre-existing psychiatric condition, including social anxiety and antidepressant treatment.

[68] The insurer notes that it lacks psychiatric records from Argentina, limiting pre-accident insight.

[69]-[70] The insurer submits that the first psychological complaint post-accident was almost three years later (2015) and that no psychological complaints were recorded again until 2020, around the time of the Claim Form.

[71]-[72] The insurer submits that despite [CED] asserting psychological treatment from 2012-2015, no records from this period were provided. It further submits that [CED] attended consultation in August 2020 stating an intention to make an insurance claim and reported several physical and mental health symptoms.

[73] The insurer submits that contemporaneous records do not support causation of psychiatric injury.

[74] The insurer submits that Dr Rikard-Bell found no diagnosable psychological injury related to the accident, only temporary exacerbation of a pre-existing condition.

[75] The insurer submits that several factors demonstrate ongoing function:

• continuous employment in multiple roles since the accident;
• ability to drive (including involvement in two further accidents), and
• self-care and childcare capacity.

[76] The insurer submits that any psychiatric injury is pre-existing, not caused by the subject accident.

1. The Panel summarises the submissions of the insurer dated 3 May 2023 by reference to paragraph numbers:

[1]-[3] [CED] sets out the background of the dispute.

[4]-[18] These submissions concern the production of requested records from

[19]-[20] The insurer notes that [CED] has a significant pre-accident history in relation to his psychiatric condition. In particular, the Insurer notes the following:

• 15 February 2012 - requested psychiatric referral; history of anxiety disorder; previous antidepressants, and
• 29 February 2012 - reported four-year history of anxiety and low mood; depression in Argentina treated with antidepressants; childhood sexual abuse; bullying; fleeting suicidal thoughts; K10 score of 22.

[21]-[23] Bridges Psychology Clinic have informed the insurer that they have updated records since 2021 and that [CED] has attended numerous times.

[CED] reported to Dr Suman (29 November 2021) that prior to 2010 he was reviewed by a psychiatrist and trialled antidepressants. He also reported that in early 2012 he was reviewed by a psychiatrist due to mild generalised anxiety disorder. Accordingly, the records of St John of God Hospital Burwood Medical Centre, Bridges Psychology Clinic, [CED]'s GP and the Medicare and PBS records are crucial.

[24]-[32] These submissions are in respect to physical injury and are not reproduced by the Review Panel.

[33]-[36] The insurer submits that [CED]'s application is premature and that an Assessor would benefit from a complete clinical picture given the time elapsed, multiple alleged injuries, and significant pre-existing psychological history. The Insurer reserves its rights to provide further submissions upon receipt of records and expert evidence.

1. On 25 September 2025, Medical Assessor Gerald Chew and Medical Assessor Samson Roberts examined [CED] on behalf of the Panel. The findings of the Medical Members of the Panel are reproduced below.

1. [CED] is 43 years old and lived with his wife and two young children. [CED] was unaccompanied at interview and attended via MS-Teams from his home. He provided his NSW Driver License as identification.
2. He was born in Argentina and migrated to Australia at three months of age. He is an Australian citizen. He grew up in Sydney. He has one younger sister who lives locally but reports limited contact with her. He describes a strained relationship with his parents for the past 8-10 years, which he dates to around the time he met his wife. His parents previously lived nearby and were involved with his children but moved to St Andrews two months ago.
3. He completed Year 12, achieving a pass. He then completed a TAFE course in welding and manufacturing. His work history includes: Managing his father's 20-room hotel in Argentina for four years; returned to Australia and started his own welding business, which he ran for 11 months prior to the 2012 accident; worked full-time at Australia Post from 2014 to 2017; worked in welding for one year; took three months off; worked at a large supermarket chain collecting trolleys for one year (c. 2018-2019); ceased work at Coles after a friend suggested he pursue a legal claim for the accident; worked as a cleaner for approximately six months, ending in June 2025, and currently assists his father with welding on a casual basis.
4. He met his wife in 2013 and married in 2015. His wife was in Australia on a student visa. They have two children, aged seven and nine. He reports his wife does most of the cooking, cleaning, and shopping. He assists with gardening and drives the children to and from school. The family travelled to China (c. 2022) and Queensland (c. 2020), with financial assistance from his father. In 2015/2016, he spent one year in China with his wife due to her visa requirements and his injury. During that time, he also travelled to the United States and Argentina.
5. He was involved in a motor vehicle accident in 2011. This was a three-car pile-up. He was in the third car. He sustained a low back injury which he felt was resolving prior to the 2012 accident. He did not think that this affected his psychological status.

1. He reported that he was diagnosed with anxiety around 2008 and received treatment including medication, which he found helpful. He said that he ceased antidepressants upon his return to Australia from Argentina well prior to the 2012 accident.

1. Alcohol: Reports drinking 300-400ml of scotch mixed with coke, three to four times per week. This level of use began this year. States he drinks to "forget" problems. Sometimes feels the urge to drink in the morning.
2. Cannabis: Began using at age 18. Use became more regular after the 2012 accident. Reports daily use since the beginning of this year. Spends approximately $50 on a "bag" which lasts two to four weeks. Smokes every day, in the evening, but sometimes in the morning. States it helps with his pain but acknowledges it causes problems, particularly with driving.
3. Other Drugs: Denies use of other recreational drugs.
4. Gambling: Denies any history of gambling.

1. [CED] reported on 13 September 2012 being struck by a car from the rear right side while walking his bicycle and two dogs on leashes across a pedestrian crossing. He states he was carried on the bonnet for approximately 15-20m before falling off. He describes one dog landing on him and the other being pushed forward by the vehicle. He reports immediate anger, an inability to get up, and loss of sensation in his legs, describing it as feeling disoriented.
2. He reports an ambulance was called and he was taken to hospital. He states he was only in hospital for approximately 20 minutes and discharged despite being in pain, recalling being told there were "no available beds". He walked out of the hospital holding onto walls.
3. His account was at odds with the hospital records provided. His explanation was that he thought that the hospital had not recorded his account correctly and had minimised his symptoms.

History of symptoms and treatment following the motor accident

1. He presented to his GP the next day. He reported significant swelling in his knees and ankles, headaches, and involuntary kicking of his legs with pain radiating up his spine that night.
2. His account was of symptoms of greater severity than in the records provided. This was put to him and he feels the GP minimised his injuries in the documentation.
3. He reports the onset of mental health symptoms after consulting a lawyer in October 2019. Symptoms at the time included depressed mood, feeling that his reports of the accident were not being believed, and worry about his inability to recover. He feels his symptoms have worsened over time.
4. He saw a psychiatrist, Dr Verma, in 2020 for approximately one year (seen every three months). He was prescribed venlafaxine and mirtazapine. He also trialled Epilim but ceased it due to excessive sedation. He stopped seeing Dr Verma due to cost.

He has been seeing a psychologist since 2012, currently on a bimonthly basis.

1. Physical: He reports chronic lower back pain, neck pain, and right knee pain, which he states have worsened over the last few years. He also reports muscle cramps.

Psychological: He reports intrusive memories of the accident, which occur almost daily and are often triggered by physical pain. He describes feeling "shut down" by these memories. He reports depressed mood, financial stress, and feeling unable to move forward with his life. He endorses feelings of being stressed, agitated, and depressed, which affects his motivation. 2. Reports social withdrawal and has lost contact with friends, attributing this to feeling overwhelmed, worry, and financial constraints. For recreation, he plays video games (PlayStation, shooting games) two to three times a week for about an hour, which is less than in previous years. He also goes for walks, listens to news podcasts, and practises meditation.

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

1. He describes a Motor Vehicle Accident (2014): He lost control of his car in wet conditions and hit a parked car at approximately 60kmph. He reports feeling sore but states the injuries were not comparable to the 2012 accident. He reports being more cautious when driving in the rain since.

**104. Note - objectively the accident appears to be more serious in its nature than the 2012 accident.

1. The assessment was undertaken using audiovisual technology. The quality of the connection was satisfactory. [CED] was unaccompanied in a room at his house. He was cooperative for the duration of the 90-minute interview. [CED] presented as casually dressed. Rapport was established. He was cooperative throughout the lengthy interview. Speech was of normal rate and volume. Mood was described as depressed. Affect appeared reactive and at times slightly defensive, particularly when his account of the accident or inconsistencies were questioned. Thought stream was coherent. There was no evidence of formal thought disorder. He expressed feelings of hopelessness related to his chronic pain and financial situation. He denied active suicidal ideation, citing his children as a protective factor. No other psychotic phenomena were elicited. Cognition appeared grossly intact. He maintained concentration for the 90-minute interview. He demonstrated some insight into his substance use as a coping mechanism but limited insight into its contribution to his current functional impairment. Judgment appears affected by his substance use. There was no suicidal ideation. He was oriented to time, place and person.

1. [CED] is a 43-year-old man with a pre-existing history of anxiety. Following a motor vehicle accident in 2012, he has developed chronic pain and psychological symptoms. His functional capacity has been variable, with his longest period of employment on the open market occurring after the accident.
2. [CED] has an adjustment disorder with mixed anxiety and depressed mood, persistent (chronic) per DSM-5-TR.
3. In response to the 2012 motor accident and the ongoing reported physical symptoms he has developed clinically significant distress which does not meet criteria for another mental disorder. The disorder is now persistent or chronic because it has persisted for more than six months in the context of ongoing physical dysfunction from the accident.
4. The panel notes that [CED] worked full-time for three years after the accident for Australia Post, a year as a welder and, after three months off, worked for Coles for a further year. The panel could not identify any basis for his apparent significant decline in functioning which, based on the employment history, only occurred several years after the subject accident. The panel further notes that these jobs have a significant physical component however it is not for a psychiatric panel to comment further on inconsistencies of a physical nature. The panel notes [CED]'s report that he ceased working at Coles after a friend advised him to seek legal advice. Despite an effort to understand the evolution and time course of symptoms the medical assessors were left without a confident explanation to these apparent incongruities.
5. His depressive symptoms are not of significant severity to warrant a diagnosis of persistent depressive disorder or major depressive disorder.
6. He does not describe symptoms which meet the criteria for post-traumatic stress disorder, in particular there is a lack of severe intrusive or avoidance symptoms.
7. The Medical Assessors considered the diagnosis of cannabis use disorder. There was an inconsistency in the history with a report of daily cannabis use this year however the quantity of cannabis reported would indicate no more than occasional use.
8. The Medical Assessors considered the diagnosis of alcohol use disorder. Although he reported significant alcohol intake, his account did not support DSM-5-TR criteria for diagnosis.

1. Adjustment Disorder with mixed anxiety and depressed mood, Persistent (Chronic)

Psychological therapy, psychiatrist (not current), medication

[CED] is able to live independently albeit with reduced pace and motivation for self-care. He contributes to household tasks and care of children.

[CED] has reduced social and recreational activities. Despite his account in interview, the documentation reveals he has been engaging in social and recreational activities including adult entertainment.

[CED] is able to drive independently and has travelled on multiple occasions overseas.

He reports some strain with relationships but no periods of separation.

He reported subjectively worse concentration. He concentrated well during the interview of 90 minutes duration. He can concentrate of podcasts on his headphones when he goes out for his 1 hour walks.

He reports pain to be a limiting factor. He lacks motivation. He has worked since the accident albeit inconsistently. His longest period of employment was after the 2012 accident. From a psychological perspective he would be able to work reduced hours in a role for which he is qualified.

He reported no concentration difficulties or problems with persistence or pace.

1. Although [CED] remains on some treatment, his account did not reflect improvement in his condition nor did he ascribe any change in impairment to the treatment. The Panel found that there was no treatment effect.

1. On 16 October 2025 at 4.00pm, the Medical Review Panel met again and discussed the issues, the reasoning process, and the conclusions reached by the Medical Assessors in terms of the medical issues before them.
2. The Panel agreed that the Medical Assessors' consideration of the PIRS classifications was reasonable and within their clinical judgement, appropriate.
3. The Panel concluded that after having taken everything into account, 5% WPI was correct.

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

24 April 2024 and substitutes the following determination that as a result of the accident,

[CED] sustained the following injuries which gave rise to a permanent whole person impairment of 5%: * adjustment disorder with mixed anxiety and depressed mood, persistent (chronic).

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