MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; assessment of whole person impairment (WPI); the claimant suffered injury in a motor vehicle accident; claimant had an earlier workplace injury; Medical Assessor found injuries referred for assessment were not caused by the accident; claimant sought review; Held - both major depressive disorder and alcohol use disorder present before the accident; deterioration in function; aggravation of major depressive disorder and alcohol use disorder caused by the accident; claimant sustained non-threshold injury; current permanent impairment of 22% plus additional 1% for the effect of treatment; pre-existing permanent impairment of 19% WPI; permanent impairment assessed at 4% as result of injury caused by the accident.

Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017

1. The Review Panel revokes the certificate of Medical Assessor Canaris dated 2 July 2024 and issues a new certificate determining that the following injuries caused by the motor accident are not threshold injuries.
   • aggravation of a pre-existing major depressive disorder; and
   • aggravation of alcohol use disorder.

1. The Review Panel revokes the certificate of Medical Assessor Canaris dated 2 July 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a permanent impairment of 4%:
   • aggravation of a pre-existing major depressive disorder; and
   • aggravation of alcohol use disorder.

1. Mr Woongnam Cha (the claimant) sustained injury in a motor vehicle accident on 24 March 2022 (the accident).
2. Mr Cha is now 38 years of age and was 34 years of age at the date of the accident.
3. Mr Cha lodged an Application for personal injury benefits dated 14 February 2023 in relation to injury allegedly sustained in the accident.
4. Insurance Australia Limited trading as NRMA Insurance is the relevant insurer with liability to pay statutory benefits to Mr Cha under the Motor Accident Injuries Act 2017 (the MAI Act).
5. Mr Cha's claim is governed by the provisions of the MAI Act. At the time of the accident statutory benefits for treatment and care under the MAI Act ceased after 26 weeks if the person's only injuries resulting from the accident were threshold injuries.
6. On 13 October 2023 the insurer issued a Liability Notice - Benefits after 26 Weeks which determined that the claimant had sustained threshold injuries for the purposes of the MAI Act based on the reports of Dr McIntosh dated 31 May 2023, Dr Mitchell dated 15 June 2023, and Dr Bisht dated 8 August 2023.
7. On 17 October 2023 the claimant requested an internal review of the threshold injury decision.
8. On 7 November 2023 the insurer issued a Certificate of Determination - Internal Review

affirming the decision that the injuries met the definition of threshold injury for the purposes of the MAI Act. 9. Section 4.11 of the MAI Act provides that there is no entitlement to damages for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%. 10. On 4 May 2023 the insurer issued a notice advising it did not concede the injuries sustained by the claimant in the accident exceeded the 10% permanent impairment threshold. 11. The claimant filed an application with the Personal Injury Commission (Commission) seeking a medical assessment to resolve the threshold injury dispute and the permanent impairment dispute between the parties. 12. Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be medical assessment matters, including the threshold injury dispute and the permanent impairment dispute. 13. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1] 14. The dispute as to threshold injury and permanent impairment in respect of the psychological injury was referred by the Commission to Medical Assessor Canaris. 15. The claimant has sought a review of the certificate of Medical Assessor Canaris.

1. In accordance with a Direction dated 22 May 2025 the claimant on 16 June 2025 uploaded to the portal a bundle of documents indexed and paginated from pages 1 to 456 (claimant's documents).
2. The Panel noted the insurer had uploaded to the portal an indexed bundle of documents paginated from pages 1 to 1004 on 2 September 2024 in response to the application for review. On 9 July 2025 in response to a direction from the Panel the insurer confirmed those documents comprised the entirety of the records to be relied upon by the insurer in the review (insurer's documents).

1. The Motor Accident Injuries Amendment Act 2022 (the MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From

1 April 2023 the MAI Amendment Act provides that a "minor injury" is known as a "threshold injury" and "minor injuries" are known as "threshold injuries". 2. The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury. 3. Any reference in these reasons to "minor injury" is a reference to a "threshold injury" and any reference to the word "minor" referring to the injury alleged to have occurred in the accident is a reference to "threshold". 4. A threshold injury is defined in s 1.6 of the MAI Act. Section 1.6(1)(a) of the MAI Act defines a "threshold psychological injury" as:

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

1. Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a threshold psychological or psychiatric injury.
2. Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) provides the following:

"Each of the following injuries is included as a threshold injury for the purposes of the Act:

(a) acute stress disorder,

(b) adjustment disorder."

1. Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by the motor accident is a threshold injury for the purposes of the MAI Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:

"5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.

5.4 Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. Diagnostic imaging is not considered necessary to assess threshold injury.

5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.

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

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

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

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

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

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

1. In respect of threshold psychological or psychiatric injury the Guidelines also provide:

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

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

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

1. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
2. The Guidelines were issued pursuant to Division 10.2 of the MAI Act. Clause 6.213 of the Guidelines requires the impairment to be attributable to a psychiatric diagnosis recognised by the current edition of the Diagnostic and Statistical Manual of Mental Disorders, that is, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Text Revision (DSM-5) or the current edition of the International Statistical Classification of Diseases & Related Health Problems (ICD). The assessment of mental and behavioural disorders must be undertaken in accordance with the psychiatric impairment rating scale (PIRS) as set out in the Guidelines.
3. Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:

"6.6 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.

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."

CERTIFICATE UNDER REVIEW OF MEDICAL ASSESSOR CANARIS

1. In a certificate dated 2 July 2024 Medical Assessor Canaris certified the following injury referred to him for assessment as to threshold injury had been assessed and determined to be not caused by the accident:
   • Alcohol use disorder.
2. Accordingly, he concluded a decision as to whether the injury was a threshold injury was not required for the purposes of the act.

1. Medical Assessor Canaris certified all the injuries referred to him for assessment had been assessed and determined not caused by the accident. An assessment of the degree of permanent impairment was therefore not required.
2. The injury referred to Medical Assessor Canaris for an assessment of threshold injury and permanent impairment was:
   • Post-traumatic stress disorder.
3. Medical Assessor Canaris reported the claimant had not worked since a workplace injury in 2021 when he fell and broke his leg on a worksite. He was shortly to have a third surgery in relation to that accident. Medical Assessor Canaris obtained a history from the claimant.
   • He was 'not sure' how he was psychologically after the workplace accident;
   • Before the workplace accident he had a normal life - working - going fishing - going out with others.
   • His heavy drinking had come on in the aftermath of the workplace accident.
   • He smoked "a bit less than a packet of cigarettes" daily.
   • He came from South Korea and was raised by his grandmother.
   • He came to Australia in 2010 and worked as a tiler.
   • He had been with his girlfriend for eight or nine years.
4. The accident occurred when he was stationary at a roundabout and was hit from behind. His whole body was pushed forward and because of the seatbelt pushed back. Airbags did not deploy. Ambulance and Police did not attend. He reported injuries to his neck, back and left wrist and subsequently started feeling pain all around his body.
5. The claimant reported he felt very depressed, financially it was hard, and he was at home. He reported he spent his days sleeping, drinking and taking medications. He was consuming up to 12 cans of beer a day and "now drinks at least six to seven beers a day". He stated he drinks because of "anger, irritation and I can't sleep". He reported dreams of being chased by something. He lived off borrowed money and did not receive Centrelink payments.
6. He saw his GP and was on Duloxetine 60mg daily. He had seen a psychologist and psychiatrist until the middle of the preceding year.
7. Medical Assessor Canaris found the claimant's presentation was consistent with a diagnosis of alcohol use disorder where he reported he spent his day doing little other than drinking. He stated:

"His reported chronic pain suggests a diagnosis of somatic symptom disorder with predominant pain, but the validity of this diagnosis is difficult to determine given his very heavy drinking, the paucity of history on offer, and his vague description of symptoms. Others have diagnosed him with a major depressive disorder, but his very heavy drinking makes it very difficult to determine to what extent if any this is currently present. ... However, he seems currently unable to describe any specific drivers of his drinking. However, it is likely that his inability to work following his workplace accident with ensuing loss of structure in his life and financial hardship would have been contributed considerably to his drinking."

1. Medical Assessor Canaris found the accident was not of the kind that would give rise to post-traumatic stress disorder or precipitate a major psychiatric disorder. He also concluded it would be unlikely to cause significant aggravation of a pre-existing condition such as a post-traumatic stress disorder or alcohol use disorder.
2. Medical Assessor Canaris concluded the alcohol use disorder was pre-existing and he could not determine whether the accident played any enduring role in exacerbating the condition. He found similar considerations applied to any possible somatic symptom disorder.

1. The claimant lodged an application for review of the medical assessment of Medical Assessor Canaris on 12 August 2024 within 28 days of the date on which his certificate was made available to the parties.
2. On 27 September 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Panel.
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[2]
4. The review is by way of a new assessment of all matters with which the medical assessment is concerned.
5. On 10 September 2025 the Panel agreed an examination was required.

1. A Medical Review Panel comprising Member Cassidy, Medical Assessor Assem and Medical Assessor Barnsley issued a certificate dated 21 November 2024. The Panel found the claimant had sustained soft tissue injuries to the cervical spine, the lumbar spine and the right shoulder. The Panel found the claimant did not sustain injury to the left shoulder.
2. The Panel certified the injuries caused by the accident were threshold injuries and that the permanent impairment resulting from the injuries caused by the accident was 0%.

1. In the application dated 4 April 2022 the claimant reported he arrived at a roundabout and stopped his vehicle for the traffic to clear when suddenly a vehicle collided with the rear of his vehicle.[3]
2. He reported he sustained an injury to his neck with radiation down the right arm, radiculopathy, injury to both shoulders, injury to the back and psychological injury.

1. Photographs were provided of the claimant's vehicle and the insured driver's vehicle.[4] The claimant's vehicle had a tow bar but there is some minor damage seen to the rear tailgate panel. The insured vehicle had a nudge bar at the front of the vehicle, and it is difficult to see if there is any damage to that vehicle, although it is noted that Dr McIntosh reported the nudge bar appeared to be deformed rearward against the bumper bar.

Dr Andrew McIntosh, collision and biomechanical expert

1. The insurer relies upon a report of Dr Andrew McIntosh dated 31 May 2023.[5]
2. Dr McIntosh reported he was not qualified to comment on psychological/psychiatric injury but otherwise concluded:
   • the speed of the insured vehicle at the moment of impact was approximately 15 km/h.
   • the change in velocity of the claimant's vehicle as a result of the collision was approximately 11 km/h.
   • the claimant would have been exposed to low magnitude biomechanical forces during the incident;
   • within the boundaries of the likely crash severity and related biomechanical forces, a whiplash associated disorder/soft tissue injury involving the cervical spine with symptoms of a closed period of short duration is plausible.
   • a collision of much greater severity would be required to have caused the injuries the claimant alleges.

1. On 4 March 2021 the claimant attended Mona Vale Hospital after slipping over and rolling his ankle whilst opening a site gate (workplace injury). An X-ray demonstrated a moderately displaced distal tibial shaft oblique fracture and oblique fibula head fracture.[6] He was referred to Northern Beaches Hospital where he underwent open reduction and internal fixation (ORIF).

1. On 29 March 2022 Dr Lam reported the claimant's involvement in the accident when his vehicle was rear ended by another vehicle. She reported the claimant presented with neck pain, right arm radiation, right shoulder pain, low back pain and right arm paraesthesia. She reported the claimant was quite shocked and hadn't driven since. Dr Lam noted he had sustained a right tibial fracture after a fall a year ago which had completely resolved. She reported the claimant's sleep was disturbed and his mood was "okay if you don't think about it".
2. On 22 September 2022 Dr Lam reported the main issue was mental health[7]. She noted Ms Truong expressed concern that the claimant was using large amounts of alcohol as a coping mechanism for pain and depression. Dr Lam referred the claimant to Dr Naresh Verma, psychiatrist for severe depression in the context of post-traumatic stress disorder.[8] In the letter of referral she reported he suffered physical injuries including his low back in the accident which progressed to chronic pain. She reported he was very traumatised with symptoms such as hyperarousal, hypervigilance, withdrawal, isolation, and avoidance, irritability and negativity with a pervasive sense of hopelessness about the future. She reported he felt suicidal.
3. On 23 February 2023 Dr Lam recorded:

"Pt now has been on escitalopram 20mg for some time.

1. However, in her second consultation note of 23 February 2023 Dr Lam referred to the injury which occurred on 4 March 2021 on a job site. She noted the claimant sustained a fracture of the right tibia and underwent ORIF at Northern Beaches Hospital. She reported he had ongoing pain and was awaiting approval for removal of the hardware. However, on 23 March 2023 Dr Lam reported the surgery had been deferred due to the claimant's alcohol use. It was reported he was down for four to five cans of beer a day.
2. On 6 May 2023 Dr Lam reported the claimant had reduced his alcohol intake a lot and had the hardware removed on 5 May 2023.On 18 May 2023 Dr Lam reported the claimant's alcohol use was down to one to two drinks per day. On 10 August 2023 Dr Lam reported the leg pain had improved, the claimant wanted to be able to look for work but considered it unrealistic because he could not walk for more than 10 minutes and the kneecap felt like it was moving. On 24 August 2023 it was reported the claimant was a lot more negative, the kneecap was loose, and he had persistent ankle pain. In a consultation dated 10 August 2023 in relation to the accident it was noted the claimant was attending psychotherapy weekly.
3. On 7 September 2023 Dr Lam reported the claimant was back to having 12 cans of beer. He reported he was still seeing the psychologist but was very angry and felt victimised. Dr Lam emphasised a need for a reduction in alcohol noting it was likely to exacerbate depression
4. On 8 September 2022 Dr Lam reported the claimant required alcohol to sleep and help with pain from both accidents.
5. On 22 September 2022 Dr Lam referred the claimant to Dr Verma for treatment of the claimant's "severe depression in the context of PTSD". She reported the claimant was suicidal and was drinking heavily.
6. On 12 January 2023 Dr Lam reported the claimant needed psychiatric intervention and she advised inpatient treatment.

1. Clinical notes of Flora Truong, psychologist relate to consultations between 11 May 2022 and 6 September 2023. The notes include the following:
   • 11 May 2022 - rear end accident; at the time experienced severe back pain and pain in the right leg.
   • 17 June 2022 - sleep disturbance; claimant consuming seven to eight bottles of beer a night to assist with sleep; staying at home makes him depressed.
   • 29 August 2022 - depressed and irritable; fear driving on busy road, avoids peak hours, drives locally, prevented by anxiety and stress - easily irritated; cannot find employment due to restrictions; limping at this stage; alcohol ten to twelve cans per day; when sober overwhelmed by depression.
   • 12 September 2022 - Dr Lam prescribed Endep for sleep.
   • 21 September 2022 - deteriorating mental health; depressed and using alcohol to cope with mood disturbances, sleep and persistent pain; ten beers a day is regular pattern of consumption; onset alcohol dependence commenced after accident.[10]
   • 28 December 2022 - minimal interaction with Soo Jin; sleep pattern is poor; been drinking; mood depressed - feeling sluggish; not eating much; no plans for Xmas; financial worries a major concern.
   • 9 January 2023 - recurrent and intrusive memories; avoids driving due to anti-depressant use and fear of driving; distressing dreams of the event; emotional distress when reminded of the accident; avoidance of thoughts and conversations associated with accident; avoids roundabouts; hyperarousal in heavy traffic; decreased interest in activities such as fishing, driving and going to restaurants; disconnected and detached from others; view future will be cut short; feeling isolated; sleep disturbance; four to six hours with alcohol or two hours without alcohol; irritable mood; concentration difficulties; hypervigilance; exaggerated startle response; feeling hopeless about financial situation; depressed mood; ruminating thoughts; conflict with partner; frustrated and upset about restriction and lack of work capacity.[11]
   • 24 April 2023 - no longer share intimacy with partner; lost all friends - he only has two friends; talks to mother on weekly basis; loses attention easily; struggles to read; ceased watching TV - hard to concentrate; cannot drive.
   • 13 June 2023 - increased dosage of Duloxetine to 60mg; sleep two to three hours; takes naps during the day; glass of wine and two cans of beer a day.
   • 16 August 2023 - three to four cans beer a day, usually when he wakes up; when he drinks he sleeps better; he drinks to prevent nightmares.
   • 6 September 2023 - 12 cans of beer already by 2pm; stress lately, bank balance; his way of coping and not have to think about problems; "I don't know how life will go on".[12]
2. In a report dated 1 August 2022 Flora Truong diagnosed post-traumatic stress disorder caused by the accident. She noted the claimant relied on alcohol to help him sleep and may require specific alcohol rehabilitation.[13]
3. In a reply to a request for medical information dated 3 May 2023 Ms Truong diagnosed post-traumatic stress disorder.[14] She reported the claimant had difficulties with self-care which was reflected in his lack of adequate personal hygiene. She reported he showered every third day and changed his clothes every 7-10 days. He did not perform any domestic activities. He mainly stayed home and no longer engaged in leisure activities of fishing, driving or eating out with friends. He struggled to socialise. She reported the claimant has difficulty with driving due to his post-traumatic stress symptoms. She reported he relies on Uber to travel to appointments. Ms Troung reported pre-injury the claimant saw friends four to five times a week and enjoyed inviting friends to his place for a meal. The claimant no longer spends meaningful time with his partner Ms Lee and there is no intimacy. Ms Truong reported the claimant said he loses attention easily and finds it hard to concentrate to read or watch television. She reported the claimant's daily reliance on alcohol leaves him in an inebriated state at times and impairs his participation in his mental health treatment.

1. The claimant was assessed by Dr Verma on 7 February 2023 by phone.[15] He did not obtain a history of the workplace accident. He reported since the accident the claimant had been drinking up to seven beers daily when prior to this he would have one to two drinks a day. Dr Verma reported he had stopped his usual activities of fishing and driving and did not see his friends much. Dr Verma reported the claimant slept for three to four hours and had nightmares of the accident which he was unable to describe. He reported the claimant felt miserable but had never experienced suicidal ideation. Dr Verma diagnosed an adjustment disorder. He reported the claimant has some features of PTSD, including nightmares, avoidance, irritability, and negative alteration in cognition and mood. He prescribed duloxetine and quetiapine.
2. On 13 June 2023 Dr verma reported the claimant continued to feel low in mood but was less irritable. He drove only if he had to. It was reported he slept for four hours at night but also sleeps in the daytime. He had ongoing nightmares and had reduced his alcohol intake to two drinks a day.[16]

1. Dr Mitchell examined the claimant for the insurer. In his report dated 15 June 2023 he concluded the claimant had sustained soft tissue injuries to the neck and lower back caused by the accident.[17] He also noted the claimant continued to have significant incapacity due to the right lower leg injury sustained in the earlier workplace injury.

1. Dr Bisht examined the claimant for the insurer and provided a report dated 27 July 2023.[18]
2. Dr Bisht stated the claimant didn't have a fear of death at the time of the accident, but he felt his sense of safety was violated abruptly and he felt shocked. However, no ambulance attended, and no hospitalisation was required.
3. Dr Bisht reported a worsening of the pre-existing psychological symptoms including:
   • lack of enjoyment in previously pleasurable activities.
   • difficulty sustaining concentration.
   • initial and middle insomnia.
   • lack of motivation towards socialising and self-care, as well as hobbies.
   • feeling anxious in day-to-day situations and being easily startled.
   • persistent flat mood.
   • irritability.
   • feeling distant from people.
   • lack of enjoyment.
4. Dr Bisht also reported he started to experience:
   • frequent recollections of the accident (nightmares and flashbacks) associated with feeling anxious/sad;
   • preoccupation with the physical injury;
   • hypervigilance when in a vehicle.
5. Dr Bisht reported the claimant still felt hypervigilant and fearful about similar experiences. He was edgy with unfamiliar places and unfamiliar people. His concentration had not improved, and he did not sleep well. His mood was flat, and he lacked motivation to socialise. He felt fatigued during the day, and nightmares continued to occur a few times a week. He no longer showered every day, missed meals and didn't exercise regularly. He was unable to travel to unfamiliar places on his own and his relationship with his family was more distant. He was often irritable. He had not returned to work. He can drive but avoids doing so.
6. He reported a prior history of an adjustment disorder arising from an earlier workplace injury. Dr Bisht noted the claimant had started to drink excessively after that injury, he found it hard to sustain focus for prolonged periods and he would not shower every day like he did before. He also became somewhat distant from his partner. He did not have any psychiatric treatment following the work-related injury.
7. Dr Bisht diagnosed a major depressive disorder and specific phobia which he considered was partially related to the accident with the remaining contribution coming from the pre-existing condition. He declined to assess permanent impairment on the basis the claimant had not reached maximum medical improvement.
8. Dr Bisht provided a supplementary report dated 8 August 2023.[19] After reviewing the report of Dr McIntosh Dr Bisht determined the accident was not of sufficient severity to cause a major psychiatric injury. He suggested the psychiatric symptoms were either a result of his work-related injury or that he was malingering. He concluded any psychiatric injury arising from the accident would have been minor such as an adjustment disorder. He found the claimant had sustained a threshold injury and assessed a 0% WPI.

1. Dr Jonathan Herald assessed the claimant and provided a report dated 3 October 2023.[20] He reported whilst the claimant was unable to return to work following the workplace accident on 4 March 2021 he was still functioning at home and driving until the accident. Dr Herald diagnosed soft tissue injury to the cervical spine with referred pain to both shoulders, bilateral shoulder impingement syndrome, soft tissue injury to the lumbar spine and chronic pain.

1. The claimant provided submissions dated 12 August 2024 in support of the application for review.
2. The claimant submitted the medical records of the claimant's treating professionals demonstrate the progression of post-traumatic stress disorder was the cause of his alcohol use disorder.
3. In relation to the threshold injury dispute the claimant noted that in accordance with David v Allianz Australia Insurance Ltd a threshold injury can occur at any time.[21] It is submitted the medical evidence establishes that the claimant had sustained post-traumatic stress disorder.
4. The claimant submits that Medical Assessor Canaris has not stated when he began to suffer from an alcohol use disorder. Noting that alcohol use disorder is recognised as a psychiatric illness as defined by the DSM-5 it qualifies as a non-threshold injury under the MAI Act and if present at any time would constitute a non-threshold injury.
5. The claimant also submits that Medical Assessor Canaris did not give the claimant an opportunity to comment on the alcohol use disorder in accordance with clause 641 of the Guidelines. The claimant submits that whilst he was drinking prior to the accident Medical Assessor Canaris failed to establish when the heavy drinking changed to "alcohol use disorder". The claimant submitted Medical Assessor Canaris found the alcohol use disorder was pre-existing when he had no evidence to support that conclusion.
6. The claimant submits in dismissing the diagnosis of post-traumatic stress disorder and replacing it with alcohol use disorder Medical Assessor Canaris failed to consider whether the alcohol use disorder developed as a result of the post-traumatic stress disorder

1. The insurer provided submissions dated 14 February 2025 in response to the application for an assessment of threshold injury and permanent impairment.[22]
2. The insurer relies upon the report of Dr McIntosh to allege a collision of much greater severity would be required to cause the injuries alleged. Dr McIntosh opined that the biomechanical forces acting on the claimant would not be strong enough to cause ongoing injury.
3. The insurer relies upon the supplementary report of Dr Bisht who concluded the accident was not of sufficient severity to cause a major psychiatric injury. He concluded the psychological symptoms reported by the claimant were either a result of the work-related injury or due to malingering.
4. The insurer relies upon the opinions of Dr Verma and Dr Bisht who both diagnosed an adjustment disorder as a result of the accident. It is noted an adjustment disorder in accordance with clause 4(2) of the Regulation falls within the definition of threshold injury.
5. The insurer also notes Dr Bisht assessed a 0% WPI.
6. The insurer provided submissions dated 2 September 2024 in response to the application for review.
7. The insurer submits Medical Assessor Canaris provided a clear path of reasoning for the conclusion set out in his certificate. It is noted that Medical Assessor Canaris was entitled to form his own determination, and he used his own expertise to conclude:

"... that the accident as described and as depicted in the documentation on hand was not the kind of event that would give rise to a diagnosis of posttraumatic stress disorder or the kind of event that would be likely to precipitate a major (non-threshold) psychiatric disorder"

1. The insurer also submits there was no denial of procedural fairness where Medical Assessor Canaris questioned the claimant about the workplace accident, his heavy drinking and how he felt in himself before and after the motor accident.

1. The claimant was assessed by Medical Assessor Yeates and Medical Assessor Baker on 24 October 2025 by videoconference through MS Teams.

1. Mr Cha was born in Seoul, Republic of Korea. His parents initially raised him, but they separated early in his life and his father moved abroad to China. Mr Cha initially followed his father to China but was returned to Korea to live with an older lady who was described as his "grandmother" and became his primary attachment figure. He has no siblings. He was raised in an apartment with his grandmother who he discovered was Mr Cha's mother's adoptive parent. Mr Cha had unclear memories of his early life and commented that, although he had the basics, such as food and clothing, he hypothesised that the money his parents sent for his care to his grandmother was not, in fact, spent on him and was spent by Mr Cha's uncle instead. He denied any enduring physical punishment from his grandmother or other exogenous traumas such as physical, sexual, or emotional abuse. Mr Cha's father died by homicide in unclear circumstances, but likely, in Mr Cha's view, related to his father being owed money that he was trying to recover. Overall, Mr Cha described his time with his grandmother as "not great," although his basic needs were met. He was an otherwise healthy child and young person.
2. Mr Cha attended school in Seoul, had some friendships and was never suspended or expelled from school. He completed year 12. Around age 15, Mr Cha was seriously assaulted in what was described as a "random attack" by 15 to 20 people, which led to hospitalisation. Mr Cha completed Year 12 with below-average results.
3. His first job was as a waiter in Seoul, where he worked for three to four years. Mr Cha also had a shop and traded on the Korean stock market, incurring losses before coming to Australia in 2010, when he was 23. He initially came to Australia on a working holiday visa and worked on the farm to obtain an extended working holiday visa. He also worked in a factory and met his future wife. His wife is an Australian citizen, and they have no children. Mr Cha worked in construction as a tiler from his mid-20s until 2021. He lives with his wife in Silverwater in Sydney.
4. In 2021, Mr Cha sustained a serious injury to his leg whilst working on a construction site. He said that he was on a muddy construction site and slipped and fractured his leg, requiring surgery and leading to chronic pain. He said he spent seven or eight months in bed due to pain and could not work at all. He began feeling hopeless and suicidal.
5. Following this injury, his alcohol intake increased significantly, and he began consuming up to 12 cans of beer per day with accompanying dependence and withdrawal symptoms. He had anxiety symptoms and felt very stressed about providing for his wife in the future. His functioning after the workplace accident, which is subject to a workers' compensation claim, was substantially impaired. For example, Mr Cha neglected his self-care, showering infrequently and eating only about one meal per day. He had no social or recreational activities other than watching television, and he never went out to see friends or participate in any group activities. He was not driving due to chronic pain and the leg injury; however, his travel was not otherwise limited by psychological symptoms. He said his relationship with his wife was very strained, with frequent arguments, but they were not planning a separation at that time. He said his concentration was poor and he was unable to focus on the television or read books. He did not work after 2021 and never attempted to return. He still has pending surgical procedures planned.
6. Before the workplace accident, Mr Cha had never been referred for or received psychological treatment. He denied any periods of enduring low mood, alcohol misuse, or anxiety symptoms before the workplace accident. He has never had a psychiatric admission. He had never experienced suicidal ideation before the workplace accident. He was unable to recall if he began taking any depressant medications after the workplace accident or beforehand. Similarly, he could not remember if he had had other psychological therapies after the workplace accident.
7. His other health issues include psoriasis, chronic low back, neck, and leg pain. Mr Cha described significant financial constraints, having received only $200 per week from his workers' compensation payments up to the present. He said he relies on borrowing from friends and estimated his debts to be up to $100,000. He is under the care of his GP, Dr Angela Lam, a dermatologist and his psychologist, Flora Kang.
8. There is no history consistent with a primary psychotic illness or bipolar affective disorder. There is no family history of major mental illness, addictions, or completed suicide. Mr Cha began drinking alcohol around age 15 but denied any significant issues of excessive alcohol consumption until later in adulthood, as outlined above. He has never taken illicit drugs and does not gamble. He smokes one pack of cigarettes per day. He is currently subject to a pending driving offence for refusing a breathalyser test.

1. On 24 March 2022, Mr Cha was stationary at a roundabout in Kemps Creek and was hit from behind by another vehicle. He was wearing a seatbelt, and the airbags did not deploy. He had his foot on the brake and the car lurched forward. It had not been long since his leg surgery, and he experienced pain in his leg. After the accident, he took photographs of the car and contacted his insurance company. He denied being intoxicated at the time of the accident. Neither the police nor the ambulance attended the scene of the accident. He was able to discuss the accident with the other driver and exchanged details. He drove his car home.
2. He consulted his general practitioner the next day, due to pain and was referred for physiotherapy. He described ongoing neuropathic pain in his right ankle. Mr Cha said he also developed psoriasis and was bedridden with pain for a substantial period.

History of symptoms and treatment following the motor accident

1. Mr Cha developed psychological symptoms that included low mood, pathological guilt, hopeless and worthless feelings, and he lost a substantial amount of weight. He also described suicidal ideation. He was referred to a psychologist whom he saw weekly or fortnightly and continues to consult to the present, Flora Kang. Mr Cha was prescribed antidepressant medication that included Duloxetine, Escitalopram, Quetiapine and Amitriptyline. He also took Oxycodone for pain.
2. Mr Cha reported that his alcohol consumption continued at high volume, with possibly some increase in the quantity of beer consumed compared with before the accident. Mr Cha described symptoms consistent with alcohol dependence, including morning alcohol consumption (eye-opener drinks), agitation when he doesn't drink alcohol and poor sleep and anxiety if not consuming alcohol, escalating quantities consumed, and neglect of other activities due to alcohol consumption.

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

1. There are no relevant injuries or condition sustained since the motor accident.

1. The mental state examination revealed a man of Korean descent who was wearing a dressing gown and appeared dishevelled with very messy hair, unshaven, and generally unkempt.
2. His social behaviour was broad but with some diffuse irritability detected, making rapport fragile He revealed during the interview that he had consumed beer before the assessment pertinent to this claim.
3. His mood was depressed and his affect was flattened, but with some periods of reactivity that were somewhat incongruent. The thought content was reality-oriented with no features of psychosis or suicidality but replete with lamentations regarding his inability to work, self-recriminating cognitions about his capacity to care for his family and a global impression of shame. His thought form was normal. His speech was normal in grammar, structure, syntax, but slightly reduced in quantity according to the interpreter. There were no perceptual disturbances. His judgement was impaired by the chronic and acute effects of alcohol, but the quality of the history was able to be trusted. The cognition was grossly normal, but with no indication for formal testing. The insight was poor.

1. Mr Cha currently showers every three to four days and only eats one meal per day. He relies entirely on his wife for domestic support provided gratis. He's a member of no social groups, clubs, churches, and has no friends with whom he has regular social contact. Although he travels to his friends' homes to borrow money. Mr Cha does not currently drive, but this is due to a pending driving charge and the current suspended license. He most recently drove two months ago. He does not use public transport, but he's not limited by psychological symptoms. He and his wife argue regularly, but they are not planning separation. He is unable to concentrate on the television such that he can't follow the story of a television show but can watch short videos on his telephone. He doesn't know other demanding cognitive tasks, such as reading or study. He has not worked since his workplace accident and has not attempted to return to work in any capacity since 2021, prior to the motor accident.

1. Mr Cha's presentation at the interview was globally consistent.

1. The medical assessors reported Mr Cha presents with symptoms and signs consistent with major depressive disorder and alcohol use disorder. Both psychiatric conditions were present before the motor vehicle accident pertinent to this claim. The index event precipitating his psychiatric conditions was the workplace accident that occurred in 2021.
2. Mr Cha's account of the motor vehicle accident confirms that it does not satisfy criterion A for post-traumatic stress disorder. Moreover, the history and examination were not consistent with post-traumatic stress disorder.
3. Nevertheless, there has been some deterioration in functioning following the motor vehicle accident due to exacerbation of his pre-existing conditions of alcohol use disorder and major depressive disorder.

1. A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

(i) Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)

Mr Cha has depressed mood for most of the day nearly every day. This criterion is satisfied.

(ii) Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).

Mr Cha has few interests and experiences minimal pleasure in nearly all of his activities nearly every day. This criterion is satisfied.

(iii) Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month) or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)

Mr Cha has lost a significant amount of weight, although he could not estimate how much. His appetite is reduced, and he only eats one meal per day. This criterion is satisfied.

Mr Cha described regular awakenings and insomnia, when he wasn't intoxicated with alcohol. This criterion is satisfied.

(v) Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

Mr Cha did not describe this symptom; this criterion is not satisfied.

Mr Cha describes significant loss of energy and motivation. This criterion is satisfied.

(vii) Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

Mr Cha described enduring feelings of worthlessness, hopelessness, and inappropriate guilt. This criterion is satisfied.

(viii) Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

Mr Cha described ongoing difficulties with concentration, thinking, and complex reasoning. This criterion is satisfied.

(ix) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Mr Cha reported suicidal ideation. This criterion is satisfied.

1. B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

There is a significant impairment in psychosocial functioning. This criterion is satisfied.

1. C. The episode is not attributable to the physiological effects of a substance or another medical condition.

There is some overlap with Mr Cha's symptoms of alcohol use disorder, as outlined below; however, the panel was satisfied that Mr Cha had globally consistent symptoms and signs of major depressive disorder in addition to alcohol use disorder.

1. A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

(i) Alcohol is often taken in larger amounts or over a longer period than was intended.

Mr Cha described escalating use of alcohol commencing after the workplace accident in 2021 and accelerating after the motor vehicle accident. This criterion is satisfied.

(ii) There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.

Mr Cha has not been able to control his alcohol use since at least 2021. This criterion is satisfied.

(iii) A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.

Mr Cha spends large proportions of his day consuming alcohol and being under the influence of its effects. This criterion is satisfied.

(iv) Craving, or a strong desire or urge to use alcohol.

Mr Cha has an ongoing strong desire to use alcohol and experiences cravings. This criterion is satisfied.

(v) Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.

Mr Cha has neglected his home and occupational duties due to alcohol consumption since at least 2021. This criterion is satisfied.

(vi) Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.

Mr Cha continues to drink alcohol in large quantities despite being aware of the issues it is causing in his life. This criterion is satisfied.

(vii) Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

Mr Cha's alcohol misuse postdates his impairment in his workplace. This criterion is not satisfied.

(viii) Recurrent alcohol use in situations in which it is physically hazardous.

Mr Cha did not provide a history consistent with the satisfaction of this criterion. This criterion is not satisfied.

(ix) Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.

Mr Cha continues to drink alcohol in large quantities despite the potential risks to his physical and psychological health. This criterion is satisfied.

(x) Tolerance, as defined by either of the following:

1. a need for markedly increased amounts of alcohol to achieve intoxication or desired effect.
2. a markedly diminished effect with continued use of the same amount of alcohol.

Mr Cha provided a history that confirmed his alcohol consumption has generally increased and that his tolerance to the effects of alcohol have also developed. This criterion is satisfied.

(xi) Withdrawal, as manifested by either of the following:

1. the characteristic withdrawal syndrome for alcohol (refer to Criteria A and B of the criteria set for alcohol withdrawal, pp. 499-500).
2. alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

Mr Cha reported that when he doesn't drink alcohol, he experiences his characteristic withdrawal symptoms such as shakes, insomnia, and nausea. This criterion is satisfied.

1. The Panel finds the claimant suffers from major depressive disorder and alcohol use disorder.

1. Mr Cha informed the Medical Assessors that he had developed chronic pain following the serious injury to his leg on a construction site in 2021. He reported he began to feel hopeless and suicidal, and his alcohol intake increased significantly up to 12 cans of beer a day with associated dependence and withdrawal symptoms. Mr Cha reported he had anxiety symptoms and felt stressed about providing for his wife. His functioning was substantially impaired including his self-care and his involvement in social or recreational activities. His relationship with his wife had become strained, his concentration was poor, and he was unfit for work. At the time of the motor accident, he had pending surgical procedures. Whilst the Panel has not been provided with the records of the claimant's general practitioner prior to the accident the history reported to the Medical Assessors is consistent with the history recorded by Medical Assessor Canaris.
2. The Panel is satisfied that both psychiatric conditions, namely major depressive disorder and alcohol use disorder were present prior to the accident and were precipitated by the workplace injury which occurred on 4 March 2021.
3. The Panel does not accept the opinion of Dr McIntosh given he was not qualified to comment on psychological/psychiatric injury. The Panel finds the circumstances of the accident, given the claimant's pre-existing psychiatric vulnerability could have caused an aggravation of each psychiatric condition.
4. The evidence supports an aggravation of the pre-existing psychiatric conditions following the accident. The claimant commenced treatment with Flora Truong, psychologist commenced treatment on 11 May 2022 and documented the claimant's deteriorating mental health. On 22 September 2022, Dr Lam reported the main issue was the claimant's "mental health". She referred the claimant Dr Verma, psychiatrist for treatment although unfortunately Dr Verma did not obtain a history of the workplace accident.
5. Whilst Dr Bisht ultimately resiled from his opinion given the report of Dr McIntosh, he initially accepted a worsening of the claimant's pre-existing psychological symptoms following his involvement in the motor accident. He noted Mr Cha did not have any psychiatric treatment following the work-related injury but diagnosed an adjustment disorder on the basis Mr Cha had started to drink excessively, found it hard to sustain focus for prolonged periods, neglected his self-care and became distant from his partner.
6. The Panel finds the motor accident did cause an aggravation of the pre-existing major depressive disorder and alcohol use disorder and that the accident was a material contribution to the worsening of the claimant's psychiatric condition.

1. The diagnoses of major depressive disorder and alcohol use disorder are recognised psychiatric illnesses as defined by DSM-5-TR 5. The panel was satisfied as a result of the accident that Mr Cha experienced an aggravation of the pre-existing major depressive disorder and alcohol use disorder. Neither condition is defined as a threshold injury by part 1 cl 4(2) of the MAI Regulation. Thus, Mr Cha sustained a non-threshold injury.

1. The Panel finds that the claimant has sustained a permanent impairment as a result of the aggravation of his pre-existing major depressive disorder and alcohol use disorder caused by the accident.
2. The Medical Assessors undertook an assessment of the claimant's current permanent impairment and an assessment of his pre-existing impairment and in accordance with clause 6.31 of the Guidelines has subtracted the value of the pre-existing impairment from the value of the current impairment.
3. The Panel adopts the findings of the Medical Assessors with respect to the assessment of permanent impairment in accordance with the Psychiatric Impairment Rating Scale (PIRS).

Mr Cha could not live independently without regular support. He needs prompting to shower and continues to shower infrequently and does not wear clean clothes. He regularly skips meals and relies on his wife for gratis support.

Mr Cha has no regular social or recreational activities. He has few activities outside the house other than visiting his friends to borrow money or going to his medical appointments.

Psychological symptoms limit Mr Cha's driving to the local area although his license is currently suspended. He most recently drove 2 months ago. He is not limited by psychological symptoms when using public transport.

Mr Cha's marriage is strained with some threats of separation but no plan to separate.

Mr Cha could not read more than a news article and cannot follow complex instructions. He has performed no complex cognitive tasks, completed no training courses and does no demanding mental activities on a regular basis.

Mr Cha has not worked at all since 2021 and cannot work at all due to psychological symptoms.

1. The Panel has concluded that the claimant suffered from the pre-existing conditions of major depressive disorder and alcohol use disorder. The panel has assessed the pre-existing impairment as follows:

Mr Cha could not live independently without regular support. He needed prompting to shower, and he regularly ate only one meal per day. He relied heavily on his wife for gratis support after the workplace accident.

Mr Cha had no structured social or recreational activities and spent his day watching television. He had no substantial social activities.

Mr Cha could drive without limitation from psychological symptoms after the workplace accident.

Mr Cha's marriage was strained after the workplace accident due to his ongoing psychological symptoms which led to tension but no planned separation.

Mr Cha could not follow a news article and performed no complex cognitive tasks due to psychological symptoms. He had substantial impairments in concentration due to both depressive and alcohol use symptoms.

Mr Cha did not work at all after the workplace accident due to psychological symptoms and limitations due to pain.

1. Mr Cha has obtained some improvements in symptoms due to medication and psychotherapy however the effect has been modest and not lead to a substantive improvement in functioning. Thus a 1% adjustment for a mild treatment effect is indicated in accordance with clause 6.222 and 6.223 of the Guidelines.

1. The panel was satisfied that Mr Cha's condition is unlikely to change by more than 3% in the next 12 months with or without treatment and thus can be considered permanent.

1. The Panel has assessed the current impairment at 22%. The addition of 1% for the effects of treatment gives rise to a current impairment of 23%. After subtracting the value of the pre-existing impairment of 19% the Panel finds the claimant has sustained a permanent impairment of 4% caused by the accident.

1. The Panel revokes the certificate of Medical Assessor Canaris dated 2 July 2024 and issues a new certificate determining that the following injuries caused by the motor accident are not threshold injuries.
   • aggravation of a pre-existing major depressive disorder; and
   • aggravation of alcohol use disorder.
2. The Panel revokes the certificate of Medical Assessor Canaris dated 2 July 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a permanent impairment of 4%:
   • aggravation of a pre-existing major depressive disorder; and
   • aggravation of alcohol use disorder.

[21] David v Allianz Australia Insurance Ltd [2021] NSWPICMP 227