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austlii:nsw/NSWPICMP/2025/378
General information, not legal advice.
NSWPICMP
2025-05-29
Original judgment source is linked above.
Insurance Australia Limited t/as NRMA Insurance v Aduah [2025] NSWPICMP 378
Insurance Australia Group Limited, trading as NRMA Insurance
MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); claimant suffered injury in a motor vehicle accident; Medical Assessor determined whole person impairment (WPI) as 15%; insurer made application under section 7.26 referral of assessment to the Review Panel; Review Panel conducted its own examination and found that whole person impairment (WPI) as a result of injuries sustained in the accident totalled 5%; MAC revoked; Review Panel substituted a 5% WPI as a result of the accident.
23 November 2023, and substitutes the determination to certify that the injuries referred to the Panel and caused by the motor accident, gave rise to a whole person impairment of 5%.
(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.
(2) Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.
(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.
(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent."
6.31 The evaluation of the permanent impairment may be complicated by the presence of an impairment in the same region that existed before the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value. If there is no objective evidence of the pre-existing symptomatic permanent impairment, then its possible presence should be ignored.
6.32 The capacity of a medical assessor to determine a change in physical impairment will depend upon the reliability of clinical information on the pre-existing condition. To quote the AMA4 Guides (page 10): 'For example, in apportioning a spine impairment, first the current spine impairment would be estimated, and then impairment from any pre-existing spine problem would be estimated. The estimate for the pre-existing impairment would be subtracted from that for the present impairment to account for the effects of the former. Using this approach to apportionment would require accurate information and data on both impairments.' Refer to clause 6.218 for the approach to a pre-existing psychiatric impairment.
6.33 Pre-existing impairments should not be assessed if they are unrelated or not relevant to the impairment arising from the motor accident."
6.5 An assessment of the degree of permanent impairment is a medical assessment matter under clause 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.
6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:
'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:
(a) The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
(b) The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'
This, therefore, involves a medical decision and a non-medical informed judgement.'
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."
23 November 2023. 2. Medical Assessor Nagesh certified that the following injuries were caused by the accident and gave rise to a permanent impairment of 15%, being greater than 10%:
(a) major depressive disorder, and
(b) post-traumatic stress disorder.
"[8] Ms Aduah is a 60 year old female, single, living with her daughter, unemployed, on Centrelink benefits. Prior to the MVA Ms Aduah denied any history of mental illness. She denied using any drugs or alcohol.
Ms Aduah reported her family to be in Ghana which include her parents and 2 bothers and 2 sisters. She denied any history of mental illness in the family. She denied suffering from any medical comorbidities before the MVA. Reports having sustained Right knee injury, underwent Right knee construction which resulted in blood clots in her lungs due to the MVA. Her current medications include amitriptyline 30 mg nocte, pregabalin 150 mg BD, Palexia 50 mg BD, prednisolone 5 mg, prazosin 1 mg. Ms Aduah was born in Ghana, reported having a normal birth, denied any delay in developmental milestones attained, reported her childhood was good with no abuse or trauma. Reported her schooling to be uneventful. Completed year 7, learnt sewing, worked as a dress maker for roughly 15 years. Migrated to Australia in 2006, carer for her husband and also was caring for her daughter who was young. Has been working in Australia as dress maker for a few years and then as a cleaner at the airport. At the time of MVA Ms Aduah was working as a dress maker, she had just obtained a job at the airport as a cleaner. Her husband passed away in 2016. She was not in any relationship. She was independent with self care and was able to cook, clean and shop. She reports having friends, her hobbies were dancing and sewing, she did go out and socialise and had no difficulty with socialising. Her attention, concentration was good, she was able to travel independently."
"[9] Ms Aduah reports having met with a MVA on 28th August 2018, she was a pedestrian and was crossing the road in Elizabeth drive, Liverpool where she was swiped by a car and she fell on to the median strip. She did not lose consciousness, ambulance was called and she was taken to Fairfield hospital. No head injury, was admitted for 12 hours, X-rays and scans were performed. No fractures identified. She was referred to Gp for follow up. Gp referred her for further MRI scan and she was diagnosed with patellar subluxation . She underwent physio initially, her injury was not healed and further underwent knee reconstruction."
"[10] Ms Aduah reports having difficulty with sleeping from the time of MVA, she became depressed in the context of her physical pain. Not able to be active, having to sit around all day, she reports having developed nightmares, flashbacks of the accident, became anxious, every time she crosses the road she develops flashbacks and becomes anxious, has totally avoided walking past the accident, she had to relocate houses because she lived two minutes away from the accident site and it reminded her of the MVA, used to go for walks all the time, worried about gaining weight, has ben restricting her diet, feels tired, lacks energy and motivation, the pain restricts her mobility, feels worthless and hopeless with her current situation. Reports being irritable at times as she does not sleep well, reports not able to enjoy anything at the moment, angry towards the driver who caused the accident, depressed all the time, she feels her life is ruined because of the accident, has had suicidal thoughts. Struggles to cross the road now, is hypervigilant when she crosses the road. She has seen her GP who has commenced her on amitriptyline which is an antidepressant medication She was referred to psychologist where she has been treated with supportive psychotherapy and Cognitive behaviour therapy, exposure therapy."
"[12] Depressed mood, anxious, lack of energy and motivation, insomnia, fluctuating appetite, diminished ability to concentrate, feels worthless, hopeless, fleeting suicidal thoughts. She also has nightmares, flashbacks of the MVA, has completely avoided walking past the MVA site, has relocated to another suburb as she lived 2 minutes from the site of MVA which has acted as a reminder of the accident. She is angry towards the driver who caused the MVA, she is irritable, has lost interest in her hobbies, nothing makes her happy at the moment. Hypervigilant when she leaves the house."
"[14] Mental State examination - Ms Aduah is a middle aged female, casually dressed, reasonable self care, during the interview she was anxious, easy to engage, made intermittent eye contact. Her speech rate/tone/volume was normal. She described her mood as depressed, her affect was anxious and restricted. There was no FTD, No delusions or obsessions. No suicidal or homicidal ideations. She was well oriented in time place and person. Her insight and judgement remain intact.
[15] Current functioning - Her current routine includes at home doing nothing, goes to her appointments with daughter, she struggles to do her domestic duties which is due to her pain, relies on her daughter to do the cooking, cleaning and sometimes she goes with daughter for shopping , showers everyday. Does not socialise at all, had plenty of friends but has. lost contact with them. Does not attend any dinner parties weddings or anniversaries, not in any relationship and has no interest in forming a relationship, she is able to walk for ten minutes on her own and take public transport on her own to see her specialists. Her attention, concentration is diminished, cannot read a book, struggles to watch TV due to her depressed mood.
[16] Comments of consistency - I could not identify any signs of inconsistency or voluntary exaggeration of symptoms on today's assessment."
"[18] In my opinion Ms Aduah meets the criteria for Major depressive disorder as follows. She has experienced depressive and anxiety symptoms in the context of her pain, not able to be active as before and loss of mobility. She fulfils the criteria under DSM V as follows. Five of the following symptoms have been present for more than two weeks where on of the symptom is depressed mood. In addition she has experienced insomnia, lack of energy and motivation, fluctuating appetite, diminished ability to concentrate, fleeting suicidal thoughts, feelings of worthless.
[19] Ms Aduah has no previous history of mental illness. The subject MVA was a traumatic incident where Ms Aduah was exposed to death. In my opinion the subject MVA has resulted in her diagnosed PTSD. The pain the functional limitations from her physical injuries has given rise to her Major depressive disorder."
If not for pain and her physical injury she would be capable of living independently but would struggle due to her depressive and PTSD symptoms and hence in my clinical judgement her level of impairment is of mild degree and hence she scores 2.
Remain socially withdrawn, has lost contact with majority of friends, does not attend any weddings, dinner parties, or anniversaries. Cannot attend large group events due to anxiety.
Dina is able to go out for walks on her own for ten minutes, she is able to take public transport independently where she can travel up to ten minutes on her own but she cannot travel to far away and unfamiliar places without her daughter.
Has lost contact with majority of friends, not in any relationship, but has no interest to form a new relationship, relationship with daughter remains intact.
Her attention, concentration remains poor, she is not able to read a book, watch TV or read magazines, which is due to her depressed mood, cannot focus for more than five minutes.
Her inability to work is partly due to her pain and her physical injury and using my clinical judgement her inability to cope with stress and work at the moment is of moderate degree and she scores 3
"[23] There is no pre existing condition and hence there is no pre existing impairment. Ms Aduah has burnt herself and had a fall in her kitchen in January 2023. This injury has worsened her pain but has not given rise to any new psychological injury. Her PTSD and Major depressive disorder are from the subject MVA and I have not deducted any portion for subsequent impairment."
"I crossed the road at Elizabeth Drive in Liverpool, from the side of the McDonald's Restaurant. I looked for cars before crossing and could not see any cars. After commencing to cross the road, as I was about to step onto the median strip, a car hit my right leg and I fell to the ground."
"On 14th August 2018, Unit 2 (pedestrian) crossed the southern kerb of Elizabeth Drive at McLean Street, walking across westbound lanes 1 and 2 of 3, intending to stop at the median strip in the centre of Elizabeth Drive.
Unit 2 then continued walking through lane 3, during which time DR 1, travelling in lane 3, collided with Unit 2. It is believed Unit 2 was about 30 cm short of reaching the median strip when DR 1 collided into her.
The area where the pedestrian crossed is not controlled by traffic lights or a pedestrian crossing.
All details were exchanged between both parties. Unit 2 was conveyed by ambulance to Fairfield Hospital for treatment."
The Panel summarises the submissions of the Insurer dated 12 December 2023 as follows:
Submissions by the claimant of 14 December 2023
[1] Ms Aduah submits that the PIRS is a guideline, not a definitive test. Medical assessors are entitled to exercise clinical judgment and consider symptoms not expressly listed in the PIRS tables.
[2] Ms Aduah submits the insurer's position that Ms Aduah should be rated Class 1 overlooks Assessor Nagesh's recorded history, including fatigue, hopelessness, suicidal ideation, and inactivity, which are all relevant to psychological functioning.
[3] Ms Aduah submits the Class 2 rating appropriately reflects both psychological symptoms and physical limitations impacting Ms Aduah's self-care.
[4] Ms Aduah submits a change from Class 2 to Class 1 would not materially affect the overall impairment.
[5] Ms Aduah submits the insurer has not substantiated its allegation that Assessor Nagesh gave inadequate reasoning for a Class 3 rating.
[6] The assessment must be read holistically, not cherry-picked. Ms Aduah submits that pages 4 and 5 of the certificate, including "current functioning" and "diagnosis and reasons," support the assessor's reasoning.
[7] Ms Aduah addresses the insurer's comment regarding the basis of social withdrawal, noting that it is both physical and psychological.
[8] Ms Aduah submits her multi-faceted injuries have elements of physical and psychological complaints, and this is acknowledged by several doctors, including Dr Prior, who notes a lack of motivation.
[9] Ms Aduah notes the insurer raises no error in this category.
[10] Ms Aduah submits that a Class 2 rating is appropriate based on her loss of motivation to engage socially. A good relationship with her daughter does not reduce the rating to Class 1.
[11] The insurer itself notes that she "has lost contact with the majority of her friends."
[12] Regardless, Ms Aduah submits the Class 2 rating does not materially alter the overall assessment.
[13] Medical Assessor Nagesh recorded that Ms Aduah cannot read a book or watch TV due to poor concentration and depressed mood.
[14] The insurer relies on Dr Prior's report, but this report actually supports a Class 3 impairment.
[15] Dr Prior documented Ms Aduah's forgetfulness, reliance on others for reminders, and frequent misplacement of items.
[16] Ms Aduah submits that the certificate, when read as a whole, justifies a Class 3 rating based on Ms Aduah's psychiatric condition.
[17] The insurer claims Medical Assessor Nagesh provided no employment-related justification for a Class 3 rating.
[18] Ms Aduah submits that this is incorrect. The certificate, when read holistically, demonstrates the rationale behind the Class 3 impairment. Multiple references across pages 2-4 detail the psychological impact of the accident, including:
[19] Ms Aduah submits that the certificate shows the Medical Assessor did not rely solely on a declaration of clinical judgment but substantiated it through detailed medical reasoning.
[20] Ms Aduah further submits that a Class 3 impairment for Adaptation is justified.
Ms Aduah on behalf of the Panel via Microsoft Teams on 27 March 2025. The Panel provides the report below:
The assessment was undertaken using Microsoft Teams. Ms Aduah participated in the interview from her home. Her daughter, Rebecca Douku was present as her support person.
Ms Aduah is a 62-year-old woman. She described herself as single. She has a 22-year-old daughter. Ms Aduah resides in Casula with her daughter and her niece, namely her sister's daughter. Ms Aduah stated that she last worked in 2019 following a motor accident. Her daughter works full time as does her niece.
Ms Aduah grew up in Tamma in Ghana. She is the eldest of five siblings. Her mother was a trader and her father worked in computers. She spoke positively of her relationship with her parents and with her younger siblings. She attended school until Year 7. She found school academically challenging. She had friends and she did not recount any behavioural or disciplinary issues. Having left school, she learned to sew. She met her husband in Ghana and her daughter was born in Ghana.
Her husband died of a heart attack in 2016 at age 72 or 73 years.
In 2006, Ms Aduah moved to Australia. Her husband was already living in Australia and working as a taxi driver. She obtained employment, sewing in a factory for four or five years. She worked in a casual capacity, up to ten hours per day. When the factory reduced its work, she sought employment as a cleaner at the airport. She commenced the role in 2018 which entailed cleaning inside aircraft.
Ms Aduah clarified that she applied for the job prior to the subject motor accident and undertook the requisite training. She was to work casual hours. She was hit by a car in the subject motor accident one day before commencing her role.
Ms Aduah clarified that she had not been working prior to attaining this role and was in fact looking for employment. She had been the carer for her husband until his death in 2016 for which she obtained payments from Centrelink. She stated that before the motor accident, she managed the house and undertook the cleaning. When her husband was alive, she would take him for walks. Her focus was primarily on family rather than pursuing other social contacts.
Ms Aduah did not report any previous injuries. She delivered her daughter via Caesarean due to her daughter's large size. She did not experience any complications. She has never been a smoker. She did not report having used alcohol or illicit drugs.
Ms Aduah did not report ever being involved in any prior motor accident or a subsequent motor accident.
Ms Aduah explained that she was crossing a road at the time of the motor accident. She had nearly arrived at the other side of the road when the vehicle hit her right leg. She recalled that she fell on her right side. She sought to protect her head with her right hand. She had not seen the car coming.
Ms Aduah recalled that the car travelled on a short distance before stopping.
Ms Aduah recalled that she experienced a severe pain in her leg. Staff from the nearby McDonald's called an ambulance. She had landed on the 'pavement'. Bystanders assisted her into a chair.
History of symptoms and treatment following the motor accident
Ms Aduah stated that she was told by ambulance officers, 'No one survives this accident.' She did not explain to what they were referring. She was conveyed to Fairfield Hospital. She recalled undergoing radiological assessment. She was given a letter for her general practitioner and she obtained a referral for an MRI scan. She has seen a pain specialist, physiotherapist, psychologist and counsellor.
Two years after the accident, in 2020, Ms Aduah underwent a surgical procedure. She explained that her kneecap had moved and she was experiencing severe pain, swelling and a dragging sensation. The surgery entailed a realignment of her patella. Three days after the operation, she developed a pulmonary embolus. She stated that she nearly died. She was prescribed anticoagulants which she took until two months prior to the interview. She stated that the clot remains in situ but it has changed over time. She recalled that the anticoagulant was Eliquis.
Details of any relevant injuries or conditions sustained since the motor accident
Ms Aduah was admitted to hospital in 2024. As stated above, she reported that this admission was an effect of excessive medication. It was not apparent that this event was of psychiatric relevance.
With respect to her physical condition, Ms Aduah stated that she continues to experience pain and swelling of her knee. On occasion, her knee collapses. She requires the use of a walking stick and, when she walks on stairs, she must go 'one by one'.
Ms Aduah did not report any past psychiatric history but expressed frustration in relation to her current physical limitations. She stated that she cannot do the things that she would like and she finds herself ruminating. She stated that the accident has ruined her life. Previously, she was very active while now she needs help with day-to-day tasks.
Ms Aduah reported that she is no longer a happy person. She reiterated frustration at the extent to which she is reliant on her daughter and, in this context, she feels sad. She told me she remains a calm person despite her frustration. She sleeps three to four hours, attributing her limited sleep to her tendency to reflect on her physical inactivity. Sometimes she feels bored. She stated that she would engage in more activities if not for the physical limitations. She spends time with her daughter but sometimes she is not in a frame of mind to talk.
When asked what plays on her mind, Ms Aduah replied that she worries about her daughter and she worries about the extent that she is sitting at home. She did not express any particular concerns regarding her daughter's circumstances other than the extent to which her daughter is required to assist her. She also finds herself thinking about her life in general and she thinks about the motor accident, for example when she closes her eyes.
Ms Aduah stated that she is now very careful when she crosses a road. She uses a zebra crossing or pedestrian lights or, if required to cross where there are no crossing facilities, she will go slowly.
Ms Aduah initially stated that her memory is poor but then said that it is in fact 'so so'. Similarly, her concentration is suboptimal but she will nevertheless watch a movie. She is perpetually affected by pain despite which she travelled to Ghana where she enjoyed seeing family.
Ms Aduah was asked regarding matters identified in the documents. She confirmed that she had remarried and then separated. It was put to her that there is reference to engagement in IVF treatment in Africa. Ms Aduah denied having participated in any such treatment. With respect to her work history, she confirmed that she in fact undertook casual employment at the airport as a cleaner despite the reported issues with her leg. She persisted in this role until the surgery of 2020. She explained that she was enduring significant financial issues at the time which compelled her to work. She also confirmed an admission to hospital in 2024. She stated that she had not in fact sustained a head injury and she stated that the fall was attributed to excessive medication.
Currently, Ms Aduah is prescribed medication which includes Panadol two tablets three times daily, Lyrica 25mg twice daily, amitriptyline 10mg twice daily, Minipress 2mg twice daily and Olmesartan the dose of which she did not state. She explained that she was previously on more medication but there has been no change in her medication regimen for six years.
Ms Aduah confirmed that she sees a pain specialist, Dr Daniel in Parramatta and a physiotherapist who is also in Parramatta. She takes the train or if she feels particularly compromised with respect to her ability to walk, she attends by Uber.
Ms Aduah named her psychologist as Maria. Ms Aduah travels by bus to see her monthly. When asked regarding the nature of the therapy, Ms Aduah stated that Maria asks questions and they talk.
As stated above, Ms Aduah was assessed using audiovisual technology. The quality of the connection was satisfactory. She presented as a neatly groomed woman of African ethnicity. She wore earrings. She did not exhibit psychomotor agitation or retardation as may arise in the context of an acute psychiatric condition. She presented a restricted range of emotional expression. Her account indicated a dysthymic mood. Frustration with her limited physical abilities represented a prominent theme. She spoke with a strong accent. Her speech was normal in terms of rate, tone and volume. The use of language was straightforward, consistent with her level of education. She did not demonstrate any difficulty making herself understood at interview. She described reflecting on the motor accident and described caution when crossing roads. She did not describe overt intrusion symptoms nor did her account indicate avoidance behaviour or hypervigilance. No features of a psychotic nature were apparent.
As stated above, Ms Aduah is not currently employed. She worked following the motor accident, ceasing work at the time of the surgery. She stated that she last worked in 2019 but she dated the surgery to 2020. She explained that her daughter manages the household. Her daughter cooks. Ms Aduah warms up food for herself. She explained that she is restricted in her ability to participate in household tasks because she cannot stand for periods of time. She is however able to put on the laundry. She cannot manage the weight of wet clothes. She cannot vacuum or mop.
Ms Aduah is able to shower herself and dress herself. She uses a stool in the shower. She showers every day and she gets dressed every day. She eats three meals a day. Her daughter oversees the household bills.
When asked how she spends her time, Ms Aduah replied that she spends much of the time lying down. She attends her appointments by Uber, bus or a train. She has never driven. She uses her walking stick to assist her to walk from her home to the bus stop, three minutes away. At the railway station, she uses a lift. Physical limitations undermine her ability to use the stairs.
In terms of other recreational activities, Ms Aduah watches television. She has no friends who visit her and she does not visit others. She goes out with her daughter every month to a nearby coffee shop. She spoke positively of her relationship with her daughter and her niece. She has no other family in Sydney. She maintains contact with family in Ghana. They ring her and she rings them. She last saw them about two years ago when she travelled to Ghana. She flew alone via Dubai. She arranged wheelchairs at each airport. She reiterated that she cannot sit or stand for long periods because her feet become swollen and she is reliant on her walking stick.
No inconsistencies were identified with respect to Ms Aduah's account nor were there inconsistencies in mental state examination. There were however inconsistencies between her account and the information contained within the documents.
The medical assessors noted the discrepancies between Ms Aduah's account and the information contained in the documents, in particular in relation to her engagement in IVF. This discrepancy could not be explained. As documented above, the medical assessors clarified Ms Aduah's work history. Namely, she explained that she had worked for a period of time following the motor accident in a casual cleaning role until the time of her surgical procedure.
The history included significant frustration, irritation and distress in the context of chronic pain and physical compromise. The assessors found that Ms Aduah had developed a depressed mood and other symptoms indicative of a depressive condition of protracted course. Based on the history provided by her, the medical assessors concluded that the most appropriate diagnosis, having regard for the criteria stipulated in DSM-5, was that of Persistent Depressive Disorder.
The medical assessors considered the possible diagnosis of post-traumatic stress disorder. They concluded that the motor accident was not of a nature consistent with a Criterion A trauma as stipulated in DSM-5 nor did they find that other diagnostic criteria were met.
The medical assessors noted the absence of any pre-existing psychiatric diagnosis and the absence of any subsequent events of a nature that could be considered to have contributed to the causation of the diagnosed condition. The relationship between the chronic pain and physical limitations ascribed to the motor vehicle accident led the medical assessors to conclude that the motor accident had caused the psychiatric injury.
Permanent impairment is defined in the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) (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.'
Given the protracted course, severity and approach to treatment, the medical assessors considered that Ms Aduah's psychiatric condition was unlikely to change substantially and my more than 3% in the next year.
Ms Aduah reported consistent attention to her personal hygiene. She ascribed her limited participation in household tasks to factors of a non-psychiatric nature. She eats three meals a day. She prepares food for self to the extent that she is able physically. Her presentation at interview was consistent with her account of attention to personal care.
Based on Ms Aduah's account, she has always been one to focus preferentially on family rather than pursuing social relationships. She described a constrained lifestyle and attributed this to factors of a physical nature. She reported undertaking outings for coffee with her daughter on a monthly basis. Her ability to undertake independent outings and her attribution of limitations in this regard to factors of a physical nature, was noted by the medical assessors. Irrespective of her description of physical constraints on her participation in recreational activities outside the home, the medical assessors considered that the nature and severity of her psychiatric diagnosis was such that she would be mildly impaired for psychiatric reasons irrespective of other factors.
Ms Aduah has never driven. She uses public transport independently to attend her appointments. She travelled to Ghana via Dubai independently, albeit with assistance due to her physical limitations. Ms Aduah expressed heightened caution when crossing the road but she did not describe limitations with respect to her ability to do so. No information was identified to indicate psychiatric compromise with respect to travel.
Based on the history obtained, it was apparent that Ms Aduah formed an intimate relationship and then separated since the accident. She spoke positively of her relationships in particular with her daughter and her niece. She maintains consistent contact with family overseas. The medical assessors considered her relationship history, noting the failure of an intimate relationship but also noting her ability to establish one. Overall, it was apparent that Ms Aduah is mildly impaired in this area.
Ms Aduah participated effectively in the interview, demonstrating no difficulties with respect to concentration or memory notwithstanding her comment during the interview that she is somewhat compromised. The medical assessors noted that Ms Aduah presented her physical symptoms as a prominent impediment to her general functioning but concluded that the nature of her psychiatric symptomatology was such that it would be expected to confer mild psychiatric impairment in this area.
As stated previously, Ms Aduah identified physical symptoms as the overwhelming limitation on her day-to-day functioning. The medical assessors noted that she had returned to work for a period of time after the accident despite her symptoms. Relying on clinical experience, the medical assessors concluded that the psychiatric condition would cause mild impairment in this area of functioning independent of non-psychiatric factors.
As specified in paragraphs 7.14 and 7.15 of the Guidelines, only those aspects of impairment attributable to psychiatric factors may be considered in the calculation of psychiatric whole person impairment. Namely, impairment arising as a result of pain and physical compromise has been excluded from the assessment of psychiatric whole person impairment.
No information was identified to indicate pre-existing or subsequent impairment.
It was not evident to the medical assessors that the psychological treatment in which Ms Aduah is participating would influence the severity of her symptoms or her psychiatric impairment. Although the medical assessors noted that she is currently prescribed a tricyclic antidepressant, the dose is so low that it would not be expected to produce any therapeutic effect. Therefore, no adjustment for the effects of treatment is required.
B Pre-existing/subsequent % permanent impairment 0%
The medical assessors identified psychiatric whole person impairment caused by the accident that is not greater than 10%."
23 November 2023, and substitutes the determination to certify that the injuries referred to the Panel and caused by the motor accident, gave rise to a WPI of 5%.
Insurance Australia Limited t/as NRMA Insurance
Aduah [2025] NSWPICMP 378