MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of medical assessment of single Medical Assessor (MA); whether psychological injuries caused by the motor accident give rise to a whole person impairment (WPI) which is greater than 10%; claimant witnessed his father being struck by a vehicle; original MA diagnosed persistent depressive disorder giving rise to a 14% WPI; issues of correct diagnosis and level of functioning; claimant went on to study at university and work part time; Held - Review Panel found 5% WPI due to a post-traumatic stress disorder caused by the motor accident; certificate of medical assessor revoked.

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

1. Revokes the certificate of Medical Assessor Christopher Canaris dated 5 June 2024.
2. Certifies that the following injury caused by the motor accident gives rise to a whole person impariment of 5% which is not greater than 10%:
   • post-traumatic stress disorder.

1. Mr Adam Abdel-Ghani (the claimant) alleges injury from a motor accident occurring on

7 June 2021. The claimant witnessed his father being hit by a car. 2. He subsequently lodged a claim under the Motor Accident Injuries Act 2017 (MAI Act) upon Insurance Australia Limited t/as NRMA Insurance (the insurer), the compulsory third party insurer of the vehicle considered at fault. 3. The insurer is liable for payments of statutory benefits and/or damages under the MAI Act. 4. A dispute has arisen between the parties as to whether a psychological injury caused by the accident gives rise to a whole person impairment (WPI) greater than 10%. 5. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor. 6. The dispute about whether the injury caused by the motor accident gives rise to a WPI of greater than 10% is a medical dispute, as defined by s 7.17 of the MAI Act, and is a medical assessment matter: Sch 2, cl 2(a) of the MAI Act. 7. The dispute was originally determined by Medical Assessor Christopher Canaris who issued a certificate and reasons dated 12 June 2024. The Medical Assessor certified a persistent depressive disorder (dysthymia) with anxious distress caused by the motor accident has given rise to a permanent impairment of 14% which is greater than 10%.

1. The insurer sought a review of the medical assessment of Medical Assessor Canaris in accordance with s 7.26 of the MAI Act. On 26 August 2024 the President's delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel).
2. Section 7.26(5A) of the MAI Act provides that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
3. 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: s 7.26(6) of the MAI Act.
4. Rules 127 and 130 of the Personal Injury Commission Rules 2021 (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: Rule 128 of the Rules.
5. The Panel met via video on two separate occasions, and determined that a

re-examination of the claimant was required. A medical examination was arranged to take place on 4 September 2025 with Medical Assessor Yeates and Medical Assessor Doris via Microsoft Teams. The examination took place as scheduled. 6. The Panel reconvened via videolink for a teleconference on 18 September 2025 where the clinical findings at re-examination were discussed. The Panel's conclusions, adopting the clinical findings are provided further below.

1. Medical Assessor Canaris noted the diagnoses of other examiners, and concluded that the claimant's presentation was consistent with a persistent depressive disorder (dysthymia) with anxious distress. He commented that the claimant may well have had post-traumatic stress disorder previously, however the presentation was very much dominated by depressed mood, lack of motivation, social withdrawal and depressed affect.
2. The Medical Assessor found a class 3 impairment in respect of self-care and personal hygiene, social and recreational activities and travel. A class 2 impairment was found in remaining categories. This resulted in a WPI of 15%, however, 1% was deducted "out of abundant caution and using clinical judgment" on the basis of a rule out diagnosis of ADHD for which he has never had treatment.

Insurer's review submissions dated 10 July 2024

1. The insurer submits that the Medical Assessor not making a diagnosis of post-traumatic stress disorder was not suffered by the claimant, he was then not permitted to go on to make an alternative diagnosis that was not referred for assessment.
2. It is submitted that the Medical Assessor misdirected himself as to the claimant's level of functioning and the reliance on self-reported symptoms was misdirected when viewed against obvious inconsistencies in the material.
3. The insurer notes that in its original submissions a knee reconstruction undergone by the claimant in 2022 has uncertain origin. The insurer submits that it had put the Medical Assessor on notice that it was anticipated the claimant may have been involved in physical recreational activities.
4. The insurer also notes desktop investigations reports that suggest the claimant had participated in football since the accident. This includes a team list suggesting the claimant was a member of the Kingsgrove Colts at a game which occurred on 13 April 2024.
5. The insurer also refers to reports of Procare that confirms the claimant had joined a Facebook Group called Security Jobs Sydney in April 2024. The insurer submits the Medical Assessor failed to engage with the fact the claimant had obtained a security licence and had also joined a Subaru WRX and Sti Owners Group in June 2024 with the Medical Assessor noting the claimant did not drive.
6. The insurer submits:

"the insurer contends the assessor's failure to have proper regard to the documentation provided, particularly in circumstances where he was put on notice in the insurer's submissions of likely inconsistencies in the claimant's histories and presentation, has seen the assessor fall into error with respect to his diagnosis and permanent impairment assessment."

Claimant's review submissions in reply (undated)

1. The claimant refers to surveillance footage that had been relied upon by the insurer (NB: footage not relied upon as part of the Review - however, accompanying investigation reports are). The claimant submits that pursuant to Blacktown City Council v Hocking [2008] NSWCA 144, apart from what is shown in the video, no conjecture or speculation can be drawn from it. It is submitted that whilst the claimant is playing sport, which is what the video shows, no other conclusions can be drawn from it.
2. The claimant submits that whilst it is asserted that the claimant rarely goes out, there is nothing in the Medical Assessor's findings with regard to social and recreational activities which is contradicted. It is submitted that playing sport, in circumstances where the claimant has had a long history of pursuing a rugby league career, does not disavow his psychiatric symptoms and complaints.

1. The Panel issued directions requiring the parties to each lodge a single bundle of all documentation relied upon for the purposes of the review. There were some delays in respect of compliance with the directions, however, eventually bundles were lodged. The Panel has considered all documentation that was provided that form part of these bundles. This includes a bundle lodged on behalf of the insurer on 28 July 2025 consisting of 1,192 pages - "Insurer's Combined index for Review Panel (Adam Abdel-Ghani)" and a bundle lodged on behalf of the claimant on 14 July 2025 consisting of 260 pages - "Claimant's Bundle of Relied Evidence - Adam Abdel-Ghani - PAGINATED."
2. Not every document has been specifically referenced within these reasons. Some documentation has been summarised and/or referenced where directly relevant to the findings made. However, the reasons and certificate had been prepared in the context of the Panel having considered all of the documentation.

Application for personal injury benefits dated 2 August 2021

1. This claim form includes a history of the motor accident, where the claimant witnessed his father being hit by a car when attempting to enter his own vehicle. It is stated the claimant's father fell head first onto the road and the claimant and other family members rushed to him and found him unconscious and bleeding from the head.
2. The claimant explains the traumatic nature of the incident. He explains that he has not recovered mentally or emotionally form the incident and keeps having flashbacks.

1. The clinical file commences in July 2021. On 27 July 2021 with the claimant providing a history of the motor accident to general practitioner (GP), Dr Ismail. The claimant was noted to have severe anxiety with recurrent panic attacks. The claimant was referred to psychologist, Dr D'Silva on 24 July 2021.
2. The claimant attends upon his GP in regular intervals complaining of various psychological symptoms related to the motor accident including social withdrawal, anxiety, depression, concentration difficulties, and a lack of motivation.
3. At a consultation of 23 August 2022 the claimant is noted to have chronic knee pain and a previous meniscal tear and ACL tear.

1. The claimant relies on a report of Dr Allan dated 9 August 2023. The claimant gave a history of social withdrawal and a lack of motivation and a fluctuating concentration. He stated that he only saw his friends around once a month and had made no friends at university.
2. The doctor commented that he was concerned that the claimant appeared to have no recall of regular contact with Dr D'Silva which is clearly outlined throughout the supplied medical material.
3. The ACL ligament repair was noted in 2022, and the claimant described a slow recovery. It was stated the claimant attends the gym weekly, and has not returned to playing sport.
4. The doctor diagnosed post-traumatic stress disorder and a WPI assessment of 15% is given.
5. The insurer relies on a report of Dr Newlyn dated 29 November 2023. Dr Newlyn also diagnosed the claimant as suffering post-traumatic stress disorder and found a 5% WPI.
6. A supplementary report of Dr Newlyn dated 30 August 2024 is also relied upon. The doctor was provided with a copy of the certificate and reasons of Medical Assessor Canaris and Procare reports of 6 June 2024 and 9 July 2024. Also provided to Dr Newlyn was a report of Dr Wernecke dated 30 June 2022. This report confirms the claimant suffered a knee injury in 2022 due to participation in a game of rugby league.
7. Dr Newlyn remarked:

"the wording of Assessor Canaris' report is that Mr Abdel-Ghani denied active involvement in a football club. When assessed, Mr Abdel-Ghani was listed as playing on the Kingsgrove Colts Emerging Cup Men's Team. Mr Abdel-Ghani did not disclose that he played rugby league in 2022. His distress in 2024 was not in keeping with my 2023 assessment."

1. Dr Newlyn revised his earlier opinion in respect of diagnosis with him changing same to post-traumatic stress disorder in remission and a reduction of PIRS assessment to 4%.

1. The insurer relies on various reports of Procare Investigations. This includes reports with accompanying video footage. It is noted the insurer has not listed the actual footage as being relied upon, and the Panel has accordingly not viewed the footage.
2. An initial report dated 6 June 2024 confirms the claimant had recently obtained his Operator Security Licence and internet searches suggested the claimant was a player of rugby league.
3. A report of 9 July 2024 states that investigations reveal the claimant was listed as a current player with Kingsgrove Colts Emerging Cup Men for season 2024. He has been mentioned in all team lists for games played from April 2024 to the date of the report. He was apparently not listed in the teams for years 2022 and 2023. The investigators downloaded a copy of a game of 25 May 2024 where the claimant is said to have played as "#11".
4. A further report of 25 October 2024 is provided. The report notes the claimant continues his involvement with the Kingsgrove Colts in the 2024 Power Waste Management Emerging Cup and had appeared in the team list of an additional five matches. Video of the claimant participating in three games were downloaded by the investigators.

1. The claimant's school records from Malek Fahd Islamic School are provided from 2014 onwards, which have been considered by the Panel. The claimant's results are variable throughout the subjects.
2. Also provided is an academic transcript from the Western Sydney University related to the claimant's degree of Bachelor of Construction Management Studies/Bachelor of Laws commenced in 2023. The results demonstrate marks that are generally above average, that includes pass, credit and distinctions.

1. Below are the clinical examination findings of the Medical Assessors following the re-examination that occurred on 4 September 2025.

1. Mr Abdel-Ghani was born in 2005 at Canterbury Hospital in Sydney and was raised in Sydney with his mother, father, and two younger brothers. His parents were both teachers. The family home was in Bankstown. Mr Abdel-Ghani was a physically healthy child and young person, denying any domestic violence or external trauma experienced inside or outside the family. He reflected positively on his upbringing, describing it as emotionally and physically nurturing. To the best of his knowledge, he met all his developmental milestones at the expected times. He stated that his closest relationship was with his father during childhood and adolescence.
2. Mr Abdel-Ghani attended Malek Fahd Islamic School for his entire education. He was an above-average achieving student with good grades. He was never suspended or expelled from school. He said he had a few minor issues with discipline at school that he attributed to adolescence. He completed Year 12, and the period from his later high school education overlaps with the accident relevant to this claim. From middle adolescence, Mr Abdel-Ghani worked at Bunnings doing three to four shifts per week after school. He was very interested in sports, such as rugby, basketball, and weightlifting at the gym. He denied any previous romantic partners. He is otherwise medically well.
3. Mr Abdel-Ghani denied any prior contact with psychologists, psychiatrists, Mental Health clinicians, or general practitioners for psychological or emotional issues before the accident relevant to this claim. He has never had a psychiatric admission, experienced suicidal ideation or intent, nor made a suicide attempt. There is no history indicating a primary psychotic illness or bipolar affective disorder. There is no family history of major mental illness, addiction, or completed suicide. Mr Abdel-Ghani does not drink alcohol by choice and follows his religion, Islam. Similarly, he has never used illicit substances and does not gamble. There is no forensic history.

1. Mr Abdel-Ghani provided an account of the accident that led to the current claim. On

7 June 2021 Mr Abdel-Ghani's father was leaving the house to go to work from the family home. Mr Abdel-Ghani was also leaving with his mother and siblings to go to school. As

Mr Abdel-Ghani was standing on the driveway to leave in another vehicle with his mother and siblings, he saw his father walking toward the driver's side of his car that was parked parallel to the street where the family home stands. Mr Abdel-Ghani reported hearing a loud bang and seeing his father covered in blood and glass, believing that his father was dead, having been hit by a vehicle that was passing by. The rest of his family was screaming, and his father was unconscious, bleeding from a laceration in his scalp. Mr Abdel-Ghani recalled encouraging his father to say particular Arabic words relevant to Islam. Mr Abdel-Ghani's neighbour contacted the ambulance, which transported Mr Abdel-Ghani's father to St George Hospital with head injuries and physical injuries. Mr Abdel-Ghani said that his father had an impact on his hearing, stiff joints, and personality changes, including emotional liability.

History of symptoms and treatment following the motor accident

1. Mr Abdel-Ghani mentioned that soon after the accident, he started to worry and dwell on the circumstances, experiencing intrusive memories of seeing blood on his school shirt and his father bleeding from the head. He was persistently concerned about his father when his father would leave the family home. He also described feeling overwhelmingly sad and believed he was not keeping pace with his peers. Mr Abdel-Ghani reported difficulty with middle-of-the-night awakening, sweating, and restless sleep. He also noted withdrawal from his usual activities, irritability, and trouble experiencing positive emotions. He took one week off school after the accident and completed Year 12 the following year, achieving an ATAR in the late 70s. He said this was not consistent with his expectation of an ATAR in the mid 90s. He denied any depersonalisation or derealisation. Soon after the accident, although he cannot specify when exactly, Mr Abdel-Ghani was referred to and consulted Mr Joseph D'Silva, psychologist. He attended Mr D'Silva until July 2025 on an approximately fortnightly basis for supportive psychotherapy. Mr Abdel-Ghani is prescribed and takes PO agomelatine 25mg at night.

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

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

1. The mental state examination showed a young man who appeared consistent with his age, of Middle Eastern descent but Australian background, who was generally socially appropriate and polite, though somewhat socially reserved. Rapport developed to a limited degree. The mood was low and the affect was flat, with no signs of spontaneous levity. Thought content was reality-oriented, with no features of psychosis or suicidality, but marked avoidance of content related to the accident relevant to this claim. The thought form was normal. Speech was normal in grammar, structure, syntax, and quantity, although with reduced spontaneous elaboration. There were no perceptual disturbances, and judgement was not acutely impaired. Cognition appeared broadly normal, with no indication for formal testing. Insight was modest.

1. Mr Abdel-Ghani is currently attending university full-time and working part-time in retail at Bunnings. He showers every second or third day and reports gaining weight due to overeating. He lives at home with his parents and siblings, where his mother handles most of the domestic chores. He attends the mosque twice a month and played rugby in 2024. Occasionally, he goes out to dinner with his family and is a member of the Subaru Owners Club, last participating about a month before this assessment. He drives, including alone when needed, though he prefers not to because of anxiety. He will catch public transport alone to Parramatta for university. He isn't in an intimate relationship but has a good relationship with his family, although he has lost contact with some friends. Mr Abdel-Ghani studied for his security guard licence in January 2024 and has passed all university courses with above-average results. He last worked a shift at Bunnings recently and has studied at a full-time load, completing his course in the predicted timeframe.

1. Mr Abdel-Ghani required additional prompting considering evidence provided to the Panel regarding his employment and recreational activities, and an inconsistency between

Mr Abdel-Ghani's account and the objective evidence provided to the Panel. Mr Abdel-Ghani also minimised and downplayed his university results, which, as provided to the Panel, were above average. This was presented to Mr Abdel-Ghani, who believed his results being above average was a matter of opinion rather than an objective fact.

1. Mr Abdel-Ghani presents with symptoms and signs consistent with post-traumatic stress disorder. He gave an account of an event that satisfied Criterion A, and a clinical syndrome of nightmares, intrusive memories, persistent negative emotional state, avoidance of cues related to the trauma and difficulty experiencing positive emotions. Globally, the clinical presentation was consistent with post traumatic stress disorder. Please find the criteria for PTSD as per the DSM-5 outlined below:

A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or

2. Witnessing, in person, the event(s) as it occurred to others.

3. Learning that the traumatic event(s) occurred to a close family member or close

friend. In cases of actual or threatened death of a family member or friend, the

4. Experiencing repeated or extreme exposure to aversive details of the traumatic

event(s) (e.g., first responders collecting human remains; police officers repeatedly

1. The accident described, witnessing his father be seriously injured by being hit by a motor vehicle as a pedestrian satisfies Criterion A for post-traumatic stress disorder from the DSM-5TR. Mr Abdel-Ghani described plausibly, feeling that his father had died and was overwhelmed with fear.

B. Presence of one (or more) of the following intrusion symptoms associated with the

traumatic event(s), beginning after the traumatic event(s) occurred:

"1. Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).

Note: In children older than 6 years, repetitive play may occur in which themes or

2. Recurrent distressing dreams in which the content and/or affect of the dream are

Note: In children, there may be frightening dreams without recognizable content.

3. Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if

the traumatic event(s) were recurring. (Such reactions may occur on a continuum,

with the most extreme expression being a complete loss of awareness of present

Note: In children, trauma-specific reenactment may occur in play.

4. Intense or prolonged psychological distress at exposure to internal or external cues

that symbolize or resemble an aspect of the traumatic event(s).

5. Marked physiological reactions to internal or external cues that symbolize or resemble

1. Mr Abdel-Ghani reported distressing nightmares related to the traumatic events. This criterion is satisfied.

C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after

the traumatic event(s) occurred, as evidenced by one or both of the following:

"1. Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about

2. Avoidance of or efforts to avoid external reminders (people, places, conversations,

activities, objects, situations) that arouse distressing memories, thoughts, or feelings

about or closely associated with the traumatic event(s)."

1. Mr Abdel-Ghani makes efforts to avoid driving, and avoids internal cues and memories of the accident. This criterion is satisfied.

D. Negative alterations in cognitions and mood associated with the traumatic event(s),

beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or

"1. Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative

amnesia and not to other factors such as head injury, alcohol, or drugs).

2. Persistent and exaggerated negative beliefs or expectations about oneself, others,

or the world (e.g., 'I am bad,' 'No one can be trusted,' 'The world is completely

dangerous,' 'My whole nervous system is permanently ruined').

3. Persistent, distorted cognitions about the cause or consequences of the traumatic

event(s) that lead the individual to blame himself/herself or others.

4. Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).

5. Markedly diminished interest or participation in significant activities.

6. Feelings of detachment or estrangement from others.

7. Persistent inability to experience positive emotions (e.g., inability to experience

1. Mr Abdel-Ghani reports difficulty experiencing position emotions. He also reports that he has diminished interest in previous significant activities such as sports and friendships.

E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or

"1. Irritable behavior and angry outbursts (with little or no provocation) typically expressed

as verbal or physical aggression toward people or objects.

6. Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep)."

1. Mr Abdel-Ghani has an ongoing sleep disturbance, partially improved by agomelatine, with middle awakening and unrestful sleep. He also described irritability and was observably irritable.

F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.

1. The symptoms have been present for several years.

G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

1. Mr Abdel-Ghani reports and describes significant distress in his social functioning. His occupational functioning is largely intact.

H. The disturbance is not attributable to the physiological effects of a substance (e.g.,

1. Mr Abdel-Ghani has no history of substance or alcohol misuse.

Mr Abdel Ghani showers every second or third day and reports that he has gained weight due to overeating. He lives in the family home with his parents and siblings where his mother performs most of the domestic duties.

Mr Abdel Ghani attends the mosque twice per month and played rugby in 2024. He will go out to dinner with his family occasionally and is a member of the Subaru owners Club, last having participated a month or so prior to this evaluation.

Mr Abdel Ghani drives, including alone when required although prefers not to due to anxiety. He will take public transport alone to Parramatta to the campus where his university is located. He has not travelled overseas.

Mr Abdel Ghani is not currently in an intimate relationship but has a harmonious relationship with his family but has lost contact with some friends

Mr Abdel Ghani has passed all his courses at university in Bachelor of Construction Management and Bachelor of Laws, with above average results. Mr Abdel Ghani has not fallen behind in his course and is completing it in the expected timeframe. Mr Abdel Ghani studied for his security guard license in January 2024. This is consistent with concentration capacity within the normal range for the population.

Mr Abdel Ghani works part time at Bunnings last doing a shift in the recent weeks. Mr Abdel Ghani has studied at a full-time load since the accident and is completing his course in the predicted timeframe. This is consistent with the adaptation within the normal range of the population.

1. There is no pre-existing impairment to apportion.

1. There is no research evidence that agomelatine is indicated for post-traumatic stress disorder. Mr Abdel Ghani's psychological therapy was supportive and CBT-based, which has research evidence in post-traumatic stress disorder. The Medical Assessors were satisfied that the treatment was reasonable and appropriate in the situation. There has been some improvement over time, but there is no clear clinical evidence of the effectiveness of either the pharmacological or psychotherapeutic treatments Mr Abdel Ghani has received. The clinical judgment of the Medical Assessors is that if the treatment is withdrawn (psychological or agomelatine), Mr Abdel Ghani would not deteriorate. In summary, the treatment has had no or negligible effect, and therefore there is no basis for an adjustment for treatment.

1. The above clinical examination findings, along with the documentation provided by the parties, were discussed by the Panel at a teleconference on 18 September 2025. It was collectively agreed by all Panel members that the findings would be accepted and adopted as part of these reasons.
2. The Panel notes the inconsistencies between evidence obtained by the insurer and the history provided to past examiners. The claimant's history provided at re-examination is more harmonious with the documentation provided, than perhaps it has been with other examiners. The Panel noted the claimant's tendency to minimise his abilities and functioning, which was put to him. Nonetheless, the Panel accepts the claimant has suffered post-traumatic stress disorder as a direct result of the motor vehicle accident, and has suffered some loss of function as a result, which is reflected in the assessment of impairment as set out above. Despite his injury, the claimant has been able to continue successfully with his university studies and participate in family life and recreational pursuits.
3. The Panel noted the insurer's complaint that Medical Assessor Canaris had certified a different psychological injury that the post-traumatic stress disorder that was referred for assessment. The Panel notes that a diagnosis has been made of post-traumatic stress disorder and therefore the issue raised by the insurer is essentially of no relevance in light of the diagnosis made.
4. The findings of the Panel differ from that of Medical Assessor Canaris and accordingly the certificate of 5 June 2024 is revoked and a new certificate is provided at the beginning of these reasons.