Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017

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

16 August 2024 and issues a new certificate as follows:

(a) the Review Panel certifies the following injury was caused by the motor accident:

(i) major depressive disorder with anxious distress, and

(b) the Review Panel finds that the above injury results in a whole person impairment of 7% which is NOT greater than 10%.

1. Ali Fayad (the claimant) was involved in a motor accident on 30 September 2020. He was the driver of a sedan, stopped in traffic heading southwards on the Sydney Harbour Bridge, when he was rear-ended at speed by another vehicle. He suffered injuries to his neck, middle back, lower back, right hip and left knee. He also claims psychological/psychiatric injury.
2. The claimant made an application for personal injury benefits with Insurance Australia Limited t/as NRMA (the insurer), the third-party insurer of the vehicle that he says caused the accident.
3. A medical dispute arose about whether the degree of the claimant's whole person impairment (WPI) is greater than 10% WPI. If there is a dispute about the degree of a claimant's WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
4. On 16 August 2024, Medical Assessor Ronald Gill found the claimant's psychiatric injury to be caused by the motor accident and assessed his WPI as 17% which is greater than 10%.
5. The insurer lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Gill's decision. This was allowed by the President's delegate (Ms Melinda Drew) and this Review Panel (Panel) was convened to conduct the review.

1. Medical Assessor Gill was referred the following injuries for medical assessment:
   • psychiatric condition - generalised anxiety disorder and major depressive disorder.
2. The Medical Assessor accepted that the claimant sustained a psychiatric injury as a result of the injury caused by the motor accident. The diagnoses were post-traumatic stress disorder with dissociative features and major depressive disorder of moderate intensity with comorbid anxiety. It is noted that this differed to the diagnosis that was referred for assessment.
3. Permanent impairment was rated under the psychiatric impairment rating scale (PIRS) as follows:
   • self-care and personal hygiene - class 2;
   • social and recreational activities - class 2;
   • travel - class 3;
   • social functioning - class 3;
   • concentration, persistence and pace - class 3, and
   • adaptation - class 3.
4. The values were arranged in ascending order 2,2,3,3,3,3 with a median class value of 3 and an aggregate score of 16. The WPI was calculated as 17%.
5. No allowance was made for the effects of treatment and no deductions were made for pre-existing or subsequent impairment.

1. The insurer provided two sets of submissions - submissions made in the WPI application and submissions made in support of the review application of Medical Assessor Gill's assessment.
2. As the Panel conducts its review denovo or afresh, with an opportunity for the parties to provide additional evidence, it is not necessary to set out in any great detail the insurer's submissions on the alleged material errors in the medical assessment under review. Where necessary, the issues will be addressed in the Panel Medical Assessors' re-examination report and the Panel's findings.
3. Sufficed to say, the insurer's primary disagreement with the medical assessment concerns Medical Assessor Gill's regard of the evidence and his analysis/assessment of that evidence when compared with the claimant's history given to him at the time of the examination.
4. The insurer's primary submission in the WPI application is that the claimant did not serve any evidence which assessed his psychiatric injury as being greater than 10%. When assessed by Dr Eva Maher, psychiatrist, on 24 August 2022 at the request of his solicitors, Dr Maher opined the claimant's symptoms to a "pain syndrome rather than mental illness" and did not make any diagnosis for the alleged psychiatric injury.
5. The insurer noted that when the claimant initially presented to his general practitioner (GP) Dr Awada on 6 October 2020, a week following the motor accident, there was no complaint of psychological or psychiatric symptoms.

1. The claimant provided submissions opposing the insurer's review application of Medical Assessor Gill's assessment. The claimant says the application should be rejected as the medical assessment contains no material errors.

1. On 26 August 2025, the Panel issued a direction to the parties requesting indexed and paginated bundles of the information they relied upon. The Panel advised that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The insurer and the claimant complied with the direction lodging bundles comprising of pages 1-610 and 1-46 respectively.
2. At its preliminary conference on 29 October 2025, the Panel issued a further direction requiring the parties to provide a joint bundle of the claimant's treating psychologist records.
3. On 28 January 2026, the insurer uploaded a joint bundle of the following:
   • clinical records of Psychlinx.
4. The Panel has read the documentation relied upon by the parties. The clinical records of Psychlinx are referred to in the Panel re-examination report. The balance of the material, where relevant to the alleged psychiatric injury and issues in dispute, will also be referred to in the Panel re-examination report or in the findings made.

1. At its preliminary conference on 29 October 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessors Baker and Rikard-Bell is below:

Panel Medical Assessors Baker and Rikard-Bell was both present during the entire duration of the re-examination. The re-examination was for about 100 minutes. Mr Fayad (the claimant) did not require an interpreter for this re-examination.

The claimant was assessed using MS teams; the video link portal was of high quality and was uninterrupted for the duration of the assessment.

The claimant was advised that he could take brief pauses throughout the re-examination. He did take short pauses at various times before continuing with this re-examination.

The claimant was re-examined alone and did not have a support person during the re-examination. He said he had been waiting for an operation on his right hip since the accident. He said that there were three people living in the house. His father was 77 years old and retired. His mother was 73 years old. The claimant was located at his parents' home where he lived in his own room.

The claimant reported he lived in a rented room. He was aged 52 years. The motor accident (the accident) happened on 30 September 2020 when the claimant was working an Uber driver which he explained was his usual occupation. He reported driving night shift as a taxi and Uber driver as his main employment since he was about 24 years of age.

The claimant was born in Lebanon. His father and mother had immigrated from Lebanon in about 1983. He said he was about 9 years of age. The claimant was the second son of six brothers. After arrival in Australia the claimant attended Bexley public school. He said that his family would move between the Southern Suburbs of Sydney and the ACT such that his father could work. During his high school years, the claimant attended Kogarah High school and Chisholm High school (ACT). He completed Year 10.

The claimant commenced his career working in KFC after about six months he changed work and worked in a fruit shop. He completed his Taxi driving course and commenced driving when he was 24 years of age. He met his now ex-wife in about 1996. They married. The marriage was unsettled and they had separated prior to the accident. The claimant said he had five children to the union aged between 27 and 9 years. He reported that he had not spoken to his children for about five years. He stated that his wife went, 'all out' about the separation.

The claimant reported that his usual employment was driving passengers at night. He said this was the most economic time to work. He had initially driven a taxi however as the industry evolved, he had changed to driving for Uber (driver) and other ride-share companies (Didi) as the work was more dependable and more profitable. He usually spent six-night shifts driving per week. He usually commenced driving at about 2:00pm and drove till about 1:00 am during the working week. On Friday, Saturday and Sunday he would start later and drive to 4:00 am. He estimated working about 60 to 70 hours per week.

The claimant reported that he had suffered an injury to his right hip and that he had a hip replacement in about 2004. He was advised that at about 4 years of age before entering Australia he was hit by a car. He recovered but subsequently developed a long-term complication affecting his right hip joint. He recovered from this surgery in 2004 and continued work as a driver. He had recently recommenced tobacco smoking after a 23-year abstinence. He smoked about 12 cigarettes per day. He did not drink alcohol. He did not gamble. He does not use illicit substances.

The claimant reported one minor accident when he was about 18 years of age. He said he did not receive medical treatment for this incident. He said he had not had any prior workplace injuries.

The claimant reported that his pain from his right hip was severe most days. He said he had recently attended a public hospital orthopaedic clinic and he had been placed on a public surgical treatment list for treatment of his right hip. He reported that his pain was usually in the range of about 8 out of 10 where zero is no pain and 10 is the most severe pain. imaginable. The claimant reported that he would use Endone 5mg tablet, one tablet at night most nights before sleep. He also used the antidepressant Escitalopram 20mg each morning. He did not reported allergies however stated he had experienced some bad reactions to medication and he preferred not to use medication.

The claimant said he had been driving for many years and in the course of his career he had been suspended due to exceeding his allowable points four to five times. He had never had any other court related offences.

During his 3-month suspensions he would look for casual work to supplement his income whilst been precluded from driving.

The claimant was driving his Uber car and had a female passenger in the rear of the vehicle before the accident. He and his passenger were wearing seatbelts. He was travelling about 70 kmph whilst crossing the Sydney Harbour Bridge. He said that the traffic came to a stop and the car behind him crashed into the rear of his vehicle. He said the accident happened early in the morning.

The claimant reported five cars in the accident. His car was the fourth. The car that hit him was the fifth vehicle. The claimant's car was shunted forward and hit the third car in front of him. The claimant was conscious in the collision. The vehicles were able to drive off the bridge to a less congested street.

The claimant was able to exit his car unaided. He exchanged details with the other drivers. The claimant returned to his car and his passenger had left the scene.

The claimant said that the collision was distressing for him. He was startled in the accident and had inadvertently urinated. He felt shame for having lost control of his bladder. He decided he needed to drive home to change his clothes. He stopped by his brother's home on route. Whilst at his brother's, the claimant telephoned his usual general medical practitioner (doctor). Dr Awada advised him to go immediately to hospital for investigations of his injuries because the claimant was suffering from pain in his right hip, neck and back.

The claimant was assessed and treated at St George Hospital, Kogarah. He was investigated for his reports of pain. He was initially advised that his right hip had not been injured in the accident. He also had x-ray findings of cervical spine showing spondylosis with foraminal narrowing and lumbar spine showing L5/S1 disc desiccation with a central bulge abutting the right S1 nerve root without nerve compression.

The claimant reported the following symptoms of major depressive disorder:

• Depressed mood most of the day, every day with an increasing feeling of hopelessness that he would never reach his goal of returning to work as a driver.
• Increased tearfulness when describing his increase social isolation from his family and friends.
• Fatigue and loss of energy nearly every day.
• Reduced concentration with a slower pace of reading and following news and current affairs that were previously of interest to him.
• Poor sleep with insomnia at night.
• Feelings of worthlessness for not being able to support himself with him having increasing reliance on his aged parents and one supportive brother.
• Marked loss of appetite with about one meals most days due to lack or interest and enjoyment of food.

The claimant also reported psychological symptoms which related to trauma:

• Nightmares about the accident.
• Increased worrying about having poor concentration and no capacity to check behind him.
• Fearful of future accidents.

The claimant also reported ongoing pain related to him moving and his right hip having trouble maintaining he weight when standing. He reported he had not been approved for any treatment on his neck, back or hip by the insurer.

The claimant reported his ability to turn to his left was impaired by his physical injuries. He said he had failed a return-to-work trial and he had not successfully returned to work as a driver since the accident.

The claimant described his pain increasing after about two days. He had an initial investigation that did not demonstrate marked change in his right hip. He said more recently he had further investigations that have confirmed his right hip replacement from 2004 was loose. He said he had physical difficulty with his mobility. He said he had failed a return-to-work trial. He was unable to turn his body to the left to check behind his car whilst driving. He had not successfully returned to his prior work as a driver since the accident.

The claimant said his doctor prescribed him Endone and Panadeine forte for his pain. He continued to use a low dose of Endone 5mg at night for sleep. He said he is waiting on being called for surgery at a public hospital because the insurer had declined surgery to his right hip. He had attended a pain clinic at Liverpool however the distance was too far so he changed to the clinic at St George Hospital as this location was closer and more familiar to him. He attended monthly. The claimant was referred to a neurosurgeon for investigation of his neck and lower back. He had physiotherapy and had been recommended to have injections in his lower back. He last attended about two weeks before this re-examination and planned to attend monthly.

The claimant reported that he had developed a depressed mood and his future was bleak. He was prescribed Escitalopram 20mg each morning by his doctor. He was initially referred to Mr Nassir a psychologist by his doctor in December 2020. He received psychological treatment with cognitive behavioural therapy. He was subsequently referred to a new psychologist Ms Carol Hayek and commenced treatment in November 2023. The AHPR 1 certificate dated 25 January 2024 a documented the diagnosis in Section 2 as 'Mixed Depression and Anxiety'. The current signs and symptoms were:

DASS 21 22.11.2023 depression (extremely severe - 20), anxiety (severe 8), stress (severe 15). The documented comment by Ms Hayek was, 'Ali complaints of pain, a pervasive low mood and emotional dysregulation. He has difficulty with sleep and executive functioning'. The claimant last attended this psychologist on 16 January 2026. He attended on 12 occasions during this treatment period. He would attend about monthly.

The claimant was not referred to a consultant psychiatrist for treatment. He had not received psychiatric treatment in hospital as an inpatient of a psychiatric unit.

The claimant presented as a man who looked his stated age. He was ungroomed and his hair unwashed and uncut. His clothes appeared unclean and he said he would change his clothes infrequently as he did not leave the house often. He was at his parents' home in his own room for the duration of the re-examination.

The claimant reported persistent pain that restricted his mobility and capacity to drive as an Uber driver or taxi driver. He reported using pain medication to assist with his nighttime pain that was more severe whilst he tried to initiate sleep.

The claimant was observed to stand, stretch, walk and pause the re-examination due to his reported pain. He self-rated his pain experience at the time of the re-examination as about 8/10, indicating his pain was in the severe range.

The claimant reported feelings of depressed mood, hopelessness and worthlessness. He had inappropriate guilt that he could not support himself financially. He said he had been provided financial support from his aged partners and brother. He stated he felt shame for receiving assistance. He did report recurrent episodes of fatigue and low energy most days.

The claimant was orientated in time, place and person. He reported that he had ruminating thoughts about his losses since the accident. The claimant did not report any delusional ideas or psychotic symptoms. His speech was not slow or slurred as might be observed due to drowsiness caused by pain medication. He was able to persist with the re-examination with the availability of necessary pauses.

The claimant reported that his memory was poor since the accident. He had a tearful mood congruent affect and reported his mood as depressed. He said his motivation for life had diminished. The claimant did not report suicidal thoughts or plans. He was insightful into the nature of his condition. His judgement appeared normal.

The claimant presented a consistent history as documented in the late forwarded documents. The claimant's current psychologist diagnosed and treated the claimant for 'Mixed Depression and Anxiety'. The claimant's presentation during the re-examination was consistent with this working hypothesis.

The claimant had reported pain in his right hip. The severity of his pain has impaired his capacity to safely return to work as a driver. His right hip injury had recently been assessed and he had been placed on a waiting list for surgical treatment of his right hip condition. His pain related to his hip, neck and back was not excessive and proportionate to the severity of his physical condition. The Panel Medical Assessors agree that the claimant does not have a DSM-5-TR F 45.1 Somatic symptom disorder with predominant pain. The physical condition and associated physical pain whilst reported as severe (8/10) is consistent with the loss of physical mobility and capacity to regain his full independence since the accident.

The claimant does not over emphasise his trauma related symptoms and the symptoms reported are consistent with mixed depressive and anxiety symptoms documented by his psychologist in the late documents."

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 (Guidelines).
2. Version 10.1 of the Guidelines, effective from 12 December 2025, applies to the review.
3. The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.
4. Permanent impairment is assessed in accordance with Part 6 of the Guidelines. Specifically, the assessment of psychiatric impairment draws from the chapter "Mental and behavioural disorders" which commence at cl 6.201 of the Guidelines.

1. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition.
2. Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:

"6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and 5E.

1. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[2]
2. The evaluation should only consider the impairment as it is at the time of the assessment.[3]
3. This means that while the Panel has reviewed the impairment evaluation of psychiatrist

Dr Eva Maher in her report dated 24 August 2022, the Panel must make its own determination with respect to Mr Fayad's pain symptoms and its implications on psychiatric impairment. 4. The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[4] 5. The Panel refers to the above re-examination report of Medical Assessors Baker and Rikard-Bell. The Panel reconvened on 3 February 2026 and discussed the re-examination report findings before collectively making the below determinations.

1. Mr Fayad had no pre-existing psychiatric conditions before the motor accident. He had a previous hip replacement in 2004 for which he recovered from and worked long hours as a taxi and Uber driver. The claimant presented to St George Hospital on the day of the motor accident complaining of pain in his trapezius muscle, right hip and lower back. In December 2020, the claimant's GP Dr Awada, referred him to psychologist Dr Nassir for 10 sessions for which, according to Dr Keller's report of 1 November 2023, the claimant attended in 2021.
2. Despite calling for the clinical notes of Dr Nassir, the Panel notes that these were not provided. The Panel however saw no reason to doubt the accuracy of the GP referral to

Dr Nassir nor Dr Keller's history of the claimant's attendance for psychological sessions in 2021. The claimant presently continues to see psychologist Ms Carol Hayek for his psychological symptoms. The Panel was therefore satisfied that the claimant sustained a psychiatric injury caused by the motor accident.

Diagnosis - Persistent depressive disorder with anxious distress

1. DSM-5-TR F32.0 Major depressive disorder with anxious distress is defined as follows:

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.

• Depressed mood most of the day, every day with an increasing feeling of hopelessness that he would never reach his goal of returning to work as a driver.
• Increased tearfulness when describing his increase social isolation from his family and friends.
• Fatigue and loss of energy nearly every day.
• Reduced concentration with a slower pace of reading and following news and current affairs that were previously of interest to him.
• Poor sleep with insomnia at night.
• Feelings of worthlessness for not being able to support himself with him having increasing reliance on his aged parents and one supportive brother.
• Marked loss of appetite with about one meals most days due to lack or interest and enjoyment of food.
• Loss of interest in socialising with his parents in the house and his extended family and past friendship circle outside of the home.
• Recurrent thoughts of suicide due to his condition not improving.

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

This criterion is satisfied as the claimant has had significant impairment in his relationship with his aged parents, extended family and friendship circle. He had significant impairment with his reduced capacity to work in his occupation as a driver at the same level as he had before the accident.

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

This criterion is satisfied as the claimant does not use illicit substances, drink alcohol or have a medical condition which could produce similar symptoms as he had at the time of this assessment.

At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders.

This criterion is satisfised as the claimant has never had any of these above conditions.

There has never been a manic episode or a hypomanic episode.

This criterion is satisfised as the claimant has never had any of these above conditions.

For the above reasons the claimant does meet criteria for major depressive disorder with recurrent episodes.

This specifier is satisfied by the claimant's report of increased worrying about having poor concentration and no capacity to check behind him while driving.

This specifier is satisfied by the claimant's report of his fearful of future accidents.

1. The Panel agrees that the claimant does not have DSM-5-TR F43.1 post-traumatic stress disorder. The reason for this assessment is that the claimant has insufficient symptoms to meet DSM-5-TR criteria for this condition. The claimant does not satisfy Criterion A for this disorder because he was assessed by the emergency service at St George Hospital and discharged the same day without specific treatment. The assessment by the hospital emergency team is inconsistent with the claimant having suffered a life-threatening injury because of the motor accident.
2. The claimant does report some symptoms of trauma related to worrying, nightmares and anxiety - however he does not meet the necessary Criterion C, Persistent avoidance of stimuli associated with driving. The claimant reported at the re-examination a desire to drive again as an Uber driver. He reported having tried to return to driving but the reason for failing his return-to-work trial was physical injury and associated pain, avoidance of the driving task itself. The claimant reported to his treating psychologist in the late documents handwritten that he "loves the conversations" he would have when driving and he is depressed because of his inability to socialise with customers. He does not fear meeting unknown clients whilst thinking about driving in the future.
3. For these reasons the claimant does not satisfy the minimum necessary criteria for the diagnosis of DSM-5-TR F43.1 post-traumatic stress disorder.

1. Permanent impairment is defined in the AMA4 Guides (p.315) as follows:

"Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment.

A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment."

1. The Panel agrees that the claimant's assessable psychological impairment has become static and well stabilised with or without medical treatment and is not likely to remit despite medical treatment. The claimant's impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment.
2. For these reasons the claimant's impairment is now a permanent psychiatric impairment.

1. The claimant reported that he was independent in his self-care and personal hygiene before the accident. He said he was able to cook food and maintain his self-care and personal hygiene without support. He reported that he was able to maintain his personal hygiene and self-care without support. He was able to perform his own with cleaning and laundry within the home.

Assessment of physical impairment and pain related impairment

1. The Panel notes cls 6.214 and 6.215 of the Guidelines:
   • 6.214 Impairment due to physical injury is assessed using different criteria outlined in other parts of these Guidelines, and
   • 6.215 The PIRS must not be used to measure impairment due to somatoform disorders or pain.
2. The claimant reported that he was physically unable to do as much around the home as he had before the accident. He said he was able to care for himself less because of his pain. He said he showered less due to his pain whilst showering. He did not assist with grocery shopping due to difficulty with his physical mobility and pain when standing for long periods. These physical and pain related impairment were not included in the measurement of the claimant's PIRS assessment incompliance with Guidelines.

Assessment of assessable psychological symptom impairment

1. The claimant reported that he had reduced interest in his nutrition as his appetite was reduced and food was not as enjoyable. He would sometimes miss meals with his family and eat leftovers that had been previously cooked by his mother. He had low energy and was less interest in his self-care and personal hygiene. He showed his room during the re-examination. There was no marked clutter or collecting of used snack packaging. He said he could care for his room independently as he had long periods of the day where he would slowly attend to his needs. On direct questioning the claimant stated he did not require the prompting of his mother to maintain his self-care and personal hygiene and he would shower when needed, usually about once to twice each week. He did not report dental problems such as gum or dental abscess as is clinically common in psychiatric patients who lack motivation or interest in maintaining self-care and personal hygiene. The claimant was able to purchase items from his local shop such as cigarettes. The claimant was independent in his self-care and personal hygiene This description of functioning was assessed as a mild impairment Class 2.

Difference in assessment compared to medical assessment certificate under re-examination

1. The assessment of impairment class was unchanged as Class 2 mild impairment. This was the same class documented by the Medical Assessor in the certificate under re-examination.

1. The claimant reported that he had enjoyed fishing in his outboard boat and watching NRL football before the accident. He stated he would socialise less before the accident as his wife and children were less interested in celebrations. He had reduced his social and recreational activities with his wife and family before the accident. He could enjoy watching movies on television before the accident and attend a local café for coffee alone. He would socialise with his brother who had supported him since the accident.

Assessment of physical impairment and pain related impairment

1. The Panel notes cls 6.214 and 6.215 of the Guidelines referred to above.
2. The claimant reported that he was unable to fish as he had too much pain to go boating or fishing. He said he would have pain as the water movement required constant re-balancing whilst fishing. He had sold his boat.
3. These physical and pain related impairment were not included in the measurement of the claimant's PIRS assessment in compliance with Guidelines.

Assessment of assessable psychological symptom impairment

1. The claimant reported that he lacked energy to socialise - however he would attend a local café alone for coffee when he was needing to be outside of his room. He said that he continued not to celebrate with his children and parents. He reported that he could watch television and he would watch movies whilst he spent his time in his room isolated from his parents. He had celebrated New Years Eve in Lebanon in 2024 whilst on vacation. This description of functioning was assessed as a mild impairment Class 2.

Difference in assessment compared to medical assessment certificate under re-examination

1. The assessment of impairment class was unchanged as Class 2 mild impairment was the same class documented by the Medical Assessor in the certificate under re-examination.

1. The claimant reported that he had driven extensively before the accident. He said his hip repair from 2004 had not caused him any difficulty from the date of the surgery to the date of the accident.

Assessment of physical impairment and pain related impairment

1. The claimant reported that his pain restricted his capacity to drive. He said he could not turn his body to the left. He reported that he was fearful of future accidents should he drive for long periods as was required as an Uber driver. He said his pain had restricted his capacity to drive when before the accident he did not have this restriction.

Assessment of assessable psychological symptom impairment

1. The claimant reported that he was able to travel to Lebanon in 2024. He said he was able to leave the home alone to travel to his local café. He said he was able to travel alone to his pain clinic to attend in person assessments. He said he was unable to drive to unfamiliar areas alone as he was too anxiously distressed about having a future accident. He confirmed he had driven to a friend's farm in the Goulburn region on one or two occasions.
2. This description of functioning was assessed as a mild impairment Class 2.

Difference in assessment compared to medical assessment certificate under re-examination.

1. The assessment of impairment class was assessed as Class 2 mild impairment by the Panel. The reasons why this assessment was different include the Panel's compliance with cls 6.214 and 6.215 of the Guidelines. The Panel notes that in the table for Travel in the certificate under re-examination, the Medical Assessor did not state that he had provided examples that had not included impairment due to theses clauses. For these reasons the assessment at the re-examination was not Class 3 moderate impairment.

1. The claimant reported that his relationship with his wife severely strained before the accident. He confirmed at the re-examination that he was separated from his wife before the accident. He reported that his relationship with his children was also severely strained. He reported a social group through his employment and one of his brothers supporting him in relation to the loss of his marriage. The claimant stated that the permanent separation from his wife was unrelated to the accident. He confirmed that he had slept in his car on multiple occasions before the accident during periods of repeated separation from his now ex-wife. For this reason, the separation was not a measurable psychological impairment due to the accident, because the claimant did not have a DSM-5-TR definable diagnosis in relation to his divorce.

Assessment of physical impairment and pain related impairment

1. The claimant did not identify any pain or physical conditions that had caused him impairment in his social functioning.

Assessment of assessable psychological symptom impairment

1. The claimant reported that he spent most of his day in his room isolated from his aged parents. He said there was tension in his relationship between him and his parents. He was not expecting to be evicted from the house.
2. The claimant said his relationship with his extended family was unchanged since the accident. He said he had not spoken to his ex-wife or children for about five years.
3. The claimant said his relationship with his friends has reduced. He reported his relationship with his brother that had supported him during the divorce remained but was strained due to his brother providing him with money to assist with his daily needs.
4. This description of functioning was assessed as a mild impairment Class 2.

Difference in assessment compared to medical assessment certificate under re-examination

1. The assessment of impairment class was assessed as Class 2 mild impairment by the Panel. The reasons for this assessment were due to the claimant having lost his primary relationship with his now ex-wife and children before the accident. The loss of this relationship was not related to the accident. For these reasons the assessment of impairment in the certificate under review was not confirmed as a Class 3 moderate impairment.

1. The claimant reported he was able to concentrate for prolonged periods before the accident. He was able to read and organise his work schedule without impairment. He could organise and manage changes in his recording of fares and applying for new opportunities successfully with Uber and Didi. He could manage his financial record keeping as required for his accountant.

Assessment of physical impairment and pain related impairment

1. The claimant did not identify any pain or physical conditions that had caused him impairment in his social functioning.

Assessment of assessable psychological symptom impairment

1. The claimant said he could watch movies which he would download from the internet. He said he could manage his phone banking. He could manage his MyGov app and he was required to interact with this portal fortnightly to record his presence in Australia and medical certificate currency required by Centrelink. These are complex tasks. The claimant was slower in his capacity to perform these essential complex tasks.
2. The claimant was assessed for about 100 minutes. He did require brief pauses to settle his emotions such as his tearfulness whilst explaining he losses during the re-examination. He was slower in his capacity to respond to questions. He was able to fully participate in the re-examination but at a slower rate.
3. This description of functioning was assessed as a mild impairment Class 2.

Difference in assessment compared to medical assessment certificate under re-examination.

1. The assessment of impairment class was assessed as Class 2 mild impairment by the Panel.
2. The Panel notes a Class 3 impairment for this table of functioning is,

"Moderate impairment. Unable to read more than newspaper articles. Finds it difficult to follow complex instructions; for example, operating manuals, building plans, make significant repairs to motor vehicle, type detailed documents, follow a pattern for making clothes, tapestry or knitting."

1. The Medical Assessor's description in the certificate under re-examination documented,

"Mr Fayad experiences notable difficulties with concentration, persistence, and pace, impacting his ability to complete tasks that require sustained mental effort. He frequently becomes distracted, struggles with memory, and finds it challenging to maintain focus, especially on complex tasks. However, he can perform simpler tasks with effort and concentration, indicating moderate cognitive impairment. A Class 3 rating is justified as it reflects the moderate impact on his cognitive functioning, acknowledging his struggles while recognising his ability to manage basic tasks."

1. The Panel notes that the descriptor above does not provide examples of the types of "complex tasks" the claimant is not able to perform. The Medical Assessor whilst stating that the impairment is of moderate severity does not provide examples of which activities the claimant can perform. Using a broad reading of the descriptor provided the Panel agree that the descriptor provided is more consistent with a Class 2 mild impairment.

1. The claimant reported that he had worked as a taxi / Uber driver for many years before the accident. He said he had enjoyed his work. He enjoyed his conversations with his customers. He enjoyed contributing to his community. He was working fulltime and stated he could work extended hours up to 60 hours per week before the accident.
2. The claimant said that he did have a right hip operation in about 2004. He said the operation was successful and he was able to drive unimpaired after the operation until the date of this accident.

Assessment of physical impairment and pain related impairment

1. The claimant reported that his pain would affect his capacity to work. He reported that he had tried a return-to-work trial but was unsuccessful due to his physical restriction of not being able to turn his body and head to the left to check behind him whilst driving. He said the pain in his right hip also restricted his capacity to drive for long hours as he had before the accident. He said he was waiting on surgery for his right hip condition to be provided by a public hospital orthopaedic team. The claimant reported that part of his Medical Certificate was due to his pain and physical impairment.

Assessment of assessable psychological symptom impairment

1. The claimant reported he would have depressive ruminations that he was not successful in his capacity to return to driving.
2. The claimant said he was sad and depressed in his mood most days as he could not perform the role he had provided for many years. He said he had become increasingly low in his energy and would easily fatigue. He could work in a different role for less than 20 hours per week at a slower pace in a role that was less stressful. The claimant was currently receiving a Centrelink Medical Certificate from his doctor placing him of temporary inability to work. The claimant reported that part of this Medical Certificate was due to his depression. This description of functioning was assessed as a moderate impairment Class 3.

Difference in assessment compared to medical assessment certificate under re-examination

1. The assessment of impairment class was assessed as Class 3 moderate impairment for this table of functioning. This was the same Class assessment as documented in the certificate under re-examination.

Degree of permanent impairment - Psychiatric Impairment Rating Scale

The claimant reported that he had reduced interest in his nutrition as his appetite was reduced and food was not as enjoyable. He would sometimes miss meals with his family and eat leftovers that had been previously cooked by his mother. He had low energy and was less interest in his self-care and personal hygiene. He showed his room during the re-examination. There was no marked clutter or collecting of used snack packaging. He said he could care for his room independently as he had long periods of the day where he would slowly attend to his needs. On direct questioning the claimant stated he did not require the prompting of his mother to maintain his self-care and personal hygiene and he would shower when needed, usually about once to twice each week. He did not report dental problems such as gum or dental abscess as is clinically common in psychiatric patients who lack motivation or interest in maintaining self-care and personal hygiene. The claimant was able to purchase items from his local shop such as cigarettes. The claimant was independent in his self-care and personal hygiene. This description of functioning was assessed as a mild impairment Class 2.

The claimant reported that he lacked energy to socialise - however he would attend a local café alone for coffee when he was needing to be outside of his room. He said that he continued not to celebrate with his children and parents. He reported that he could watch television and he would watch movies whilst he spent his time in his room isolated from his parents. He had celebrated New Years Eve in Lebanon in 2024 whilst on vacation. This description of functioning was assessed as a mild impairment Class 2.

The claimant reported that he was able to travel to Lebanon in 2024. He said he was able to leave the home alone to travel to his local café. He said he was able to travel alone to his pain clinic to attend in person assessments. He said he was unable to drive to unfamiliar areas alone as he was too anxiously distressed about having a future accident. He confirmed he had driven to a friend's farm in the Goulburn region on one or two occasions.

This description of functioning was assessed as a mild impairment Class 2.

The claimant reported that he spent most of his day in his room isolated from his aged parents. He said there was tension in his relationship between him and his parents. He was not expecting to be evicted from the house.

The claimant said his relationship with his extended family was unchanged since the accident. he said he had not spoken to his ex-wife or children for about 5 years.

The claimant said his relationship with his friends has reduced. He reported his relationship with his brother that had supported him during the divorce remained but was strained due to his brother providing him with money to assist with his daily needs.

This description of functioning was assessed as a mild impairment Class 2.

The claimant said he could watch movies which he would download from the internet. He said he could manage his phone banking. He could manage his MyGov app and he was required to interact with this portal fortnightly to record his presence in Australia and medical certificate currency required by Centrelink. These are complex tasks. The claimant was slower in his capacity to perform these essential complex tasks.

The claimant was assessed for about 100 minutes. He did require brief pauses to settle his emotions such as his tearfulness whilst explaining he losses during the re-examination. He was slower in his capacity to respond to questions. He was able to fully participate in the re-examination but at a slower rate.

This description of functioning was assessed as a mild impairment Class 2.

The claimant reported he would have depressive ruminations that he was not successful in his capacity to return to driving.

The claimant said he was sad and depressed in his mood most days as he could not perform the role he had provided for many years. He said he had become increasingly low in his energy and would easily fatigue. He could work in a different role for less than 20 hours per week at a slower pace in a role that was less stressful the claimant was currently receiving a Centrelink Medical Certificate from his doctor placing him of temporary inability to work. The claimant reported that part of his Medical Certificate was due to his depression. This description of functioning was assessed as a moderate impairment Class 3.

1. The claimant did not have a psychiatric or definable DSM-5-TR diagnosed condition before the accident. The Panel notes that the reasons for separation from his now ex-wife and children was not related to the claimant having a diagnosed psychiatric condition. The Panel agrees that it is common in clinical practice for people to separate, divorce or cease relationships without suffering from a psychiatric condition. For these reasons the claimant does not have a pre-existing psychiatric impairment.

1. The claimant had not suffered from any subsequent impairment. He has not had any surgical treatment for his right hip prior to this re-examination. For these reasons the claimant does not have a subsequent psychiatric impairment.

1. The Panel refers to cls 6.222 and 6.223. The Panel notes that there is no clear clinical evidence of the treatment provided to the claimant has been effective, that is, the claimant's symptoms have not improved and his functioning has not improved. For these reasons the assessment of the effects of treatment was determined as 0% WPI.

1. The Panel concludes that the claimant's psychiatric injury caused by the motor accident results in a WPI of 7% WPI which is not greater than 10%. The Panel's diagnoses and WPI findings differ to that found by Medical Assessor Gill.
2. The certificate issued by Medical Assessor Gill dated 16 August 2024 is therefore revoked. A new certificate is issued at the front of this determination.