1. The Panel revokes the certificate and reasons of Medical Assessor Sidorov dated

9 May 2024. 2. The claimant is diagnosed as having major depressive disorder-moderate severity with substance use disorder (including opioids and benzodiazepines). 3. The assessment of treatment effects is 0% whole person impairment. 4. The assessment of whole person impairment due to pre-existing conditions is 1% whole person impairment. 5. The claimant is assessed as having 15% whole person impairment minus 1% whole person impairment for pre-existing conditions giving a final 14% whole person impairment.

1. This is an application by the claimant for review of a certificate and reasons of Medical Assessor Sidorov (the Medical Assessor) dated 9 May 2024 who assessed the claimant as having a 7% whole person impairment (WPI).
2. The Medical Assessor also diagnosed the claimant as having a major depressive disorder and a substance use disorder.
3. The following injuries were referred by the Personal Injury Commission (Commission) for assessment:
   • psychological sequelae - post-traumatic stress disorder, anxiety and depression.
4. The claimant was not involved in an accident. The review involves the claimant's circumstances following a fatal accident involving the passing of her daughter when she was a passenger in a car.
5. The claimant had previously been assessed by Medical Assessor Barrett about whether she had a threshold injury. Medical Assessor Barrett found the following injuries were caused by the accident in 2019:

(a) exacerbation of pre-existing post-traumatic stress disorder and new onset post-traumatic stress disorder;

(b) relapse of opioid analgesic use disorder, and

(c) Benzodiazepine use disorder.

1. Medical Assessor Barrett also found that the following injuries were not caused by the motor accident:

1. The parties have each presented their respective bundles of documents upon which they rely. The Panel have read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel or a Panel Member has not read it, in much the same manner as parties not referring to or not specifically relying on a document in their own bundle and submissions.
2. The fact that evidence is not referred to in these reasons does not mean it has been overlooked and nor is it required that each piece of evidence be mentioned - see WAEE v Minister for Immigration and Citizenship (2003) 75 ALO 630 at [46].The Panel is not required to "analyse every piece of information from every opinion contained in a document with which he [it] was provided" - see Farr v Insurance Australia Limited t/as NRMA Insurance Ltd [2014] NSWSC 1435 at [46]. The Panel has come to its own conclusion and has taken its own history.

1. In April 2019, the claimant found out that her 19-year-old daughter, was involved in motor vehicle accident. She had been sitting in the backseat of the car which collided with a stationary bus in a breakdown lane. The claimant's daughter passed away nine days after the accident.
2. Dr Bisht, psychiatrist, who provided a report for the insurer, reported that from the day of passing of the claimant's daughter, she started to have the following symptoms:

(a) frequent recollections of that traumatic experience, in the form of nightmares and flashbacks, as well as frequent thought about her sense of loss;

(b) hypervigilance about the safety of her other family members;

(c) feeling anxious/sad while having these recollections/ruminations;

(d) lack of enjoyment in previously pleasurable activities;

(e) lack of motivation towards socialising and self care, as well as hobbies;

(f) poor sleep - initial and middle insomnia;

(g) feeling distant from people;

(h) difficulty concentrating for long periods and making complex decisions feeling anxious in day to day situations, and being easily startled;

(i) persistent flat mood, and

(j) irritability.

1. The claimant submits that resulting from the accident, she becomes severely hysterical in remembering and discussing her daughter's accident which, amongst other things, affects her ability to recollect information and communicate.
2. The claimant submits that this problem was not considered by the Medical Assessor in her assessment of 9 May 2024.
3. It is submitted that during and upon the assessment, the claimant was undergoing a psychological episode consequent to her injuries upon the accident, specifically major depressive disorder, so that the Medical Assessor did not obtain a full and proper history from her.

Ground 1: Failure to attain full medical history upon assessment

1. The claimant submits that the Medical Assessor failed to appropriately assess the claimant's WPI as the Medical Assessor did not obtain a full history on account of the claimant's psychological episode insofar as:

(a) The claimant was unable to explain, or fully explain, that she routinely wakes herself approximately three hours before leaving for work as she needs time to compose her racing mind and depressive emotions before she begins her day. The claimant submits that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI especially with regard to assessments of Travel, Social Functioning and /or Adaptation Impairments.

(b) The claimant was unable to explain, or fully explain, that she cries every day in the car due to her mind associating driving with her daughter's death and this causes her to have to routinely park her car mid-journey to finish crying. The claimant says that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI especially with regard to assessments of Travel impairments.

(c) The claimant was unable to explain, or fully explain, that her employment with the Department of Education is likely to end due to her psychological injuries since she must return to work at Canterbury Public School in 2025 from her secondment at the Cairnsfoot School which will require substantially more driving from her, the prospect of which causes her to have panic attacks so that she prefers simply becoming unemployed due to the severity of her emotions. The claimant says that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI especially with regard to assessments of Travel, Concentration, Persistence and Pace and / or Adaptation impairments.

(d) The claimant was unable to explain or fully explain that she has no social life and does not socially interact at work. The claimant says that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI especially with regard to assessments of Social and Recreational Activities and/or Social Functioning Impairments.

(e) The claimant submits that she was unable to explain, or fully explain, that she does not attend her son's sporting fixtures due to feelings of anxiety around travel and socialising. The claimant submits that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI especially with regard to assessments of Travel, Social and Recreational Activities and /or Social Functioning Impairments.

(f) The claimant says that she was unable to explain, or fully explain, that her only social functioning occurs inside the family home with her children and husband. She says that she avoids contact with the friends of family members if they attend her home. She does not go out with her husband, and she does not go to any of her children's activities. She submits that she is totally socially withdrawn except for necessary contact at school. The claimant submits that this is a matter the Medical Assessor did not include in calculations of the WPI especially with regard to assessments of Travel, Social and Recreational Activities and/ or Social Functioning Impairments.

(g) The claimant submits that she was unable to explain, or fully explain, that her psychological injuries have resulted in her becoming completely unable to self-motivate to do domestic duties including any shopping, cooking, or house cleaning. The claimant says that observations by the Medical Assessor that her husband does the housework misses this critical contextualisation. The claimant submits that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI.

(h) The claimant submits that she was unable to explain, or fully explain, that she has not been able to maintain her five day per week work schedule, missing work on a routine basis due to her psychological injuries. The claimant says that this is despite the Medical Assessor's claim that the claimant has been able to maintain work five days per week. The claimant submits that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI consideration, especially regarding assessments of Concentration, Persistence and Pace and / or Adaptation Impairments.

(i) The claimant submits that she was unable to explain, or fully explain, that she has become careless with her personal appearance and hygiene. Contrary to the Medical Assessor's opinion, the claimant says that she does not wear make-up and did not wear any make up at the time of the assessment. The claimant says that she showers, at most, once per week and not simply daily as stated by the Medical Assessor. The claimant submits that this is a matter the Medical Assessor therefore did not include in calculations of the claimant's WPI especially with regard to assessments of Self-Care and Personal Hygiene Impairments.

1. The claimant submits that she was unable to explain, or fully explain, that in January 2024, as a result of her psychological injuries upon the accident, she attempted suicide as a way of stopping her constant anguish over the death of her daughter. The claimant says that to this point, this attempted suicide had not been disclosed to her solicitor out of the claimant's feelings of shame about it. The claimant says that she was transported to St George Hospital and treated there for a period due to this suicide attempt. The claimant submits that this is a matter the Medical Assessor did not include in calculations of the claimant's WPI.

1. The claimant submits that the Medical Assessor's WPI assessment of the claimant at 7% is inconsistent with the WPI assessment of the claimant of 13% in the report of

Dr Rastogi dated 28 April 2023. In that regard, the claimant says that whilst Dr Rastogi's assessment is noted by the Medical Assessor in his certificate, there is no discussion in relation to the basis for which the Medical Assessor's WPI assessment produced a substantially different result. 2. Additionally, there is no indication that any of the, prima facie, inconsistent facts between those relied upon by Dr Rastogi to assess 13% WPI and those relied upon by the Medical Assessor were raised with the claimant for discussion, elaboration and/or explanation of the assessment which might be inferred to explain the basis of the Medical Assessor's conclusion that the claimant's WPI was properly below 10%. 3. The claimant submits that the Medical Assessor has not set out his reasoning and was 'incorrect in a material respect' in relation to the assessment in failing to do so to clarify his reasoning which is, prima facie, in conflict with the assessment of Dr Rastogi. 4. The claimant has provided a statutory declaration of 5 June 2024. She explained her state of mind at the commencement of the medical examination and that she became disoriented at the beginning of the assessment and thereafter was reluctant to communicate with the Medical Assessor. Consequent upon this the claimant said that she was unable to open up to the Medical Assessor about the effect that the death of her daughter had on her and continues to have on her.

1. The claimant acknowledges that, from an historical point of view, the medical records refer to, inter alia, child abuse at about age 6/7 years old as well as varying degrees of depression and anxiety mostly related to marital problems, weight gain and surgeries. The claimant further acknowledged there is also some history of prescription drug abuse related to marital difficulties and surgeries.
2. The claimant submits that she suffers greater than 10% WPI as a result of the accident in April 2019 following which her daughter passed away.
3. The claimant relies on the report and assessment by Dr Rastogi who assessed 13% WPI after pre- accident WPI deduction which the claimant says is supported by the non-minor determination and opinions concerning injury and causation of Medical Assessor Barrett as well as the opinion of Ms Delov.
4. The claimant, with reference to the sub-threshold" assessment by Dr Bisht acknowledges and agrees with Dr Bisht's assessment of the claimant's pre-existing condition.
5. The claimant also acknowledges Dr Bisht's opinions concerning the claimant's extensive psychological issues. The claimant does, however, take issue with Dr Bisht's observations that she is able to travel to familiar places on her own and unfamiliar places such as to see him for his examination which the claimant says is wholly inconsistent with the history provided by her.

1. The insurer has addressed the grounds of review made by the claimant.

Error 1 - Failure to obtain full medical history upon assessment

1. The insurer submits that failure of the claimant to provide a full history relating to her psychological function is not an error made by the Medical Assessor and relies on Regulation 1.21 of the Motor Accident Permanent Impairment Guidelines (the Permanent Impairment Guidelines) that the evaluation should only consider the impairment as it is at the time of the assessment.
2. The insurer further submits that the Medical Assessor had given consideration to the full medical history, as noted in his certificate where full consideration was given to the evidence submitted by both parties, including the claimant's employment and medical history.
3. The insurer submits that failure of the claimant to provide a full history relating to her psychological function is not an error made by the Medical Assessor and relies on Regulation 1.21 of the Permanent Impairment Guidelines that the evaluation should only consider the impairment as it is at the time of the assessment.
4. The insurer further submits that the Medical Assessor had given consideration to the full medical history, as noted in his certificate and reasons where full consideration was given to the evidence submitted by both parties, including the claimant's employment and medical history.
5. The insurer refers to the claimant's submissions, where it is alleged that the claimant failed to explain that she attempted suicide in January 2024. The insurer submits that the claimant was questioned in respect of her current functioning and psychological history, and no mention was made of an attempted suicide in January 2024.
6. The insurer further submits that, updated clinical records from the claimant's general practitioner (GP) indicates no mention of an attempted suicide, and that the claimant failed to provide any evidence of the alleged suicide attempt in January 2024. The insurer further submits that self-harming thoughts were reported pre-accident, as noted in the clinical notes of Kings Medical Centre, on 27 August 2013.

1. The claimant submits that the Medical Assessor was in error by referring to the reports of

Dr Rastogi dated 5 May 2021 and 28 April 2023 and not addressing the differences between the opinion and assessment of Dr Rastogi and what the Medical Assessor assessed. 2. The insurer submits that the Medical Assessor was not required to choose between competing opinions, nor comment on the 'correctness' of other opinions. 3. The insurer relies on the decision of Hoeben CJ in Common Law in the matter of Allianz Australia Insurance Limited v Mackenzie & Ors [2014] NSWSC67 at paragraph 56 where it was said:

"A medical panel explaining in a statement of reasons the path of reasoning by which it arrived at the opinion it formed is under no obligation to explain why it did not reach an opinion it did not form, even if that different opinion is shown by material before it to have been formed by someone else."

"In accordance with the requirement in Wingfoot (Wingfoot Australia Partners Pty Limited v Kocak [2013] HCA 43), I am of the opinion that the Review Panel's statement of reasons explains the path of its reasoning in sufficient detail to enable the Court to see whether the opinion did nor did not involve an error of law. I agree with the first defendant that the function of the Review Panel was neither arbitral nor adjudicative and that it was not necessary for it to choose between competing arguments, nor to opine on the correctness of other opinions on a medical question. Its function was to form and give its own opinion as to the medical questions referred to it by applying its own medical experience and its own medical expertise. This is what it did. In doing so, it sufficiently set out its reasoning process."

1. From the insurer's submissions and the various many clinical notes provided by the parties, the following pre-accident medical history is noted;

The claimant has been consulting with a psychologist since April 2007 for depression.

The claimant advised her doctor that she is taking medication for insomnia in June 2010.

In 2011, the claimant attended Bay Healthcare and reported feeling 'blue' and that she is suffering from depression. Complaints included poor sleep, depressed mood, low self- esteem, and suicidal thoughts.

The claimant was referred to the Mental Health Team at St George Hospital in May 2011 for post-natal depression.

In June 2011 the claimant requested medication for anxiety

In July 2011, the claimant attended three sessions with her psychologist, Ms Savic, and was diagnosed with moderate depression, severe anxiety, and stress [A16].

In May 2012, the claimant attended a further session with Ms Savic, in which her elevated symptoms of depression, anxiety and stress have been attributed to her history of abuse as a child.

In May 2013, the claimant attended a session with a psychologist, Ms Trijbetz, where the claimant reported marital problems.

The claimant reported to her GP in August 2013 that she was suffering from marriage difficulties and felt depressed. She reported suffering from poor sleep, low self-esteem, panic attacks and suicidal thoughts. The claimant was prescribed antidepressants.

In the same month, the claimant attended her psychologist and reported crying constantly, feeling controlled by her husband, and a history of trauma and domestic violence. The claimant reported being addicted to alcohol and Panadeine. A K10 assessment completed by her psychologist noted a possible diagnosis of severe depression and anxiety disorder.

In September 2013 the claimant attended sessions with her psychologist weekly. The claimant reported escalating conflict with her husband due to his infidelity, fears that he might leave her, and analgesic addiction. The claimant exhibited many symptoms of post-traumatic stress disorder and appeared to be hypervigilant.

The claimant returned a score for severe depression, anxiety and stress during a DASS 21 assessment in October 2013.

The claimant's GP Mental Health plan was reviewed in November 2013, and her medication dosage was increased. The claimant and her partner participated in weekly couples therapy since October 2013.

The claimant reported ongoing verbal abuse and marital issues. She reported that trust and alcohol were significant issues in their marriage.

The claimant commenced working as a teacher's aide at The St George School.

In January 2014 the claimant reported taking Avanza to assist with insomnia and depression to her GP.

In March 2014, the claimant reported ceasing pain killers and reducing her alcohol intake, however continued antidepressant medication and counselling.

The claimant attended weekly sessions with Ms Trijbetz and scored in the extremely severe range for depression, anxiety and stress.

The claimant received ongoing counselling for her marriage breakdown.

In August 2014 the claimant returned a normal score for depression and stress and mild for anxiety on a DASS 21 assessment

The claimant reported a further incidence of domestic violence in November 2014.

In January 2015, the claimant's daughter (deceased) reported sexual assault and was seen by the claimant's psychologist, Ms Trijbetz.

In March 2015, the claimant reported increased consumption of Panadeine and alcohol. She reported that her anxiety and stress had escalated as a result of the conflict with her husband.

The claimant was charged with driving under the influence of a substance in 2016.

During 2016, the claimant attended her GP on numerous occasions for prescription antidepressants.

The claimant continued attending on her GP for anxiety and depression related symptoms. In July 2017 the claimant reported not coping and that her marriage had broken down. She reported being addicted to Panadeine and seeing a psychologist for help with the addiction.

In July 2017 the claimant reported to her psychologist that her husband moved in with his brother and accompanied her to an Alcoholics Anonymous meeting.

In September 2017, the claimant reported to her GP that she was stressed and eating a lot. She complained of significant stress and depression,

In December 2017 the claimant reported being separated from her husband for the past 3 - 4 months.

The claimant further attended 9 sessions with her psychologist between the period August 2017 and December 2017.

The claimant continued to attend her GP with ongoing complaints of depression and weight gain and continued to take antidepressant medication during 2018.

In September 2018, the claimant was prescribed Endone.

In December 2018, the claimant reported to her GP that she was very emotional, depressed and upset.

In April 2019, the claimant attended her GP with complaints of insomnia, anxiety and stress. She reported that her mother was sick in hospital.

In May 2019, the claimant attended her GP for a Mental Health Care plan following acute anxiety and reactive depression following the death of her daughter. She reported being very depressed, poor sleep and a history of depression, anxiety and Panadeine addiction was noted.

A certificate of capacity dated 20 May 2019 noted the claimant had not been able to work since the accident. The claimant received grief and bereavement counselling.

The claimant continued attending her GP for grief and anxiety related symptoms and reported seeing a psychologist during June 2019 She reported being under huge stress, not coping and grieving on numerous occasions with her GP and psychologist.

The claimant reported being unable to reduce her medication and it was recommended that she attend an addiction centre upon her return.

The claimant travelled to Turkey and Greece from 12 July 2019 to 14 August 2019 with her family.

The claimant demonstrated intense grief that is mixed with fear for the safety of her surviving children.

A certificate of capacity dated 24 July 2019 notes severe depression, anxiety, and grief.

In August 2019, the claimant reported explosive outbursts of anger towards her husband and reported that their marriage had become even more strained to her psychologist.

The claimant reported to her GP that she was unable to continue working due to emotional stress, grief and anxiety on 19 August 2019.

During August 2019 and September 2019, the claimant continued attending on her GP for anxiety and depression related symptoms, as well as the breakdown of her marriage. She reported hopefully being able to return to work in 2020.

The claimant was referred to Dr Sazhin in October 2019. The referral noted a history of depression, abuse and marriage difficulties. The claimant was reported to be suffering from ongoing depression, despair and grief.

On 31 October 2019 the claimant commenced treatment with Dr Sazhin. She reported taking a lot of medication to numb herself, that she had depression for 6 years, noted her history of domestic abuse and marriage difficulties, including her husband having affairs and severe depression, which has affected her ability to return to her normal life

In November 2019, the claimant reported that she felt sedated, had no feelings and was triggered by her therapist.

In January 2020, the claimant reported feeling better, managed to decrease her medication and was getting out of bed with more energy.

The claimant reported to her psychologist that she was deeply concerned about her daughter who talked about suicide and cutting herself.

A certificate of capacity dated 29 January 2020 noted the claimant to have no capacity for work between 20 January 2020 and 31 March 2020 as a result of severe depression, anxiety, grief and medication addictions.

A report from the claimant's psychologist recommended ongoing psychological support

In February 2020, the claimant's psychiatrist records note that the claimant had indicated some subjective and objective signs of improvement but was not yet able to return to her normal level of functioning. There had been a deterioration of the claimant's mental state and considered the claimant's depression to be so severe that it warranted inpatient treatment.

The claimant was admitted to Wesley Mission Hospital on 27 February 2020 for inpatient treatment of severe major depression as well as her dependence on medication. The claimant underwent a dissociative episode, a fainting episode and complained of paranoia whilst admitted.

In March 2020 the claimant's psychiatrist noted that it took 3 weeks for the claimant to detox from her codeine dependence, which had been complicated by a high level of emotional instability and insomnia. Dr Sazhin considered the claimant's mental state to have improved but noted the claimant is unable to maintain stability of mood, remains preoccupied by the death of her daughter. It was recommended that the claimant remains an inpatient for a further 3 weeks.

On 4 April 2020, the claimant was discharged from Wesley Mission. She was detoxed from codeine and treated with higher doses of antidepressants for severe depression with suicidal ideation.

On 16 April 2020, the claimant reported that her anxiety reduced and that she spends time with her children and cooks lunch and dinner. She reported feeling nothing

On 7 July 2020, the claimant reported to Dr Sazhin that she started working again, but only 2 days. She reported that she wished she would not wake up.

On 5 August 2020, the claimant reported that she managed to return to work 3 days at the school and 3 days at St George Hospital in a Child Care Centre, since May/June 2020.

The claimant attended her GP during August 2020 to December 2020 on numerous occasions for weight management.

A report of Dr Youssef dated 29 October 2020, noted the claimant successfully detoxed from opiates and Valium prior to her discharge from Wesley Mission Hospital. He considered the claimant suffered from major depression on a background of opiate and benzodiazepine dependence.

The claimant attended her GP for generalized anxiety disorder in January 2021. She had further attendances relating to back pain and weight management. She requested a referral to a physiotherapist and requested analgesics.

In February 2021, the claimant attended Dr Sazhin for depression and her addiction to codeine. She reported being back to taking large doses of diazepam and Panadeine.

In April 2021, the claimant reported to Dr Sazhin that she worked at St George 2-3 days per week. She complained of low mood, being tired, triggered by driving. She reported poor sleep and the use of analgesics. She reported seeing a psychologist weekly to fortnightly.

In November 2021, the claimant attended the National Centre for Childhood Grief and reported feeling the worst she had ever felt and feeling overwhelmed.

In December 2021, the claimant reported having dreams of her daughter and waking up crying. She noted an offer for a 5-day-a-week job; however, she does not feel ready yet.

In January 2022, the claimant commenced treatment with Ms Jessica Dolev. It was reported that the claimant was very emotional and that she first met with Ms Dolev for her daughter.

The claimant had a further session with Ms Dolev in January 2022, where the claimant reported that she was no longer needed at work and that she lost all the friends she worked with.

The claimant continued treatment with Ms Dolev and noted a lot of distress, that she did not feel capable of working and that she was not sleeping or eating

In March 2022, the claimant reported commencing work at a new school, however noted that she felt overwhelmed, suffered from panic attacks and fainted twice. She reported suicidal ideation and being anxious all the time.

In June 2022, the claimant reported that she was working 4 days a week, and it was getting easier.

In September 2022, the claimant reported that she requested to work 4 days per week as she needed the money. In October 2022, she reported that she commenced 4 days of work.

1. The insurer relies on a report of Dr Bisht, psychiatrist, dated 10 January 2023. He diagnosed the claimant as suffering from major depressive disorder and substance abuse disorder.
2. Dr Bisht attributed 90% of the claimant's diagnosis to the subject accident and 10% to her pre-existing substance use disorder and recurrent depressive disorder.
3. Dr Bisht assessed the claimant as having 6% WPI.
4. Ms Moodley, psychologist, provided a report to the insurer dated 2 September 2019. She concluded that the claimant was suffering from an adjustment disorder following the accident.
5. The claimant was admitted to the Wesley Hospital in late February 2020. She came under the care of Dr Sazhin, who provided a report to the insurer of 27 March 2020. He reported that the first goal of her treatment was to detox the patient from Codeine and benzodiazepines before implementing the treatment for her depression. The claimant required high doses of Quetiapine and Baclofen to come off Codeine and Diazeparn. It took three weeks to complete the detox that was complicated by a high level of emotional instability and insomnia.
6. Dr Sazhin said that little progress was achieved because of the claimant's prolonged grief reaction to the death of her daughter in 2019. It was said that although the claimant improved in her mental state, she was not able to maintain stability of her mood during the daytime, remained preoccupied with the death of her daughter, and at that stage, was unable to return home to her husband and her children.
7. Ultimately, the claimant became more resilient to grieving and more confident to deal with her grief at home. She was noted to be still quite fragile but was able to go home to continue her treatment in the community.
8. The claimant came under the care of Ms Jessica Dolev who provided a report of

6 April 2023. She is a mental health social worker. The claimant reported that she was previously hospitalised against her will in 2020, for treatment of severe depression complicated by codeine dependence. She refuses to be hospitalised again and said that the treatment did not help her at all. She said that she finds it difficult to relate to therapists and open up fully about her grief, often finding that she disassociates, faints or shuts down. 9. Medical Assessor Barrett issued a certificate dated 5 January 2020. The certificate noted the claimant's injuries including an exacerbation of a pre-existing post-traumatic stress disorder and a new onset post-traumatic stress disorder, as well as a relapse of an opioid and analgesic use disorder and a benzodiazepine use disorder. These were noted not to be minor (threshold) injuries for the purposes of the Motor Accident Injuries Act 2017 (the Act). The report noted a significant pre-existing psychiatric history, including a pre-existing post-traumatic stress disorder related to childhood trauma, as well as the misuse of Panadeine Forte from 2012. 10. Dr Rastogi, gave a diagnosis of a major depressive disorder with complicated bereavement and pre-existing benzodiazepine and codeine dependence in a report dated

5 May 2021. A subsequent report, of 28 April 2023, provided the same diagnoses, and an associated WPI was assessed at 13%. 11. The Medical Assessor provided his certificate dated 9 May 2024. 12. Regarding the claimant's pre-existing psychiatric condition, the Medical Assessor noted that the claimant had a significant past psychiatric history, including depression, in a context of being abused as a child, as well as a history of domestic violence, as well as history of substance addiction, including opioids, specifically Panadeine or Panadeine Forte. The Medical Assessor said that the claimant appeared to minimise and deny her psychiatric history. She denied a history of domestic violence and stated that she has had no problems prior to the death of her daughter as she had a good job and was functioning well. The Medical Assessor reported an ongoing history of depressive and anxiety symptoms. 13. The Medical Assessor concluded that based on the account provided by the claimant, her presentation and a review of the documentation submitted by the parties, the claimant met the diagnostic criteria for a major depressive disorder, as DSM-5. This assessment was based on a history of the claimant experiencing a depressed mood most of the day nearly every day for more than a two-week period, with a markedly diminished interest and ability to derive pleasure from most of her activities, significant weight and appetite disturbance, feeling fatigued and low on energy nearly every day, feelings of worthlessness, low self-esteem, helplessness and hopelessness, as well as a diminished ability to think and concentrate and recurrent thoughts about death and dying. 14. The Medical Assessor also concluded that the claimant met the diagnostic criteria for a substance use disorder, based on the long-term, problematic use of opioids and benzodiazepines. 15. An assessment of 7% WPI was made. 16. The Medical Assessor's psychiatric impairment rating scale (PIRS) follows;

2. Substance Use Disorder (including opioids and benzodiazepines)

Mirtazapine, 90 milligrams daily, and Diazepam, 5 milligrams twice a day

There is evidence of mild impairment. Ms Dagli reported that she does not shower daily and does not brush her teeth regularly, although she was well-presented, wearing make- up during the assessment.

There is evidence of moderate impairment. Ms Dagli reported that she has become socially disengaged and does not partake of any social or recreational activities.

There is evidence of mild impairment. Ms Dagli is able to leave home independently, including to travel to work, but prefers to stay at home due to a reduced motivation.

There is evidence of mild impairment. Ms Dagli has become more socially withdrawn, however, she maintains a good relationship with her husband.

There is evidence of mild impairment. Ms Dagli reported difficulties with her memory and concentration since the subject accident, however, she is able to maintain employment five days per week in her pre-injury role, although at a different school.

There is evidence of mild impairment. Ms Dagli works five days a week for six hours per day in a role as a teachers aide although at a different school to the one prior to the subject accident.

1. The PIRS assessment of the Medical Assessor for the claimant's pre-existing psychiatric disability follows;

Antidepressant medications and psychological therapy

There was no evidence that Ms Dagli had impaired self-care or personal hygiene prior to the subject accident.

There was no evidence of impairment in regard to Ms Dagli's social and recreational activities prior to the subject accident. She stated that she was social and engaged well with her friends and extended family.

There was no evidence of impairment in regard to travel prior to the subject accident.

There was likely evidence of mild impairment prior to the subject accident as Ms Dagli did experience intermittent anxiety and depressive symptoms, which likely affected her social interactions, particularly in the context of her history of child sexual abuse.

There was no evidence of impairment in regard to Ms Dagli's concentration, persistence and pace prior to the subject accident.

There was no evidence of impairment in regard to Ms Dagli's adaptation and/or capacity for employment prior to the subject accident.

1. With no deduction for the claimant's pre-existing condition, her WPI assessment remained at 7%.

1. The claimant was examined by Senior Medical Assessor Baker and Medical Assessor Yeates on 9 July 2025. Their report follows:

"The claimant attended this assessment using MS Teams. She was noted to have been late to the assessment. Commission staff rang the claimant's legal service, and her lawyer contacted the claimant with the claimant subsequently attending.

The claimant was assessed by Assessors Baker and Yeates.

The claimant provided a complex history of her life prior to the motor accident and subsequent to the motor accident.

The claimant reported that she had no contact with her father for many years. She said her mother was 82 years of age. Her mother separated from her father when the claimant was aged 11 years of age. Her mother lived alone in her own home. The claimant said her children were close to their grandmother, and that before the motor accident, the claimant was close to her mother and her children. the claimant said that her mother was a religious person and that since the motor accident and death of the claimant's daughter, the claimant's mother spent less time with her family. The claimant said the reason for this was because her mother would speak about her beliefs as to what happens to a deceased person after their death. The claimant said she did not want to hear her mother repeat her beliefs as the restating of her mother's beliefs distressed the claimant.

The claimant had an elder sister aged about 52 years. She said she had not had contact with her sister for more than 10 years.

The claimant said she was married and had four children tot his union. She said her husband worked with his father. He was aged 43 years. She said her daughter died when she was 19 years of age. She said she ahd two surviving sons aged 24 and 14 years and a daughter 18 years. Her 14-year-old son was in his bedroom during the re-examination.

The claimant said she attended to Year 11 of school. She said she was diagnosed as having-Dyslexia. Dyslexia is not a DSM-5-TR diagnosis. The condition affects the person with difficulty with reading, spelling, letter reversal, and fine motor co-ordination. She said she played basketball as her school sport. The claimant said she ahd friends and they would go walking on the beach. She would also attend Blue Light Discos as a youth.

The claimant reported a history of having been traumatised as a child. She said she had ongoing difficulties because of the childhood abuse she had suffered. She described having the known difficulties associated with childhood trauma and abuse that included:

• Impulsive and risky behaviour, with her having driven a car under the influence of a substance.
• Emotional lability with her having difficulty controlling her emotions when distressed.
• Difficulty with relationships, as seen with the claimant having been separated from her husband on at least three occasions.
• The use of substances such as alcohol and opiates in attempt to regulate her emotions, which resulted in opiate dependence by the use of Panadeine and Panadeine Forte which both have oxycodone (an opiate) in the formulation and well as alcohol use disorder.

The claimant had been diagnosed with many different conditions prior to the motor accident.

• Posttraumatic stress disorder
• Opioid use disorder
• Alcohol use disorder
• Major depressive disorder with recurrent episode of depression, including an episode of postnatal depression.

The claimant had received treatment for these conditions prior to the motor accident. She had been in long-term treatment with a clinical psychologist. She said she had been trialled on antidepressant medication in the past and had side effects from these medicines. She had been able to return to the workforce and was working in a permanent full-time role at a public primary school, assisting children with disabilities. At the re-examination, she said she derived satisfaction from her work role and the opportunity to contribute. She said she was not feeling happy since the motor accident, but she had held a full-time role since 2017 until the date of this re-examination.

The claimant was asked if she could talk about the motor accident. She said that she and her daughter had a disagreement before the motor accident. The claimant stated that she had asked her daughter to find her own way to the meeting she was attending. She said she was told her daughter was injured in a car crash. She said she attended Liverpool Hospital and that her daughter died.

The claimant was dishevelled, disorganised and anxious in her presentation. She said she would cry and be tearful most days. She reported inappropriate shame and guilt for the death of her daughter. She reported having thoughts of suicide. She was initially orientated in time place and person. She did not suffer from delusional ideas or psychotic symptoms. She was aware that she had periods of absences where she would have no memory. She said that she could not remember specific details or dates, as recalling them would make her feel worse.

The claimant said, "I believe it is my fault. If I stuck to the plan, she would never have been in the car. I have to live with that! It is my fault! You don't understand! It's terribly hard to live with that guilt, I have ruined everyone's life!" because of motor accident. The claimant was then observed to stop talking. She then slowly moved out of view of the camera at about the forty minute mark of the re-examination.

The claimant was out of view and was unable to rejoin the re-examination. She was asked to wave her hand to indicate that she was safe. Initially this invitation did not result in the claimant responding.

The Medical Assessors notified the Commission case-holder and with assistance, the claimant's lawyer was notified. The Medical Assessors requested that a Welfare Check be performed at the claimant's home in Rockdale. The claimant was re-assured and informed verbally by the Medical Assessors as to the progress of gaining more help for her. During this process the claimant was able to wave her hand and indicate that she was safe.

The claimant was then approached by her 14-year-old son who said that the NSW Police were at the door. He said he had telephoned his father. The claimant was then approached by her husband, who was wearing work clothing. He immediately consoled and soothed the claimant, who was tearful and distressed.

In a brief conversation with the claimant's husband, he stated that his wife would frequently suffer from these episodes of inability to move, speak or respond whenever she remembered the death of her daughter. He said that he would usually be required to spend up to 3 hours reorienting his wife and encouraging her to speak. After the claimant's husband provided this collaborative history, the re-examination ceased.

In the claimant's submission, she reported that she had a psychological episode whilst being assessed by another medical assessor for the Commission.

The claimant was observed whilst admitted to Wesley Mission Hospital on 27 February 2020 for inpatient treatment of severe major depression as well as her dependence on medication, that she did have a dissociative episode, a fainting episode and complained of paranoia whilst admitted. The behaviour observed during the re-examination was best defined as a dissociative episode and is consistent with the claimant's submission where it is documented:

"The claimant submits that resulting from the accident, she becomes severely hysterical in remembering and discussing her daughter's accident which, amongst other things, affects her ability to recollect information and communicate."

The Medical Assessors note that dissociative episodes can occur in the following DSM-5-TR diagnoses that had already been made by prior assessor and report writers':

• Post-traumatic stress disorder
• Chronic depressive disorders
• Substance use disorders

The Medical Assessors agree that the dissociative episode as seen during this re-examination was consistent with the other reports of dissociative episodes that were clinically significant to the observer and record in the forwarded documents.

Significant documented collaborative history in the medical record that presented prior to the motor accident:

• Childhood trauma diagnosed as posttraumatic stress disorder.
• Substance use disorder impairing her capacity to drive due to an episode of been detected whilst driving under the influence.
• Marital discord with repeated episodes of separation between the claimant and her husband before the motor accident.
• Substance use disorder including alcohol and opioids.

The claimant, whilst having the above diagnosed condition and impairment, was still capable of being permanently employed in her role in 2017 after a period of probationary employment.

In November 2021, the claimant attended the National Centre for Childhood Grief and reported feeling the worst she had ever felt and feeling overwhelmed.

The claimant had been treated as a psychiatric inpatient of a private psychiatric hospital. She had her opioid and benzodiazepine use disorder withdrawn under medical supervision.

The claimant had been treated with antidepressant medication. Her current antidepressant medication was mirtazapine 90mg. This is an evidence-based treatment for major depressive disorder and quetiapine up to 200mg daily. This is an evidenced-based modo stabiliser and was used when the claimant was in hospital and been medically withdrawn from her substances.

The claimant had received psychological treatment in hospital and outside of hospital from various providers. She continued to suffer from her psychological injury without the injury entering remission prior to this re-examination.

The Medical Assessors discussed the finding at this re-examination. The Medical Assessors agree that they had sufficient verbal history from the claimant, collaborative history from the claimant's husband and sufficient behavioural observations made during the re-examination to enable the diagnosis of DSM-5-TR F32.1 Major depressive disorder- moderate severity. The behavioural observations made by the Medical Assessors were discussed and the Medical Assessors both agreed that talking about the claimant's daughter's death was the reason for onset of the claimant's dissociative episode, Dissociative episodes are clinically known to be part of major depressive disorder when this condition is associated with trauma. Major depressive disorder is the second most common diagnosis in relation to trauma suffered by people. The claimant did not suffer from dissociative episodes prior to the motor accident.

The collaborative history from the claimant's husband confirmed that the claimant's dissociative behaviour was frequently exacerbated by the claimant's memory of her having changed her plans in relation to transporting her daughter to her daughter's event and then being told that her daughter had died in a car crash whilst a passenger.

The Medical Assessors' note that Dr Rastogi gave a diagnosis of a Major Depressive Disorder with complicated bereavement.

The Medical Assessors note that the term "complicated bereavement" is defined as DSM-5-TR 43.8 prolonged grief disorder. Using DSM-5-TR the claimant is not diagnosed with this condition because of criterion F. for this disorder as follows: "the symptoms are not better explained by another mental disorder, such as major depressive disorder or posttraumatic stress disorder and is not attributable to the physiological effects of a substance (e.g. medication, alcohol) of another medical condition."

In the opinion of the Medical Assessors the best DSM-5-TR diagnosis that explains all of the claimant's condition since the death of her daughter is DSM-5-TR F32.1 Major depressive disorder. The claimant had an intercurrent condition of substance use disorders due to benzodiazepines (diazepam) and opioids (Panadiene and Panadiene Forte), which were treated in Wesley Mission Hospital in 2020 by medically supervised withdrawal.

The claimant could not live independently without the regular support of her husband and adult children. The claimant's family members are required to ensure a minimum level of safety, hygiene, and nutrition at least 2-3 times per week. The claimant was unable to ensure her own safety during her frequent dissociative episodes without family supervision during these times. This is a moderate Class 3 impairment.

The claimant had rarely been on vacation with her husband and family once since the motor accident. The claimant does not attend social gatherings with the extended family or her mother as she had before the motor accident. The claimant had lost interest in her prior hobbies such as walking on the beach and sharing time with friends. This is a moderate Class 3 impairment.

The claimant could drive to and from her employment. She would become anxious and agitated. She would have times when she stopped to use her psychological skills to calm herself before continuing. She never travelled alone to unfamiliar locations. She could attend her psychological and medical treatment venues alone. This is a mild Class 2 impairment.

The claimant reported that there was tension in her relationship with her mother. The claimant said that there was tension in her relationship with her husband. She did not report recent episodes of separation after the motor accident. This is a mild Class 2 impairment.

The claimant would have poor concentration, persistence and pace when having to perform complex tasks. She was slower in her thinking; she is forgetful and frequently distracted. She could not read emails, or her son's school report as she too distressed and would become indecisive as to how she should progress once learning the new information. This is a moderate Class 3 impairment.

The claimant was working in a permanent fulltime position. She would use her psychological skills to enable her to work in her role. She would have time away from work should she be too distressed or symptomatic to function in her role. She was able to work in a different location since the motor accident. She was not happy to work in her prior role before the motor accident at a different location. She would not be able to work more than 20 hours per week in a different role should she have her position re-located due to secondment duties coming to a close. This is a mild Class 2 impairment.

The claimant had a pre-existing psychological condition which had been present for many years prior to the motor accident and associated with driving a car whilst under the influence, substance use disorders including alcohol and opioids, marital discord with repeated periods of separation between her husband and the claimant. The claimant had received psychological treatment for these conditions. The result of her extended treatment included her capacity to return to the workforce in a fulltime permanent position. The permanent psychiatric impairment from her pre-existing condition was the ongoing marital discord with repeated periods of separation before the moto accident.

The claimant was independent in her self-care and personal hygiene. She had extended periods of months where she was required to care for herself and her child alone without support of her husband. This is a Class 1 impairment.

The claimant was able to engage in her hobbies of walking on the beach and socialising with extended family, her mother and her children. she had maintained an interest in her children's hobbies and interest. She was able to participate and become involved in family events and celebrations. This is a Class 1 impairment.

There was evidence of impairment the claimant's capacity to drive. She had one episode of driving whilst under the influence of a substance. She regained her licence and continued driving. She had a mild impairment due to this 2016 incident. This is a Class 2 mild impairment.

There is evidence of the claimant having experienced repeated separation from her husband due to marital discord. The claimant's husband lived outside the house for a few months after each episode of separation. The claimant had sought psychological advice and reported period agitation and distress due to her husband's behaviour. This is a moderate Class 3 impairment.

The claimant had been able to concentrate, persist with complex tasks and progress at pace whilst learning new skills during her probationary period. She had reported satisfaction with her capacity to learn new skills and participate in complex situations. This is a Class 1 impairment.

The claimant had been able to work initially in a probationary role and them was promoted to a permanent fulltime role, prior to the motor accident. The claimant's return to the fulltime workforce was successful before the motor accident. This is a Class 1 impairment.

2. Substance Use Disorder (including opioids and benzodiazepines)

Mirtazapine, 90 milligrams daily, and Diazepam, 5 milligrams twice a day

The claimant could not live independently without regular support of her husband and adult children. The claimant's family members are required to ensure minimum level of safety, hygiene and nutrition between 2-3 times per week. The claimant was unable to ensure her own safety during her frequent dissociative episodes without family supervision during these times.

The claimant had rarely been on vacation with her husband and family once since the motor accident. The client does not attend social gatherings with the extended family or her mother as she had before the motor accident. The claimant had lost interest in her prior hobbies such as walking on the beach and sharing time with friends.

The claimant could drive to and from her employment. She would become anxious and agitated. She would have times when she stopped to use her psychological skills to calm herself before continuing. She never travelled alone to unfamiliar locations. She could attend her psychological and medical treatment venues alone.

The claimant reported that there was tension in her relationship with her mother. The claimant said that there was tension in her relationship with her husband. She did not report recent episodes of separation after the motor accident.

The claimant would have poor concentration, persistence and pace when having to perform complex tasks. She was slower in her thinking; she is forgetful and frequently distracted. She could not read emails, or her son's school report as she too distressed and would become indecisive as to how she should progress once learning the new information.

The claimant was working in a permanent fulltime position. She would use her psychological skills to enable her to work in her role. She would have time away from work should she be too distressed or symptomatic to function in her role. She was able to work in a different location since the motor accident. She was not happy to work in her prior role before the motor accident at a different location. She would not be able to work more than 20 hours per week in a different role should she have her position re-located due to secondment duties coming to a close.

Antidepressant medications and psychological therapy

The claimant was independent in her self-care and personal hygiene. She had extended periods of months where she was required to care for herself and her child alone without support of her husband.

The claimant was able to engage in her hobbies of walking on the beach and socialising with extended family, her mother and her children. she had maintained an interest in her children's hobbies and interest. She was able to participate and become involved in family events and celebrations.

There was evidence of impairment the claimant's capacity to drive. She had one episode of driving whilst under the influence of a substance. She regained her licence and continued driving. She had a mild impairment due to this 2016 incident.

There is evidence of the claimant having experienced repeated separation from her husband due to marital discord. The claimant's husband lived outside the house for a few months after each episode of separation. The claimant had sought psychological advice and reported period agitation and distress due to her husband's behaviour.

The claimant had been able to concentrate, persist with complex tasks and progress at pace whilst learning new skills during her probationary period. She had reported satisfaction with her capacity to learn new skills and participate in complex situations.

The claimant had been able to work initially in a probationary role and them was promoted to a permanent fulltime role, prior to the motor accident. The claimant's return to the fulltime workforce was successful before the motor accident.

1. List classes in ascending order: 1, 1, 1, 1, 2, 3

1. The Panel met on 23 July 2025 to discuss the Medical Assessors findings on examination. The legal Member of this Panel did not participate in the medical examination but prior to the Panel meeting on 23 July 2025, the legal Member had the benefit of reading and considering the Medical Assessors examination report. On 23 July 2025 the Panel met and discussed the examination findings and the issues going to causation and assessment of WPI. It is from this teleconference of the Panel that the Panel has agreed and reached its conclusion and determination.
2. The Panel adopts the report of Senior Medical Assessor Baker and Medical Assessor Yeates.

1. The claimant was independent and capable of working full-time in her chosen role before the motor accident. The claimant, whilst having diagnosed conditions related to childhood trauma and abuse, had demonstrated many episodes of resilience and capacity to adapt to complex issues and psychiatric conditions.
2. The claimant had accepted many years of psychological and medical treatment concerning her pre-existing psychological conditions. The claimant reported that she had decided to change a plan she had made with her daughter, regarding how her daughter would travel just prior to the motor accident.
3. The claimant discovered that her daughter had been seriously injured in a motor accident soon after the claimant had changed her plan for the date of onset of this psychological injury. The claimant's daughter died soon after the motor accident in Liverpool Hospital.
4. The Medical Assessors agree that the diagnosis of major depressive disorder could be caused by the nature of the motor accident and the involvement of the claimant immediately prior to the incident.
5. The Medical Assessors agree that in their opinion the motor accident did cause the psychological injury suffered by the claimant as assessed at this re-examination.

1. The claimant had suffered from several known conditions associated with childhood trauma and abuse. The claimant had demonstrated many years of resilience and had accepted many years of psychological and medical treatment. The claimant suffered from repeated periods of separation from her husband for months due to his behaviour. She was independent during these periods of separation.
2. Before the motor accident the claimant had suffered from various diagnosed conditions such as post-traumatic stress disorder, major depressive disorder, alcohol use disorder and opioid use disorder. She had one recorded incident of driving under the influence of a substance in a motor car in 2016. She had her licence returned prior to this motor accident.
3. The claimant accepted treatment. Her husband was documented as supporting her attendance at Alcoholics Anonymous (AA). The claimant was fit to return to probationary employment in her role. After successfully completing her probationary period, she was promoted to work full-time in 2017. She remained working full-time prior to the motor accident.
4. The claimant did suffer from a psychological injury caused by the motor accident. The psychological injury is best defined by the DSM-5-TR F32.1 major depressive disorder diagnosis. The claimant had intercurrent substance use disorders that included opioid and benzodiazepine use disorders. These disorders were treated in a private psychiatric hospital. The treatment had not placed the claimant's psychological injury into remission.
5. The claimant continued to have psychological symptoms clinically known to be associated with major depressive disorder, including dissociative episodes. Dissociative episodes in major depressive disorder are clinically known to cause impairment in social functioning.

1. The Panel revokes the certificate and reasons of Medical Assessor Sidorov dated

9 May 2024. 2. The claimant is diagnosed as having major depressive disorder-moderate severity with substance use disorder (including opioids and benzodiazepines). 3. The assessment of treatment effects is 0% WPI. 4. The assessment of WPI due to pre-existing conditions is 1% WPI. 5. The claimant is assessed as having 15% WPI minus 1% WPI for pre-existing conditions giving a final 14% WPI.