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

1. The Medical Review Panel revokes the certificate of Medical Assessor Christopher Canaris dated 24 September 2024 and issues a new certificate determining that:
   • the claimant suffered a psychiatric injury which gave rise to a degree of permanent impairment of 0%.

1. Robert McBlain (the claimant) is a 58-year-old man who was injured in a motor vehicle accident on 18 September 2021. Following the accident an application for Personal Injury Benefits was lodged and the claimant sought a concession from the insurer that his injuries ought to be considered non-threshold injuries. This matter was ultimately determined when Medical Assessor Barrett certified on 8 February 2023 that the claimant had sustained an exacerbation of pre-existing persistent depressive disorder with anxious distress which was a non-threshold injury.
2. Thereafter the claimant sought a concession from the insurer that his injuries exceeded 10% whole person impairment (WPI). Following a review, the insurer declined to make this concession. Consequently, the claimant lodged an application for assessment of whole person impairment.
3. The claimant was assessed by Medical Assessor Christopher Canaris on

24 September 2024 who, in a certificate of the same date, certified that the claimant suffered injuries caused by the motor accident which gave rise to a permanent impairment of 17%. 4. The insurer sought a review of this determination and, in a certificate dated

4 December 2024, President's delegate Kenneth Ho decided that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The matter was then referred to this Panel. 5. The Panel has determined that a neuropsychological assessment is not required as the Panel is reviewing the degree of WPI caused by the psychiatric injury sustained in the accident which has been identified as post-traumatic stress disorder and depressive disorder with anxious distress. 6. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply. 7. The new review provisions provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Commission. 8. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor. 9. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application. 10. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.

1. Section 17 of the Motor Accident Injuries Act 2017 (MAI Act) defines a "medical dispute" as:

(a) a dispute between a claimant and an insurer about a medical assessment matter, or

(b) an issue arising about a medical assessment matter in proceedings before a court for damages or in connection with the assessment of a claim by the Commission.

1. The panel was satisfied with all relevant materials were before it and determined that it was appropriate that the claimant be examined by both Medical Assessors.

1. The claimant was examined by Teams video conferencing on 15 January 2026.

1. The claimant lives with his partner, Noosha, and their 13-year-old daughter in Warilla. A 15-year-old friend of their daughter has been living with them for the last two months.
2. The claimant is financially supported by a Disability Support Pension due to peripheral neuropathy affecting his legs. He last worked in a flour mill in Dubbo over 13 years ago. He has been a single parent to his daughter for most of this time.
3. The claimant grew up with his parents and three older sisters. He is not aware of any family history of mental disorders. His father passed away two years ago.
4. The claimant was born in Scotland and grew up in the Macquarie Fields area of Sydney. The claimant described his upbringing as "shit" and he has subjected to recurrent physical abuse by his father.
5. At school the claimant was placed in remedial classes to assist his education. He recalled difficulties with attention and frustration in the classroom environment. He had a group of friends who were often older friends of his sisters. The claimant left school at age 15.
6. After leaving school the claimant obtained work in landscaping and he worked in that area for several years. He recalled frequently moving between jobs as he would become bored easily. He went on to work at Liverpool Hospital as a storeman for eight years, and as a Ward Orderly for 7 years. He last worked at a flour mill in Dubbo 13 years ago.
7. The claimant has two children from a marriage in his early adult life, though he has had no contact with them for many years. He was with his partner, Noosha, in Dubbo for four years and their daughter was born there. The claimant has been a single parent since his daughter was a baby until his partner joined them at their current home one year ago.
8. The claimant has had some legal problems including being charged with discharging a firearm in public. He explained that this occurred in the context of a dispute with a neighbour. The claimant said that his last charges were 15 years ago.

1. The claimant has had asthma since childhood. He recalls being treated in hospital with oxygen on several occasions during his childhood. His asthma has improved in adult life though he still occasionally uses a Ventolin inhaler when he experiences symptoms.
2. The claimant developed pain and altered sensation in his legs approximately 13 years ago. He had difficulty walking and could not drive far due to pain in his legs.
3. After consultation with his doctor a diagnosis of peripheral neuropathy secondary to alcohol abuse was made. Due to this, he stopped work.
4. The claimant has been prescribed medication for his persistent neuropathy since this time which has reduced his symptoms.
5. The claimant recalled first consulting with a health professional about a mental health problem when his daughter was aged 5 years in 2017. He recalled being prescribed antidepressant medication and being referred for counselling.
6. The claimant was referred back to psychologist Maris Deepers before the motor accident and started meeting with her after the accident. He said that at the time of referral he was thinking excessively about challenges in his life, such as supporting his daughter as a single parent. He was having some emotional difficulties due to this.
7. The claimant smokes 10-15 cigarettes per day.
8. The claimant has a history of alcohol abuse in his early adult life, and this led to peripheral neuropathy in his legs. He has been abstinent from alcohol for many years.
9. He has been prescribed medical cannabis and does not use this in a non-prescribed form.
10. He denied use of any illicit substances. There is a history of previous drug use.

1. The claimant said that he is currently prescribed gabapentin 150mg twice daily and Panadeine Forte four tablets daily for pain arising from his peripheral neuropathy. He is prescribed dothiepin 75mg daily and quetiapine 100mg twice daily for his psychological symptoms. He takes Nexium for reflux.

1. Before the accident the claimant was a single parent of his 9-year-old daughter. He attended to his own self-cares and provided for his daughter. He played lawn bowls at a local club several times each week. He was able to travel independently by car and motorcycle. The claimant was separated from his partner though maintained relationships with his family of origin and had some friends at the bowling club. He had longstanding difficulties with concentration and could become easily frustrated.

1. On 18 September 2021, the claimant's car had stalled on a road and was struck from behind by another vehicle. The claimant had little recollection of the motor accident as he believes that he was knocked out. His first memory after the accident is in an ambulance being taken to hospital in Wollongong.

HISTORY OF SYMPTOMS AND TREATMENT FOLLOWING THE ACCIDENT

1. The claimant was assessed in the Emergency Department of Wollongong Hospital. He was found not to have sustained a fracture or other serious injury. He was concerned for the care of his daughter and so was keen to return home as soon as possible. He was discharged home on the same day.
2. The claimant returned to his usual activities of daily living including caring for his daughter and playing lawn bowls. He was provided with a temporary vehicle and continued to drive this, as well as his motorcycle.

INJURIES OR CONDITIONS SINCE THE MOTOR ACCIDENT

1. On 1 October 2021 the claimant was driving towards his home in a temporary vehicle with his daughter when he saw smoke rising from his property. As he got closer, he realised the car which he had been driving in the accident and was being repaired had caught fire. This caused damage to his home. He recalls being shocked, and his daughter frightened by this event.
2. The claimant had a further accident on 16 November 2021. He said that he had been playing bowls at his local club and had some difficulties with his balance and holding the bowl. He said that he fell over when bowling. He got on his motorcycle to return home though lost his balance when travelling at approximately 5kmph in the carpark. He fell from the motorcycle and injured his calf muscle.
3. The claimant was likely suffering the effects of a subdural haematoma of which he gave a history of symptoms being present for a few weeks prior to this fall. It was this subdural haematoma that likely caused him to lose his balance whilst travelling on his motor bike.
4. The claimant returned home and went to bed.
5. He recalls when he woke he continuing to feel unbalanced and weak. A friend persuaded him to be assessed at hospital and so drove him to Shellharbour Hospital. At the hospital a cerebral CT scan found a subdural haematoma.
6. The claimant said that he was then transferred as an emergency from Shellharbour Hospital to Wollongong Hospital with the ambulance siren sounding. He went on to have surgical treatment for the haematoma on 17 November 2021. He was discharged home on

20 November 2021. 7. The claimant recalled experiencing panic attacks in the weeks following surgery and a general increase in anxiety. 8. The claimant said that he had been involved in another motor vehicle accident. He said that this occurred during 2023 before he went into a rehabilitation facility. He could not recall the details of this accident.

1. The claimant describes a persistent desire to avoid returning to hospital. He related this to an awareness that he could have died following the subdural haematoma if he had not taken his friend's advice to go to hospital. He describes an increase in psychological distress and associated physiological symptoms of anxiety when he hears emergency sirens which remind him of the emergency ambulance transfer between hospitals.
2. The claimant described his mood as "terrible". He said that when he worries about things he becomes more irritable and frustrated.
3. The claimant gets enjoyment from spending time with his daughter and partner. He is pleased that the relationship with his partner has been re-established and they are living together again.
4. The claimant described his sleep as poor which he said was because he finds himself thinking excessively about the motor accident. He said that his weight is stable and he eats food cooked for him by his partner.

1. The claimant is not currently under the care of a psychiatrist. He said that he was seeing a psychiatrist during 2025 and this was to assist in the return of his driving licence.
2. The claimant's medication is prescribed by his general practitioner.
3. He is not currently having any psychological treatment.

1. The claimant joined the video assessment from his home in Warilla. There were some technical difficulties initially and the claimant's partner assisted in resolving these.
2. The claimant became quickly frustrated and angered by the technical difficulties, though these emotions settled quickly with the resolution of the problems.
3. The claimant's appearance and self-care appeared reasonable. He pointed out an indentation on the right side of his skull which was the result of surgery on his subdural haematoma in November 2021.
4. The claimant provided a comprehensive and spontaneous history. His speech was moderately dysarthric which required some of his speech to be repeated. There was no indication that the history he provided was pre-prepared or "coached" in any way.
5. His affect was appropriately reactive to the material under discussion and showed a good range. He described his mood as "terrible". Objectively it was moderately low with increased anxiety and irritability. He was future focussed.
6. There were no abnormalities in the form of the claimant's thoughts. There were no abnormal beliefs in the form of delusions and no abnormal perceptions. Thought content revealed anxious cognitions relating to the development of the subdural haematoma and the possibility that this could have led to his death.
7. The claimant was fully alert and orientated. He attended adequately for the purpose of the assessment. A formal cognitive assessment was not carried out.

1. The claimant lives with his partner, their 13-year-old daughter and a 15-year-old friend of their daughter. He is the principal carer of his daughter, though for the last one year his partner has lived with them and joint parented.
2. The claimant attends to his own self-care and said that he typically showers every two or three days.
3. He does not cook as that is his partner's domain, and his weight is stable. He spends time at home watching television or playing on a PlayStation. The claimant does some gardening.
4. The claimant will travel between his home and his partner's property. He was pleased to have the return of his driving licence last year. He believes that he is not as good a driver now compared to before his brain bleed. He has not ridden his motorcycle since that time.
5. Occasionally the claimant, his partner, and daughter go for a walk on the beach.
6. The claimant last was bowling at his club approximately two years ago.
7. The claimant has re-established a positive relationship with his partner over the last year. He is in regular contact with his mother who lives independently in the local area.
8. He participates in family events and recently joined his extended family at his nephew's home in Camden to celebrate Christmas.

1. The history provided by the claimant is generally consistent despite the complexity of his health problems over many years. There are some differences between documents with respect to timing of events which is inevitable. His mental state examination was consistent with the history.

1. The Panel noted the material included clinical records of Warilla Family Medical Practice. These records contained numerous references in 2017 to the claimant being referred to a psychologist and psychiatrist and the instigation of a mental health care plan to treat depression secondary to bodily complaints and anger management issues stemming from frustration.
2. The Panel noted continuing treatment for psychiatric disabilities in the years following.
3. The claimant's treating practitioner diagnosed depression, anxiety and stress and prescribed Lyrica and amitriptyline.
4. The Panel further notes the referral dated 20 May 2021 in respect to what was described as a deterioration in the claimant's mental state.

1. The claimant is a 58-year-old man who experienced abuse in his family of origin and persistent difficulties in the education system. It is likely he had undiagnosed attention deficit hyperactivity disorder (ADHD) as a child leading to difficulties with attention, persistence and regulation of emotion. Abuse of alcohol and other drugs in his early adult life led to health problems including chronic and disabling peripheral neuropathy.
2. The claimant has had relationship problems during his adult life, though has been a consistent parent to his daughter who is now 13 years old.
3. The claimant has had intermittent treatment for mood and anxiety problems over the last 10 years or so, including in the period leading up to the motor accident on 18 September 2021. The history from the claimant is that following that accident he continued with his usual activities of daily living.
4. Some weeks following the accident - the Panel is unable to clearly identify how long following the subject accident - the claimant developed neurological symptoms including headache, loss of balance and left sided weakness. These symptoms contributed to a fall at his bowls club and a minor fall from his motorcycle on 16 November 2021. He was subsequently assessment at Shellharbour Hospital. This assessment found a right sided subdural haematoma which was surgically treated on 17 November 2021.
5. The claimant's current mood and anxiety symptoms are chronic and characterised by anxiety symptoms relating to his family situation, the brain bleed and emergency treatment of that.
6. The claimant has some reduction in function, particularly socially, over the last four years. The claimant has a permanent impairment due to his pre-existing mental disorder. The Panel now found no psychiatric injury arising from the subject motor vehicle accident. The claimant has suffered a subdural haematoma and following this, and the subsequent surgery, he has suffered an exacerbation of his pre-existing persistent depressive disorder with an anxious distress. The Panel is not qualified to comment on any relationship between the subdural haematoma and the motor vehicle accident.

1. The Panel assesses WPI consequent on any psychiatric injury caused by the subject accident at 0%.