WHETHER THE INJURED PERSON'S DEGREE OF PERMANENT IMPAIRMENT AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10%

THE REVIEW PANEL'S ASSESSMENT UNDER S 7.23(1) OF THE MOTOR ACCIDENT INJURIES ACT 2017 IS:

1. Revokes Medical Assessor Atsumi Fukui's certificate dated 25 March 2024, which found that the psychological injuries arising from the motor accident gave rise to permanent impairment of 22%.
2. The Review Panel certifies that Mr Halabi's permanent impairment resulting from the injury caused by the accident is 11% permanent impairment arising from a major depressive disorder of moderate severity caused by the accident, which is greater than 10%.

1. The claimant was injured in the subject accident (accident) on 19 July 2019.
2. The claimant was driving his son at about 50 kph in his van when an emerging vehicle T-boned them on the passenger side and pushed his van to the other side. He said he didn't hit his head but was shook in his seat. He denied losing consciousness.
3. After the accident, they pulled on the side, and he tried to call the police, but the offending driver called people to attend the scene, and they tried to snatch his phone from him. He has told doctors that these people were aggressive in their manner.
4. The insurer is responsible for loss arising from the claimant's injuries from the accident under the Motor Accident Injuries Act 2017 (MAI Act)
5. Medical disputes have arisen in connection with the claim and Mr Halabi referred the dispute about the degree of the claimant's permanent impairment resulting from the injuries caused by the accident to the Personal Injury Commission (Commission) for assessment.
6. On 29 February 2024, Medical Assessor Atsumi Fukui (Medical Assessor) examined the claimant and issued an assessment in a certificate dated 25 March 2024, which found that the psychological injuries arising from the motor accident gave rise to permanent impairment of 22% from post-traumatic stress disorder and major depressive disorder.
7. The insurer applied for review on the basis the assessment was incorrect in a material respect.
8. On 23 October 2024, the President of the Commission's delegate constituted this Review Panel (the Panel) to review the original certificate (the Review).
9. 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'.
10. On 11 July 2025, the Panel wrote to the parties to direct the parties to provide their evidence and submissions.
11. The Panel met on 2 September 2025 to discuss how this matter would proceed. The Panel relied on the available insurer's bundle of documents.
12. The claimant's solicitor had provided no submissions other than to say the claimant's treating psychologist notes were not available. The only evidence the claimant provided were the claimant's general practitioner (GP) notes.
13. The Panel considered it was necessary to re-examine the claimant and Medical Assessors Baker and Gupta 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 PIC 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:

(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.[2] 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. Pre-existing impairment is addressed in cls 6.31-6.33 of the Guidelines. Clause 6.34 deals with subsequent injuries.
2. 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 AMA 4 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 AMA 4 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 psychiatric 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

ss 5D and 5E.

Degree of psychiatric impairment rating scale (PIRS)

1. Impairment is assessed following 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 Medical Assessor must obtain a psychiatric diagnosis before assessing PIRS 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 cl 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]

1. Medical Assessor Shen performed the initial psychological permanent impairment assessment to produce a certificate dated 27 March 2023. That Medical Assessor assessed 16% permanent impairment caused by the accident. This was adjusted upward by 1% for treatment.
2. Shen found 0% permanent impairment before the accident.
3. The Medical Assessor recorded that before the accident the claimant's psychological condition had been good apart from seeing a psychologist after he was assaulted at work in 2000. His relationships with his children and wife were strong before the accident but these had deteriorated.
4. The claimant said since the accident he has had intrusive memories and dreams of the collision. His mood has been labile and withdrawn. He also lost concentration easily and his memory was weaker.
5. The claimant was seeing his psychologist Mr Anthony from a week after the accident up to the time of Medical Assessor Shen's assessment. He also saw a psychiatrist monthly and received medication.
6. Medical Assessor Shen diagnosed post-traumatic stress disorder as he was involved in a motor vehicle accident, and at the time he described a frightening recollection of the accident circumstances such that he was in fear of him and his son dying.
7. Medical Assessor Shen classified the claimant as two in three areas of function and three in the remaining areas.

1. The insurer applied for further psychological permanent impairment assessment after Medical Assessor Shen produced his certificate dated 27 March 2023.
2. This was on the basis that s 7.24 of the MAI Act enables the matter to be referred for further assessment. Regulation 13 of the Regulations provides that a medical dispute may be referred again for assessment on the grounds of deterioration of the injury or additional relevant information about the injury.
3. The insurer successfully submitted that clinical notes and Centrelink records obtained since the earlier assessment was capable of having a material effect on the outcome of the previous assessment.
4. Medical Assessor Atsumi Fukui issued an assessment in a certificate dated

25 March 2024, which found that the psychological injuries arising from the motor accident gave rise to permanent impairment of 22%. He found that the accident had caused the claimant's psychological injuries which the Medical Assessor diagnosed as post-traumatic stress and major depressive disorders. The additional diagnosis arose from the claimant's deterioration since the earlier assessment. 5. Medical Assessor Fukui was instructed with the relevant records obtained since the earlier assessment and acknowledged he had considered them. The claimant described the same history he had given Medical Assessor Shen. 6. The claimant described symptoms which demonstrated that the psychological condition was worse. However, he said he had been able to manage his "pain." It was not clear whether the Medical Assessor was recording whether his emotional or physical pain was now manageable. 7. The claimant's self-care had declined. He avoided leaving home and driving. He described isolating himself, decline in the quality of his close relationships and ignoring home maintenance with gardening. 8. Medical Assessor Fukui noted that the claimant was not obviously inconsistent in his history or presentation in respect of recent events.

1. Psychiatrist Dr Vickery reported on 1 February 2022 that the claimant's alleged injuries and disabilities were not caused by the accident.
2. Mr Halabi reported to Dr Vickery that his 'whole life has changed since the accident.' He also described that the circumstances of the accident had been frightening and he was fearful about the behaviour of bystanders who knew the insured driver.
3. There is a disturbed sleep with waking and feeling fearful.
4. Mr Halabi avoids social interaction and driving.
5. There was tension in his marital and family relationship.
6. Mr Halabi had lost concentration and memory.
7. Dr Vickery's report contains large amounts of material referring to literature about the prevalence of malingering in patients claiming to suffer from post-traumatic stress disorder and somatic disorders.
8. In Dr Vickery's view the accident was relatively minor and he would not expect it to cause any permanent impairment, and there have been similar symptoms since 2001 for which the claimant received Centrelink disability benefits.
9. Dr Vickery did not diagnose post-traumatic stress disorder because the altercation with the five men and the accident appeared to Dr Vickery to be relatively minor in nature.
10. Dr Vickery reported that there has not been any psychiatric incapacity to work directly due to the accident. He declined to assess permanent impairment arising from the accident.

1. The claimant's Centrelink records refer to a history of depression as of 11 December 2018.
2. Centrelink Employment Services Assessment Report dated 12 October 2018 (approximately nine months before the accident) refers to a diagnosis of sleep apnoea and depression by

Dr Sidrak (GP) in March 2017 which had started onset 10 years earlier. 3. The assessment report refers to symptoms of poor sleep, tiredness, low mood, difficulty with concentration and limited socialisation. The claimant was reported to be using a Continuous Positive Airway Pressure (CPAP) machine. Centrelink reported that the claimant's work capacity was reduced to 0-7 hours/week due to the impact of his physical and psychological health conditions including chronic pain, physical limitations, impaired tolerances, mood fluctuations, range of motion limitations, and limited endurance. 4. Shortly before the accident the claimant had been assessed as being well enough to undergo a work trial, which he was about to attend when the accident occurred.

1. The obligation for procedural fairness imposes a positive duty on the Medical Assessors to ensure that their decision includes a detailed line of reasoning which acknowledges and responds to the parties' substantial and clearly articulated arguments: see Chahrouk v Allianz Australia Insurance Limited NSW [2021] NSWSC 1457.
2. Whilst Medical Assessor Fukui acknowledged the insurer's submissions, the Medical Assessor did not respond to the argument that the evidence of the claimant's significant pre-accident psychological history does not suggest that the accident caused an exacerbation or relapse of the claimant's pre-existing physical conditions but rather a continuation of his condition from which he would have suffered but for the accident in any event, noting his extensive history.
3. By failing to respond to the insurer's argument, the parties have been denied procedural fairness: Rodger v De Gelder [2015] NSWCA 211 at [108]- [109] and Chahrouk.
4. When Medical Assessor Shen assessed the pre-existing impairment on the PIRS scale, he assessed the claimant in class one for all six categories, based only on the claimant's self-reporting that he had no issues in any of the categories before the accident.
5. If Medical Assessor Fukui had considered the insurer's further assessment submissions, pre / post PIR scale, and full pre-accident records, he would have reached alternative conclusions regarding the claimant's pre-accident psychological condition as well as a greater understanding of his pre accident physical condition.
6. In turn, she would have reached reduced impairment calculations for both the pre and post- accident permanent impairment below the 10% threshold and would have attributed a greater percentage of impairment to the claimant's pre-accident conditions.
7. In fact, despite the insurer performing its own pre and post-accident PIRS assessment in the submissions placed before Medical Assessor Fukui. The insurer submitted:

"There was no evidence of any pre-existing or subsequent impairment", which is plainly wrong, and flies in the face of the evidence placed before Assessor Fukui that included pre accident impairments of poor sleep, tiredness, low mood, difficulty with concentration and limited socialisation, as well as the Insurer's submissions pointing out the pre accident impairments."

1. The Panel must consider the evidence of sleep apnoea and past psychological treatment.
2. The insurer submits that the claimant is an unreliable historian. The claimant's history provided to Medical Assessors Shen and Fukui is vague because the claimant denied to Medical Assessors Shen and Fukui that he was depressed before the accident.
3. Medical Assessor Shen may have misunderstood and believed that the claimant was working as a truck driver before the accident, or that the claimant had no issues with working, when he had been unemployed for a year, and the Centrelink employment services assessment report referred to below indicated that he had limited work capacity only 0-7 hours per week, due to a number of physical issues as well as depression.
4. Medical Assessor Shen said the following in regard to each of the pre accident PIRS categories:

"He said he had no issues with self-care. He had no issues with seeing his friends and would go out regularly. He had no issues with driving. He had no issues with his relationship with his wife and children. He had no issues with concentration or energy prior to the accident. He was able to work full time without issues."

1. This does not match with the Centrelink records.
2. This would call into question each of the PIRS category classes assessed by Medical Assessors Shen and Fukui, being both pre accident and post-accident PIRS.

1. The re-examination was conducted via an audio-visual link (MS Teams). Mr Halabi (claimant) attended unaccompanied. The claimant did not require an interpreter. The claimant was assessed by Medical Assessor Gupta and Senior Medical Assessor Baker.

Psychosocial history and pre-accident history

1. The claimant was born in 1964 in Ghana, Africa and was 61 years of age at the time of this re-examination. His parents raised him. He said his family of origin consisted of two brothers who lived in Africa, three sisters and his mother, who lived in Australia. He said his father was about 87 years of age when he died four years ago. He said he had resolved his normal grief due to the death of his father. He said his father died from old age.
2. The claimant completed his education in Ghana. He has studied Certificate IV in Information Technology (IT) and cookery. He has worked as a taxi driver, a chef, a croupier and as a security guard in Australia.
3. The claimant said he enjoyed his childhood. He reported he was never exposed to any childhood trauma, abuse, or neglect. He said his family home had sufficient food. He was not exposed to war or war-like conditions. Both his brothers remain living in Africa and his three sisters are in Australia. Before the accident, he would have contact with his mother most days. He would have telephone contact with his sisters most weeks, and his brothers would call him about monthly.
4. The claimant denies any history of mental illness in his family.
5. The claimant first entered Australia in 1986 on a visitor's visa. He settled in Australia in about 1996. He said he is now an Australian citizen.
6. The claimant has lived with his second wife for 30 years and their three children. His three children are a 23-year-old daughter, a 22-year-old son and a 20-year-old son. He lived in the family home with his second wife and children before the accident. He said he had a prior relationship, and he had one child from this union, born in 1992. He did not have routine contact with his first wife or child. He said he had two grandchildren.
7. The claimant enjoyed attending his local cafes to meet his friend about twice each week before the accident.
8. The claimant reported that he had worked in various roles during his career in Australia. He reported that whilst working as a croupier at Star City Casino in about 2000 he was hit in the head during the physical assault. He reported that he developed tinnitus. He said he lodged an NSW WorkCover claim for treatment. The claimant was asked if he had suffered from any psychological injury or condition after the assault. The claimant initially said he was not psychologically injured in the assault. He was advised that there was a medical record of "depression" dated 16 July 2001 after the assault, documented in a letter of referral to

Dr Simon McKechnie from his treating general practitioner. The claimant replied by saying he did not remember much from that long ago; however, he concurred that it was likely, as his tinnitus was severe at that time. He reported that he also developed falls from suffering from "disequilibrium," which he thought was an inner ear problem. 9. The claimant had suffered from pain in his right shoulder, back and both legs after the injury sustained at Star Casino. He also suffered from gastritis before the 2019 accident. He stated he was treated for hypertension and also persistent pain due to his physical injuries sustained in the Star Casino incident. 10. During 2024, the claimant was diagnosed with diverticulitis. He was admitted to Bankstown Hospital, and a partial colectomy was completed. He fully recovered from the surgery and was not required to have a colostomy postoperatively. 11. The claimant denies any alcohol or drug use. He denies any forensic history. He does not gamble. 12. The claimant was running his online business Elec2to.com.au. He sold neon lights. He only sold these retail items through his website. He ran his business from about 2004 to 2018. He says that he ran the business with his second wife. There were no employees and he worked from his garage in this home-based business. The business collapsed in 2018/19 after "China flooded the market" with a similar product to that he was selling. The claimant said the business was struggling before the accident. He said his prices for these items were too high, and he could not compete with the very cheap items from China. The claimant said that he had experienced several months of no business before the accident and the small business was closed after the accident. 13. The claimant said he had received a supplement from Centrelink before the accident. He said the business was not able to support him or his family, as the income was very small. Due to the downturn in the small business, he had not worked for several months before the accident. 14. The claimant showed the Medical Assessors his Health Care Card and this document had written on it that he was receiving a disability support payment from 11 December 2018. 15. He commenced receiving the disability support payment about seven months before the accident. His health care card commencement was consistent with his history of not working and having a pre-existing psychological condition. 16. On direct enquiry, he said he could not remember the reasons for the commencement of his disability support payment (DSP) as it had been commenced many years ago, and he remained in receipt of Australian government payments through this scheme.

1. The claimant was driving his son to his son's work on 19 July 2019, the day of the accident. His son was 18 years old and was seated in the front passenger seat. The claimant was driving a Hyundai Imax van. He was unable to remember the name of the street he was travelling on.
2. The claimant said he remembered a car parked on the street on his left. The car "took off suddenly." This car T boned the claimant's van. The claimant's van was pushed into the opposite lane.
3. The claimant said he remembered that the force from the collision lifted his van sideways. The claimant's van was briefly tilted and balanced on two wheels before falling back onto its four wheels. The van, upon falling back onto its four wheels, began to shake.
4. The claimant reported that the accident happened suddenly. His airbags were not deployed. He says that he was "scared" and looked at his son, who was in shock.
5. The claimant reported that he immediately suffered pain in his neck and his left shoulder. The claimant was asked about his son's condition, and the claimant reported that his son "reckoned that he was alright." He says at the time of this re-examination that his son does not complain of any injuries from the incident.
6. The claimant was able to get out of the van unaided and his son did the same. He tried to call the police, but neither the police nor ambulance attended the scene.
7. The claimant reported a group of people collecting around the accident scene. He said that he was beginning to be harassed by members of the crowd. He decided to drive the van home, as it was a short distance from the accident scene. After arriving home, he called the police and reported the accident.
8. The claimant reported the other car had been written off, but the driver was "okay." His van was not written off. He continues to drive the same van as at the time of the accident at the time of this re-examination. He says that he is scared to drive near the site of the accident.

History of symptoms and treatment following the motor accident

1. The claimant said he developed pain in his neck and left shoulder and down his left arm and hand. He also had back pain, radiating down his left leg. His GP referred him for various investigations and treatment. He was prescribed Lyrica and a traction machine for his neck pain. He said he would use his traction machine once to twice daily. He said that the traction machine provided him with significant relief from his pain; however, the reason for the pain remained, and he was required to treat himself daily. He was continuing this treatment for his pain at the time of this re-examination.
2. The claimant was also treated with cortisone injection and hydrotherapy. He reported small improvements with temporary relief from these treatments.
3. The claimant reported that his pain was not his primary problem since the accident.
4. The claimant reported that he developed a low, depressed mood. He became tearful whilst recalling his losses since the accident. He said he had lost his relationship with his family members and that he spends his time alone in his own room. He reported that he was irritable and agitated. His energy levels were low, and he would suffer from repeated rapid onset of fatigue, which prevented him from performing any home chores or participating in the life of his family. He reported that he suffered from guilty ruminations as he had lost so much and could not support his wife, children, and grandchildren.
5. The claimant reported that he had become very frustrated and had punched holes in the wall at home. He denies being violent towards his family but says that he shouts and screams all day. He says that no one talks to him. His wife wants to divorce him. His children, sisters and mother do not want to talk to him like they had before the accident. He described becoming isolated from his family since the accident. He described poor sleep with initial, middle, and terminal insomnia. The claimant's appetite was reduced and he eats only once a day. He reported 17kg of unintentional weight loss since the accident that occurred more than six years ago.
6. The claimant said he did not have any legal problems in relation to his irritable and agitated behaviour. He reported loss of his self-esteem. He inappropriately blames himself for the accident and the impact that it has had on him and his family. He is hopeful that the new psychiatrist he is due to see in December will help him get better. He denies any suicidal ideation.
7. The claimant did report symptoms consistent with post-traumatic stress disorder. He described panic attacks and less frequent flashbacks of the accident. He says that he can suffer a flashback when he sees a car going fast outside his window or sees a police car or ambulance. He avoids the scene of the accident when driving the same van that was in the accident. He startles when he hears loud noises, and he has fewer nightmares disrupting his sleep than he did during the initial phase of his psychological injury sustained in the accident.

1. The claimant reported persistent pain in his neck, headaches, pain in his shoulder, left arm, back and left leg. He attributed his pain to his neck injury and reported it was manageable with his daily routine of neck traction and pharmacotherapy. He no longer attended physiotherapy. He continued to perform his own physiotherapy with the use of daily traction. He also continued his use of Lyrica for the treatment of pain.
2. The claimant has suffered a clinically significant psychological injury because of the accident. At the time of this re-examination, the claimant's psychological injury was best defined as DSM-5-TR F32.1 Major depressive disorder- of moderate severity.
3. The claimant continued to report the following symptoms consistent with major depressive disorder:
   • depressed mood most of the day, nearly every day, as evidenced by the claimant reporting frequent depressive worries of having failed in maintaining his role as father to his children, husband to his wife and marked tearfulness whilst describing his long periods of isolation from the members of his household and extended family since the accident;
   • markedly diminished interest and pleasure in all or almost all activities nearly every day, as demonstrated by his loss of capacity to experience happiness and having to isolate himself from his family, avoid watching television, which might have inadvertent reminders of the accident;
   • loss of happiness with him no longer participating in his old friendships or having interest in making new friendships;
   • poor sleep with difficulty initiating sleep and remaining asleep, with repeated waking from sleep and delayed return to sleep on waking most nights;
   • fatigue and loss of energy nearly every day, with the claimant being unable to engage in his self-care and personal hygiene without prompting and support from his wife, as well as his lack of participation in the cleaning and maintenance of the family home;
   • persistent intrusive distressing thoughts of hopelessness every day as he had lost his old friends and was no longer "talking" with his wife, children, and grandchildren;
   • diminished ability to concentrate with marked indecisiveness whilst making simple everyday decisions regarding simple activities at home or in the home that he leaves to his wife and children, and
   • inappropriate depressive guilty ruminations that he caused the accident.
4. The claimant does have symptoms consistent with post-traumatic stress disorder. However, the claimant does not meet all the necessary symptoms and criteria for this condition. The claimant does not meet the criteria for criterion A for DSM-5-TR F43.1 post-traumatic stress disorder. The claimant's reports to this Panel's Medical Assessors of his behaviour and the behaviour of others, including his son, at the time of the accident, were inconsistent with the claimant having experienced or perceiving a severe life-threatening injury. He was not admitted to a physical or psychiatric hospital in relation to the psychological injury.
5. The claimant was treated conservatively for his physical injuries and he continues to engage in his routine of daily neck traction to relieve his pain and enable him to mobilise without severe pain. He is on painkillers and anti-inflammatory medication to assist with his physical treatment of pain.

1. The claimant is prescribed Escitalopram 40mg, which is an evidence-based antidepressant medication. He was referred to a psychiatrist, Dr Selwyn Smith (late). He attended and benefited from his sessions with Dr Smith. Dr Smith, in his report to the referring general medical practitioner Dr Con Costa, identified the claimant as having an adjustment disorder; however, since that report, the claimant's depressed mood, insomnia, depressive ruminations, irritability and agitation, as well as the other described symptoms above of a major depressive disorder, have persisted and remain the primary reasons for his reduced psychological functioning.
2. The claimant is due to see a new psychiatrist next month (December 2025). He says that he also attended a psychologist, Dr Spiro Antony (late), who also died whilst the claimant was receiving psychological treatment for his depression.

1. The claimant presented as a casually dressed man who appeared unkempt but adequately nourished. He was helpful in his manner and did not display any psychomotor agitation or retardation. He maintained good eye contact within the context of videoconferencing. Rapport was readily established and maintained during the re-examination. His mood was low and his affect was flat. He was tearful whilst describing his losses during the re-examination. He had an angry outburst whilst talking about his isolation and his family, "not talking to me." His speech was normal in rate, rhythm, tone, and volume.
2. His thought content revealed worry about his pessimistic future and recurrent depressive rumination of worthlessness and inappropriate guilt that he was responsible for the accident. There was no suicidal ideation. There were no perceptual abnormalities. He appeared well-orientated to time, place, and person. He was able to attend during the re-examination, as the pace of the re-examination was slow, as details of the claimant's history needed to be questioned when he would initially say he could not remember.
3. This response was less as the re-examination progressed and the claimant was able to confirm various details in the record. The spontaneous stating of the repetitive phrase, "I don't know... It's too long ago..." settled when the issue under re-examination was put to the claimant as having been recorded by his medical team for many years before the accident, including the initial Workcover injury due to the assault at the Star City Casino. His insight seemed intact as did his judgement.

1. There is no evidence of pre-existing impairment in this domain. He was able to manage his self-care and personal hygiene without impairment.

1. An Australian government employment services assessment report dated 12 October 2018 noted that he had morbid obesity and chronic pain. In compliance with Guidelines 6.214 and 6.215 impairment for physical injury and pain is not measurable in a PIRS assessment.
2. An Australian government employment services assessment report dated 12 October 2018 also reported the claimant suffering from depression. He reported not having any treatment but had been suffering from poor sleep, low mood, and limited socialisation for more than two years. He had lost his friendship group during this time and he was increasingly isolated from his wife and extended family. He would not participate in family events or social and recreational activities. This is consistent with moderate impairment.

1. There is no evidence of pre-existing impairment in this domain.

1. The claimant did not report any physical or pain-related restriction of his functioning for social functioning at the time of the re-examination.
2. There was increasing tension between the claimant and his wife as he had financial problems due to the business no longer being able to compete and finances in the home becoming restricted.

1. There is no evidence of pre-existing impairment in this domain. He was able to manage his complex business without impairment.

1. The claimant was receiving a disability support pension and was considered totally impaired to work. According to his NSW Healthcare card, he has been on Disability Support Pension since 11 September 2018. His inability to work was related to physical disabilities. He was also noted to have persistent pain. In compliance with Guidelines 6.214 and 6.215 impairment for physical injury and pain is not measurable in a PIRS assessment.
2. The claimant had also been diagnosed with depression and had ongoing psychological symptoms due to this condition. He was booked to attend a return-to-work role as a truck driver. He had never driven trucks before the planned date of commencement of the work trial. The Medical Assessors agree that the claimant would be erratic in his capacity to attend any workplace due to his psychological symptoms alone. He would not be able to work more than one to two days per fortnight and less than 20 hours per fortnight.

1. The claimant said he needs someone with him when he showers because of the physical injury, which makes it difficult for him to wash himself. He said he would shower more, but not daily, if there was no pain restricting his frequency of showering. In compliance with Guidelines 6.214 and 6.215 impairment for physical injury and pain is not measurable in a PIRS assessment.
2. The claimant said he tries his best to keep himself clean and tidy. He says that he showers once a week. He said he cleans his teeth between once a week and once a fortnight. He has been seeing a dentist for gum disease. He said he prepares a cheese sandwich for himself at night and sometimes eats what his wife cooks. He did not describe needing to be prompted to eat. He does not engage in any household chores because he is not interested, and he remains isolated in his room, away from his wife and children. He can go to the shops on his own if needed. He picks up food from McDonald's sometimes and on other occasions gets take-away food delivered to his home.

1. The claimant did not report any physical or pain-related restriction of his functioning in social and recreational activities at the time of the re-examination.
2. The claimant said he does not have friends anymore. He has lost touch with them because he stopped answering their calls and did not attend any invitations. He reported he had never been close to his grandchildren. He says that he does not enjoy going out with his past friendship circle or with his wife and extended family.

1. The claimant did not report any physical or pain-related restriction of his functioning for travel at the time of the re-examination.
2. The claimant could travel independently; he drives to his medical appointments. He drives to his dentist, who is 15 minutes away. He said he planned to drive to his psychiatrist next month, which is a new place for him. He had planned the trip and thought the journey would take approximately 20 minutes. He says that the furthest he has driven is 20 minutes to get to his doctor. He denies any interstate travel since he accident.

1. The claimant did not report any physical or pain-related restrictions on his social functioning at the re-examination.
2. The claimant said his wife has told him that she wants a divorce. He says that his children do not talk to him either. He says that he lives independently in the house. He says that his mother has stopped talking to him because he stopped answering her phone calls. He would ignore her calls on his mobile phone and would not return calls when she was seeking to talk with him.

1. The claimant said the pain he experiences does not impact his concentration. He did report headaches, neck, and back pain, which he reported were reduced with his daily routine of traction and his analgesic medication. In compliance with Guidelines 6.214 and 6.215 impairment for physical injury and pain is not measurable in a PIRS assessment.
2. The claimant reports he had reduced capacity to focus after about five minutes when trying to read short messages or texts. He does not read newspapers or longer-length articles. He says that he receives money from Centrelink into a joint account, which is managed by his wife, and she gives him a small amount for incidental spending, like a meal from McDonald's.
3. His wife pays the family bills. He says that he has become forgetful and his memory is "all over the place." He struggles to remember things as he has to put effort into his concentration. He was slow in his capacity to answer questions. He lacked motivation when answering questions and would frequently say, "I don't know... It's too long ago..." before being reassured, and then he would be able to recall long-term memories when he applied effort. He was distressed when describing his losses because of the accident and he was observed to become tearful and have an irritable outburst of emotions, which impaired his concentration and resulted in him not persisting with the topic of the question asked.

1. The claimant reported that pain and his physical injuries did not impair him in his capacity to return to the workforce. He was not working in any labouring role or role where he was required to stand for long periods, such as working as a croupier, due to his pain in his neck, back and leg. In compliance with Guidelines 6.214 and 6.215 impairment for physical injury and pain is not measurable in a PIRS assessment.
2. The Medical Assessors agree that the claimant would be erratic in his capacity to attend to any work-like role. He has limited capacity to participate in any role since the accident. Prior to the accident, he was planning to return to work as a truck driver; however, the accident intervened the day before he was to commence his return-to-work trial and this part of his DSP program did not eventuate.

1. The Medical Assessors agree that, at times during the re-examination, the claimant was an inconsistent historian. He required assistance by having his inconsistent responses identified and brought to his attention during the re-examination process.
2. The claimant stated that he was experiencing persistent pain and needed traction on his neck most days; however, when the Medical Assessors enquired about the impact of pain on his psychological functioning, he stated that "pain comes and goes" and the pain in his neck was manageable as long as he attended to his daily routine of neck traction and compliance with his analgesic medication.
3. The claimant initially denied any pre-existing psychiatric history. The Medical Assessors brought this inconsistency with the medical record to the claimant's attention during the re-examination. He was able to talk about his workplace injury, which was an assault whilst working as a croupier at Star City Casino. He was able to confirm a prior documented history of depression; however, he said that the psychological injury occurred a long time ago and he could not remember details of this event.
4. The claimant did say that he was assaulted around 2000 at the casino. He said he did developed tinnitus and disequilibrium due to the assault. He stated that the episode of depression he suffered before the accident had resolved. The Medical Assessors asked him about the documented episode of depression in 2017 but he says that he could not remember that and was never given any medication or referred to a psychologist or psychiatrist. He did not contest that he had not suffered from depression before the accident.
5. The claimant was informed during the re-examination about the Australian Government employment services assessment report. This report, dated 12 October 2018, noted that the claimant as having the following disabilities: morbid obesity, chronic pain, and depression. He was not on any treatment but had been suffering from poor sleep, low mood, and limited socialisation for more than two years before this report was completed.
6. According to Centrelink records dated 13 October 2020 (after the accident in 2019), the claimant had been diagnosed with multiple conditions by Dr John Dimitriades, which included spinal disorder, chronic pain, and anxiety.
7. According to a certificate dated 11 December 2018, it was noted that the claimant had multiple conditions, including depression and anxiety.
8. An employment services assessment report dated 12 October 2018 noted that he had morbid obesity, chronic pain, and depression. He was not on any treatment but had been suffering from poor sleep, low mood, and limited socialisation for more than two years.
9. Each of these reports was brought to the claimant's attention, and he did not disagree. He said he could not remember details from long ago, and he lacked energy and would become more distressed thinking about his losses. He summarised his circumstances by stating, "Can you see, I have lost everything."
10. The Panel was of the opinion that while the claimant was an inconsistent historian that there were other reasons which could be attributed to causing the inconsistency, such as the passing of time, the claimant's psychological condition, and the effect of medication rather than an intention to mislead the Medical Assessors.

1. Medical Assessor Yu Tang Shen's certificate dated 27 March 2023 advised that the diagnosis was post-traumatic stress disorder, which had led to 16% permanent impairment. It was noted that he had seen a psychologist after an assault by a customer at Star City Casino in 2000, which had led to tinnitus, but he could not remember his diagnosis. He had denied any other psychiatric history until the claimed injury.
2. Medical Assessor Jonathan Herald's certificate dated 31 May 2023 advised that the diagnosis for the physical injuries was cervical spine soft tissue injury, thoracolumbar spine soft tissue injury, and left shoulder rotator cuff tear, which had led to 14% permanent impairment.
3. Complete record from GP Dr Costa printed on 6 February 2020 was provided. The following pertinent information is:
   • documentation starts from 1 February 2001 when he was prescribed amitriptyline 10 mg. No reason for the prescription was noted;
   • on 16 Jul 2001, he was prescribed fluoxetine 20 mg for depression, and
   • Amitriptyline 10 mg was stopped on 16 Jan 2003.
4. Psychiatrist Dr Graham Vickery's independent medical examination report dated 1 February 2022 noted that there was a history of depression related to weight gain and obesity in 2001. No other psychiatric history was noted. He noted that the claimant had reported that he did not drive very much because of pain and fear of having another accident. He noted that there was excessive psychopathology and pain-related behaviour in relation to an apparently minor motor vehicle accident. He further noted there had been similar symptoms since 2001 for which he had been receiving Centrelink disability benefits. He opined that the injuries and disabilities complained were not caused by the motor vehicle accident because not only was it minor, but similar symptoms had been reported since 2001. He advised that the claimant needed to be assessed utilising other validated tools. He advised that Mr Halabi's symptoms satisfied diagnostic criteria for somatoform chronic pain disorder. He advised that there had not been any psychiatric incapacity to work directly because of the motor vehicle accident.
5. According to Centrelink records dated 13 October 2020, he had been diagnosed with multiple conditions by Dr John Dimitriades, which included spinal disorder, chronic pain, and anxiety. The same was noted according to a certificate dated 11 December 2018, it was noted that he had multiple conditions, including depression.
6. An employment services assessment report dated 12 October 2018 noted that he had morbid obesity, chronic pain, and depression. He was not on any treatment but had been suffering from poor sleep, low mood, and limited socialisation for more than two years. Psychological and psychiatric condition was considered to be one of the barriers for him to work and it was considered that he needed support to cope with work-related stress and pressure. Anxiety management and cognitive behavioural therapy were recommended as well.
7. Dr Costa's documentation printed on 19 October 2023 from Busby First Care Medical Centre was provided. The following pertinent information is documented:
   • his BMI was noted to be 37.7 on 28 July 2017. It was 39.8 on 11 November 2020;
   • documentation starts from 8 January 2011 when he was prescribed diazepam;
   • on 25 November 2019, Dr Con Costa, GP referred the claimant to Mr Spiro Anthony, psychologist and noted a history of depression with gain weight and obesity in 2001 (clinical notes of Spiro Anthony), and
   • the last recorded consult was on 27 September 2023. There were no consults regarding mental health recorded.
8. Patient health summary from All Medical Centre, Hammondville, printed on 28 November 2023, was provided, and the following pertinent information is documented:
   • documentation starts from 1 April 2013, and
   • psychiatrist Dr Selwyn Smith's dated 15 Jul 2020 advised that Mr Halabi had reported that he had experienced a depressive episode following an assault whilst working, which had led to tinnitus. No other psychiatric history was noted. Dr Smith opined that Mr Halabi was suffering from adjustment disorder with mixed depressed and anxious mood from the motor vehicle accident sustained on 19 July 2019.
9. Dr Costa's documentation printed on 19 August 2025 documented the following pertinent information:
   • on 13 May 2022, it was noted that he was suffering from insomnia, agoraphobia, and chronic pain;
   • depression with weight gain and obesity was noted on 10 July 2022;
   • ongoing psychological problems were noted on 13 September 2022;
   • his K10 score was 37 on 14 Oct 2022, indicating the presence of severe psychological distress;
   • he continued to present with complaints related to pain from then on. However, on 17 April 2025, it was noted that his scores on the depression, anxiety, and stress scales were elevated on all three subscales. He was prescribed mirtazapine to aid with sleep, and
   • the last recorded consult was on 18 Aug 2025, and there is no documentation regarding ongoing emotional symptoms between April and August 2025.
10. On 18 March 2019, Dr Loretta Rozario, rheumatologist reported a history of sleep apnoea.

1. The Medical Assessors agree that the best diagnosis to define the claimant's injury is an aggravation of DSM-5-TR F32.1 major depressive disorder, which was permanently aggravated and was of moderate severity at the time of the re-examination.
2. The DSM-5-TR criteria for major depressive disorder are as follows:

(a) Criterion A. Five (or more) of the following symptoms have been present during the same 2-week period 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.

• Depressed mood most of the day, nearly every day, as evidenced by the claimant reporting frequent depressive worries of having failed in maintaining his role as father to his children, husband to his wife and marked tearfulness whilst describing his long periods of isolation from the members of his household and extended family since the accident.
• Markedly diminished interest and pleasure in all or almost all activities nearly every day as demonstrated by his loss of capacity to experience happiness and having to isolate himself from his family, avoid watching television which might have inadvertent reminders of the accident.
• Loss of happiness with him no longer participating in his old friendships having interest in making new friendships
• Poor sleep with difficulty initiating sleep and remaining asleep with repeated waking from sleep and delayed return to sleep on waking most nights.
• Fatigue and loss of energy nearly every day, with the claimant being unable to engage in his self-care and personal hygiene without prompting and support from his wife, as well as his lack of participation in the cleaning and maintenance of the family home.
• Persistent intrusive distressing thoughts of hopelessness everyday as he had lost his old friends and was no longer "talking" with his wife, children, and grandchildren.
• Diminished ability to concentrate with marked indecisiveness whilst making simple everyday decisions regarding simple activities at home or in the home that he leaves to his wife and children.
• Inappropriate depressive guilty ruminations that he caused the accident.

1. Criterion B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning,
   • this criterion is satisfied because the claimant has lost his ability to return to work, his relationship with his wife and extended family members, as well as his friendship circle, is markedly strained.
2. Criterion C. The episode is not attributable to the physiological effects of a substance or to another medical condition,
   • this criterion is satisfied because the claimant does not drink alcohol except on special occasions, smoke tobacco or use substances or suffer from a medical condition that may cause depressive symptoms.
3. Criterion D. The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other unspecified schizophrenia spectrum and other psychotic disorders,
   • this criterion is met because the claimant does not suffer from any of the above conditions.
4. Criterion E. There has never been a manic episode or a hypomanic episode,
   • this criterion is met because the claimant does not suffer from any of the above conditions.
5. For the above reasons, the claimant's psychological injury caused by the accident was a permanent aggravation of a major depressive disorder that increased in severity from a mild depressive disorder to moderate depressive disorder.
6. The Medical Assessors agree that the severity of the accident on 19 July 2019 was not a life-threatening event. The claimant's van was not written off and the airbags were not deployed either. The claimant was able to drive home from the accident and continues to drive the same van. The claimant's son has not reported any enduring physical or psychological sequelae form the accident either. Therefore, the Medical Assessors agree that the behaviour of the claimant and his son was not in keeping with a person who had a severe injury or life-threatening event.
7. The claimant called police after returning to his home. He did not attend the emergency department or call for an ambulance as would be expected had he suffered from a severe life threating injury.
8. The treatment provided by his medical team was not consistent with a severe injury. For these reasons, the claimant's injury sustained in the accident does not satisfy criterion A for DSM-5-TR F43.1 post-traumatic stress disorder.
9. The Medical Assessors noted that Dr Vickery had diagnosed the claimant's injury as, "somatoform chronic pain disorder." Dr Vickery noted that the claimant had a pre-existing depression. At the time of this re-examination the claimant did not demonstrate overt, "pain related behaviours." The claimant's presentation was consistent with DSM-5 TR F 32.1 major depressive disorder of moderate severity. His depressive disorder symptoms were the primary reason for his incapacity to recover from this accident.

1. The claimant was able to manage his small business before the accident. There was stress in his relationship with his wife due to restricted funds from the business not been able to compete with the open market competition for many months before the accident.
2. The claimant was granted a DSP for his physical and depressive conditions. He was attempting to return to the work force and had agreed to commence a work trial; however, the accident happened the day before the trial was to commence, and he had never worked since.
3. The claimant provided a complex history, which included his disability in relation to both physical and psychological conditions before the accident.
4. The claimant's pre-existing major depressive disorder symptoms were of mild severity before the motor accident on 19 July 2019. This is evidenced by the claimant planning to commence a work trial in a new role before the accident occurred, one day prior to the commencement of the work trial. The mild depression was aggravated by the motor accident. His symptoms became more severe and he was unable to return to any form of work. His relationship with his wife and children, and his access to his grandchildren, became much more stressful. He became increasingly isolated.
5. The psychological injury is best defined as a permanent aggravation of DSM-5 TR F 32.1 major depressive disorder. The claimant's depressive disorder symptoms became more severe, his sleep became poor, he developed low energy, recurrent episodes of fatigue, poor concentration and a depressed mood on most days, associated with increased isolation and social withdrawal from his wife, children, and extended family.
6. Whilst the claimant did suffer from a pre-existing depressive disorder, best described as a major depressive disorder, the Medical Assessors both agree that the accident on

19 July 2019 could have caused a permanent aggravation of the claimant's depressive disorder symptoms. 7. The Medical Assessors agree that the motor accident on 19 July 2019 did cause the psychological injury. The psychological injury caused a permanent aggravation of the mild pre-existing major depressive disorder, which, after the accident, became best defined as DSM-5 TR F 32.1 major depressive disorder of moderate severity because of the motor accident and the psychological injury it caused.

DSM-5 TR F 32.1 major depressive disorder of moderate severity.

The claimant was treated by a psychiatrist, a psychologist, and a general medical practitioner. His evidence-based antidepressant medication was Escitalopram 40mg daily. He was not admitted to a psychiatric hospital. He had not been treated with rTMS or Esketamine for his depressive disorder.

The claimant said he tries his best to keep himself clean and tidy. He says that he showers once a week. He said he cleans his teeth between once a week and once a fortnight. He has been seeing a dentist for gum disease. He said he prepares a cheese sandwich for himself at night and sometimes eats what his wife cooks. He did not describe needing to be prompted to eat. He does not engage in any household chores because he is not interested, and he remains isolated in his room, away from his wife and children. He can go to the shops on his own if needed. He picks up food from McDonald's sometimes and on other occasions gets take-away food delivered to his home.

The claimant said he does not have friends anymore. He has lost touch with them because he stopped answering their calls and did not attend any invitations. He reported he had never been close to his grandchildren. He says that he does not enjoy going out with his past friendship circle or with his wife and extended family.

The claimant could travel independently; he drives to his medical appointments. He drives to his dentist, who is fifteen minutes away. He said he planned to drive to his psychiatrist next month, which is a new place for him. He had planned the trip and thought the journey would take approximately twenty minutes. He says that the furthest he is driven is twenty minutes to get to his doctor. He denies any interstate travel since he accident.

The claimant said his wife has told him that she wants a divorce. He says that his children do not talk to him either. He says that he lives independently in the house. He says that his mother has stopped talking to him because he stopped answering her phone calls. He would ignore her calls on his mobile phone and would not return calls when she was seeking to talk with him.

The claimant reports he had reduced capacity to focus after about five minutes when trying to read short messages or text. He does not read newspapers or longer-length articles. He says that he receives money from Centrelink into a joint account, which is managed by his wife, and she gives him a small amount for incidental spending, like a meal from McDonald's. His wife pays the family bills. He says that he has become forgetful and his memory is "all over the place." He struggles to remember things as he has to put effort into his concentration. He was slow in his capacity to answer questions. He lacked motivation when answering questions and would frequently say, "I don't know... It's too long ago..." before being reassured, and then he would be able to recall long-term memories when he applied effort. He was distressed when describing his losses because of the accident, and he was observed to become tearful and have an irritable outburst of emotions, which impaired his concentration and resulted in him not persisting with the topic of the question asked.

The Medical Assessors agree that the claimant would be erratic in his capacity to attend to any work-like role. He has limited capacity to participate in any role since the accident. Prior to the accident, he was planning to return to work as a truck driver; however, the accident intervened the day before he was to commence his return to work-trial as part of his DSP program.

There is no evidence of pre-existing impairment in this domain. Brown and fun as sorry

as wearing something else for right so what was that this is regarding hand wearing thousand and going to eyebrows lay

An Australian government employment services assessment report dated 12 Oct 2018 also reported the claimant suffering from depression. He reported not having any treatment but had been suffering from poor sleep, low mood, and limited socialisation for more than two years. He had lost his friendship group during this time and he was increasingly isolated from his wife and extended family. He would not participate in family events or social and recreational activities.

There is no evidence of pre-existing impairment in this domain.

There was increasing tension between the claimant and his wife as he had financial problems due to the business no longer being able to compete, and finances in the home were becoming restricted.

There is no evidence of pre-existing impairment in this domain.

The claimant had also been diagnosed with depression and had ongoing psychological symptoms due to this condition. He was booked to attend a return-to-work role as a truck driver. He had never driven trucks before the planned date of commencement of the work trial. The Medical Assessors agree that the claimant would be erratic in his capacity to attend any workplace due to his psychological symptoms alone. He would not be able to work more than 1 to 2 days per fortnight and less than 20 hours per fortnight.

1. The Medical Assessors agree that there was no adjustment of treatment effects. The claimant has remained symptomatic since the date of the accident in 2019. The claimant's assessment of permanent impairment would be unlikely to change with or without medical treatment. For these reasons, the assessment of the effects of treatment was 0%WPI.

1. The assessment of permanent impairment was 17% - 6% equals 11% permanent impairment, which is greater than 10%.
2. The insurer has argued that Medical Assessor Shen's original psychiatric impairment assessment was based on incomplete information and understated significant pre-existing conditions leading him to assess 0% pre-existing WPI and attributing the full (15%) permanent impairment to the accident. The insurer submitted that the claimant's Centrelink records demonstrate that the claimant had substantial pre-existing physical and psychological conditions, including long-standing depression, spinal pain, sleep apnoea, morbid obesity, fatigue, concentration difficulties, limited socialisation, and reduced work capacity.
3. The insurer submitted that there was a 6% pre-existing impairment and a 7% current impairment, resulting in only 1% impairment attributable to the claimed injury. The Medical Assessors reviewed the submissions, including the Centrelink records, and agreed that there was a 6% pre-existing impairment. However, they assessed the current impairment to be 17%, resulting in an 11% impairment attributable to the referred injury, which exceeds the 10% threshold.
4. The Medical Assessors noted that in the insurer's Further Assessment Application Submissions at paragraph 56, presents an assessment of PIRS permanent impairment for post-accident and pre-accident permanent impairment.

1. The Medical Assessors note that in Table 6.12 Social and recreational activities of the Guidelines:

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, or cheering his favourite team.

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.

1. The Medical Assessors noted in relation to assessment of the claimant's pre-accident table of functioning as following: An Australian government employment services assessment report dated 12 October 2018 also reported the claimant suffering from depression. He reported not having any treatment but had been suffering from poor sleep, low mood, and limited socialisation for more than two years. He had lost his friendship group during this time and he was increasingly isolated from his wife and extended family. He would not participate in family events or social and recreational activities.
2. This finding at the re-examination is consistent with a Class 3 moderate impairment pre-accident for and not a Class 2 mild impairment for this table of functioning.
3. The Medical Assessors noted in relation to assessment of the claimant's post-accident table of functioning as following: The claimant said he does not have friends anymore. He has lost touch with them because he stopped answering their calls and did not attend any invitations. He reported he had never been close to his grandchildren. He says that he does not enjoy going out with his past friendship circle or with his wife and extended family.
4. This finding at the re-examination is consistent with a Class 3 moderate impairment pre-accident for and not a Class 2 mild impairment for this table of functioning.
5. The Medical Assessors noted in respect to Table 6.13 of the Guidelines regarding travel that the insurer submits that the claimant has a "Class 1 or 2" impairment, for pre-accident capacity to travel. The Medical Assessors note the guidelines require a selection of only one class of impairment when using PIRS to measure pre-existing permanent impairment. The Medical Assessors noted that Class 1 impairment score was used to measure pre-accident permanent impairment.
6. The Medical Assessors assessed the claimant as having a Class 1 impairment pre-accident.
7. The Medical Assessors note that in respect to Table 6.15 Concentration, persistence, and pace, of the Guidelines,

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.

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.

1. The Medical Assessors noted that the insurer submitted Class 2 mild impairment for pre-accident and post-accident impairment for concentration, persistence, and pace.
2. The Medical Assessors noted that the claimant had a Class 1 impairment for his pre-existing functioning for concentration persistence and pace. This is consistent with his plan of attending the work trial and is consistent with the Australian Government assessor' assessment of his safety and capacity to learn to drive a truck before the accident.
3. The Medical Assessors noted that the claimant had Class 3 moderate impairment for post-accident impairment for concentration, persistence, and pace.

The reason for this assessment is that the claimant reports he had reduced capacity to focus after about five minutes when trying to read short messages or text. He does not read newspapers or longer-length articles. He says that he receives money from Centrelink into a joint account, which is managed by his wife, and she gives him a small amount for incidental spending, like a meal from McDonald's. His wife pays the family bills. He says that he has become forgetful and his memory is "all over the place." He struggles to remember things as he has to put effort into his concentration. He was slow in his capacity to answer questions. He lacked motivation when answering questions and would frequently say, "I don't know... It's too long ago..." before being reassured, and then he would be able to recall long-term memories when he applied effort. He was distressed when describing his losses because of the accident, and he was observed to become tearful and have an irritable outburst of emotions, which impaired his concentration and resulted in him not persisting with the topic of the question asked.

These findings at the time of the re-examination are consistent with Class 3 moderate impairment.

The Medical Assessors note that in Table 6.16 Adaptation of the Guidelines,

Class 3. Moderate Impairment is supported by the descriptors:

"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.

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."

1. The Medical Assessors note that the claimant was to attempt his first return to work trial one day after the accident. The claimant's DSP received by the claimant indicates he is erratic and unable to work more than one or two days per week. He was not working for many years before the accident. It is unlikely he would be able to work consistently at 20 hours per week as a truck driver immediately. He had not worked as a truck driver before and learning to drive a truck would require success over many months of training, similar to when learning to drive a car.
2. Typically, a return-to-work trial require graded return to work plans and he was attempting to attend his first day of trial after many years of no work. For these reasons, the claimant was assessed as having a pre-existing impairment as Class 4, Severe impairment and a post-accident impairment as Class 4, severe impairment and not Class 3, moderate impairment. For these reasons, the claimant was assessed as Class 4, severe impairment for Adaptation.
3. For the above reasons, the findings in relation to the claimant's pre-accident and post-accident PIRS scale scores are different to those submitted by the Insurer.

1. The Panel considered all of the information provided, including that obtained at the examination and submissions.

1. The Panel has considered the evidence relating to the claimant's pre-accident psychological history and the IME reports.
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 pre-existing psychiatric condition at the time of the accident capable of formulating permanent impairment. The Medical Assessors assessed the relevant permanent impairment and deducted that from the permanent impairment arising from the accident.
3. The Panel has also considered the claimant's treating health practitioners' opinions, the IME, and the insurer's submissions.
4. 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.
5. 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.
6. The following injuries WERE caused by the accident:
   • major depressive disorder of moderate severity.

1. The Panel has found that the degree of permanent impairment of the claimant that has resulted from the major depressive disorder of moderate severity caused by the accident is 11%, and that the permanent impairment is greater than 10%.
2. Given those findings, the Panel revokes Medical Assessor Fukui's certificate dated

25 March 2024, which found that the psychological injuries arising from the motor accident gave rise to permanent impairment of 22% and issues a new certificate certifying that the degree of permanent impairment of the claimant that has resulted from the major depressive disorder of moderate severity caused by the accident is greater than 10%.

[2] Version 10 since 15 September 2025. Referred to as the Guidelines.

[6] See cls 6.222 - 6.223 of the Guidelines.