89 I turn now to the challenge to his Honour's acceptance that Mr Kazic's psychological condition was caused by the accident.
90 Shortly after Mr Kazic stopped working in late 2002 he was referred by his general practitioner to a clinical psychologist, Wendy Bailey. She recorded his complaints of ongoing and persistent pain, chronic headaches, sleep disturbance, low energy, lethargy and reduced appetite. He expressed feelings of hopelessness and worthlessness. He described memory and concentration difficulties, breathing problems, irritability and mood swings, loss of libido, negative thinking patterns and excessive worry. Ms Bailey diagnosed an adjustment disorder with mixed anxiety and depressed mood. Mr Kazic's symptoms persisted over the course of a number of counselling sessions.
91 Mr Kazic was seen by Dr Zepinic, a consultant in psychological medicine, who also undertook therapy sessions with him. Dr Zepinic diagnosed an adjustment disorder with mixed emotional features, secondary to Mr Kazic's physical injuries and incapacity for work. It was not clear how many times Mr Kazic attended therapy sessions with Dr Zepinic, but he told Dr Sachdev in August 2004 that he had been seeing a psychiatrist fortnightly for 18 months.
92 On 18 August 2004, Dr Sachdev, Professor of Neuropsychiatry at the University of New South Wales, saw Mr Kazic at the request of his solicitors. Dr Sachdev commented that Mr Kazic did not report a loss of consciousness at the time of the accident, nor any period of amnesia after the injury, and that, by conventional criteria, Mr Kazic had sustained "very mild brain trauma which manifested in the form of a 'dazed' mental state". (Blue 319.E) Dr Sachdev commented that there was no report that Mr Kazic sustained any direct injury to the neck or back, although he considered that the weight of the falling object was likely to have led to an acute flexion of the neck and possibly the back. (Blue 319.F-G)
93 Dr Sachdev reported that Mr Kazic gradually developed psychiatric symptoms, which had been more pervasive in the last year (2004). Mr Kazic attributed these symptoms to the persistence of his pain, his loss both of work and a role in life, financial pressures and his bleak assessment of the future. His biggest loss was of his job, which had resulted in a substantial reduction in income. He reported difficulty in managing and that he did not see a way out of his predicament. He said that he and his wife had put their house on sale because he could no longer afford the mortgage repayments. (Blue 321.J-O)
94 Dr Sachdev's conclusions in his first report were as follows:
"The salient feature of his presentation is the chronicity of his pain syndrome, with little resolution and poor response to treatment. The pain appears to be out of proportion to the injury sustained or currently observable, and his presentation during the interview was suggestive of some dramatization of this pain syndrome. In such cases of chronic pain, it is not unusual for psychological factors to be quite important in the maintenance of the pain. These psychological factors, in his case, are likely to be the stress of migration, the disappointment of not achieving stable occupation, the threat of invalidity with the incident, and potential secondary gain from the disability. However, the fact that his income now is much below the level while he was working suggests that material gain is not understandable as a strong motivating factor.
His psychiatric symptoms are characterised by depression and anxiety which is best understood as a response to the chronic pain and the consequent disablement from an occupational and social viewpoint. These symptoms are however significant enough to cause disability in their own right. They are of moderate intensity. I agree with the diagnosis given previously of an Adjustment Disorder with depression and anxiety. In other worse (sic), this is a reaction to his pain and distress as well loss of occupational and social roles.
He did not have spontaneous complaints of cognitive problems, and the clinical assessment suggested mild deficits in attention and memory. These may well be due to the psychiatric problems and cannot necessarily be attributed to the incident.
His pain syndrome warrants an opinion of an orthopaedic surgeon or a pain specialist. However, it can be attributed to the work-related accident. He did not have pain before the accident and it has been consistently present since the accident. As I stated above, the backache is difficult to understand from the nature of the accident, but it is possible that he became and apprehensive after the accident and therefore was more prone to back injury from the work he did following the accident. Even though psychiatric factors appear to have been important for the persistence of the pain syndrome, the origin of the pain was with the accident. Mr Kazic, from his account, did not contribute to the accident by his negligence or lack of due diligence, and was in fact an innocent victim. The accident was therefore a substantial contributory factor to the injury." (Blue 323.E - 324.D)
95 Dr Sachdev prepared a supplementary report, dated 31 July 2007, in which he said:
"My opinion in relation to the pain is unchanged from my last report. While pain is not my area of specialisation, my opinion is that his pain is out of proportion to the degree of injury he sustained. However, the onset of the pain is clearly related to the accident, and he attributes it to the accident as well. There are likely to be psychological factors in the persistence of the pain, but my understanding is that psychological intervention has not been successful. Chronic pain of this nature in the medicolegal setting often becomes chronic and poorly responsive to treatment. His level of pain is such that it would preclude him from gaining or maintaining employment in the open market. The usual experience is that such pain does not remit even after medicolegal issues have been satisfactorily resolved, although some better adaptation to the pain may occur. (Blue 328.T-329.C)
…
Mr Kazic has a mild depressive syndrome which is secondary to his pain syndrome and the stresses of unemployment, financial difficulties and poor relationship. (Blue 329.M-N)
…
Mr Kazic's disability is chronic and likely to be persistent. It is possible that with intensive physical rehabilitation and psychiatric input, he will improve partially. The medicolegal settlement will assist in the process. However it is quite likely that some of his symptoms will be persistent even after this." (Blue 330.P-R)
96 Mr Kazic was also assessed for medico-legal purposes by Dr Thomas Oldtree Clark. Dr Clark diagnosed a dysthymic disorder, persistent mild depression. Dr Clark disagreed with the opinions of those doctors who diagnosed an adjustment disorder. This was because an adjustment disorder may be cured when the stressor is removed but, in Dr Clark's opinion, Mr Kazic's condition was chronic.
97 John Holland qualified Dr Phillips, a consultant psychiatrist, who saw Mr Kazic on 24 June 2005. Dr Phillips considered Mr Kazic was mildly depressed, but that his symptoms were not sufficient to warrant a diagnosis of a major depressive disorder, dysthymic disorder, generalised anxiety disorder or post-traumatic stress disorder. At worst, in Dr Phillips' opinion, Mr Kazic had a very mild adjustment disorder with mixed features. Dr Phillips commented on Mr Kazic's histrionic and exaggerated presentation. In his opinion, the "relatively mild injury in the work incident" was of insufficient intensity to explain Mr Kazic's ongoing physical and psychological symptoms.
98 The primary judge considered that Dr Phillips' opinion was not consistent with his finding with respect to the orthopaedic picture. (Red 80.L) For this reason he rejected it. His Honour noted that the exaggeration and histrionics described by Dr Phillips were consistent with other evidence, including the report of Dr Sachdev. His Honour rejected Dr Clark's diagnosis, preferring the diagnosis of adjustment disorder, which was attributable to stressors: Mr Kazic's pain and his inability to work and to provide financial support for his family, with consequential distress, worry and anxiety and associated feelings of hopelessness and worthlessness. (Red 80.O-Q)
99 His Honour was mindful that Mr Kazic lacked candour in his consultations with the various doctors who assessed him in connection with the litigation. That fact did not require that his case be rejected in its entirety. His Honour's assessment of the whole of the orthopaedic evidence was thorough. It is to be borne in mind that Mr Kazic had been in employment up until the date of his accident. His return to work had been accompanied by complaints of pain, leading to him giving work up in October 2002. From that time on he had attended counselling sessions both with Ms Bailey and later with Dr Zepinic, in which he complained of symptoms consistent with an adjustment disorder. Dr Sachdev was conscious of the suggestion of "some dramatisation of his pain syndrome". It will be recalled that Dr Sachdev, in reviewing the psychological factors in Mr Kazic's case, took into account potential secondary gain from the disability, noting that the reduction in Mr Kazic's income suggested that this was not likely to be a strong motivating factor. It was open to the primary judge to accept the considerable body of medical opinion that pointed to Mr Kazic having developed an adjustment disorder as the result of suffering soft tissue injury in the accident.
100 In the submissions filed for John Holland and Waco Kwikform it was noted that the primary judge had been sceptical about the persistence of a physical basis for Mr Kazic's psychological symptoms beyond 2004. (Red 78.R) As I understand his Honour's reasons, he accepted that the adjustment disorder was a response to pain, loss of employment and the associated financial stress. The physical symptoms had resolved by 2005, but the psychological symptoms continued. This is explained in Dr Sachdev's report. The primary judge approached the matter on a basis that may be thought optimistic having regard to Dr Sachdev's prognosis. His Honour considered that Mr Kazic's problems were likely to resolve after a relatively short period, partly as the result of the litigation coming to an end.
101 Counsel for John Holland and Waco Kwikform submitted that Dr Sachdev, and the other medical professionals who had commented on Mr Kazic's psychological condition, were unaware of "the true position concerning the plaintiff's post-injury activity in Perth". (Orange 78.M-N) It was said that Mr Kazic's ability to supervise the construction of his new home in Perth evidenced a significant capacity for work and demonstrated that, whatever his chronic symptoms, they had not prevented him from engaging in work.
102 At the date of the trial, Mr Kazic's wife was living in Perth and Mr Kazic was living half of the time at his brother's home in Wetherill Park and half of the time with his family in Perth. The family live about 30 kilometres from the centre of Perth. Mr Kazic had acquired a block of land in this vicinity and his wife, who appears to have obtained an owner/builder licence, was arranging for the construction of a home on it. An architect had been retained in connection with the project. It was not clear from the evidence whether the architect was supervising the project or whether the architect had merely been retained to draw up the plans. Mr Kazic said that when he is in Perth he would give instructions to the tradesmen if things needed to be changed. He did not himself do work on the construction.
103 The primary judge was mindful of the evidence that Mr Kazic was able to participate in supervising the construction of the new home. (Red 80.R) The evidence of the plaintiff's involvement in this activity was not of such materiality as to require the rejection of the medical and psychiatric evidence.
104 In my opinion, it was open to the primary judge to assess Mr Kazic's economic loss in the amount that he did. The related challenge in the written submissions on behalf of John Holland and Waco Kwikform with respect to a reduction in the out of pocket expenses falls with their contention that past economic loss should have ceased at mid-2005.
105 The award for future economic loss was also challenged. His Honour's allowance of a buffer weighted in the short term was open. Dr Sachdev's prognosis was guarded. His Honour's assessment was an evaluative determination, which, in my opinion, cannot be said to be unreasonable. I would reject the challenge to the assessment: Moran v McMahon (1985) 3 NSWLR 700.
106 The appellant's challenge to the assessment of Mr Kazic's non-economic loss was dependent on acceptance of its submissions on causation. (Orange 38.D-E) Counsel for John Holland and Waco Kwikform did not press the challenge to the assessment of non-economic loss. In light of his Honour's findings as to the soft tissue injuries and the consequential psychological condition in my opinion the assessment of non-economic loss as 27 per cent of a most extreme case was within the range of discretion.
107 For these reasons I propose that the appeal and cross-appeals be dismissed with costs.