Insurance Australia Limited trading as NRMA Insurance

MOTOR ACCIDENTS - Motor Accident Compensation Act 1999; treatment dispute; psychological injury; post-traumatic stress disorder; medicinal cannabis; causation; reasonable and necessary; joinder of Lifetime Care and Support Authority; claimant sustained injury in a motor vehicle accident on 11 April 2019 whilst riding his motor bike; claimant was diagnosed with post-traumatic stress disorder; dispute as to whether medicinal cannabis reasonable and necessary and whether causally related to injury sustained in the accident; Medical Assessor (MA) had determined the prescription of medicinal cannabis was reasonable and necessary in the circumstances and related to injury caused by the accident; Held - best available evidence does not support use of medical cannabis for post-traumatic stress disorder; claimant had a pre-existing generalised anxiety disorder; approval was for the treatment of anxiety; limited clinical benefit from use of medicinal cannabis; short term benefit does not outweigh the adverse effects; certificate of the original MA revoked; medicinal cannabis not related to the injury caused by the accident and not reasonable and necessary in the circumstances.

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

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

20 November 2023. 2. The Review Panel finds that the medicinal prescription of cannabis prescribed by Dr Christopher Lloyd does not relate to the injury caused by the accident. 3. The Review Panel finds that the medicinal prescription of cannabis prescribed by Dr Christopher Lloyd is not reasonable and necessary in the circumstances.

1. On 11 April 2019 whilst riding his motorbike Dean McCarthy (the claimant) was stationary behind the insured vehicle at a stop sign when the insured vehicle reversed colliding with the motor bike causing the claimant to sustain injury (the accident).
2. Insurance Australia Limited trading as NRMA Insurance (the insurer) is the relevant insurer with liability to pay any damages to Mr McCarthy under the Motor Accident Injuries Act 2017 (MAI Act).
3. Mr McCarthy submitted an Application for personal injury benefits dated 30 April 2019 in respect of injury sustained in the accident. He described the injuries sustained as "lower back, neck/whiplash, increased anxiety/PTSD".[1]
4. On 9 May 2022 the claimant asked the insurer to reimburse a pharmacy receipt dated 6 May 2022 for the provision of prescribed medicinal cannabis.
5. On 11 May 2022 the insurer declined reimbursement of the medicinal cannabis prescription.[2]
6. On 7 September 2022 the claimant requested an internal review of the treatment decision dated 11 May 2022.[3]
7. On 19 September 2022 the insurer issued a Certificate of Determination - Internal Review determining that the medicinal cannabis prescribed by Dr Lloyd was not reasonable and necessary.[4]
8. The claimant filed an application with the Personal Injury Commission (Commission) seeking a medical assessment to resolve the treatment dispute between the parties.
9. Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter, including (b) "whether any treatment and care provided or to be provided to the injured person is reasonable and necessary in the circumstances or relates to the injury caused by the motor accident for the purposes of section 3.24" of the MAI Act.
10. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[5]
11. This dispute was assessed by Medical Assessor Samuell Doron who issued a certificate dated 20 November 2023.

1. Section 3.24 of the MAI Act refers to an injured person's entitlement to statutory benefits for treatment and care as follows:

"(1) An injured person is entitled to statutory benefits for the following expenses (treatment and care expenses) incurred in connection with providing treatment and care for the injured person-

(a) The reasonable cost of treatment and care,

(b) Reasonable and necessary travel and accommodation expenses incurred by the injured person in order to obtain treatment and care for which his statutory benefits are payable,

(c) If the injured person is under the age of 18 years or otherwise requires assistance to travel for treatment and care, reasonable and necessary travel and accommodation expenses incurred by a parent or other carer of the injured person in order to accompany the injured person while treatment and cate for which statutory benefits are payable is being provided.

(2) No statutory benefits are payable for the cost of treatment and care to the extent that the treatment and care concerned was not reasonable and necessary in the circumstances or did not relate to the injury resulting from the motor accident concerned."

PROCEDURAL STEPS AND DOCUMENTS CONSIDERED BY THE REVIEW PANEL

1. On 10 February 2025 the insurer uploaded to the portal an indexed bundle of documents sought to be relied upon paginated from page 1 to page 476 (insurer's documents).
2. On 25 March 2025 the claimant uploaded to the portal an indexed bundle of documents sought to be relied upon paginated from page 1 to page 332 (claimant's documents).

1. On 1 April 2025 the Review Panel (Panel) issued a report advising a re-examination would be conducted by both Medical Assessors on 23 May 2025. The Panel made the following additional directions:

"1. The Panel attaches a copy of the Clinical Memorandum "Therapeutic use of medicinal cannabis products" March 2024. This is an updated version of the 2021 Memorandum relied upon by the insurer. The Panel proposes to consider the updated Memorandum when determining this dispute. If either party wishes to make any further submissions in respect of this Memorandum, they should do so by close of business 13 May 2025.

1. The Panel notes the Medicare and Pharmaceutical Benefits Scheme reports relied upon by the insurer were furnished on 13 September 2021. The Panel also notes there are no treating records since 2022.
2. Accordingly, the claimant is, by close of business 13 May 2025 to upload to the portal the following:

(a) Medicare and Pharmaceutical Benefits Scheme reports for the period 1 January 2022 to date;

(b) updated clinical records from any treating general practitioner, including Dr Lloyd from 1 January 2022 to date;

(c) updated clinical records from any treating psychologist from 1 January 2022 to date; and

(d) updated clinical records from any treating psychiatrist from 1 January 2022 to date."

1. On 21 May 2025 the medical examination was deferred until the records sought by the Panel were available.
2. On 11 September 2025 the claimant uploaded an Application to Lodge Additional Documents incorporating the Medicare/PBS Patient Summary dated 22 August 2025.

1. Having regard to the failure of the claimant to furnish the records the matter was listed for a teleconference on 2 September 2025. Member McTegg appeared on behalf of the Panel with Ms Lydia Wheatley of Law Partners for the claimant and Mr Mark Malley of Moray & Agnew for the insurer on 2 September 2025. Noting the accident occurred on 11 April 2019 Member McTegg informed the parties the Panel would only be able to make a binding decision as of 11 April 2024 unless the Lifetime Care and Support Authority were joined as a party to the proceedings. Following that teleconference the following directions were made:
   • On or before 5 September 2025 the claimant is to upload to the portal the Pharmaceutical Benefits Scheme (PBS) records.
   • On or before 16 September 2025 the insurer is to reach agreement with the claimant as to the wording to the schedule and upload to the portal Directions for Production with a return date of 7 October 2025 addressed to the following:
     • Dr Christopher Lloyd for updated clinical records from 1 January 2022 to date; and
     • Dr Goriparti and Berkeley Vale Private Hospital for updated clinical records from 1 January 2022 to date.

• On or before 16 September 2025 Mr Malley on behalf of the insurer is to notify CTP Care of these proceedings and to seek their advice as to whether they wish to be joined to the proceedings and to advise the Panel of their position.
• On or before 30 September 2025 the claimant is to upload to the portal the claimant's Medicare records.

Joinder of Lifetime Care and Support Authority

1. The Panel was informed the Lifetime Care and Support Authority consented to being joined as a party to these proceedings. On 14 October 2025 the Panel ordered that the Lifetime Care and Support Authority be joined as a party to these proceedings.
2. On 28 October 2025 the Lifetime Care and Support Authority (known as CTP Care) uploaded to the portal an indexed bundle of documents sought to be relied upon paginated from page 1 to page 300 (CTP Care's documents). These documents include the PBS Summary and the updated clinical notes of Dr Lloyd and of Dr Goriparti produced in response to Direction for Production.

1. The medical examination to be conducted by Senior Medical Assessor Baker and Medical Assessor Verma through MS Teams was rescheduled to 13 February 2026. The claimant failed to attend. No response was received from the claimant as to why he failed to attend.
2. On 2 March 2026 the Commission sent the following message to the parties:

"The Panel notes the claimant failed to attend the medical assessment to be conducted by MS Teams on 13 February 2026 without explanation. The Panel notes the Commission has made follow up enquiries with the claimant's lawyer on a number of occasions. On 25 February 2026 the claimant's lawyer stated they had been unsuccessful in contacting the claimant. No further response has been received.

Given this is a dispute about medicinal cannabis, the claimant's non-attendance and the failure to provide any explanation for that non-attendance that the Panel proposes to determine the matter on the papers."

1. Accordingly, the dispute has been determined on the papers.

1. In a certificate dated 20 November 2023 Medical Assessor Samuell certified the following treatment and care did relate to the injury caused by the accident and was reasonable and necessary in the circumstances:
   • cannabis prescribed by Dr Christopher Lloyd.[6]
2. The following treatment dispute was referred to Medical Assessor Samuell:
   • whether the medicinal prescription of cannabis prescribed by Dr Christopher Lloyd relates to the injury caused by the accident, and
   • whether the medicinal prescription of cannabis prescribed by Dr Christopher Lloyd is reasonable and necessary in the circumstances.
3. Medical Assessor Samuell reported the details of the accident. He noted at that time the claimant felt as though his throat may be closing, he experiences chest pain, shallow breathing and has sweating hands. He also reported nightmares about the accident at least four times a week. He dreams about a car reversing over him.
4. Mr McCarthy was under the care of Dr Suresh Goriparti, psychiatrist and was presently taking Mirtazapine, 30mg, Diazepam, 5mg, and medicinal cannabis, four puffs from a vaporiser at night.
5. Medical Assessor Samuell notes he had issued an earlier certificate in which he diagnosed post-traumatic stress disorder. He reported the claimant, his general practitioner (GP) and psychiatrist all supported the use of medicinal cannabis. Mr McCarthy reported some attenuation of his symptoms from the medicinal cannabis. He noted the TGA (Therapeutic Goods Administration) approved the prescription of medicinal cannabis for anxiety. He noted post-traumatic stress disorder contains a significant anxiety component.
6. Medical Assessor Samuell concluded the treatment had been effective whilst other treatments had been ineffective. He noted it had been tolerated well and was, on balance, reasonable and necessary.

1. The insurer lodged an application for review of the medical assessment on 19 December 2023 within 30 days of the date on which the certificate was made available to the parties.
2. On 6 March 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Panel.
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act, 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[7]
4. The review is by way of a new assessment of all matters with which the medical assessment is concerned.

1. In a certificate dated 24 December 2020 Medical Assessor Cameron certified the following injuries caused by the accident gave rise to a 2% permanent impairment:
   • lumbar spine - soft tissue injury, and
   • left shoulder - soft tissue injury.
2. Medical Assessor Cameron certified the following injuries caused by the accident had resolved and gave rise to no assessable permanent impairment:
   • right hip injury with sciatic radiation into the legs;
   • neck - soft tissue injury, and
   • left wrist -aggravation of pre-existing injury.

1. In a certificate dated 12 January 2021 Medical Assessor Samuell certified the following injuries caused by the accident gave rise to a permanent impairment of 19%:
   • post-traumatic stress disorder.

1. In a certificate dated 2 August 2022 Medical Assessor Lim certified the following injuries caused by the accident gave rise to a permanent impairment of 14%:
   • post-traumatic stress disorder.

1. In a certificate dated 1 June 2023 a Medical Review Panel comprising Member Cassidy, Medical Assessor Friend and Medical Assessor Hong revoked the certificate of Medical Assessor Lim dated 2 August 2022 and certified the claimant had a permanent impairment of 11% as a result of post-traumatic stress disorder and aggravation of Obsessive-compulsive disorder (OCD) and generalised anxiety disorder caused by the accident.
2. The claimant was assessed by Medical Assessors Friend and Hong on 8 May 2022. At that time his treatment included Panadol and Nurofen for pain. He was taking Mirtazapine 30mg at night and medical cannabis flower prescribed by Dr Lloyd which helped him to relax and with nightmares. It was reported he originally took Cannabidiol (CBD) oil which made him more anxious. He also took Diazepam, two tablets each day.
3. The Panel concluded the claimant had pre-existing conditions of OCD and generalised anxiety disorder and probably panic disorder. Following the accident the Panel found the claimant had developed post-traumatic stress disorder and the pre-existing generalised anxiety disorder and OCD have become more intense.
4. The Review Panel concluded that the claimant had anxiety symptoms for many years before the accident. He had a particularly intense episode of increased anxiety in 2017 caused by becoming a father for the first time. The Panel found those symptoms whilst present in 2018 appeared to have diminished somewhat. Further the Panel found in early 2019, before the accident, the claimant appears to have experienced another episode which left him unable to work.

1. The claimant consulted Dr Van Der Walt at the Elden Street Medical Centre, Dr Lloyd at Mingara Better Health and Grace Medical Centre pre-accident as follows:

(a) 23 May 2016 - Dr Abadir GP at Grace Medical Centre for anxiety - he runs a business and is very stressed;

(b) 30 June 2016 - Grace Medical Centre - work injury with severe back pain in the lower thoracic region. He started to experience anxiety that he used to have before;

(c) 22 October 2016 - Dr Kumar reported a history of anxiety. The claimant had been on and off Lovan for two years;

(d) 5 November 2016 - Grace Medical Centre - reviewed by Dr Padmakaran in relation to anxiety - seen previously in May 2015 and prescribed Diazepam and Lovan for anxiety. Takes Diazepam when needed infrequently when anxiety flares up;

(e) 15 December 2016 - Elden Street - he reported anxiety and depression and panic attacks all his life. Panic attacks can happy every day. He was working as a truck driver and was unable to sleep very well. He was taking Lovan 20mg;

(f) 22 December 2016 - Dr Younes Ismail GP reported the claimant went to the Emergency Department the previous night due to epigastric pain. The claimant was feeling anxious and taking Lovan;

(g) on 24 January 2017 the claimant reported pain in his right shoulder occasioned when pulling backwards whilst using a trolley jack. A X-ray and ultrasound of the right shoulder was recommended;

(h) 7 February 2017 - Elden Street - he reported Lovan was not helping. He was very anxious. He was to be weaned off Lovan and commenced on Pristiq 50mg;

(i) 27 March 2017 - Elden Street - felt anxious of Pristiq. He is anxious when leaving home and it was affecting his job. He sought referral to a psychologist;

(j) 4 April 2017 - the claimant experienced epigastric pain and was feeling anxious. He was not working;

(k) 28 April 2017 - Dr Lloyd - mental health assessment with diagnoses of anxiety, somatising with chest pain, nausea, abdominal pains and shortness of breath. He recommended referral to a psychologist;

(l) 1 May 2017 - anxiety. Hit from behind whilst car stationary. He had neck and back pain;

(m) 4 May 2017 - Dr Lloyd noted a bad day yesterday and wondered if it related to ADHD which was previously diagnosed. Difficulty holding down long-term employment;

(n) 19 and 26 May 2017 - Dr Lloyd reported persistent pain which he suspected to be anxiety driven. The claimant was consulting a psychologist. He was prescribed Valium;

(o) 19 June 2017 - Dr Lloyd - remains anxious. Changed from Valium to Clonazepam. Referred to Ms Stella Bowring, clinical psychologist;

(p) 7 July 2017 - noted the claimant had some "OCD type traits" and was "short fused";

(q) 29 August 2017 - Elden Street - anxiety and depression and recommended trial of Buspar;

(r) 13 September 2017 - Elden Street - prescribed Paxam (Clonazepam) 0.5mg;

(s) 5 October 2017 - Elden Street - he remains anxious. Buspar ceased. Referred to Dr Morice, psychiatrist for panic disorder and anxiety. Medications were Lovan 20mg, Nortriptyline 25mg, Pariet 20mg and Maxam 0.5mg;

(t) 13 November 2017 - Elden Street - severe anxiety and Nortriptyline increased to two at night;

(u) 28 November 2017 - Elden Street - remains anxious and not driving at present. He has seen a counsellor for cognitive behavioural therapy (CBT).

(v) 4 January 2018 - remains very anxious and unable to work. Nortriptyline increased to three 25mg tablets per night. Referral to Mr Ian Kilpatrick of Best Practice Psychological services for cognitive behavioural therapy "for gripping anxiety-generalised and panic disorder";

(w) 10 January 2018 - a mental health care plan was completed;

(x) 10 February 2018 - a GP Mental health treatment plan noted claimant suffered anxiety/depression since 1995, provision diagnosis of generalised anxiety and panic disorder;

(y) 16 February 2018 - referred to Dr Iyer, psychiatrist for severe anxiety and panic disorder;

(z) 5 March 2018 - Centrelink medical certificate certified claimant unfit for work to 5 August 2018 as a result of an exacerbation of pre-existing anxiety and panic disorder;

(aa) 13 April 2018 - referral to Dr Miller psychiatrist and repeat prescription for Lovan;

(bb) 31 May 2018 - referral to Dr Lim of the Hills Clinic at Hornsby for psychiatric treatment;

(cc) 7 June 2018 - Nortriptyline, Inderal and Lovan ceased. Commenced on Clomipramine 25mg;

(dd) 17 June 2018 - Clomipramine increased to two tablets;

(ee) 2 August 2018 - Clomipramine ceased. Continuing to take Paxam 0.5mg;

(ff) 29 September 2018 - discharge referral from Wyong Hospital indicated the claimant presented with pain in his chest in keeping with an acute anxiety attack that occurred whilst at work. Claimant admitted to ongoing life stresses;

(gg) 1 November 2018 - had stopped counselling but mood stable;

(hh) 3 January 2019 - Dr Lloyd - taking Lovan 20mg;

(ii) 17 January 2019 - Dr Lloyd - he somatises with significant anxiety and worries about health. Clonazepam ceased and commenced on Lorazepam. A Mental health assessment plan noted "long hx anxiety and PTSD following a traumatic experienced 4 yr ago", and

(jj) 19 February 2019 - Dr Lloyd - he has OCD type symptoms with anxiety. Dr Lloyd provided a medical certificate where he certified the claimant was suffering from a medical condition (generalised anxiety disorder) and would be unfit for work from 23 January 2019 to 23 April 2019.

1. The client intake form of Spectrum Health and Training dated 18 May 2017 notes "suicidal thoughts about taking pain away years ago. He had a difficult childhood involving significant abuse. Gets tired and cranky and verbal at partner". Has had anxiety all his life. Not working for fear of anxiety and something bad will happen. On the depression, anxiety and stress scale (DASS) he scored as moderate for depression, extremely severe for anxiety and moderate for stress. On 1 June 2017 he reported panic attacks, Attention-deficit/hyperactivity disorder (ADHD) and needed to reduce his diazepam dose.
2. On 18 January 2018 Mr Ian Kilpatrick, psychologist reported the claimant had anxiety for a long time. He noted a genetic predisposition due to family history on both parent's sides. He was referred for a psychiatric assessment at Brisbane Waters Private Hospital. He completed the DASS which showed severe depression, extremely severe anxiety and moderate stress.
3. On 4 June 2018 Dr Yenson, psychiatrist reported the claimant had been diagnosed with ADHD and managed with Ritalin until aged 15 years. Dr Yenson reported the claimant had multiple somatic symptoms including pain in the chest, shortness of breath, light headedness and tingling in his hands. Dr Yenson diagnosed a panic disorder.
4. An employment services assessment report of Dr Van Der Walt dated 13 September 2018 for Centrelink noted the claimant suffered from anxiety and panic disorder. Barries to employment included anxiety, no or limited support network, domestic violence, no or limited formal education and confidence.
5. On 29 January 2019 the claimant submitted an online disability claim form to Latitude Insurance. The main medical condition which had stopped him from working as anxiety/depression. He was certified unfit for normal duties until 15 February 2019.

1. The claimant consulted Dr Van Der Walt at the Elden Street Medical Centre, and Dr Lloyd at Mingara Better Health post-accident as follows:
2. The claimant consulted Dr Lloyd at Mingara Better Health on 12 April 2019. It was reported he had been in a motorcycle accident the day before when a vehicle reversed at a stop sign and collided with his motorbike.
3. On 8 May 2019 Dr Lloyd recorded low back pain and anxiety and on 13 May 2019 he noted pain and stiffness in the claimant's lower back.
4. On 11 August 2019 Dr Naresh Verma noted the claimant had a pre-existing history of anxiety and panic disorder which caused him to leave his job as a truck driver in January 2019.[8] At the age of 20 he fell from a moving vehicle and sustained a scaphoid fracture and could not work for five years. His anxiety "flared up and never settled". Dr Verma reported since the accident the claimant wakes multiple time during the night with pain and has nightmares about being hit by a car. He has suicidal ideation. His anxiety was reported to be terrible; he is easily startled and has daytime flashbacks and daily panic attacks. Dr Verma diagnosed a generalised anxiety disorder, panic disorder, post-traumatic stress disorder and cluster C personality traits.
5. On 14 August 2019 Dr Marc Russo, pain management specialist diagnosed chronic widespread pain, anxiety, depression and post-traumatic stress disorder.[9] He recommended a trial of Norspan 10mcg/hour patch and continued psychiatric care under Dr Verma although he thought he might need antidepressant, antipsychotic and Minipress to manage his post-traumatic stress disorder.
6. On 28 August 2019 Dr Russo noted the ongoing low back and occipital neuralgia symptoms.[10] He reported the claimant ceased the Norspan 10mcg/hr patch because of nausea and vomiting. He suggested he trial the Norspan 5mcg/hr patch and recommended a caudal epidural injection and bilateral suboccipital space pulsed radiofrequency neurotomy to treat the occipital neuralgia.
7. On 25 October 2019 the claimant presented to Wyong Hospital with symptoms of anxiety. A referral to a psychologist or psychiatrist was recommended.
8. The claimant attended the Elden Street Medical Centre on 7 and 29 November 2019 when Diazepam was prescribed.
9. On 16 December 2019, 13 January 2019, 3 February 2020 the claimant attended the Elden Street Medical Centre. He was prescribed Diazepam.
10. On 25 February 2020 post-traumatic stress disorder was diagnosed. The claimant attended the Elden Street Medical Centre on 17 March 2020, 6 April 2020, 24 April 2020, 7 May 2020, 29 May 2020, 16 June 2020, 16 July 2020, 10 December 2020 and 10 May 2021 in relation to his psychological symptoms.
11. On 3 October 2019 Suzanne King, clinical psychologist of Innervate Pain Management reported Mr McCarthy was struggling with severe symptoms of post-traumatic stress disorder which was exacerbating his pain experience.[11] She reported a high level of distress with repeated, disturbing memories of the accident, an avoidance of everyday activities as he perceives high levels of threat associated with his own incapacity. She noted multiple pain behaviours.
12. On 6 February 2020 Ms King reported the claimant was struggling with his symptoms of post-traumatic stress disorder and his chronic pain which had led to him recently ceasing work again.[12]
13. On 17 February 2020 Dr Verma noted the claimant had ceased Fluoexetine a weeks ago and had been prescribed Olanzapine 5mg twice daily. She reported nightmares and a choking sensation, poor sleep, weight loss and erectile dysfunction. She concluded he continued to have post-traumatic stress disorder, anxiety-based symptoms and cluster C personality traits. She recommended he wean of Olanzapine, start Mirtazapine and increase to 15mg and start Prazosin 1mg increasing to 3mg and start Quetiapine.
14. Dr Andepalli psychiatrist provided a report dated 1 June 2021.[13] He noted the background history of pre-existing anxiety disorder. The claimant was not working, had been depressed, had a lack of interest and is irritable and angry. His sleep was disturbed, and he had feelings of worthlessness. He has panic attacks with palpitations, decreased breathing, dry throat, sweaty palms and feels he is going to die. He was taking Mirtazapine 15mg at night. Dr Andepalli reported the claimant trialled CBD oil but it increased his anxiety and he ceased. He diagnosed symptoms of major depression and anxiety disorder previously and possible post-traumatic stress disorder symptoms following the accident. He recommended taking Venlafaxine 37.5mg increasing to 75mg after four days. He also recommended he commence Quetiapine 25mg at night.
15. On 17 January 2022 Dr Chris Lloyd issued a certificate in which he confirmed authorisation from the TGA to prescribe medicinal cannabis for Mr McCarthy.[14]
16. On 4 February 2022 Dr Lloyd diagnosed post-traumatic stress disorder, and anxiety. It was noted the claimant was going well on flower, much calmer, sleeping, and with less intrusive thoughts.
17. On 23 February 2022 the claimant attended the Central Coast Transitional Care Facility requesting admission for "anxiety symptoms". The risk of harm was considered low so his care was transferred to his GP.[15]
18. The claimant attended on the surgery of Dr Lloyd 24 February 2022, 1 March 2022, 31 March 2022, 2 May 2022, 30 May 2022, 28 June 2022, 22 July 2022, 19 September 2022, 6 January 2023, 14 April 2023, 22 June 2023 and 3 July 2023 in respect of panic disorder, anxiety and or post-traumatic stress disorder. On these occasions he was prescribed various forms of medicinal cannabis.
19. On 31 July 2023 Dr Lloyd reported:

Ongoing psychological injury but is now able to aim to retrain .

1. The next attendance was on 15 January 2024 when Dr Lloyd reported that the claimant suffered an injury to his right knee when he fell from a motorbike on 12 January 2024. On 19 January 20924 it is noted that he sustained a complete or near complete avulsion of the anterior cruciate ligament (ACL) distally and a torn medical meniscus.
2. On 16 April 2024 Dr Lloyd recorded a change in the dried Cannabis prescription.[17] On 30 April 2024 Dr Lloyd recorded the reason for visit as post-traumatic stress disorder and prescribed medicinal cannabis which he reported helps the claimant sleep.
3. On 22 August 2024 D Lloyd noted anxiety, he provided a prescription for medicinal cannabis and noted "all well, add oil in the evening, reduce how much is smoked, no longer using axit."
4. On 4 March 2025 Dr Lloyd noted anxiety, provided a prescription for medicinal cannabis and noted "cannabis helps".
5. On 8 May 2025 Dr Lloyd recorded:

asking for reassurance he isn't having a heart attack

Nil N/V nil sweating friend recently had 'plaque build up' and found from shoulder pain

1. On 12 May 2022 Dr Goriparti reported the claimant suffered anxiety most of his life, but he was never admitted to a mental health unit and never saw a psychiatrist prior to the accident as he couldn't afford one.[18] He was diagnosed with ADHD as a child. Mr McCarthy feared in the accident he would be crushed by the reversing vehicle and would die or get seriously injured. He experiences nightmares and flashbacks and wakes with palpitations, anxiety, sweating and in a state of arousal. He is anxious on the road and hypervigilant.
2. Dr Goriparti diagnosed post-traumatic stress disorder, mixed anxiety and depression and recommended the claimant commence Venlafaxine 75mg daily. He also diagnosed secondary depressive symptoms of anhedonia, pervasive low mood, decreased energy and motivation, worthlessness and hopelessness and passive suicidal thoughts.
3. Dr Goriparti reported Mr McCarthy had been trialled on various medications including Fluoxetine, Olanzapine, Prazosin, Duloxetine and Mirtazapine, all of which caused side effects. He reported Mr McCarthy turned to medicinal cannabis to manage his symptoms and it was prescribed by Dr Lloyd.
4. On 1 September 2022 Dr Goriparti reported the claimant was struggling and continued to have symptoms of post-traumatic stress disorder.[19] He was using medicinal cannabis to get to sleep and stay asleep. Dr Goriparti provided a literature study as follows:

"• https://www.tandfonline.com/doi/abs/10.1080/02791072.2013.873843: PTSD Symptom Reports of Patients Evaluated for the New Mexico Medical Cannabis Program - Greater than 75% reduction in CAPS symptom scores were reported when patients were using cannabis compared to when they were not.

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397040/: Cannabis: A potential efficacious intervention for PTSD or simply snake oil? - There have been indications that cannabis or some of its components, primarily THC and CBD, diminish particular symptoms of PTSD. In this regard, in a small study (n = 10), 5 mg of THC twice a day as an add-on treatment enhanced sleep quality and reduced the frequency of night-mares, PTSD hyperarousal (based on the Clinician Administered PTSD Scale) and global symptom severity. The synthetic analogue of THC, nabilone, similarly enhanced sleep, reduced nightmares and diminished other PTSD symptoms among patients.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8222769/: Cannabis in the management of PTSD: a systematic review - RoB studies showed that cannabis was associated with a reduction in overall PTSD symptoms and improved QOL. Dry mouth, headaches, and psychoactive effects such as agitation and euphoria were the commonly reported adverse effects.
• https://www.mdpi.com/1648-9144/55/9/525: Use of Medicinal Cannabis and Synthetic Cannabinoids in Post-Traumatic Stress Disorder (PTSD): A Systematic Review - Present data show that cannabis and synthetic cannabinoids, both acting on the endocannabinoids system, may have a potential therapeutic use for improving PTSD symptoms, e.g., reducing anxiety, modulating memory-related processes, and improving sleep.
• https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2409-8: Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review - isolated positive studies have, however, revealed tentative support for cannabinoids (namely cannabidiol; CBD) for reducing social anxiety; with mixed (mainly positive) evidence for adjunctive use in schizophrenia. Case studies suggest that medicinal cannabis may be beneficial for improving sleep and post-traumatic stress disorder, however evidence is currently weak."

1. On 3 November 2022 Dr Goriparti reported the claimant said he is "not bad overall". He felt better with Diazepam. He was using medicinal cannabis flower 0.25 - 0.5 gram a day which was helping him to sleep.[20]
2. On 8 December 2022 Dr Goriparti reported the claimant was struggling badly.[21] He was sleeping well with medicinal cannabis. He continued to have some suicidal thoughts, but his son was his protective factor.
3. In a report dated 6 June 2024 Dr Goriparti reported the claimant was struggling after he was involved in an incident when his brother's friend died in his arms after an accident in the bush. Dr Goriparti refers to flashbacks about that incident as well as anxiety. He reported the claimant has recently starting work for a trucking business and that he was in the process of acquiring a tow truck business.
4. On 12 September 2024 Dr Goriparti reported persisting anxiety, sometimes affecting the claimant at work.[22] The claimant had purchased 110 acres in Coonabarabran for potential medicinal cannabis cultivation. He had acquired a tow truck business with five to six employees. He was using medicinal cannabis only as night.
5. On 5 December 2024 Dr Goriparti reported the claimant was doing well, he had started a truck company and had seven employees.[23] He reported residual anxiety symptoms. He was using Mirtazapine to sleep and medicinal cannabis only at night for anxiety and insomnia.
6. On 20 February 2025 Dr Goiriparti reported the business was going well and the claimant was able to manage his work-related stress.[24] He reported some residual anxiety symptoms, managed with Diazepam as needed. He was taking medicinal cannabis (THC flower) at night for sleep.
7. On 17 April 2025 Dr Goriparti reported the claimant continued to experience post-traumatic stress disorder and physical anxiety.[25] He noted the business was going well. He used Diazepam as needed, and Mirtazapine for anxiety. He reported the claimant was sleeping well with the use of cannabis flower.
8. In a report dated 19 June 2025 Dr Goriparti refers to increased anxiety and stress due to business issues. The claimant was using Valium as a "safety net" for anxiety management. He was using cannabis for sleep management only.
9. On 10 July 2025 Dr Goriparti reported increased anxiety and stress related to the business sale, workplace stressors, issues with his operations manager and unexpected complications.[26] He was using medicinal cannabis flower for nighttime use and Diazapam for elevated stress levels.
10. On 11 September 2025 Dr Goriparti referred to significant financial stresses and legal negotiations.[27] He was using cannabis, but it was not helping with his sleep.

1. The records demonstrate that from 3 October 2014 until the date of the accident the claimant was frequently prescribed Fluoxetine.

1. Dr Cocks assessed the claimant at the request of his lawyers and provided a report dated 5 May 2020. He diagnosed post-traumatic stress disorder and assessed a 22% whole person impairment (WPI).
2. Dr Cocks reported prior to the accident the claimant's anxiety was in remission secondary to treatment with antidepressant medication. He gradually developed distressing nightmares waking in distress, sweating and anxious. He can travel in a motor vehicle but is anxious on the roads, He experiences intense anxiety with palpitation and travels in familiar local areas. He is more irritable; his energy is depleted, and he struggles with motivation and drive. His mood was depressed with a sense of hopelessness. He has difficulty focusing and feels worthless.

1. Dr Rikard-Bell assessed the claimant at the request of the insurer and provided a report dated 6 October 2021.
2. Dr Rikard-Bell reported insomnia, nightmares of the accident. The claimant was anxious, scared and gets angry, snappy and irritable. He is fearful of the future. He has recurrent panic attacks with shortness of breath, palpitation, chest pain and tightness.
3. Dr Rikard-Bell diagnosed post-traumatic stress disorder arising from the accident. He had a pre-existing diagnosis of generalised anxiety disorder and panic disorder. Dr Rikard-Bell assessed a 9% WPI after making a deduction of 6% for the pre-existing impairment.

1. The insurer provided submissions dated 9 January 2023 in respect of the treatment dispute.
2. The insurer notes on 17 January 2022, a medical certificate from Dr Lloyd noted that the TGA approved the claimant's use of medicinal cannabis. The insurer notes that the approval letter did not provide any indication for the prescription of medicinal cannabis.
3. In accordance with s 3.24 of the MAI Act, the insurer submits the claimant's treatment request for medicinal cannabis is not reasonable and necessary. The insurer submits that the claimant did not experience any relief in his psychiatric symptoms from his prior use of cannabis as reported by Dr Andepalli's on 1 June 2021. Indeed, Dr Andepalli reported he had to stop the use of medicinal cannabis because it increased his anxiety.
4. On 1 September 2022, Dr Goriparti reported that the claimant continued to use medicinal cannabis to "get to sleep and stay asleep". Dr Goriparti provided some literature in relation to the use of medicinal cannabis which found there is no conclusive evidence as to the effectiveness in the use of medicinal cannabis in patients suffering from post-traumatic stress disorder, nor does it support improvement in symptoms and recovery management in post-traumatic stress disorder patients.
5. Moreover, the insurer submits that the requirements of section 4.80 of the Motor Accident Guidelines have not been satisfied, because the request for medicinal cannabis does not meet any of the five guiding principles for consideration in the Clinical Framework for the Delivery of Health Services (Clinical Framework) which includes the effectiveness of the treatment, biopsychosocial approach, recovery management, goal implementation, and best research.
6. The Australian Government Department of Health Therapeutic Goods Administration - Medicinal products patient information guide outlines the following:

"There have been very few well-designed clinical trials using medicinal cannabis, so there is limited evidence on its success in treating different medical conditions, or on effective forms and dosages."

1. The insurer submits there is no definitive research that supports the claimant's contention that medicinal cannabis will improve his pain symptoms and psychiatric condition.
2. The insurer provided submissions in support of the application for review dated 19 December 2023.[28]
3. The insurer accepts the claimant suffers from post-traumatic stress disorder caused by the accident. However, the insurer notes the claimant has an extensive pre-accident history of psychological complaints including severe anxiety and depression. The insurer submits Medical Assessor Samuell failed to explain how the requirement for treatment is related to the accident injury, as distinct from the claimant's pre-existing severe anxiety.
4. The insurer submits the claimant's history includes a longstanding history of anxiety, together with medication (various types), psychological treatment and support, difficulties holding down long-term employment, obsessive compulsive traits, panic disorder, post-traumatic stress disorder following a previous trauma, and depression.
5. The insurer notes the Panel found at the time of the accident the claimant had the following pre-existing symptomatic and treated psychiatric conditions:

(a) obsessive compulsive disorder;

(b) generalised anxiety disorder, and

(c) a probable panic disorder.

1. The insurer submits the Medical Assessor failed to address the appropriateness of the treatment considering the following treating evidence:
   • On 1 June 2021, the claimant reported to Dr Andepalli, psychiatrist that he had to stop the use of medicinal cannabis because this only caused to increase his anxiety.
   • Dr Verma, psychiatrist, in a report dated 1 June 2021 opined CBD oil had increased the claimant's anxiety and hence he ceased this treatment.
   • On 1 September 2022, Dr Goriparti reported that the claimant continued to use medicinal cannabis to "get to sleep and stay asleep." On this occasion, the doctor provided some literature in relation to the use of medicinal cannabis which found there is no conclusive evidence as to the effectiveness in the use of medicinal cannabis in patients suffering from post-traumatic stress disorder, nor does it support improvement in symptoms and recovery management in post-traumatic stress disorder patients.
2. In Diab v NRMA Ltd[29] the following factors were found to be relevant to, but not determinative of, reasonableness in the workers compensation scheme:

(a) the appropriateness of the treatment in dispute;

(b) the availability of alternative treatment;

(c) the cost effectiveness of the treatment;

(d) the actual or potential effectiveness of the treatment, and

(e) the acceptance by medical experts of the appropriateness of the treatment.

1. The insurer also refers to the Motor Accident Guidelines which provide:

"4.80 The insurer should apply the principles of the nationally endorsed Clinical Framework for the Delivery of Health Services, which sets out five guiding principles for consideration by health professionals and insurers when reviewing treatment plans and requests for services:

(a) measure and demonstrate the effectiveness of the treatment.

(b) adopt a biopsychosocial approach - consider the whole person and the individual circumstances.

(c) empower the injured person to manage their recovery.

(d) implement goals focused on the optimising function, participation and return to work or other activities.

(e) based treatment on the best available evidence."

1. The insurer also refers to the current Clinical Memorandum from the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which provides that the evidence upon which to base an assessment of the efficacy, effectiveness and safety of medicinal cannabis products is limited.[31] The insurer submits the Medical Assessor failed to provide reasons as to why the prescription of medicinal cannabis is safe given the risks and inconsistent results of the claimant using medicinal cannabis and the advice of the Royal Australian College and New Zealand College of Psychiatrists.
2. The insurer submits there is no definitive research that supports the contention that medicinal cannabis will improve the claimant's symptoms, by reference to the above Guide.
3. The insurer provided further submissions dated 28 October 2025.
4. The insurer notes that the information in the PBS Patient for the period 1 January 2022 to 31 July 2025 confirms that scripts for Mirtazapine and Diazepam have been a feature. Earlier in the period covered by the records, Clonazepam and Venlafaxine also featured. A script (with three repeats) issued for Diclofenac on 20 October 2022, and the records indicate that one supply of 100 tablets issued 31 October 2022, another on 3 June 2023 which was followed by another supply on 17 July 2023.
5. The insurer submits that having settled his damages claim the claimant's overall situation dramatically improved over time having regard to the reports of Dr Goriparti. It is submitted that the claimant has substantially, if not completely psychologically recovered from the effects of the accident and his day-to-day life is that of a person with well-established, lifelong pre-existing psychological issues which from time to time will require treatment and other interventions.
6. It submitted that cannabis treatment prescribed by Dr Lloyd is not, as required by s 3.24 of the MAI Act, related to the injuries resulting from the accident and reasonable and necessary in all the circumstances.

1. CTP Care provided submissions dated 28 October 2025.[32] These submissions are in identical terms to the insurer's submission dated 28 October 2025.

1. The claimant provided undated submissions in support of the substantive dispute.[33]
2. The claimant submits the provision of medicinal cannabis is in relation to the treatment of the physical and psychological injuries sustained in the accident. Dr Lloyd and Dr Goriparti diagnosed post-traumatic stress disorder and recommended the use of medicinal cannabis.
3. The claimant has trialled analgesic, anti-inflammatory, opioid and anti-depressant medication, including, Mirtazapine, Lansoprazole, Rivotril, Seroquel, Fluoxetine, Olanzapine, Prazosin, Duloxetine, Norspan patches, and over the counter analgesic medication for the management of his injuries and pain levels. Dr Goriparti noted he had experienced side effects from all those medications. In addition, he has participated in physiotherapy, hydrotherapy, exercise physiotherapy, pain specialist consultations, counselling sessions, eye movement desensitization and reprocessing therapy (EMDR) and psychiatry consultations. The claimant has exhausted a large number of treatment options for the management of his condition.

1. Given the claimant failed to participate in the medical assessment scheduled to take place on 13 February 2026 the Panel concluded it was appropriate to determine the matter on the papers.
2. The Panel has had regard to the Motor Accident Guidelines and the five guiding principles of the nationally endorsed Clinical Framework for the Delivery of Health Services and to the decision in Diab.
3. The claimant was injured in the accident on 11 April 2019.
4. The claimant had a complex pre-existing psychiatric history. In a certificate dated 1 June 2023 a Medical Review Panel concluded the claimant had the following pre-existing conditions:
   • (a) OCD;
   • (b) generalised anxiety disorder, and
   • (c) a probable panic disorder.
5. The Panel notes the claimant has an extensive documented history which included a wide rubric of diagnoses made by different clinicians and assessors prior to the accident on 11 April 2019. The Panel has reviewed the claimant's clinical records and is satisfied his presentation with various severity of anxiety in conjunction with other reported symptoms is consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) diagnostic criteria of each diagnosis made by the Medical Review Panel in its certificate dated 1 June 2023.
6. The Panel notes the insurer accepts that the claimant has sustained the DSM-5-TR diagnosis of post-traumatic stress disorder caused by the accident.
7. The Panel notes the claimant suffers from pain from both his physical and psychological injuries as well as posttraumatic stress disorder.
8. The Panel notes from careful review of the claimant's clinical records that the primary documented intended use for THC was in relation to insomnia, nightmares and pain. In the early phase of treatment beneficial changes to these symptoms were noted by the prescribing general practitioner Dr Lloyd and by the treating psychiatrist Dr Goriparti. On 4 February 2022 Dr Lloyd reported the claimant was calmer, sleeping and with less intrusive thoughts. Dr Goriparti reported the medicinal cannabis was helping the claimant to sleep, but he also reported the claimant still had symptoms of post-traumatic stress disorder.
9. There, was no suggestion the claimant's condition of post-traumatic stress disorder had entered full remission and by 11 September 2025 Dr Goriparti reported; "He was using cannabis, but it was not helping with his sleep". Clearly, one of the symptoms used to monitor the effectiveness of the treatment had not remitted and remained active despite extensive treatment with medicinal cannabis.
10. Schedule 1 to the letter from the Therapeutic Goods Administration to Dr Lloyd dated 17 January 2022 provided approval for a Category 1 - THC medicinal cannabis product (THC greater than 98%) for anxiety. The product description "Herb, dried (for vaporisation)". The product medicinal cannabis THC is clinically very different to medicinal cannabis (CBD Oil). CBD Oil does not contain THC. According to the clinical records the claimant reported an exacerbation of his anxiety when he was initially prescribed CBD Oil.
11. The increase in anxiety caused Dr Lloyd to seek permission for THC in the form of dried herb (flowers) for vaporisation and inhalation. THC is clinically well known to cause changes in cognitive functioning and euphoria. The letter of approval dated 17 January 2022 notes that patients should not drive or operate machinery while being treated with medicinal cannabis. Prescribers of THC are advised to inform patients that THC usage can significantly increase the risk of future motor accidents and accidents when using heavy machinery.
12. The Panel notes the approval dated 17 January 2022 was for 24 months' supply of THC. The Panel has not evidenced a further approval from the TGA, noting the date for reapplication by the prescribing doctor would be January 2024. However, in April 2024 Dr Lloyd referred to the prescription of medicinal cannabis and in September 2025 Dr Goriparti reported the claimant was using cannabis but it is not clear whether this was medicinal THC or an alternative supply.
13. The Panel notes the claimant returned to riding his motorcycle and on 15 January 2024 Dr Lloyd reported that the claimant injured his right knee when he fell from a motorbike on 12 January 2024.
14. The Panel was referred to the RANZCP clinical memorandum regarding medicinal cannabis dated January 2021. The Panel notes a more recent version of this memorandum was issued in January 2024. The position is largely unchanged with both memoranda asserting that the evidence upon which to base the assessment of the efficacy, effectiveness and safety of medicinal cannabis is limited. Moreover, both the 2021 and the 2024 memorandum noted there was very little evidence to suggest that cannabinoids improve post-traumatic stress disorder and only low-quality evidence that pharmaceutical THC leads to a small improvement in symptoms of anxiety among individuals with other medical conditions. Further both memoranda note that medicinal cannabis products are found to increase the risk of short-term adverse effects such as disorientation, dizziness, euphoria, and confusion.
15. The Panel notes that since about July 2022 the claimant's routine medication as listed in PBS Patient summary included only the antidepressant mirtazapine and diazepam 5mg. These two medications are commonly prescribed for post-traumatic stress disorder.
16. The Panel notes the claimant's pre-existing conditions included a generalised anxiety disorder and suggests even if it supported the use of medicinal cannabis for anxiety, the claimant's anxiety was pre-existing and was not caused by the accident. In any event on 1 June 2021 both Dr Andepalli and Dr Verma psychiatrist reported the claimant had stopped the use of medicinal cannabis because it had increased his anxiety suggesting it was not an effective or appropriate treatment.
17. The Panel notes that the best available evidence does not support the use of THC for post-traumatic stress disorder, anxiety or non-cancer pain. Schedule 1 to the approval dated 17 January 2022 document identifies the supply of THC for anxiety. However, the diagnosis DSM-5-TR F43.1 post-traumatic stress disorder does not include "anxiety" in the criteria of symptoms (criteria B, C, D, and E) for this condition. The Panel does not concur with the opinion of Medical Assessor Samuell that post-traumatic stress disorder contains a significant anxiety component. The reported anxiety in relation to this claimant's psychological condition is best explained as part of his pre-existing generalised anxiety disorder as diagnosed by the Medical Review Panel in a certificate dated 1 June 2023.
18. Whilst the Panel notes the diagnosis of post-traumatic stress disorder includes sleep disturbance the Panel notes the evidence as to the efficacy of medicinal cannabis in respect of the claimant's sleep disturbance is equivocal. On 17 April 2025 Dr Goriparti reported the claimant was sleeping well with the use of cannabis but by 11 September 2025 he reported the claimant was no longer gaining any clinical benefit from the use of cannabis with respect to his sleep disorder.
19. The Panel has a adopted a biopsychosocial approach and consideration of the claimant as a whole and his individual circumstances. Other than some limited improvement in his sleep in the early phase of treatment there has been limited clinical benefit demonstrated by the claimant as a result of the use of medicinal cannabis. The Panel does not consider those short-term benefits outweigh the risk of adverse effects such as disorientation, dizziness, euphoria, and confusion.
20. The Panel finds in accordance with the TGA approval the prescription of medicinal cannabis was for the treatment of anxiety and not for the treatment of post-traumatic stress disorder. Accordingly, the Panel finds the proposed treatment does not relate to the injury caused by the accident.
21. The Panel finds that the proposed treatment is not reasonable and necessary in the circumstances given there is currently insufficient evidence to support the use of medicinal cannabis for post-traumatic stress disorder.

1. The Panel revokes the certificate of Medical Assessor Samuell dated 20 November 2023.
2. The Panel finds that the medicinal prescription of cannabis prescribed by Dr Christopher Lloyd does not relate to the injury caused by the accident.
3. The Panel finds that the medicinal prescription of cannabis prescribed by Dr Christopher Lloyd is not reasonable and necessary in the circumstances.

[29] Diab v NRMA Ltd [2014] NSWECCPD 2 at [88].30