Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. revokes the certificate of Medical Assessor Shen dated 3 July 2024, and
2. certifies that the degree of the claimant's permanent impairment resulting from the injuries caused by the motor accident on 1 October 2019 is 7% which is not greater than 10%.

A statement setting out the Panel's reasons for the assessment is included with this certificate.

1. Alex Alzanati was involved in a motor accident on 1 October 2019. He was stationary at traffic lights when the driver of the vehicle behind him failed to stop, and a collision occurred.
2. Mr Alzanati says he injured his back in the accident (and other parts of his body) and because of that injury he made a claim for statutory benefits and then damages against NRMA Insurance the third-party insurer of the vehicle that he says caused his accident.
3. A medical dispute about the degree of the claimant's whole person impairment (WPI) has arisen in connection with that claim and Mr Alzanati referred that dispute to the Personal Injury Commission (the Commission) for assessment.
4. The claimant's physical injuries were assessed by Medical Assessor Bodel and attract a WPI of 5%.
5. On 3 July 2024 Medical Assessor Shen determined Mr Alzanati had a WPI of 23% which is of course greater than 10%.
6. The insurer lodged an application with the Commission seeking a review of the Medical Assessor's decision. On 9 September 2024, Ms Gupta a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and has allowed the Review and on 21 May 2025 the President's delegate convened this Panel to conduct the Review.

1. Mr Alzanati's claim and entitlements to compensation are governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act).
2. In a claim for lump sum compensation, damages are assessed in accordance with common law principles as modified by the MAI Act. Under Part 4 of the Act, an injured person can make a claim for damages for both certain types of economic (pecuniary) losses and damages for non-economic (or non-pecuniary) loss.
3. Damages for non-economic loss are limited and restricted by the provisions in Division 4.3 of the MAI Act. For example, non-economic loss damages are limited to a maximum amount in accordance with s 4.13[1] and entitlement to those damages is restricted by s 4.11 to persons who have a greater than 10% WPI as a result of the injuries sustained in the accident.
4. If there is a dispute about the degree of the claimant's permanent impairment, damages for non-economic loss cannot be awarded and disputes must be referred to a Medical Assessor for determination.[2]

1. Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Shen, further medical assessments and the review of medical assessments by this Panel[3].
2. Applications for review of a medical assessment are made to the President of the Commission on grounds that the assessment "was incorrect in a material respect" (s 7.26(1)). If the President, or his delegate is satisfied "there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect" then the President arranges for the application to be referred to a review panel consisting of a member of the Commission and two medical assessors (s 7.26(2) and (2B)).
3. The review is not an appeal looking for error and is not confined to the issues raised in the application (or the reply) but is "a new assessment of all the matters with which the medical assessment is concerned" (s 7.263A).
4. Rule 128 of the Personal Injury Commission Rules (the Rules) 2021 permits the Panel to determine its own proceedings and the Panel is not bound by the rules of evidence and may inquire into relevant matters as it thinks fit.

1. Permanent impairment is to be assessed in accordance with Chapter 6 of the Motor Accident Guidelines (the Guidelines)[4].
2. The Guidelines include a section entitled "Mental and behavioural disorders" and require the assessment to be undertaking in accordance with the psychiatric impairment rating scale (PIRS). The Guidelines say that the mental and behavioural chapter of the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides) are to be used as "background or reference only"[5].

1. The Medical Assessor examined the claimant on 1 July 2024 and issued his certificate on

3 July 2024. The Medical Assessor confirms at [2][6] that he was asked to assess "psychological condition - adjustment disorder with mixed anxiety and depression, Persistent Depressive Disorder, sleep disturbance". 2. At [3] Medical Assessor Shen refers to the certificate of Medical Assessor Sidorov dated

23 March 2023 noting that Assessor had earlier diagnosed a persistent depressive disorder with anxious distress in the course of a threshold injury dispute. Medical Assessor also noted:

(a) the report of Dr Argyle for the claimant who, on 21 June 2023, diagnosed a persistent depressive disorder with a WPI of 15%, and

(b) the insurer had not yet obtained a report although one had been commissioned.

1. The Medical Assessor records a history at [8] - [10] as follows:

(a) the claimant was 47 years of age living with his wife and twin girls. He was separated from his wife and had an 18-year-old daughter from a previous marriage;

(b) the claimant said he had a good relationship with his 18-year-old daughter but a poor relationship with his twin daughters as they were in hospital after their birth and he could not look after them "due to his back injury";

(c) since the accident he has lost friends, rarely goes out and does not attend social events;

(d) he had no previous psychiatric condition or medical conditions;

(e) the rear end collision occurred when he was stationary at traffic lights, the other car was driving "not less than 70 kms" and he feared dying. He was wearing a seatbelt but "hit his head against the glass." His airbags did not deploy. Emergency services did not attend but his car was later written off;

(f) he did not go to a doctor for a couple of days and a week after the accident he felt "like he was carrying a block of cement on his back";

(g) he attended physiotherapy and a chiropractor, and

(h) a year after the accident he developed psychological symptoms, inability to sleep due to pain, lost relationships and stress. He saw a psychologist which gave him some benefit. He saw a psychiatrist and was prescribed agomelatine which he has felt was helpful.

1. Medical Assessor Shen records a history of the claimant having had a stroke and a heart operation in February 2024.
2. He reports current symptoms of depression, four hours of sleep with initial insomnia, general reduction of appetite, low energy, showering less, not exercising at all, poor concentration and easy forgetting things. He fells worthless and hopeless all the time. He has recurrent intrusive memories of the accident, no nightmares, avoids traffic lights, cannot trust anyone and constant angry feelings, diminished interest in previous activities, he is estranged from friends.
3. After reviewing the medical evidence, Medical Assessor Shen diagnosed a posttraumatic stress disorder and persistent depressive disorder caused by the accident.
4. In terms of impairment - the class for each functional category was:

(a) self-care and personal hygiene class 2

(b) social and recreational activities class 3

(c) travel class 2

(d) social functioning (relationships) class 4

(e) concentration persistence and pace class 3

(f) adaptation class 4

1. The class scores were 2, 2, 3, 3, 4, 4 which gave a median of 3; an aggregate score of 18 and a WPI of 22%. An additional 1% was given for the mild improvement effect of treatment.

1. The insurer argues at [15] - [25] that the Medical Assessor had been provided with and considered the certificate of Medical Assessor Bodel but neither party had been given the opportunity to provide submissions about it, and this was a breach of procedural fairness. Medical Assessor Bodel's findings of physical injury and symptoms were relevant to the issue of causation and impairment of the claimant's psychological injuries.
2. The insurer submits at [26] - [31] that Medical Assessor Shen did not properly consider the effects of the claimant's stroke and heart surgery and did not explain why all the claimant's current impairments were said to be due to his psychological injuries and not his recent stroke and surgery.
3. The insurer submits at [32] - [36] that the Medical Assessor has not considered whether the claimant's recent stroke and heart surgery have affected his psychological symptoms and whether his condition had stabilised.
4. The insurer then proceeds through the various functional categories and the class assessment and says the effect of the claimant's physical complaints were not considered.

1. The claimant submits that the certificate of Medical Assessor Bodel was made available to the parties on 23 May 2024 (over a month before Medical Assessor Shen's examination) and the insurer did not seek a review of that certificate. The claimant says Medical Assessor Bodel's certificate is of little relevance to the psychological injuries.
2. The claimant says the Medical Assessor assessed causation and explained his reasons about the unrelated stroke and heart operation.

1. The Panel issued directions to the parties dated 10 June 2025. The Panel sought bundles of documents for the parties and asked the parties to ensure the Panel had up to date records from the claimant's treating General Practitioner (GP), psychologist and psychiatrist.
2. The insurer filed its bundle of documents on 9 July 2025 comprising 106 pages of material and the claimant filed his bundle of documents on 5 August 2025 comprising 109 pages.
3. The Panel met on 17 September 2025 and reported to the parties. After referring to the various diagnoses of Medical Assessor Shen and the medico-legal experts, the Panel advised that the medical Assessors would be making a diagnosis themselves and that:

"The Medical Assessors may, in their clinical judgment, diagnose a condition that is the same as, or different to, the diagnosis of the original Medical Assessor or the diagnoses of the treating doctors or medico-legal experts or the particular diagnosis that may have been included in the application or reply form."

1. The Panel noted there were no pre accident records and requested documents from five years before the accident to date. The Panel also requested up to date treatment records.
2. The Panel advised the parties of the re-examination date and directed the claimant to attend.
3. The insurer provided a bundle of additional documents on 24 October 2025 comprising records from Dr Chugh and the Bankstown Medical and Dental Care centre. Despite a document which suggests the claimant has been a patient of that practice since

18 November 2002[8], the notes provided only commence in 2021. The Panel has no pre-accident records.

1. The claimant completed a claim form dated 3 December 2019. The claimant denied ever making a CTP claim before and said he was not suffering an illness or injury affecting him at the time of the accident.
2. The claimant said he slowed down to stop at an orange light and was hit in the back by another vehicle.
3. The claimant identifies his injuries as a spine injury with back pain and a split disc and that he is in a lot of pain.

1. The Panel has been provided with records from Dr Chugh. A mental health treatment plan was developed on 29 November 2021.
2. Dr Batty, psychologist wrote to Dr Chugh on 29 January 2022.[9] Dr Batty has a history of the car accident with pain in the shoulder, whole spine and that this has affecting his mental health. He reported his father had passed away seven months earlier and this made him feel worse.
3. Dr Batty has a history of the claimant's first marriage and him having a daughter from that marriage and his second marriage saying it was "affected by the accident" and that he and his wife had separated and he had called the police.
4. The claimant reported he was a painter with his own company and staff but that the accident has affected the profitability of that business. The claimant reported poor sleep, sadness, tiredness, thoughts of worthlessness and helplessness, memory difficulties, being snappy and angry. He was anxious and worried about his future and family.
5. In the GP notes is an extract of a third session with Dr Batty dated 30 March 2022.[10] This refers to the claimant's father passing away and he worried about his mother and tried to bring her out to Australia, but immigration rejected his request.
6. In a fourth session on 25 May 2022 the claimant reported both he and his wife were both moody and that she was having IVF. At the fifth session on 23 July 2023 the claimant's twins were in hospital and his wife was recovering from a "big caesarean". They had been going to the hospital every four days. In a sixth session on 23 November 2022 the claimant reported many conflicts with his wife. She had returned home and was suffering from postnatal depression. Her family were not helping and she expected him to help when he returns home from work.
7. The claimant reported on 9 May 2024 to Dr Chugh that he was low and depressed and on

15 May 2024 that he was stressed and wanted to see Mr Attai. There is a reference to income protection insurance on 6 June 2024. 8. There is a further referral to Dr Batty dated 24 July 2024[11], but no further reports. 9. Dr Chugh referred the claimant to Dr Miah for treatment of his "depression and anxiety" on

9 March 2022[12]. The only active past history was said to be lumbar discopathy dating from

30 October 2019 and the claimant was taking Crestor. 10. Dr Miah provided a report dated 24 April 2022[13] addressed to Dr Chugh. He has a history of chronic back pain and severe adjustment disorder after a car accident in 2018. The claimant referred to making a "new CTP claim" after an earlier claim had been rejected and was in the meantime funding his own treatment. 11. The claimant reported "significant physical" impairment with fluctuating depressive symptoms anxiety, mood lability, insomnia and so on. His back injury had been managed conservatively, and he was reliant on anti-inflammatory and analgesic medication physiotherapy and family support. The claimant reported frequent flare ups of back pain. 12. Mr Alzanati said his father had died the previous year and ongoing grief was compounding his suffering. 13. The claimant denied previous mental health issues or medical problems and said he was seeing a psychologist. Dr Miah prescribed Valdoxan to assist and recommended fortnightly psychological treatment and psychiatric review. 14. Dr Miah said in his view the claimant's current condition arose from the motor accident in 2018. 15. In terms of the claimant's physical symptoms Dr McKechnie was of the view the accident caused the claimant neck and lower back problems. He was of the view the claimant would not need surgery but that his return to his painting duties was unlikely. 16. The claimant attended Bankstown hospital on 30 September 2023 with a "semi deep hand laceration sustained at work[14]. The claimant was said to have been working as a painter and cut his hand on a hard piece of glass. The claimant was admitted to Bankstown hospital[15] with cardiac symptoms from 21 February to 24 February 2024. The claimant had an angiogram and stent inserted. 17. On 15 May 2024 Dr Chugh referred the claimant to Mr Attai, psychologist[16] for further assessment and managements "he is undergoing lots of stress." 18. Dr Assad cardiologist wrote to the claimant's GP on 21 July 2025[17] noting that Mr Alzanati was reporting "significant psychosocial stress and feelings of depression due to his family's situation in Syria. These stressors are impacting his mental well-being." There is no mention of the car accident or any related stress or depression. In an earlier report of 15 April 2024, it is noted the claimant was working as a painter and running his own business. 19. On 21 July 2025 there is a note from Dr Chugh that the claimant was "taking off the market testosterone" from his gymnasium. 20. The claimant had an ultrasound of the right elbow and x-ray performed on 11 August 2025 due to sharp pain in the right upper limb. According to Dr Chugh's note of 18 August 2025 this occurred on Saturday 9 August 2025 when he threw the remote. The claimant was diagnosed with a partial tear of the distal biceps.

1. Dr Argyle saw the claimant at the request of his solicitors on 19 June 2023.
2. Dr Argyle has a history of the claimant having been a successful businessman who had lost a great deal of self-esteem. The claimant had seen Dr Zachariah, psychologist and Dr Miah who he had seen only once.
3. The claimant reported poor sleep, anxious and sad thoughts and preoccupation with the loss of his capabilities and role in life.
4. The claimant had been married and had a daughter. He had a second marriage which required seven years of fertility treatment before producing twins. They had required three months of hospital treatment, and his wife had an operation earlier in the year and his mother came to visit.
5. While Dr Argyle noted the presence of anxiety, he was of the view the claimant did not have symptoms of a post-traumatic stress disorder. He diagnosed a persistent depressive disorder.
6. Dr Argyle assessed the claimant with a 15% WPI.
7. Dr Potter saw the claimant at the request of the insurer and provided a report dated

5 December 2023. It would appear Dr Potter had difficulty understanding the claimant. It is not clear whether there was an interpreter or not. 8. Dr Potter notes that the claimant's description of injury and experience does not suggest a post-traumatic stress disorder. 9. Dr Potter has a history of a neck operation 20 years before and a vein issue and a squashed nerve. He says, "the theme in the ongoing history was the decline of a hardworking successful man." 10. The claimant reported the birth of twins and difficulties caring for them and the requirement to have his mother come from Syria to provide assistance. 11. Dr Potter was told the claimant had seen a psychologist but was not seeing him at the time as he "just wants to stay home." Mr Alzanati said he had seen a psychiatrist and had been given medication. 12. Dr Potter diagnosed a persistent major depressive disorder caused by the accident. He assessed impairment at % with an additional 1% for the effect of treatment.

1. Medical Assessor Bodel examined the claimant on 23 April 2024 for the purposes of Mr Alzanati's physical injuries (cervical posterior central disc extrusion and lumbar spine L3-4 discopathy).
2. Two and a half months before the examination the claimant had been diagnosed with a cerebrovascular accident. He was taken to hospital with coronary artery damage, and a stent was inserted.
3. The claimant reported neck and lower back pain, pain over the top of his shoulders but not in the arm, pain in the lower back and into the buttocks and intermittently down the right leg.
4. Medical Assessor Bodel diagnosed soft tissue injuries to the cervical spine and aggravation of underlying degenerative changes and internal disc disruption in the lumbar spine.
5. Impairment was assessed at 0% in the neck (DRE Category I) and 5% in the back (DRE category II).
6. Medical Assessor Sidorov assessment the claimant's psychological injuries for the purposes of the threshold injury dispute on 24 April 2023. He diagnosed a persistent depressive disorder with anxious distress.
7. The claimant reported running his own painting business doing the contracts and quotes but not doing the physical component. The claimant reported ongoing pain with intermittent exacerbations. He had an unstable mood and felt depressed. He had developed anxiety and felt tense and restless and had difficulty concentrating. The claimant was taking Agomelatine, Endone and Naproxen.
8. Medical Assessor Sidorov says the claimant meets the criteria for a Persistent Depressive Disorder along with symptoms of anxious distress which has evolved out of the adjustment disorder and is secondary to his physical impairments and pain.

RE-EXAMINATION FINDINGS - MEDICAL ASSESSORS BAKER AND VERMA

1. The claimant attended the re-examination on the 17 November 2025 alone.
2. The re-examination proceeded by way of a MS Teams telehealth type examination. Good internet connectivity was established and maintained throughout the re-examination.
3. Mr Alzanati advised us that English was his second language. We noted that no interpreter had been arranged by the Commission for this re-examination and that the certificates of Medical Assessors Shen and Bodel did not indicate an interpreter was present at their examination. Mr Alzanati provided verbal consent to proceed without an interpreter.
4. The assessment was conducted in simple English without the use of complex medical terms. The re-examination progressed without any difficulty. At no stage did we fail to understand anything the claimant said and the claimant did not demonstrate a lack of comprehension on his part at any stage during the course of the re-examination.

1. The claimant provided a complex history.
2. The claimant said he was born in Tartus, Syria. He said he was the first-born child to his parents. He was 49 years of age at the time of the re-examination. His eldest sister lives in Melbourne. His second sister lives in Syria caring for their mother who is about 66 years of age. His youngest sister lived in Sweden.
3. The claimant said he was about 16 years of age when he was informed by his father about his father's first relationship and the older children to this union. The claimant said his eldest stepbrother (Zain) was aged 60 years and lived in Sydney. The claimant said he had become estranged from this brother. He said he has not had a good relationship with Zain's wife and that this occurred prior to the motor accident in 2019.
4. The claimant explained that his father and members of his family were living in Lebanon when his father was kidnapped while leaving a bank and money was stolen. During the kidnapping and robbery, his father was shot. His father sustained a spinal cord injury and was paralysed from below the T4 level of the anterior chest wall. His father spent one year in London where he was treated for his injuries and rehabilitated. His father was wheelchair bound for about 38 years, before passing at age 72 years, about three years before the

re-examination. After the kidnapping and his injury the claimant's father returned to live in Syria with his second wife and four children. 5. The claimant explained he was educated to year 9 at school. He said his high school was a private school. He did not enjoy school. He commenced working as a junior painter at about 15 years of age. He has worked as a painter since. 6. The claimant said he was not required to perform national service with the Syrian military and he had never been exposed to war or war-like conditions. He said he never suffered from lack of food or shelter during his childhood and was never exposed to any childhood trauma, abuse or neglect. 7. The claimant reported that he enjoyed his childhood and early adult life. He enjoyed going to the gym and socialising with his friends and family. He would celebrate the traditional family events with birthday, weddings, Eid and Ramadan being celebrated each year. 8. The claimant reported working five days per week between 7am to 3pm in his trade as a painter. He did not attend technical college or business college. He said on the weekends he would socialise with his friends at parties, beach meetups, restaurants and cafes. He said he enjoyed his life. He said on occasion he would travel to Lebanon to socialise in the nearby towns and villages. 9. The claimant said he would attend the gym three to four days per week. He said he would perform various set programs. He said he was not a "body builder" or "body sculpturer." He said he attended the gym to make himself more noticeable amongst the community in which he socialised. 10. The claimant first entered Australia with his father in about 1994. His father had organised for a medical opinion regarding his injuries and possible treatments for the complications of his high-level paraplegia. He said his stepbrother, Zain had already immigrated and settled in Sydney at this time. The visit lasted for two weeks before the claimant and his father returned to Syria. 11. The claimant said that whilst in Sydney he had an incidental conversation in Arabic with a woman whilst they were waiting for service in Marrickville. The meeting resulted in the couple forming a union and becoming engaged. She was also from Syria. After the claimant returned to Syria, his partner travelled to Syria with her family. The relationship dissolved after nine months. There were no children to the union. 12. The claimant said he returned to Sydney for a second time in 1995. He spent time looking around the city and investigating the city for business opportunities as a painter. He said he decided he wanted to live in Sydney and leave Syria. 13. The claimant returned to Syria after spending about two months in Sydney during 1995. He spoke with his father about immigrating to Sydney. He said his father was unhappy with his choice, however he moved to Sydney in 1996. The claimant said that at the time of this re-examination he was an Australian citizen. 14. In 1997 the claimant married for the first time. He said his union with Jaqui lasted for about two years. He said she was working in the Australian finance industry, and they would disagree about how business should be undertaken and the risks involving working as a painter. He said there were no children to this union. 15. In 2000 the claimant married for a second time to Rena. He said the marriage was unsettled. After two years the claimant and Rena separated. After a break, the couple tried to reunite. In 2005 the claimant had one child to this union (Nour). Nour is now aged 20 years and has completed her first year at university. The claimant said that Rena was about six years older than him and she worked as a banker. He said she also disagreed with him working in the development of property because she assessed the risk as too great. The claimant said that Rena had a son from a prior relationship and he was now about 30 years old. He said he had sustained his relationship with Nour since the divorce from Rena. 16. In about 2015 the claimant said he injured a ligament behind his left knee. He did not have surgery. He was told to be cautious and not to exert himself whist the ligament recovered. He was not impaired by this minor injury. 17. The claimant married for the third time to Hanna. At the time of this re-examination the claimant said he was divorced from Hanna. He was living in a rented unit with his friend Michael. Michael's father and the claimant's father had known each other in Syria. Michael was also divorced from his wife. 18. The claimant provided the following history of his relationship with Hanna. She worked in the banking sector. He said that they married about 10 years ago. He said that before she conceived, on her fifth cycle of IVF, the couple would take two vacations per year and fly internationally to the Mediterranean region and Europe. They enjoyed vacations in various locations in the different countries they visited. 19. The claimant said Hanna required his support during her pregnancy and he was worried for her. He said he was not psychologically ill. He was able to perform all his workplace duties. 20. The claimant said that he and his wife were trying to conceive before the 2019 accident. Hanna conceived and gave birth in 2021. The pregnancy was complex. He said Hanna had an "emotional breakdown" because of the difficulties in this pregnancy. One of the embryos had not progressed in development - however the remaining embryo split into two. Hanna gave birth to identical twin girls. The twins were born at about six months and remained in Liverpool Neonatal Intensive Care for about three months. Both Hanna and the claimant would visit daily. 21. As the twins progressed the couple were encouraged to provide "kangaroo-care." The claimant said this meant that Hanna and the claimant were required to have a baby in contact with their skin in a "kangaroo-like pouch", so the baby was in contact with the skin of the parent above the breast on the anterior chest wall." The claimant said because of the 2019 accident he was unable to sit in a chair for the necessary time of about two hours as he would suffer from pain in his back. He said that both parents became frustrated and he became upset that he could not participate in the same manner as Hanna in the twin girls' early neonatal care. 22. The claimant said that his daughters were discharged to the care of Hanna and himself after three months. The twins were not identified as having any disability or physical injuries beyond being born three months early. 23. The claimant said he was physically fit and capable of working in his role as a painter. He said he was managing his company and was successful in completing large projects whilst supervising his workers and continued to participate in the painting work himself. 24. The claimant reported that his father died about three years before the 2019 accident. He said he attended the funeral service for his father when he died. He said this was the last time he saw Zain and his family. The claimant said he missed his father's wisdom and guidance. He said he accepted his father's death and respected his father's 38 years of living in a wheelchair. 25. The claimant reported that he did not have any medical problems before the accident. He showed a photograph of himself without his shirt on to display his anterior chest muscles. The claimant was informed that in his medical record there is a note about him using testosterone. He said he did not use steroids and his physique was natural. 26. The claimant said he smoked about 20 cigarettes daily. He said he had a "stroke" in 2024. He said he had suffered from severe chest pain. He reported that he drove to Bankstown hospital emergency room at 3am. He reported difficulty breathing whilst sitting. He thought he was having a heart attack. He was admitted to hospital. He remembers not being able to move his left side. He remembered tingling in his dominant right hand. He said his walking was affected. 27. The claimant was informed that the medical record stated that he had a stent put into his heart and he was treated for a heart complaint. The claimant said that was incorrect and his understanding was that he had a "stroke." The claimant said that he did not have loss of speech or change in his thinking. He did not lose his independence in walking or using his hands. He said he did not suffer from any loss of function with swallowing. He was not referred to a stoke rehabilitation unit. From careful consideration of the claimant's records, it became apparent Mr Alzanati did not have a good understanding of medical conditions, and this was in keeping with his education level as would be seen in the normal general population completing their education at about the same stage. 28. The claimant did not report any exacerbation of his medical condition or psychological condition due to this event, and he has continued to work and interact with his family as before this event. 29. The claimant said that after this, whilst working he was cutting through a "gap-filler" tube and his hand slipped. He cut his left forearm which required surgical treatment. The injury affected mainly muscle in his left forearm. He said he had a small area of numbness on the dorsal aspect of his left hand between the thumb and the first finger. He said the injury site became infected. He required surgical debridement, re-suturing and oral antibiotics. The wound healed with some scarring over the injured site. He also confirmed the incident reported in the GP notes associated with throwing a remote control. 30. Mr Alzanati was adamant that the main reason he was suffering was due to his pain caused by the physical injuries sustained in the accident and his subsequent depression. 31. The claimant said he was prescribed the following medications at the time of this re-examination:

(a) Panadeine forte two tablets at night, for pain;

(b) Diclofenac 100mg for pain as required (purchased online);

(c) Moxicam 7.5 mg daily for pain;

(d) Ezetrol 10mg daily for hyperlipidaemia;

(e) Atorvastatin 40mg daily for hyperlipidaemia;

(f) Piax 75mg daily and Aspirin 100mg daily for anticoagulation;

(g) Adensan 4mg daily for high blood pressure, and

(h) Agomelatine 25mg, two tablets daily for his psychological symptoms.

1. The claimant said he did not use illicit drugs, and he denied taking testosterone. He said he did smoke about 20 cigarettes daily. He said he rarely drank alcohol. He would drink alcohol occasionally for example if at a wedding. He said he was not allergic to any medication.

Matters relevant to the claimant's functioning before the 2019 accident.

1. The claimant was independent in his self-care and personal hygiene prior to the accident. He was independent and capable of caring for himself after separation from Rena. He was able to care for his daughter to this union (Nour) when she spent weekends with him. He was able to sustain his nutrition. He was able to wash and clean his own clothes. He was able to clean his home where he lived. The claimant remained independent in his self-care and personal hygiene after he formed his third union with Hanna.
2. The claimant was able to socialise with his friendship circle and Hanna prior to the motor accident. He would attend weddings, birthdays and participate in Ramadan and Eid. He said he would also participate in Christmas celebrations when invited by friends and colleagues to their homes during this festival. The claimant would purchase gifts for Nour for her birthdays and at Eid each year as was his tradition from his youth. He would take vacations once every six months with Hanna to visit Europe and the Mediterranean. He said he would attend the gym about three times each week. He enjoyed attending the gym and socialising with this friendship group.
3. The claimant was independent in his capacity to drive and travel. He could travel internationally without support. He last travelled overseas to Fiji in 2018 before the accident. He could drive his car to the various venues he had to work and could find his route to unfamiliar and distant locations without impairment.
4. The claimant was resilient in his capacity to form new relationships after a prior relationship had ceased. The claimant was in a new relationship with Hanna before the accident. The couple were using IVF to enable Hanna to fall pregnant. The claimant saw his role as "her main supporter." He said he was able to support the expense of IVF by working harder to raise the funds. He was hopeful she would fall pregnant. He said the process was hard, however he looks on his twin girls as "God's gift."
5. The claimant said his relationship with Zain and his wife was tense, but he was not estranged from this part of his extended family.
6. The claimant said he was able to concentrate to perform complex tasks regarding scheduling, preparation of paint, and procuring resources, men and projects before the accident. The claimant was able to plan his vacations and organise for his trips overseas with Hanna without impairment.
7. The claimant was able to work in his role as a painter. He reported he was successful in his business and had built a good reputation. He was able to work whilst supporting Hanna through her IVF process. He was able to support his daughter Nour during her childhood and teenage years. He reported he continued to work in his business and planned to improve his business before the accident.

1. The claimant said he was driving home in his van from work. He said it was about 3pm. He was approaching a traffic control light. The light changed from green to orange. He said he slowed his car to a stop and then was hit in the rear by a ute. He said he did not lose consciousness; his airbags did not deploy. No ambulance or police were called.
2. The driver of the ute left his vehicle and checked on the claimant. Both vehicles were movable after the accident and the two men decided to move the cars off the road. The two men exchanged information. He had his van towed and he returned home in the tow truck. A replacement car was provided whilst the claimant's car was in repaired.

History of symptoms and treatment following the accident

1. The claimant said he began to feel pain the following day after the accident. Initially he felt pain in his groin. He informed his doctor who advised he rest and allow the pain to settle. The doctor also organised for further investigations. He said he had X-rays of his neck and back. He was referred to attend a physiotherapist.
2. After attending the physiotherapist, the claimant said he was told that he had three "slipped discs" in his back. He had pain and said he was told that his back muscles were "spasming". He continued to attend his physiotherapist about two to three times each week. He failed to improve. He reported that he developed a depressed and irritable mood.
3. The claimant said he was restricted in his capacity to work full time as he had persistent pain in his back. He said that the pain continued and he had to change position. He said his pain slowed down his capacity to work because he had to take frequent breaks.
4. The claimant was referred for cortisone injections into his back. Initially the injections were successful, but the efficacy of the treatment failed, and he required increasing amounts of oral analgesia for management of his pain. He was not referred to a pain clinic.
5. The claimant's mood became depressed. He became increasingly irritable as his pain failed to remit. He reported deterioration in his sleep. His mood became more depressed, and he became impulsively angry. He said he would throw things that were in front of him. He said his mood became worse as his sleep became poor. He reported that his energy deteriorated and he was unable to organise his business as he had before the accident.
6. The claimant reported the relationship between he and his wife deteriorated as he was unable to support her needs. He said that she commenced asking for divorce in about 2023. He reported that she organised to buy the house and he left the relationship permanently. He started renting with Michael, a family friend.
7. The claimant reported that his capacity to find business deteriorated as he was unable to reliably work at pace and his relationship with his workers deteriorated. He said one of his workers told him he would, "never work with him again." He said he could not organise to be at work as often as needed as he was required to attend for treatment. He stated he became indecisive as to what medical advice to accept. He declined surgical treatment as he did not want more problems if the treatment did not work. He described developing increased thoughts of worthlessness. He struggled to pay his bills. He relied increasingly on credit. He said he now has a debt of $180,000 and he was working three days per week to try and pay the interest on the borrowings.

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

1. The claimant reported that he had suffered a "stroke" and had also injured his left forearm since the accident. He said both these conditions were now well controlled. He said that these conditions had not restricted his work. He said his pain, which commenced before the accident, continues to slow his capacity to work at the time of this assessment.

1. The claimant reported the following depressive symptoms:

(a) depressed mood;

(b) depressive rumination that he is worthless;

(c) recurrent intrusive thoughts of death and dying without intent to self-harm;

(d) poor concentration with difficulty making decisions and marked indecisiveness when required to make decisions about work, workmen, purchasing of paint and other business decisions;

(e) increased feelings of hopelessness about his future;

(f) poor sleep due intrusive thoughts about the accident and its effects on his career, life and twin daughters, and

(g) low energy and increased fatigue since the accident.

1. Mr Alzanati reported the following pain related symptoms.

(a) pain in his arms, legs and back;

(b) he struggles to work and needs more rest, and

(c) he has reduced his capacity to physically work and he works less hours because of his pain.

1. The claimant was referred to a psychologist. He was treated with cognitive behavioural therapy, relaxation skills and mindfulness. He said he had stopped attending the psychologist and had no plan to return.
2. The claimant said that he had received antidepressant medication for treatment of his major depressive disorder, prescribed by his doctor. He said he would take Agomelatine 25mg, two tablets each night. He said if he were too upset, he would take up to four tablets of Agomelatine on some nights. He continued to attend his doctor for regular follow-up and review.
3. The claimant said he was referred to a psychiatrist for treatment. He was commenced on the antidepressant medication Agomelatine 25mg daily to treat his depressed mood and anxiety symptoms. He said he was not referred to a psychiatric hospital for inpatient treatment. He was not referred for repetitive transcranial magnetic stimulation as an outpatient. He was not referred for Esketamine treatment as an outpatient.
4. The claimant had been prescribed analgesic medication and physiotherapy as well as cortisone injections for treatment of his pain. He remained with pain and continued to use his prescribed analgesics.

1. The claimant presented as an irritable and tearful man. He spoke with increased tearfulness when thinking about his losses since the accident. The claimant said he has a depressed mood most of the time. He said he could not make decisions any more and he worried for his future. He said he felt worthless as his debts increased and he is unable to stop "trying to fight through."
2. The claimant had a short hair cut and a groomed bread. He spoke in irritable and angry tones. He required pauses in the assessment to manage his frustration and tearfulness. He was orientated in time, place and person. He did not report delusional ideas or psychotic symptoms. He said he could experience satisfaction when he was able to visit his daughters, including Nour, who would go to Hanna's place where the daughters gathered for their father's visit.
3. The claimant said he had thoughts of worthlessness and he would have thoughts of death and dying however he had no plans to harm himself. He was appreciative of the support provided by Michael. The claimant was insightful, and his judgment was fair.

1. The PIRS requires a psychiatric diagnosis to be undertaken first in accordance with whatever the current edition of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD)[18].
2. It is the clinical judgment of the Medical Assessors that the claimant's presentation was consistent with a major depressive disorder (DSM-5-TR F32.1) as he satisfied the following criteria:

(a) Criterion A - five (or more) of the following symptoms have been present during the same two week and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

(i) depressed mood most of the day, nearly every day, as indicated by the claimant's subjective report of feeling sad and hopeless and observations of increased irritability and tearfulness at the time of the re-examination;

(ii) insomnia nearly every day. This criterion is satisfied as the claimant reports difficulty in sleeping with him having difficulty in initiating and remaining asleep, because he would ruminate about his losses and debts accumulated since the accident;

(iii) fatigue or loss of energy nearly every day. This criterion is satisfied as the claimant reports frequent rapid onset of fatigue with low energy nearly every day which is most prominent after attempting to work in his role as a painter;

(iv) feelings of worthlessness or excessive or inappropriate guilt nearly every day. This criterion is satisfied as the claimant has ruminations of worthlessness and having failed in his business;

(v) recurrent thoughts of death, recurrent suicide ideations without a specific plan. This criterion is satisfied as the claimant has daily ruminations about death and dying without him planning to harm himself, due to cultural traditions that forbid suicide, and

(vi) diminished ability to think or concentrate with increased indecisiveness nearly every day as the claimant is slow in making decisions in his business that he could have easily made quickly and successfully before the accident.

(b) Criterion B - the symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The claimant satisfies this criterion because he is divorced from Hanna which on his report is due to the effects of the accident, and his occupational activity is markedly reduced markedly.

(c) Criterion C - The episode is not attributed to the physiological effects of a substance or another medical condition. The claimant's depressive condition is not attributable to the physiological effects of a substance, and he does not have a medical condition which would cause the same symptoms as he has reported at the re-examination.

(d) Criterion D - At least one major depressive episode is not better explained by schizoaffective disorder and is not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or another specified and unspecified schizophrenia spectrum and other psychotic disorders. The claimant does not suffer from any of the above conditions.

(e) Criterion E - There has never been a manic episode or a hypomanic episode. The claimant does not suffer from any of the above conditions.

1. The claimant reported psychological symptoms and had received treatment for these symptoms. He described various symptoms and said he had been diagnosed with, post-traumatic stress disorder (PTSD), anxiety and depression and panic attacks that had not prevented him continuing his self- employment albeit at a reduced capacity.
2. The claimant did not, in the clinical judgment of the Medical Assessors have post-traumatic stress disorder (DSM-5-TR F43.1). The circumstances of the accident and the claimant's immediate post-accident behaviour is inconsistent with him having sustained a life-threatening injury. He travelled home with the tow truck and did not go to hospital for emergency medical assessment. Neither the claimant nor the other driver agreed on the need for emergency services at the scene of the accident. The claimant attended his doctor soon after the accident. His doctor did not refer him to hospital as would have occurred had the doctor assessed the claimant as having a severe injury. The claimant reported at this assessment the main problems preventing him working was his pain and physical restrictions, not any avoidance of the workplace, or avoidance of driving because of the accident.
3. While upset at the death of his father, Mr Alzanati did not satisfy the criteria (DSM-5-TR F 43.8) for a prolonged grief disorder in relation to his father's death.
4. The claimant has been diagnosed by other examiners and assessors as having a persistent depressive disorder. Whilst the claimant had some symptoms of a persistent depressive disorder, a careful re-examination by the medical assessors and review of the forwarded documents identifies sufficient major depressive disorder symptoms to confirm the claimant continued to meet this diagnosis at the time of the re-examination and the symptoms are best defined within the condition DSM-5-TR F32.1 major depressive disorder. For these reasons, this diagnosis is preferred as defined above.

1. The test of causation as set out in the Guidelines at cl 6.5 - 6.7 involves two aspects:

(a) could the accident have caused or materially contributed to the psychological or psychiatric injury, being a medical judgment, and

(b) did the accident in fact cause or materially contribute to the psychological or psychiatric injury.

1. The claimant suffered physical injuries. He developed pain in relation to his physical injuries. It is the clinical judgment of the Medical Assessors that physical injuries resulted in prolonged symptoms can cause or materially contribute to the development of a depressive disorder such as a major depressive disorder.
2. Mr Alzanati has received physical treatment from a physiotherapist, injections of cortisone into the symptomatic areas of pain and has been prescribed analgesia. His pain had not remitted from the date of the accident to the date of the re-examination.
3. The claimant's psychological condition commenced with the onset of a depressed mood associated with the effect of the claimant's physical injuries and in particular with the effect of those injuries on his ability to work and maintain his business. The claimant's symptoms deteriorated over time and have required referral to a psychologist and psychiatrist. He was diagnosed as having anxiety and depression. He was prescribed Agomelatine. He was provided with psychological treatment. His psychological injury did not improve and he developed sufficient symptoms to suffer from a major depressive disorder.
4. The claimant's major depressive disorder caused increased tension in his relationship with Hanna, with divorce prior to the re-examination.
5. The Panel accepts that the accident on 1 October 2019 did cause the claimant to suffer from a major depressive disorder.

1. The PIRS provides in clause 6.219 for six areas of function:
   • 6.219.1 self-care and personal hygiene;
   • 6.219.2 social and recreational activities;
   • 6.219.3 travel;
   • 6.219.4 social functioning (relationships);
   • 6.219.5 concentration persistence and pace, and
   • 6.219.6 adaptation.
2. The PIRS then provides at 6.220 for five classes with a descriptor for each which is "illustrative rather than literal criteria" and which is based on:

"... a history of the injured person's pre-accident lifestyle, activities and habits, and then [an assessment of] the extent to which these have changed as a result of the psychiatric injury".

1. The impairment may be adjusted for treatment[19] that is treatment such as medication being consumed to treat the psychiatric condition.
2. Once all six areas of function have been categorised into a particular class, the median class score is determined, the aggregate score is determined and the median and aggregate are converted to provide a WPI percentage[20].
3. The Guidelines also provide as follows:

(a) clause 6.214 statements that impairment due to physical injury is assessed using other parts of the Guidelines, and

(b) clause 6.215 which states that "the PIRS must not be used to measure impairment due to somatoform disorders or pain".

1. The PIRS provides the following five classes of impairment for this area of functionality as follows:

(a) Class 1 - No deficit, or minor deficit attributable to normal variation in the general population.

(b) Class 2 - Mild impairment. Able to live independently and look after self adequately, although may look unkempt occasionally. Sometimes misses a meal or relies on takeaway food.

(c) Class 3 - Moderate impairment. Cannot live independently without regular support. Needs prompting to shower daily and wear clean clothes. Cannot prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) two to three times per week to ensure minimum level of hygiene and nutrition.

(d) Class 4 - Severe impairment. Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.

(e) Class 5 - Totally impaired. Needs assistance with basic functions, such as feeding and toileting.

1. Mr Alzanati did not report pain preventing him from maintaining his self-care and personal hygiene. The claimant did describe low energy and a loss of interest his self-care and personal hygiene. He said he would attend his barber to cut his hair and groom his beard but less that he did before the accident. He did not require prompting by Michael to ask him to shower. He would shower after returning from work on the days he was at painting sites. He reported that Michael would purchase groceries and cook the meals. He said Michael would vacuum and clean the unit. The claimant said he was able to perform laundry duties and incidental cleaning and assistance with dishes.
2. It is the clinical judgment of the Medical Assessors that the claimant has a class 2 (mild) impairment in this area.

Social and recreational activities (Table 6.12)

1. The PIRS provides the following five classes of impairment for this area of functionality as follows:

(a) Class 1 - No deficit or minor deficit attributable to normal variation in the general population. Able to go out regularly to cinemas, restaurants or other recreational venues. Belongs to clubs or associations and is actively involved with these.

(b) Class 2 - Mild impairment. Able to occasionally go out to social events without needing a support person, but does not become actively involved; for example, in dancing, cheering favourite team.

(c) Class 3 - Moderate impairment. Rarely goes to social events, and mostly when prompted by family or close friend. Unable to go out without a support person. Not actively involved, remains quiet and withdrawn.

(d) Class 4 - Severe impairment. Never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or the garden when others visit family or flatmate.

(e) Class 5 - Totally impaired. Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.

1. The claimant said while he continued to attend the gym from the date of the accident, he stopped attending the gym during 2024 because his pain was too much and he could not perform the physical routines. This pain related impairment was not measured in the assessment of PIRS in compliance with the Guidelines.
2. The claimant said he maintained a good relationship with Hanna and would still visit his daughters at Hanna's home. He said he would bring gifts to his daughters. He said he had celebrated Eid with them during 2025. He said he had celebrated family birthdays for his children. He had access to his youngest daughters, and they would be left in his care should Hanna agree. The claimant was less interested in socialising in extended family groups, and he was less interested in meeting with his past friendship circle due to his low energy. The claimant reported a strained relationship with his brother Zain and Zain's wife but that this occurred before the accident.
3. It is the clinical judgment of the Medical Assessors that the claimant has a mild (class 2) impairment in this area.

1. The PIRS provides the following five classes of impairment for this area of functionality as follows:

(a) Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. Able to travel to new environments without supervision.

(b) Class 2 - Mild impairment. Able to travel without support person, but only in a familiar area such as local shops or visiting a neighbour.

(c) Class 3 - Moderate impairment. Unable to travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.

(d) Class 4 - Severe impairment. Finds it extremely uncomfortable to leave own residence even with a trusted person.

(e) Class 5 - Totally impaired. Cannot be left unsupervised, even at home. May require two or more persons to supervise when travelling.

1. The claimant said that if he drove for more than 30 minutes, he would experience pain and must take brief pauses away from the car to stretch. Pain associated with prolonged sitting whilst travelling was not included in the PIRS assessment in compliance with the Guidelines.
2. The claimant said he was able to drive on his own about 20 to 30 minutes. He said he was too low in energy and was too fatigued to be interested in driving further. He said he would restrict his destinations to areas that were close, familiar and usually local to where he was living. The claimant has travelled overseas since the date of the accident.
3. It is the clinical judgment of the Medical Assessors that the claimant has a class 2 (mild) impairment in this area.

1. Clause 6.208 says that "social functioning refers to the capacity to get along with others and communicate effectively".
2. The PIRS provides the following five classes of impairment for this area of functionality as follows:

(a) Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. No difficulty in forming and sustaining relationships; for example, a partner or close friendships lasting years.

(b) Class 2 - Mild impairment. Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.

(c) Class 3 - Moderate impairment. Previously established relationships severely strained; evidenced, for example, by periods of separation or domestic violence. Partner, relatives or community services looking after children.

(d) Class 4 - Severe impairment. Unable to form or sustain long-term relationships. Pre-existing relationships ended; for example, lost partner, close friends. Unable to care for dependants; for example, own children, elderly parent.

(e) Class 5 - Totally impaired. Unable to function within society. Living away from populated areas, actively avoids social contact.

1. The claimant reported that that he was affected by his back pain and that this had impaired his capacity to provide "kangaroo-care" for his twin daughters whilst they were in neonatal intensive care until they reached their expected date of delivery. He said he could not sit for the two hours as was required for this three month period. Pain associated with prolonged sitting was not included in the PIRS assessment in compliance with the Guidelines.
2. The claimant reported he had lost his libido due to pain and was unable to show affection towards his wife, Hanna. He said his irritability increased and he would become impulsively angry. He said he had impulsively thrown items when frustrated and angry. He said all of this led to the divorce from Hanna at the time of the re-examination and that a property settlement had occurred with Hanna buying the house they had lived in. The claimant remained amicable with his former wife and was still able to visit his twin daughters and could look after them at Hanna's (their former) home. He said Nour would also attend Hanna's home for family gatherings.
3. He said he did not socialise with any of his old friendship circle.
4. It is the clinical judgment of the Medical Assessors that the claimant has a moderate impairment (class 3) in this area primarily as a result of the deterioration of his marital relationship with his wife Hanna.

Concentration, persistence and pace (table 6.15)

1. Clause 6.209 defines this criteria as "the ability to sustain focused attention, for long enough to permit the timely completion of tasks commonly found in work settings".
2. The PIRS provides the following five classes of impairment for this area of functionality as follows:

(a) Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. Able to operate at previous educational level; for example, pass a TAFE or university course within normal timeframe.

(b) Class 2 - Mild impairment. Can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for up to 30 minutes, for example, then feels fatigued or develops headache.

(c) Class 3 - Moderate impairment. Unable to read more than newspaper articles. Finds it difficult to follow complex instructions; for example, operating manuals, building plans, make significant repairs to motor vehicle, type detailed documents, follow a pattern for making clothes, tapestry or knitting.

(d) Class 4 - Severe impairment. Can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.

(e) Class 5 - Totally impaired. Needs constant supervision and assistance within an institutional setting.

1. The claimant did not report pain as impairing his concentration, persistence and pace. However, Mr Alzanati reported he was slower in his capacity to make decisions. He said he was indecisive and was delayed in purchasing or organising his employed workers to paint. He said however he could perform the necessary bookkeeping for his business, submitted BAS statements and taxation records. He said he maintained his own bill paying and was able to manage his finances and was working towards the elimination of his debts.
2. The claimant was able to focus during the length of the re-examination (in excess of one and a half hours).
3. The Medical Assessors in their clinical judgment are of the view the claimant has a mild (class 2) impairment in this area.

1. Clause 6.210 of the Guidelines states that "Adaptation (also called deterioration or de-compensation in work or work-like settings) refers to the repeated failure to adapt to stressful circumstances".
2. The PIRS provides the following five classes of impairment for this area of functionality as follows:

(a) Class 1 - No deficit, or minor deficit attributable to normal variation in the general population. Able to work full time. Duties and performance are consistent with injured person's education and training. The injured person is able to cope with the normal demands of the job.

(b) Class 2 - Mild impairment. Able to work full time in a different environment. The duties require comparable skill and intellect. Can work in the same position, but no more than 20 hours per week; for example, no longer happy to work with specific persons, work in a specific location due to travel required.

(c) Class 3 - Moderate impairment. Cannot work at all in same position as previously. Can perform less than 20 hours per week in a different position, which requires less skill or is qualitatively different; for example, less stressful.

(d) Class 4 - Severe impairment. Cannot work more than one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic.

(e) Class 5 - Totally impaired. Cannot work at all.

1. Mr Alzanati reported that the pain caused by his physical injuries restricted his capacity to paint for long periods or lift heavier items. He said this pain caused him difficulty with working at the same pace and slowed his progress. Pain associated with the claimant's adaptation was not included in the PIRS assessment in compliance with the Guidelines.
2. The claimant reported he had lost interest, and his loss of interest restricted his hours of work. He said his hours of work were about 13 hours per week over three days. He said he could work about 26 hours per fortnight. He said he was slow in his administration of his business and he was unable to be at the worksite supervising his workers which resulted in him having paint and equipment going missing with the rate of work slower. He said the size of the projects he would contract for were smaller so that he could manage the project without excessive losses.
3. On the basis of this reduction in stated work capacity it is the clinical judgment of the Medical Assessors that the claimant has a moderate (class 3) impairment in this area of functioning.

1. A summary of the PIRS assessment including the form required by cl 6.220 is provided below.

1. The Medical Assessors are of the view that on the history as provided by the claimant and in the available medical records there is no evidence of a pre-existing symptomatic impairment due to any psychological or psychiatric disorder. There is therefore no basis for the adjustment of the current impairment under cl 6.218.
2. The claimant remained symptomatic since the accident until the date of this re-examination despite counselling with a psychologist, referral to a psychiatrist and medication. It is the clinical judgment of the Medical Assessors that the treatment the claimant has had, and continues to have, is not effective in that there is no improvement in his psychiatric or psychological symptoms or functioning. There is therefore no adjustment to be made in accordance with cl 6.223 and cl 6.31 of the Guidelines.
3. The claimant reported that he had no subsequent psychological injury or condition. The claimant's February 2024 medical episode may have caused a temporary exacerbation of his psychological condition, but the Medical Assessors are not satisfied on the basis of the claimant's history that there has been any long-term aggravation of the claimant's mental state as a result of this medical episode.
4. There is therefore no adjustment to be made in accordance with cl 6.34 of the Guidelines.

1. In summary and in accordance with cl 6.225 of the Guidelines:

(a) the class scores for the six areas of functioning in ascending order according to cl 6.226 are 2, 2, 2, 2, 3 and 3 with a median of 2;

(b) the aggregate score calculated in accordance with cl 6.227 is 14, and

(c) using the conversion table 6.17 this translates to a WPI of 7%.

1. As the Panel has come to a different outcome to Medical Assessor Shen, it follows that his certificate must be revoked, and a fresh certificate issued.

[1] The current maximum as of October 2025 is $651,000.

[4] Section 7.21. The current version of the Guidelines is Version 10.

[6] The numbers in square brackets are a reference to the section number in the Medical Assessor's reasons.

[7] The numbers in square brackets are a reference to the paragraph number in the submissions.

[10] Page 128 pf the additional bundle.

[13] The report is at page 33 of the claimant's bundle. There are handwritten notes as well which are difficult to read.

[14] Page 162 of the additional bundle.

[15] Page 167 of the additional bundle.

[16] Page 86 of 171 of the additional bundle.

[17] Page 136 of the additional bundle.

[19] See clauses 6.222 - 6.223 of the guidelines.

[20] See clauses 6.225 - 6.228 and table 17.