(a) Revokes Medical Assessor Abhishek Nagesh's certificate dated 28 November 2023, which found that the psychological injuries arising from the motor accident gave rise to whole person impairment of 15%.

(b) Certifies that Mr Adam Elabed's permanent impairment resulting from the injury caused by the accident is 7% permanent impairment arising from a major depressive disorder and post- traumatic stress disorder caused by the accident, which is not greater than 10%.

1. The claimant, Mr Adam Elabed was a delivery driver managing a schedule over a regular route in a light truck in Sydney's outer suburbs. On 25 October 2020 Mr Elabed had completed his first delivery that day and was driving to his second delivery.
2. He was stopped at red traffic lights. The traffic light changed to green and he had just started driving forward when an oncoming vehicle jumped the median strip and collided head on with the claimant's truck. His truck was flipped over, coming to rest on the driver's side.
3. Bystanders helped him climb out of the passenger side door.
4. After the accident, Mr Elabed had time away from work. He returned to work in January for five hours, three days each week on light duties until the COVID-19 lockdown.
5. He has not worked since.
6. Mr Elabed claimed workers compensation benefits for treatment and time away from work. Eventually, Mr Elabed also claimed damages against the third-party insurer of the vehicle that the claimant says caused this accident.
7. Medical disputes have arisen in connection with the claims and Mr Elabed referred the dispute about the degree of the claimant's whole person impairment (WPI) resulting from the injuries caused by the accident to the Personal Injury Commission (Commission) for assessment.
8. On 24 October 2023, the claimant was assessed by Medical Assessor Abhishek Nagesh (Medical Assessor) and he issued an assessment in a certificate dated 28 November 2023, which found that the psychological injuries arising from the motor accident gave rise to WPI of 15%.
9. The insurer applied for review on the basis the assessment was incorrect in a material respect.
10. On 5 March 2024 the President of the Commission's delegate constituted this Review Panel (the Panel) to review the original certificate (the Review).
11. Following rule 128(1) of the Personal Injury Commission Rules, 2021 (the PIC Rules) the Panel will 'conduct and determine the proceedings in accordance with procedures determined by the panel'.
12. The Panel met on 12 February 2025 to discuss how this matter would proceed. The Panel relied on the available insurer's bundle of documents.
13. The points apparent to the Panel were as follows:

(a) the claimant's general practitioner (GP) had referred him to a treating psychiatrist, and

(b) the workers compensation material provided with the insurer's bundle did not contain records of interactions with a rehabilitation provider.

1. The Panel directed the parties provide up to date clinical notes and any rehabilitation material that would inform the Panel of how the claimant temporarily returned to work and the reasons for him discontinuing work.
2. The Panel considered it was necessary to re-examine Mr Elabed and Medical Assessors Friend and Newlyn agreed to conduct this examination on behalf of the Panel on

"the degree of permanent impairment of the injured person that has resulted from the injury caused by the accident (including whether the degree of permanent impairment is greater than a particular percentage)" is a medical assessment matter"

1. If there is a dispute about the degree of permanent impairment of an injured person being sufficient to award non-economic loss damages i.e. greater than 10%, then those damages may not be awarded unless the degree of permanent impairment has been assessed by a Medical Assessor under Division 7.5: s 4.12(1) MAI Act.
2. Division 7.5 of the MAI Act provides for the Commission to assess declared medical disputes including provisions relevant to an original medical assessment and for appointing Panels to review those medical assessments.[1]
3. Parties may apply to the President of the Commission for review of a medical assessment on grounds that the assessment "was incorrect in a material respect" (sub-s (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 refers the application to a review panel consisting of a Member of the Commission and two Medical Assessors (sub-ss (2) and (2B)) to reassess the dispute.
4. The review 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" (sub-s 3A).
5. Rule 128 of the Personal Injury Commission Rules 2021 (the Rules) permits the Panel to determine its own proceedings and the rules of evidence do not bind the Panel, which may inquire into relevant matters as it thinks fit, while observing procedural fairness.
6. The method of assessing the degree of impairment is dealt with in s 7.21, which is in the following terms:

"7.21 Assessment of degree of permanent impairment

(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 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."

1. Clause 6.35 of the Motor Accident Guidelines states that psychiatric impairment is assessed in accordance with 'Mental and behavioural disorders' found in cls [6.201]-[6.228] of the Guidelines.
2. Pre-existing impairment is addressed in cls 6.31-6.33 of the Guidelines. Clause 6.34 deals with subsequent injuries.
3. The Guidelines state as follows with respect to causation of injury:

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 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:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.

2. 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 accident. The accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

1. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

1. Medical Assessor Abhishek Nagesh issued an assessment in a certificate dated

28 November 2023, which found that the psychological injuries arising from the motor accident gave rise to WPI of 15%. 2. Medical Assessor Abhishek Nagesh recorded that the accident occurred as described above and the following:

(a) Mr Elabed said he did not lose consciousness. An ambulance and the police attended. He did not go to hospital as he felt he did not need any assistance. His brother collected him from the accident site and took him home;

(b) he was later in pain, could not sleep, and subsequently consulted his GP. He was not able to sleep because of the pain and not able to be active as previously and became depressed;

(c) he had flashbacks, lost his appetite and lost weight. He felt tired, lacked energy and motivation, was anxious and worried about the future. He felt guilty about not being able to provide for his family;

(d) he felt worthless and his concentration was diminished, and

(e) his GP prescribed duloxetine, and mirtazapine. He was referred to a psychologist. He saw two different psychologists over a period of 18 months and is currently consulting a psychologist.

1. He described his functioning to the Medical Assessor as spending the majority of the time at home, rarely does much, and only goes out to see health professionals.
2. He could do light cooking but struggles to cook. He was struggling to clean and shop.
3. He showered every couple of days.
4. He was socially withdrawn. He was becoming anxious when he had contact with others and had ceased attending large group events, including weddings, dinner parties, and anniversaries.
5. He can drive to his local practitioner, independently. He needs to be accompanied by his partner to travel away to unfamiliar places.
6. The relationship with his wife was strained and they have arguments.
7. He had poor attention and concentration. He was easily distracted. He no longer reads books, had poor memory and misplaced items.
8. A score was undertaken in accordance with the psychiatric impairment rating scale (PIRS) under the Guidelines. Medical Assessor Nagesh assigned class 2 to self-care and personal hygiene, travel and social functioning. He assigns class 3 to the remaining three categories.

1. The documentary evidence before the Panel consists of material in the joint bundle of 1383 pages filed in accordance with the Panel's directions. The Panel has considered all this material.
2. The Panel's Medical Assessors Friend and Newlyn interviewed Mr Elabed via MS Teams on 12 March 2025.
3. The Panel met on 26 March 2025 to discuss the report produced after that examination.
4. The points apparent to the Panel at an earlier meeting were as follows:

(a) the claimant's GP had referred him to a treating psychiatrist, and

(b) the workers compensation material provided with the insurer's bundle did not contain records of interactions with a rehabilitation provider.

1. The Panel did not discern in the insurer's bundle any clinical notes from psychiatrist consultations with the treating records.
2. Likewise, there did not appear to be any rehabilitation material that would inform the Panel of how the claimant temporarily returned to work and the reasons for him discontinuing work.
3. The joint bundle item 33 contains brief notes that referred to current psychological counselling and receiving psychoactive medication, but it appears the claimant had not received any psychiatric treatment.
4. However, the claimant spoke during the examination as if he is currently interacting with a rehabilitation provider who is actively looking for suitable positions and retraining.
5. Following the directions from the Panel's report dated 26 February 2025 the parties produced a bundle from EML and the claimant provided further submissions, his statement and copies of certificates of capacity.
6. The EML bundle did not include any further information after March 2022 regarding the claimant's rehabilitation.

1. Medical Assessor Alan Home's certificate, dated 18 September 2023, stated the following injuries gave rise to a permanent impairment of 7%:

(a) cervical spine, soft tissue injury;

(b) left shoulder, soft tissue injury - resolved;

(c) left knee, tibial fracture;

(d) lumbar spine, aggravation of underlying degenerative change, and

(e) thoracic spine, soft tissue injury, underlying T6/7 disc protrusion.

1. Psychiatrist Dr Ben Hooi-Beng Teoh's report, dated 22 February 2022, states that Mr Elabed was involved in a head-on collision and his vehicle was flipped onto its side.
2. Mr Elabed said he sustained injuries to his shoulder, left knee, back and neck.
3. The doctor recorded Mr Elabed felt useless, worrying about his future and says he is not the same person.
4. He was irritable, argumentative, and socially withdrawn.
5. He had insomnia and was preoccupied with negative thoughts.
6. He worried about safety when driving and showed avoidant behaviour. The marriage was strained and he felt dependent on his wife.
7. Mr Elabed was not able to do activities like cleaning, shopping and gardening.
8. The persistent pain affecting his neck, shoulder, back and knees restricted his movements. He cannot do physical activities which he did previously.
9. Dr Teoh diagnosed a major depressive disorder.
10. Dr Teoh's additional report dated 22 February 2022, assigns WPI of 17% assigning class 2 to self-care and personal hygiene and travel and class 3 to the remaining four classes.
11. Orthopaedic surgeon Associate Professor Michael Shatwell's report dated

29 December 2022, states as a result of the accident on 26 October 2020, Mr Elabed had low back pain probably related to degenerative change in lumbar spine. 12. That doctor opined it was unlikely the current pain was related to the accident which occurred over two years ago and acute effects of the accident would have settled within a matter of a few weeks after the collision. 13. The doctor opined the claimant was not severely affected by pain at the time of the accident and did not go to hospital in the first 24 hours. 14. He was fully mobile when he attended his doctor within a few hours of the accident and did not have any major limitation of movement, although there were complaints of pain in many areas after the accident. 15. Associate Professor Michael Shatwell assessed WPI of 0%. 16. Psychiatrist Dr Michael Prior's report, dated 22 August 2023, states that following the accident on 25 October 2020, Mr Elabed developed irritability and anger, felt sad, was crying and screaming and wept on a daily basis. 17. The claimant was not able to enjoy activities or derive pleasure from activities. He lacked motivation, and he had poor concentration and memory. He had poor self-esteem and he felt useless. He had periodic thoughts of death and suicide but had not attempted self-harm. He generally felt hopeless and pessimistic. 18. He had no energy and always felt tired with diminished appetite. 19. He sleeps only two to three hours, having initial insomnia due to spontaneous intrusive distressing recollection of the accident and ruminating about the accident. He woke on average four times during the night in response to nightmares or pain. 20. He worried about everything, including the future. 21. He had symptoms of panic including struggling to breathe, pounding heart, kind of sweating and shaking legs, which often trigger thoughts about the accident and worrying. 22. He avoids people and prefers to be alone. 23. He had nightmares occurring up to five times each week. 24. He had distressing recollections of the accident which could be triggered by passing by the site of the accident or reading news or media reports of truck accidents. 25. He had an elevated startle response to unexpected movement and was generally more cautious in looking around himself when driving a vehicle and drove more slowly. 26. The current medications are mirtazapine, Panadeine Forte and Palexia. 27. Dr Prior diagnosed chronic posttraumatic stress disorder, delayed onset, and co-morbid, persistent depressive disorder, with associated generalised anxiety and panic phenomena. 28. Mr Elabed had eight to nine months off work after the accident, which he attributed mainly to pain and physical limitations. 29. He returned to work on light duties, which was paperwork and administrative duties. 30. He worked for a month, several hours each day for a couple of days each week. He ceased working because of pain and having problems with the long drive to and from work. 31. He said "I'm always in pain; it's the pain, but it's also what's happening in my head" that prevents him from working. 32. Under daily activities Dr Prior also recorded that Mr Elabed does nothing because he cannot do physical activities and feels worthless. He lacks motivation, had poor variable appetite. He occasionally helps his wife by feeding his daughter and changing her nappy. 33. His wife needs to help him shower at times because of the pain and physical limitations, and sometimes there was a need to help him with toileting. 34. He was withdrawn and isolated from previous social networks because he cannot do what he previously did and he tells them to go away. 35. He rarely watches television and cannot physically do four-wheel driving, fishing or motorbike riding. He drives a couple of times each week but only to appointments and only for short distances. He avoids busier streets and takes quieter back streets. 36. He was more anxious and vigilant when driving. 37. There are some arguments with his wife and he had pushed her away. 38. He does not feel close to her anymore but was bonded with his five-month-old daughter. He had pushed away his siblings and parents, stating he previously had good relations with them. He no longer speaks to his in-laws. 39. He can read a couple of paragraphs but needs to re-read it. He cannot concentrate for more than 5 to 10 minutes on television and his maximum concentration span for driving was 15 minutes. He forgets conversations, activities, and appointments, and needs to write down appointments to remember them. He misplaces his mobile telephone, wallet, and remote control of the television. He describes his thinking as speeded up and agitated.

1. Orthopaedic surgeon, Associate Professor Sameer Viswinathan's report dated

13 January 2021, states that Mr Elabed returned for review 10 weeks after the accident and could discard his crutches and get on with life. The oedema had completely settled in the lateral tibial plateau of the left knee and he had full range of movement with no pain. 2. Neurosurgeon and spinal surgeon Dr Balsam Darwish's report dated 13 July 2021, states that following the accident on 26 October that the MRI scan of the whole spine, dated

10 November 2020, showed: * cervical spine - normal cervical spine with no obvious nerve root or spinal compression and no disc protrusion; * thoracic spine - T6/T7 disc protrusion, but no spinal cord compression, and * lumbar spine - L3/4, L4/5 and L5/S1 disc dehydration and bulges, but no significant nerve root compression. 3. Dr Darwish recommended physiotherapy and progress to an exercise gym program, after his leg pain improves. 4. Dr Darwish referred the claimant for an L4/5 and L5/S1 epidural corticosteroid injection and prescribed Naprosyn. 5. The epidural corticosteroid injection helped for a couple of days. 6. Dr Darwish reviewed the claimant on 2 March 2021 who complained of low back pain and stiffness with no radicular symptoms. He was prescribed Palexia SR 100 mg at night and was advised to continue with Naprosyn. 7. The claimant had returned to work five hours each day, three days each week. He was not to lift more than 5kg. 8. Dr Darwish reviewed him again on 27 April 2021. He had three-level disc hydration and bulges which if surgery occurred would require three level fusion with a high risk of complications and failures. 9. It was recommended Mr Elabed continue working five hours each day, three days each week. He was reviewed on 7 January 2021, had ongoing low back pain and stiffness, for which he was taking Palexia and Naprosyn twice daily. Palexia was increased to 150 mg twice daily and was advised to continue with the exercise gym program. 10. The clinical notes from the Optimal Health Medical Centre from 5 August 2020 to 6 May 2022 include the following entries. 11. Current medications: * Celebrex 100 mg daily; * Circadin; * Duloxetine; * Paracetamol/Codeine; * Somac, and * Sporanox. 12. The entry dated 5 August 2020, which was a telehealth consultation, states the claimant had right knee pain and swelling occurred since he woke up from a nap this afternoon. There was no trauma. 13. The entry dated 26 October 2020, states he presented after an accident in which he was driving straight and another vehicle came over the midline, struck the left side of his truck. He was extracted with the help of another person. He had pain in the left side of his neck, left shoulder pain, left knee and ankle pain, wrist pain and back pain. He looks well and was not in pain. 14. The entry dated 5 November 2020 states he had pain between the shoulder blades and lower back pain. Top of the shoulders are painful as well. 15. The left knee pain comes and goes. He had been taking Endone but still had pain. 16. The entry dated 26 November 2020 states he had shoulder pain, back pain and knee pain, with difficulty with sleep and had some nightmares. He was not working. 17. The entry dated 10 December 2020 states he had posttraumatic stress disorder like symptoms, still gets nightmares and was agitated. 18. The entry dated 19 February 2021 states he had posttraumatic stress disorder like symptoms with nightmares, but he was better. He was waiting for approval to see the psychiatrist. 19. The entry by Dr Kay Alex, psychologist, dated 16 July 2021, states he works as a truck driver for Fishboy Seafoods, delivering food to clubs, pubs, cafes and houses. 20. He was stood down due to COVID-19. 21. He was doing his usual delivery round when an oncoming vehicle struck his vehicle head on. 22. He fractured his knee, had micro tears in his neck, muscular strain to his shoulder and multiple lumbar injuries. 23. He returned to work three days per week, five hours per day and then increased to six hours per day until 12 August 2021. 24. He thinks about the injury and accident and feels anxious about getting back into the truck and on the road. He had flashbacks of the accident. 25. He was feeling bored, isolated and useless. He had lost his sense of independence, purpose and motivation. 26. He had not been able to engage in outdoor activities that he did previously. 27. He avoids social activities and gatherings. He feels fed up and wants to get back to normal. 28. He was upset by the reduced income. 29. Psychologist, Dr Kay Alex's note dated 20 August 2021, states he had chronic pain affecting his lower back and cervical spine and stiffness in his muscles. He feels depressed, anxious, and useless. He feels guilty and cannot do things independently. 30. He slept about three hours each night and was tired during the day. He was irritable, short-tempered at home, and ruminating about the accident. 31. He was fearful of getting back into a truck. He was upset that he had no interaction with customers or people and felt isolated and lonely. 32. The entry dated 4 November 2021 states he was taking Palexia 150 mg twice daily. He consults the exercise physiologist two times each week. 33. He can lift 6kg to hip level and 5kg to shoulder. He uses an exercise bike for three to four minutes. He had physiotherapy twice each week. 34. The entry dated 21 February 2022 states that he was in pain which was worse with movement. He does some shopping and cooking but needs assistance. 35. Prolonged standing and sitting causes pain. 36. He was happy to start looking for suitable work. He will try to get work at his previous workplace. 37. The entry dated 21 March 2022 states he commenced work last week. His medication was Celebrex, Panadeine Forte, and Duloxetine. 38. The entry dated 14 April 2022 states he was working five hours, three days each week, and the pain was worse after finishing a shift. 39. Psychologist, Dr Kay Alex's entry dated 6 May 2022, states he was currently working four days per week, five hours per day on restricted duties. He needs to have time to rest and to compose himself when he feels his frustration was building up. He feels he needs more emotional and psychological support. 40. Pain specialist, Dr Trudi Richmond's report dated 29 November 2021, states following the accident on 26 October 2020, he sustained a left patella fracture causing occasional pain, low back pain, and left anterior neck/supraclavicular pain. 41. He had been treated with physiotherapy. 42. He had a right L4-5 perineural injection and a right L5-S1 epidural corticosteroid injection. 43. He returned to work in January for five hours, three days each week on light duties until the COVID-19 lockdown. 44. He had not returned to work. He can stand and sit for 10 to 15 minutes. He had difficulty getting to sleep because of trauma symptoms. He was cautious when driving and struggles passing a vehicle. He struggles driving in peak hours, not socialising as much. 45. He had not ridden his motorbike since the accident. 46. His medication was Tapentadol 150 mg twice daily, Panadeine Forte, Celecoxib and Somac. 47. There was evidence of central sensitisation, degenerative disc disease and facet joint arthropathy in the lumbar spine with evidence of significant mood disturbance and ongoing trauma symptoms. 48. Dr Richmond recommended: * continue with psychological treatment; * wean off tapentadol; * commence orphenadrine/paracetamol; * commence duloxetine, 30 mg daily; * Versatis, 5% patches; * referral to a psychiatrist, and * may benefit from a caudal epidural steroid injection. 49. Surgeon and neurosurgeon Dr James Van Gelder's report dated 12 May 2022, states

Mr Elabed had returned to part-time work doing administrative type work but had not returned to truck driving. 50. He had low back pain radiating to his right thigh and knee and sometimes to his buttock. He cannot stand or walk or sit for long. 51. Dr Van Gelder states that the claimant would benefit from rehabilitation and addressing psychosocial risk factors. 52. The clinical notes of the Optimal Health Medical Centre from 6 May 2022 to 10 October 2024 do not contain any new information regarding the psychiatric, psychological symptoms, condition or treatment. 53. The Workers' Doctors' Medical Centre's clinical notes from 12 May 2022 to 12 October 2024 include the following:

(a) Dr Eric Lim noted dated 12 May 2022, states this was a telehealth presentation. He was a truck driver for Fishboy Seafood. He was working five hours, four days each week, and had been a truck driver for four years. He was previously a spray painter for four years, a brick cleaner for one year, and completed year 12 at school. He had neck, back, knee, and psychological injuries. He described having neck stiffness, lower back pain radiating down both legs, pins and needles in both legs and left knee pain. He had trouble sleeping, nightmares, flashbacks, ruminates, was anxious, hypervigilant, had panic attacks and feels stressed, and

(b) Dr Lim did not provide a psychiatric diagnosis but referred him to a psychiatrist and psychologist. It states that he was unfit for work until his medication was stabilised.

1. That clinic's psychologist's entry dated 17 May 2022 states he lives with his partner in a private rental accommodation and had no psychiatric or psychological history. Following the accident, he suffered deterioration in his mental state with repeated disturbing and unwanted memories of the accident, specifically regarding the collision and the vehicle driving directly at him.
2. He avoids driving trucks. He avoids social interactions. He had negative thinking. He was anxious and depressed and feels unable to do things.
3. He can be irritable, have hypervigilance, low mood and anger.
4. He was unable to return to pre-injury duties.
5. He avoids social interactions and he was unable to ride his motorbike.
6. The psychologist diagnosed post-traumatic stress disorder.
7. Psychologist Carl Nielsen's report dated 17 May 2022 states that following the accident he had repeated disturbing memories of the accident. He avoided driving trucks and had not driven since the accident. He avoided social interactions. He had negative thinking characterised by anxious and depressive cognitions regarding feeling useless, being unable to do things he was previously able to do.
8. He had irritability, hypervigilance and low mood and anger. He was unable to ride his motor bike.
9. He had not returned to pre-injury duties.
10. He avoided recreational activities and playing sports such as soccer and fishing.
11. The diagnosis was post-traumatic stress disorder.
12. The psychologist's entry dated 27 August 2024, which appears to be about the 40th session of psychological treatment, states he had a diagnosis of post-traumatic stress disorder. He was fearful, worries and was angry.
13. He showered every two to three days and cannot read newspapers or focus on a story.
14. He had anxious and depressive cognitions, loss of confidence, broken trust, poor sleep hygiene, and appetite disturbance.
15. His mood was depressed.
16. He avoids recreational activities, was unable to vacuum, cook, go to the gym and was socially withdrawn.
17. The entry dated 6 September 2024 states he had T6/7 disc protrusion, L3-S5 disc bulging and a left tibial plateau fracture as well as post-traumatic stress disorder with a score of 60 on the checklist for post-traumatic stress disorder (PCL-5).
18. He had chronic pain, poor sleep and recurrent nightmares.
19. His medication was gabapentin and mirtazapine.
20. Neurosurgeon and spinal surgeon, Dr Peter Khong's report dated 20 May 2022 states a few hours after the accident Mr Elabed had lower back pain, bilateral shoulder pain and neck pain
21. Dr Khong diagnosed lower back pain due to musculoligamentous pain and exacerbation of pre-existing degenerative changes.
22. Dr Khong recommended non-operative management with physiotherapy, hydrotherapy, swimming, yoga and Pilates.

1. The report by Star Injury Management's Raveena Hadfield dated 8 July 2021 states he was stood down from pre-injury employment from 26 June 2021 because of COVID-19 restrictions.

"Mr Elabed reported being independent in his selfcare, his wife will occasionally assist with actions such as putting on socks, shoes or pants when he was limited by his pain symptoms. Mr Elabed reported avoiding asking for assistance as he prefers to be independent."

1. She notes he took time off after injury and returned on suitable duties.
2. The report by Star Injury Management dated 13 July 2021 states he returned to work in suitable duties in February or March 2021 working inside a warehouse doing light duties and assisting other staff.
3. The report by Star Injury Management dated 21 August 2021 appears to state that he continues to be stood down because of COVID-19 Pandemic restrictions. He was certified to work six hours each day, three days each week.
4. The report by Star Injury management dated 21 March 2022 states that in June 2021 suitable duties were no longer available due to COVID-19 restrictions and he ceased work. His symptoms deteriorated and he was certified unfit to work for six months.

1. The claimant had failed to particularise or provide submissions in respect of any psychological injuries arising from the subject accident.
2. Dr Teoh's diagnosis was inconsistent with the treating evidence of Mr Hadfield, and

Dr Richmond, in which the claimant was assessed to be independent and restrictions attributed to physical injuries. 3. Further submissions dated 12 December 2023 state that Medical Assessor Nagesh failed to provide adequate reasons for his assessment of WPI. 4. He could have assigned class 1 or 2 to adaptation, considering that Mr Elabed did return to work. 5. The claimant was stood down from his pre-injury position in June 2021 due to the COVID-19 lockdown and resumed suitable duties on 18 March 2022.

1. The insurer does not dispute Medical Assessor Abhishek Nagesh's diagnosis in that the claimant suffered a major depressive disorder which whilst not identical with Dr Prior's diagnosis of Chronic posttraumatic stress disorder and persistent depressive disorder was identical with psychiatrist Dr Teoh's diagnosis.
2. Before the accident the claimant was working full time driving trucks weighing approximately 4.5 tonnes with no history of psychological conditions and not taking any medication.
3. Since the accident the claimant did not return to his pre-accident employment as ongoing symptoms including poor sleep, three to four hours each night, impaired concentration and focus affected his ability to perform pre-accident duties.
4. The insurer's only contention may be distilled into a complaint that the assessor failed to provide adequate reasons for the classification of class 3 impairment in adaptation.

1. Medical Assessors Newlyn and Friend examined Mr Elabed by video teleconference on

Psychosocial history and pre-accident history

1. Mr Elabed was born in Canterbury Hospital and lived in the Bankstown area.
2. He is the eldest in a sibship of five, having three brothers and one sister.
3. He lived with his parents and siblings and described home as a normal household.
4. He completed school until the end of Year 12 and had no difficulties at school.
5. His first job was as a spray painter and powder coater in an industrial setting for five years.
6. The next job, for a short period of time, was delivering parcels. He left the job because he did not like the company environment.
7. He next worked doing brick cleaning and acid washing.
8. He commenced working for Fishboyz Seafood Delivery in 2018 or perhaps 2019. He was working in this job at the time of the accident.
9. The work involved loading the truck, with seafood, in the morning delivering the seafood to various customers. He typically delivered to restaurants, pubs, clubs, cafes and to some residential locations.
10. He drove a 4.5 tonne truck which required a light rigid licence.
11. He had been in a relationship with his partner, since soon after leaving school in 2010.
12. He and his partner now have a two-year-old daughter.
13. There were no difficulties in the relationship before the accident.

1. Mr Elabed had no significant medical history.
2. He had not been involved any previous accidents, sustained any fractures or undergone any surgery before the accident.

1. Mr Elabed abstains from tobacco, alcohol and illegal substances.
2. He has an occasional cup of coffee and occasionally consumes a cola or energy drink.

1. The accident occurred on 25 October 2020 after Mr Elabed completed his first delivery of the day and was driving to his second delivery.
2. He had stopped at red traffic lights. The traffic light changed to green and he had just started driving forward when an oncoming vehicle jumped over the median strip and there was a head-on collision.
3. This caused his truck to flip or roll, coming to rest on the driver's side.
4. He was helped out of the passenger side door by bystanders. He sat on top of the truck. He contemplated what happened and described feeling that he had "a high level of adrenalin". He did not fully realise what had occurred.
5. He felt shocked. He had been driving the route that he regularly took at work.
6. The police arrived and interviewed him. He cannot remember if he was breathalysed.
7. He cannot remember whether an ambulance attended.
8. He was not aware of any physical symptoms.
9. He was collected by his brother and driven to his home. He started to develop pain in his mid to lower back, both shoulders, about an hour after arriving home. He consulted his family doctor the same day. This is confirmed by the entry in the Optimal Health Medical Centre entry dated 26 October 2020.
10. His doctor gave him a medical certificate for a few days off work. He returned to the doctor after that period of time, because he was still in pain. He believes that his doctor referred him for scans and X-rays. He was recommended to take and/or prescribed medication but cannot remember the names.

History of symptoms and treatment following the accident

1. He continued to have pain in his mid-lower back and pain and aching in both his shoulders.
2. He had pain in both buttocks with pins and needles radiating down to as low as his left knee.
3. He had pain and aching in both shoulders.
4. Mr Elabed had pain in his left knee and believes he was told that it was fractured. It healed without any surgical intervention, but he was left with variable pain and aching in his left knee.
5. He had various corticosteroid injections into his back which were not helpful.
6. He was told that surgery on his back was not suitable because he was too young.
7. He had physiotherapy which continued at weekly intervals until last year.
8. He has also had hydrotherapy and exercise physiology.
9. He cannot recall the names of the medications that he took.
10. He had nightmares from soon after the accident. The content of the nightmares were of his accident and fictitious accidents in which he died. He woke from a nightmare feeling scared and distressed, perhaps crying and was unable to get back to sleep. They initially occurred each night.
11. He repeatedly thought about the accident and had images of the accident come into his mind during the day, when he was lying down to go to sleep at night, or if he saw trucks particularly driving on the road.
12. He thought that the accident would have not occurred, if he had been two minutes earlier or two minutes later.
13. He became irritable and felt angry towards the other driver because this person had changed his life.
14. He felt depressed and was repeatedly tearful. He lost interest in every activity, did not want to answer his mobile telephone and wanted to be left alone. He described pushing everyone away, including his partner with whom he lived.
15. He stopped seeing his friends and ceased all social activities. He felt useless and worthless that he was not working and lost interest in all his previous social and recreational activities.
16. He had previously enjoyed his job because he met different people each day.
17. He avoided talking about the accident because that brought back those memories.
18. He initially felt too scared to drive and ceased driving for a period of time but could not say how long. He felt fearful of a further accident, generally scared, and drove more cautiously and carefully when he resumed driving. He scanned for danger when he resumed driving.
19. If he travelled as a passenger he would sit in the back seat and tell the driver to slow down, watch out and pointed out potential danger. He described himself as "not a good passenger".
20. He avoided the accident site.
21. The psychiatric/psychological symptoms intensified when he realised that he was not physically recovering.
22. Mr Elabed returned to work in February or March 2021. He returned to the warehouse where they loaded the trucks at his previous employer.
23. He worked as a "caller", reading aloud from a printed list to the storemen, the items needed to be loaded onto a truck.
24. He typically worked Monday, Wednesday and possibly Friday, starting at 4.00am and finishing after three hours although he was cleared to work for six hours, until 10.00am.
25. He found it difficult to look at the trucks. He felt that others were looking down on him, although no one made any derogatory remarks to him. He generally felt diminished and worthless.
26. The standing caused increased pain in his mid and lower back. He periodically needed to take a break,sit down and relax because of the pain but also to get away from the others.
27. He avoided talking about the accident at work, because this made him think about the accident.
28. Mr Elabed believes that he only worked for a few weeks.
29. The Star Injury Management document dated 8 July 2021 states that he worked until

26 June 2021 when he was stood down because of COVID-19 restrictions. Mr Elabed reaffirmed that he only worked for a short period, he believes a few weeks, when this statement was put to him. 30. He ceased working because of the pain, the medication was affecting his concentration making it more difficult to drive and he continued to have thoughts about the accident when he was driving. It took him one and a half hours to drive home from the warehouse because he was driving in peak hour traffic. 31. He repeatedly needed to stop, get out and stretch several times when driving to and from the warehouse. He thought about the accident, scanned around him for danger and generally drove slowly and carefully. 32. Before the accident he could manage the commute as a 30-40 minute drive each way. 33. Mr Elabed was terminated from his job on 10 February 2023 and has not attempted to return to work, in any capacity. 34. A rehabilitation provider has been appointed who has been trying to find him courses that might be suitable for him to do, but so far none have been identified. 35. Mr Elabed's relationship with his partner was very stressed. He "pushed" her away, did not want to undertake social activities with her and generally "pushed" others away.

Details of any relevant injuries or conditions sustained since the accident

1. Mr Elabed has not been involved in any subsequent accidents of any kind, sustained any fractures or undergone any surgery unrelated to the accident.
2. Before the accident he and his partner had been trying to become pregnant. They suspended their attempts, after the accident, but later they sought fertility assistance to become pregnant.
3. He described his now two-year-old daughter as "a blessing" and "a big help" in assisting him to get through life day-to-day.

1. Mr Elabed continues to have pain in the mid and lower back. He has stabbing and numbness in both buttocks and can have pins and needles radiating down his left leg as far as his knee.
2. He has aches and pains in his left knee but the intensity varies from 2/10 to 8/10 day-to-day.
3. Cold weather exacerbates his aches and pains.
4. Mr Elabed has similar psychiatric/psychological symptoms to the earlier symptoms described above.
5. He feels depressed, worthless and useless.
6. He is angry and irritable but does not act on these feelings. He remains withdrawn from others and does not undertake any social or recreational activities. He continues to feel diminished as a person and thinks that others look down on him. He wants to be left alone. He is tearful from time to time and distressed and upset because of his current situation.
7. He continues to have intrusive images and memories of the accident which occur each day and are provoked by seeing trucks which he tries to avoid.
8. He has these images and memories come into his mind when he lies down in bed to go to sleep. He continues to have the nightmares which now occur most but not every night.
9. He continues to avoid the site of the accident.
10. He continues to be overly alert and scan for danger when driving. He continues to drive more slowly and carefully and behaves as described above when travelling as a passenger. The symptoms when travelling as a passenger are somewhat improved.

1. Mr Elabed is currently prescribed gabapentin, mirtazapine, Panadol and Nurofen, and uses various muscle rubs and gels and heat patches.
2. He was asked about the patches and said that he had tried the Versatis patch but it was not helpful.
3. He will be having what he referred to as a median nerve block some time in the future, and if that is successful, may have another nerve block. He does not know if it is a similar block or another type of block.

1. Mr Elabed was on time, alert and orientated, and understood the purpose of the examination.
2. There was no evidence of thought disorder, psychomotor retardation, perceptual disturbance or other phenomena of psychosis.
3. Mr Elabed repeatedly looked away. There was a sense that he was embarrassed by having to relate the history, but also that he was tired of having to repeat the history again.
4. He remained engaged in the examination which lasted about 1.5 hours. He did not complain of being fatigued and did not appear to become fatigued.
5. He has ongoing pain in his mid to lower back and pain in both buttocks with pins and needles radiating down to as low as his left knee.
6. He has pain and aching in both shoulders.
7. He has variable pain and aching in his left knee.
8. He struggled to describe his psychiatric/psychological symptoms. This appeared to be because he lacked the vocabulary to describe psychiatric/psychological concepts and symptoms.
9. Mr Elabed is low in mood, socially withdrawn, has a loss of motivation and drive and a loss of interest in social and most other activities.
10. He is repeatedly tearful, feels worthless and useless and thinks that others are looking down on him. He feels that he had lost his role as the provider for the family.
11. He continues to have nightmares of the accident and fictitious nightmare where he was killed in an accident. [2] These cause him to wake up feeling scared and being unable to get back to sleep.
12. He is angry and irritable.
13. He is hypervigilant when driving and drives more slowly and carefully. He continues to sit in the back seat, to be hypervigilant and calls out to the driver to be careful when travelling as a passenger.
14. He has recurrent intrusive images and memories of the accident which occur spontaneously, when he sees a truck and, when he lays down to go to sleep.
15. He still avoids the accident site.
16. He has withdrawn from others, in part because he feels diminished and that others are looking down on him and in part because he does not want to talk about the accident.

1. Mr Elabed finds it difficult to get up in the morning because of pain but also because of a lack of motivation. He sometimes needs assistance to shower and get dressed. Sometimes he "will push through" and shower, dress and brush his teeth. He will eventually get up, if he stays in bed, but will not shower, feeling that it is not necessary because he is not going anywhere.
2. He has no appetite in the morning and only eats breakfast if his partner prepares it, and even so, only on some days.
3. If he eats breakfast, he does not eat lunch. He is more likely to eat lunch if he does not eat breakfast.
4. He eats a small dinner in the evenings but sometimes does not eat dinner, again because of a poor appetite.
5. His partner prepares the meals. Before the accident he usually purchased his breakfast on the way to work.
6. He no longer does any chores at home because of the pain. He no longer helps with grocery shopping because walking and standing causes pain in his back.
7. Previously he and his partner would do the grocery shopping together and/or he would get items that were needed.
8. Mr Elabed has ceased all social and recreational activities. He previously like being active and outdoors.
9. Before the accident he rode a dirt bike with friends but has been unable to attempt to ride because of the pain involved by the position required to sit on a motorbike and needing to hold on to the grips on the handlebars.
10. He sold his motorbike after the accident.
11. He also did four-wheel driving which he has ceased as part of his fear of a further accident and the ongoing physical symptoms described previously.
12. He has no interest in social activities and has pushed away all his friends and family.
13. He just does not want to be asked about the accident.
14. It is difficult to attend doctors' appointments and to talk about the accident.
15. Mr Elabed now drives to appointments. The symptoms associated with driving are less intense but continues to still drives slowly and carefully and to be hypervigilant.
16. He travels on backroads to avoid traffic and because he is less likely to see trucks on backroads. He avoids travelling in peak hour.
17. He drives at most about 15 minutes from South Wentworthville where he lives to Parramatta.
18. He continues to have pain when driving. He feels he could probably drive for a bit a longer, if he were not in pain, but wants to minimise the amount of driving because of the psychiatric/psychological symptoms.
19. He had his partner drive him past the site of the accident sometime after the accident but described being very tearful and distressed and has not subsequently attempted to drive past the accident site.
20. He describes the relationship with his partner as "up and down" and that he pushes her away. He wants to be left alone, at least on some days.
21. He describes his partner as very supportive and describes his daughter as a blessing.
22. He had a good relationship with his family before the accident but has pushed them away even though they try to maintain contact.
23. Mr Elabed describes his thinking, concentration and memory as "up and down". He can forget where he has put his mobile telephone and other personal items.
24. He generally drives familiar routes but sometimes will take a wrong turn. He is able to find his way back to where he was going although sometimes, he may need to use his Google maps on mobile telephone.
25. He reads Facebook posts but does not do any other reading. He was able to read out the list when he was working as a caller when he returned to work.
26. Before the accident he did not read books or magazines but was able to read order and delivery sheets at work without difficulty.
27. When Mr Elabed returned to work, he did so as a caller working for a maximum of three hours per day. He loaded two to four trucks in a three hour period. Sometimes a truck would require 500-600 items to be loaded. He needed to repeatedly sit down and take breaks whilst loading a large order, because of the physical symptoms and the psychiatric/psychological symptoms.
28. He worked a maximum of nine hours each week when he returned to work.

1. Mr Elabed was consistent in his account of his symptoms throughout the examination. As noted previously, he struggled to describe his psychiatric/psychological symptoms.
2. His description of his symptoms was generally consistent with that of the various supplied psychiatrist and psychologist reports.

1. The Panel considered all of the information provided, including that obtained at the examination and later submissions with the claimant's statement regarding his attempts to return to work and treatment, which were sought in the Panel's request for further submissions on 26 March 2025.
2. The Panel determined that Mr Elabed reached criterion for a diagnosis of major depressive disorder.
3. He had a depressed mood which was present each day and had been so since soon after the accident.
4. He had lost interest and enjoyment of all activities quite apart from his physical symptoms.
5. He was socially withdrawn, avoids contact with others, had a lack of motivation and drive and a poor appetite. He had a sense of worthlessness and uselessness and found it more difficult to think and concentrate.
6. These symptoms are distressing for him and interfere with his life.
7. There are not the direct physiological effects of a substance or medical condition.
8. He has never met criteria for a mixed affective episode or a hypomanic or manic episode.
9. They are not better accounted for under the schizophrenia spectrum or other psychotic disorders and are not representing of bereavement.
10. Mr Elabed also satisfies the criterion for the diagnosis of posttraumatic stress disorder as follows:

Mr Elabed was involved in a potentially serious accident in which his vehicle rolled onto its right side. He was shocked at the time and struggled to comprehend what had occurred.

Mr Elabed has recurrent involuntary intrusive memories of the accident and has recurrent nightmares of the accident as described.

He was distressed at driving past the site of the accident.

He is distressed by seeing trucks which cause him to think about the accident.

Mr Elabed avoids talking to others about the accident which has caused him to avoid seeing others.

He avoids the site of the accident and travels on backroads so that he is less likely to see trucks.

Mr Elabed has a loss of interest in significant activities.

He does not experience positive emotions and sees himself as worthless, useless and looked down upon by others.

Mr Elabed is irritable but does not act on his irritability.

He is hypervigilant as a driver or travelling as a passenger in a motor vehicle.

He has difficulty getting to sleep and getting back to sleep after a nightmare.

The symptoms have been present for more than a month.

These symptoms cause significant distress and impairment in social and occupational functioning and generally day-to-day.

The disturbance is not attributable to the physiological effects of a substance or another medical condition.

1. The Panel has considered the evidence relating to the claimant's pre-accident psychological history.
2. The Panel has given weight to its medical members' opinions who, following a thorough examination of the claimant's pre-existing functioning, were satisfied there was no pre-existing psychiatric condition at the time of the accident.
3. The Panel has also considered the claimant's treating psychologists' opinions and the IME.
4. Considering the evidence, the Panel is satisfied Mr Elabed was a well man before the accident and had no impairment in his functioning and no history of exposure to previous accidents or trauma of any kind.
5. He had never previously been depressed or had any psychiatric/psychological symptoms.
6. Mr Elabed has subsequently not been involved in any accidents or other traumatic events.
7. He has not developed any new medical conditions or undergone any surgery or sustained any fractures unrelated to the accident.
8. There is a plausible mechanism of injury from the circumstances of this accident and the development of his psychiatric injuries, and there is a temporal and thematic association with his psychiatric symptoms and the accident, which maintains a nexus between this accident and his psychiatric injuries.
9. There was no other cause for the conditions of post-traumatic stress disorder and major depressive disorder other than the accident on 26 October 2020.
10. Given its finding that the claimant was not suffering a psychological condition immediately before the accident the Panel is satisfied there was no pre-existing impairment.
11. The Panel is satisfied that the claimant also suffered physical injury as a result of the accident.
12. The Panel gives weight to its medical members opinion that as a result of the accident the claimant developed the disorders listed above. The Panel agrees with and adopts the reasons given by its medical members in their re-examination report in support of this finding.
13. The Panel is satisfied that the accident made a material contribution to the development of the psychological conditions, and that but for the accident the claimant would not have developed this condition.
14. The following injuries WERE caused by the accident:
    • posttraumatic stress disorder, and
    • major depressive disorder.

1. Permanent impairment is defined in the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) (AMA 4 Guides) (p 315) as follows:

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

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

1. Impairment is assessed following the Motor Accident Guidelines version 9.3 (the Guidelines) which include a chapter entitled "Mental and behavioural disorders." The assessment is to be undertaken in accordance with the PIRS and the AMA 4 Guides are to be used as "background or reference only".[3]
2. The PIRS requires a psychiatric diagnosis to be undertaken first in accordance with the current editions of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD).[4]
3. The PIRS provides[5] for the consideration of any psychiatric condition present before the accident in question:

"In order to measure impairment caused by a specific event, the medical assessor must, in the case of an injured person with a pre-existing psychiatric diagnosis or diagnosable condition, estimate the overall pre-existing impairment using precisely the method set out in this part of the Guidelines, and subtract this value from the current impairment rating."

1. The PIRS provides in cl 6.219 for six areas of function:

(a) self-care and personal hygiene;

(b) social and recreational activities;

(c) travel;

(d) social functioning (relationships);

(e) concentration persistence and pace, and

(f) adaptation.

1. The PIRS then provides at 6.220 for five classes of impairment 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,[6] that is treatment such as medication being taken 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 is converted to provide a WPI percentage.[7]
3. The accident occurred on 20 October 2020, over four years ago. Mr Elabed has been treated by probably three psychologists and has been prescribed psychiatric medication and currently takes mirtazapine. He has continued to have symptoms which have continued to impact his ability to work, drive and his day-to-day life.
4. His condition is not improving and not deteriorating.
5. It is stabilised and should be regarded as permanent and unlikely to change in the next twelve months and by not more than three percent with or without medical treatment.

Degree of permanent impairment (psychiatric impairment rating scale)

1. The determination as to permanent impairment is made in accordance with the AMA 4 Guides and Part 6 of the Guidelines.

Treatment with antidepressant medication including mirtazapine.

Mild impairment. Mr Elabed does have a lack of motivation and sometimes will stay in bed longer, finding it difficult to get up.

He does require physical assistance with showering and getting dressed on at least some days.

He misses one meal each day because of his poor appetite.

He does not do any household chores because of the pain.

He similarly does not do any grocery shopping with his partner because of the pain.

The functioning in this category is limited by both physical and psychiatric/ psychological symptoms. The panel determined that most of the impairment was attributable to the physical symptoms and using clinical judgement assigned a mild impairment.

Moderate impairment. Mr Elabed has ceased all social and recreational activities.

He cannot ride motorbikes or do outdoor activities because of the pain but he does not want to see friends because he doesn't want to talk about the accident, and he does not see friends or family because they will talk about the accident and he has no interest in social activities and just prefers to stay at home and be alone.

Mild impairment. Mr Elabed can drive locally for as long as 15 minutes. He could probably drive for longer, if he did not have pain. He nonetheless drives on backstreets or back roads, avoids peak hour and avoids main roads so that he is less likely to see trucks and avoids traffic. He minimises his driving because of the psychiatric/psychological symptoms.

Mild impairment. Mr Elabed's relationship with his partner is strained and he has much less contact with his family and no contact with friends. He has repeatedly pushed people away including his partner but there have been no separations and no particular arguments.

Mild impairment. Mr Elabed is forgetful and has occasionally taken a wrong turn when driving but can eventually find his way to his destination.

His rehabilitation provider is trying to find a course to do but so far, no suitable courses have been identified.

Prior to the accident he was able to read delivery and product sheets. He was able to do the calling when he returned to work in 2021 which involved reading printed lists of goods to be loaded.

Moderate impairment. Mr Elabed cannot work in his previous job in part because of the physical injuries but also because of the psychiatric/psychological symptoms especially with regard to his driving but also because of his depressive symptoms.

He did return work for a maximum of nine hours each week as described which was a different and less skilful role but he was limited in doing this role at that time because of a combination of physical and psychiatric/psychological symptoms.

The panel considered this very carefully and felt that moderate impairment reflected the component attributable to his psychiatric/psychological symptoms.

Apportionment - pre-existing/subsequent impairment

1. The Panel has considered the class descriptors for each category of functioning in the PIRS and has evaluated the history provided by the claimant when the Panel's medical members re-examined him.
2. The Panel notes that the clinical judgment of its medical members, both of whom are psychiatrists, is the most important tool in the application of the PIRS. The Panel has given weight to the findings of its medical members with respect to the class they assigned for each PIRS area of functioning, and agrees with and adopts their findings, and the reasons they have given in support of those findings.
3. Mr Elabed had no pre-existing impairment or psychiatric/psychological condition.
4. He has not been involved in any subsequent accidents or accidents of any kind, or developed any new medical conditions.
5. There is no need to do a pre-or post- accident apportionment.

1. Mr Elabed has been treated by probably three psychologists and taken at least two types of antidepressant medication with no beneficial effect.
2. No allowance is made for the effect of treatment.

Degree of permanent impairment caused by the accident

1. Permanent impairment ratings take symptoms into account, however the percentage permanent impairment is not a direct measure of disability.

1. The Panel has found that the degree of permanent impairment of the claimant that has resulted from the adjustment disorder caused by the accident is 7%, and that the permanent impairment is not greater than 10%.
2. Given those findings, the Panel revokes Medical Assessor Abhishek Nagesh certificate dated 28 November 2023, which found that the psychological injuries arising from the motor accident gave rise to WPI of 15% and issues a new certificate certifying that the degree of permanent impairment of the claimant that has resulted from the adjustment disorder caused by the accident is not greater than 10%.

[2] A "fictitious nightmare" refers to a nightmare that is not based on the real-life experience or trauma but rather is a product of the imagination or a dream sequence that is not rooted in reality.

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

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