MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); psychological injury; post-traumatic stress disorder (PTSD); persistent depressive disorder; diagnosis; causation; Medical Assessor (MA) certified 16% whole person impairment (WPI) in respect of PTSD and persistent depressive disorder caused by the accident; Held - accident causative of persistent depressive disorder; symptoms insufficient to meet criteria for PTSD; MAC revoked; 7% WPI assessed as a result of persistent depressive disorder caused by accident.

Whether the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%

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

1. The Review Panel revokes the certificate of Medical Assessor Yu Tang Shen dated

11 January 2024 and issues a new certificate determining that the following injuries were caused by the accident and give rise to a whole person impairment of 7%: * persistent depressive disorder.

1. On 27 November 2019 Mr Ali Taleb (the claimant) was driving his vehicle on the M5 when the insured vehicle collided with the rear of his vehicle at a speed of 80 to 90kmph (the accident).
2. Mr Taleb has brought a claim for common law damages under the Motor Accident Injuries Act 2017 (the MAI Act).
3. Insurance Australia Limited trading as NRMA Insurance (the insurer) is the relevant insurer with liability to pay any damages to Mr Taleb under the MAI Act.
4. Section 4.11 of the MAI Act provides that there is no entitlement to damages for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%.
5. This dispute is in relation to whether the degree of permanent impairment sustained by

Mr Taleb as a result of the injury caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act. 6. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1] 7. The dispute as to permanent impairment in respect of the claimant's psychological injury was referred to Medical Assessor Yu Tang Shen. He issued a certificate dated 11 January 2024.

1. The Review Panel issued a Direction to the parties on 3 February 2025 (the first Direction) requiring each party to file an indexed, paginated bundle of documents.
2. In response to this Direction the solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 177 (insurer's documents).
3. The solicitor for the claimant uploaded to the portal a bundle of documents paginated from pages 1 to 110 (claimant's bundle).

1. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Motor Accident Guidelines (the Guidelines).
2. The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.[2]
3. Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:

"6.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows:

'Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following:

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.'

This, therefore, involves a medical decision and a non-medical informed judgement.

6.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question 'Would this injury (or impairment) have occurred if not for the accident?' may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes."

CERTIFICATE OF MEDICAL ASSESSOR SHEN[3]

1. The injury referred to Medical Assessor Shen for assessment was:
   • psychiatric condition - post-traumatic stress disorder.[4]
2. Medical Assessor Shen assessed the claimant and issued a certificate in which he certified the claimant had sustained a permanent impairment of 16% in respect of the following injuries caused by the accident:
   • post-traumatic stress disorder, and
   • persistent depressive disorder.
3. Medical Assessor Shen reported the claimant was 42 years of age and lived with his wife and two children. The relationship with his wife was strained with frequent conflicts. As a result of the accident, he is no longer able to support his children with sports and other activities and they can become frustrated at times.
4. Pre-accident he had regular meetings with many friends during the week and weekends for barbecues and sporting events and coffee. He no longer sees his friends as much, talking to some friends once a month and seeing two close friends once every six weeks. Prior to the accident he worked in cabling with installation for Foxtel and NBN as a contractor on full time hours.
5. Since the accident he no longer enjoys sports, soccer training, and going out for coffee, movies, swimming, bowling and barbecues.
6. Mr Taleb was born in Syria with no adverse childhood experiences. He came to Australia after completing high school. He completed a Degree in IT in 2005. He has worked in various roles.
7. Medical Assessor Shen reported following the accident Mr Taleb experienced pain in his lower back and right knee. He developed psychological symptoms within a month, he was angry towards the children, anxious and sleepy. He saw a psychologist who provided guidance on how to manage his emotional distress and his concentration. He has also seen a psychiatrist for two years and has trialled medication including Duloxetine.
8. Medical Assessor Shen reported depressed mood, sleeplessness due to pain and nightmares and poor appetite. Mr Taleb reported recurrent memories of the accident and nightmares. He avoids getting into cars or driving and is hypervigilant and anxious when driving. He avoids talking about the accident with his wife. He has feelings of shame, is detached from people, easily angered and has diminished interest in activities.
9. Mr Taleb reported his concentration was reduced and he can lose concentration in meetings or when reading and needs to re-direct his concentration. Medical Assessor Shen noted he was alert during the assessment, appeared grossly cognitively intact and was able to sustain his concentration for the assessment.
10. Mr Taleb reported he showered himself every three or four days, he does not prepare meals and depends on his wife. He does not engage in cleaning or laundry, but he goes shopping when needed usually with his wife. He started working from home in Cyber Security and Technical Support in September 2021 and has continued in this role on a full time basis on a flexible schedule.
11. Medical Assessor Shen found class 3 for self-care and personal hygiene, class 3 for social and recreational activities; class 2 for travel, class 4 for social functioning, class 3 for concentration, persistence and pace and class 2 for adaption. He made an adjustment of 1% for the effects of treatment.

1. The insurer has sought a review of the medical assessment of Medical Assessor Shen.
2. The application was lodged on 6 February 2024 within 28 days of the date on which the certificate of Medical Assessor Shen was made available to the parties.[5]
3. On 4 March 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Review Panel (the Panel).[6]
4. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[7]
5. The review is by way of a new assessment of all matters with which the medical assessment is concerned.
6. On 1 April 2024 the Panel agreed an examination was necessary.

1. Mr Taleb has provided a statement dated 25 February 2025.[8]
2. He states following the accident he experienced nightmares and was also anxious and irritated. Mr Taleb states he has flashbacks of the accident and nightmares where he sees the van coming towards his vehicle. He has lost confidence in driving and is always on high alert when driving.
3. He has become anxious and irritated. He states his irritation worsened over time and he has become increasingly angry with friends and family leading to conflict.
4. Mr Taleb states he has trouble with concentration, he forgets things and he is angry and cannot focus.
5. He states his friends try to motivate him to go out for coffee and he occasionally attends but does not enjoy going out and watches his watch to see when he can leave.
6. Mr Taleb states he and his wife are now talking about separation. He does not like people coming to his home and is rude and inhospitable to any friends brought home by his children. He says his children are embarrassed by him because he does not shower regularly.
7. Mr Taleb says he prefers to be by himself. His work from home allows him to work from a separate room away from everyone. Whilst he has been asked to go into the office two days a week, he finds this causes anxiety and he can only attend the office one day a week.

Mr Taleb says the eight hours a day he works extend into the evening due the breaks he requires to allow for his lack of concentration. 8. Mr Taleb states he continues to suffer from knee and back pain, but asserts it is his psychological injury which precludes him from participating in life.

1. Clinical notes of Greenoaks Medical Centre detail attendances between 19 September 2013 and 20 January 2024. Other than a complaint of insomnia on 20 January 2014 there is no relevant psychological history.[9]

Clinical notes of Rickard Road Medical Centre

1. Clinical notes of Rickard Road Medical Centre detail attendances between 19 March 2010 and 13 November 2023. There is no relevant psychological history.

Clinical notes of Ingleburn Village Medical Centre

1. On 11 December 2019 Dr Fatima reported the accident about two weeks earlier and noted Mr Taleb had injured his knee and had been experiencing knee pain since.[10]
2. Mr Taleb attended on 27 December 2019, 29 January 2020, 3 February 2020 in respect of knee complaints. On 7 February 2020 Amber Glanville, chiropractor reported lower back pain which was progressing and waking the claimant at night. She also reported right sided knee pain and noted Mr Taleb had stopped soccer since the accident, gardening had been affected, he was not lifting a basket of washing and was unable to move furniture. Driving was also restricted.
3. On 8 February 2020, 11 February 2020, 22 February 2020, 6 March 2020, 9 March 2020,

12 March 2020, 16 March 2020, 23 March 2020, 16 April 2020, 22 April 2020, 24 April 2020 and 1 May 2020 Mr Taleb attended on either a general practitioner (GP) or chiropractor with persistent pain in the back and knee. 4. On 1 May 2020 Dr Malik, GP reported Mr Taleb had been struggling to sleep, he felt tired, sad as well. He complained of lethargy, depressed mood, low self-esteem, poor sleep, and early morning wakening. Dr Malik suggested counselling. 5. On 5 May 2020 Dr Fatima GP reported Mr Taleb had been feeling quite anxious and stressed, having trouble sleeping. Dr Fatima reported a high DAS score and recommended counselling. On 12 May 2020 Dr Fatima prescribed Pregabalin. 6. On 16 April 2021 Dr Fatima referred the claimant to Dr Renata Abraszko, neurosurgeon. 7. On 28 November 2023 Dr Irfan Malik reported ongoing mental health issues and prescribed Cymbalta.[11] 8. On 9 April 2014 Dr Malik reported the claimant was still seeing a psychologist.[12]

1. On 16 September 2020 and 7 December 2020 Dr Kathleen Casey, clinical and health psychologist completed an Allied health recovery request.[13] Mr Taleb had competed some online courses aimed at moving back into IT work. It was noted he had presented consistently for sessions and engaged in therapeutic homework and had made an effort to improve socialising. The diagnosis reported was as follows:
   • major depressive disorder;
   • injury related anxiety disorder;
   • chronic pain syndrome with concomitant sleep disturbance and kinesphobia, and
   • sexual dysfunction - secondary to his pain and limited mobility.

1. In a report dated 27 August 2020 Dr Nouh diagnosed a lateral meniscus tear with possible medial meniscus tear. Dr Nouh thought it was likely to be related to the accident and was likely to be an acute injury.[14]
2. On 8 June 2021 Dr Nouh reported ongoing non-specific pain in the right knee. He recommended an arthroscopy of the right knee.

1. Mr Taleb consulted Dr McKechnie for his persistent back pain. On 18 May 2020 he noted there were no neurological deficits. Mr Taleb was undergoing chiropractic treatment.

Dr McKechnie recommended a long-term core strengthening programme. He suggested a cortisone injection but did not recommend surgical intervention.

1. On 20 January 2021 Leudmila Ugov, occupational therapist reported barriers to recovery included low mood, irritability, frustration and anger related to the accident and fatigue due to difficulties with sleeping (psychological and physical causes).[15]
2. On 29 March 2021 Ms Ugov reported Mr Taleb had engaged in active job seeking by contacting various IT job agencies to assist him to find work in cyber security.
3. On 5 May 2021 Ms Ugov reported the claimant was continuing to see the psychologist for counselling. He advised he had seen a psychiatrist and had trialled anti-depressant medication without success.[16]
4. In a Benchmark closure report dated 12 May 2021 Ms Charles-Bellamy reported Mr Taleb had not reported any functional improvement or capacity for activities since the initial review on 30 September 2020. He was still certified with no capacity for work. He had completed several courses within the IT field.

1. On 27 July 2021 Pinnacle undertook a recovery assessment.[17] It was noted Mr Taleb was independent with self-care, his wife was undertaking primary cleaning tasks around the house, he was only attending 20% of social activities compared to pre-accident, he was not performing any recreational activities, and he was able to drive 30 minutes at a time. He was not working. Mental health factors of stress and anxiety were flagged as were uncertainty about the future, and pain disproportionate to the condition and capacity not in line with stage of healing/recovery.

Christina King, psychologist, Complete Allied Health Care

1. Ms King provided a report dated 13 December 2024 following a referral from Dr Malik.[18]

Mr Taleb had attended an initial appointment on 2 December 2024. She stated he reported intrusive distressing images, avoidance, hopelessness, nightmares, pain, worry and distress. 2. She recommended psychological counselling involving CBT (cognitive behavioural therapy) integrated with motivational interviewing, psychoeducation and relaxation strategies.

1. Dr Gehr assessed the claimant at the request of his lawyers and provided a report dated

4 March 2021.[19] 2. Dr Gehr diagnosed a right knee injury and a lumbar spine soft tissue injury caused by the accident.

1. Dr Canaris assessed the claimant at the request of his lawyers and provided a report dated

9 July 2021.[20] 2. Dr Canaris concluded the accident gave rise to injuries to the knee and back which have caused chronic pain with limitations and restrictions which distress him greatly because he has not been able to work. He reported the claimant was limited in his involvement with his children, with housework and cooking. He is anxious driving and has nightmares of the accident. He has insomnia. He has a heightened startle reflex with poor noise tolerance. He is irritable. He feels sad and purposeless and complained of loss of motivation and tiredness. Dr Canaris reported he did not attend to his self-care and was socially withdrawn. His concentration was poor and his affect at the interview was depressed. 3. Dr Canaris diagnosed post-traumatic stress disorder and assessed a 17% WPI. He assessed class 3 for self-care and personal hygiene, class 3 for social and recreational activities, class 2 for travel, class 2 for social functioning, class 3 for concentration, persistence and pace and class 3 for adaptability.

1. Dr Shahzad assessed the claimant for the insurer and issued a report dated 19 July 2021.
2. He reported Mr Taleb is independent with self-care, dressing and showering but is unable to complete many domestic activities. He has a variable capacity for doing the shopping but can drive normally. He had been spending time completing further cyber security certifications.
3. Dr Shahzad found the claimant's physical examination was limited due to his pain-focused behaviour and limitations. He concluded injuries to the lower back and right knee relate to the accident.

1. Dr Wallace assessed the claimant for the insurer and issued a report dated

14 February 2022. Dr Wallace concluded the lumbar spinal and right knee injuries sustained in the accident have resolved. He considered the residual lumbar spinal symptoms are due to pre-existing multilevel degenerative disc disease. 2. Dr Wallace reviewed the claimant and provided a report dated 14 November 2024. He reported the claimant returned to work as an information technology consultant in cyber security, working full time from home. He diagnosed a lateral meniscal tear of the right knee and a musculoligamentous strain of the lumbar spine which has resolved.

1. The insurer provided submissions dated 5 February 2024 in support of the application for review.[21]
2. The insurer submits Medical Assessor Shen erred in his assessment of various PIRS (psychiatric impairment rating scale) categories.

1. The insurer submits the claimant can live independently which is consistent with his return to full time employment. The insurer notes he can shower himself three or four days a week and goes shopping once or twice a week. Whilst he does not engage in cleaning, laundry or cooking there is no evidence that he engaged in those tasks prior to the accident. The insurer submits the claimant has a mild impairment and should be assessed as class 2.

1. The insurer submits this should be assessed as class 2 where there is no evidence the claimant only goes out when prompted by family or friends and where he does not require a support person. The insurer notes he has maintained relationships with friends although he does not see them as often. He goes out with friends for coffee or to the park.

1. The insurer submits an appropriate assessment would be class 1 or at most class 2. It is noted the claimant has maintained full time employment as a Cyber Security and Technical Support officer for the past two and a half years. He has undertaken further courses since the accident. Assessor Shen noted the claimant maintained good concentration throughout the examination and appeared grossly cognitively intact.

1. The insurer submits this should be assessed as class 1 where the claimant has maintained full time employment for the past two and a half years and prior to that undertook further education and training with a view to obtaining employment. The claimant reported he was managing his work without any performance issues or significant difficulties.

1. The claimant provided undated submissions in response to the application for review.[22]
2. The claimant submits an administrative decision maker's reasons are entitled to a beneficial construction. Reading the reasons as a whole the claimant submits the findings were reasonably available to the Medical Assessor.
3. The claimant also notes that as stated in cl 6.220 of the Guidelines the classes outlined in tables 6.11 to 6.16 are intended to be illustrative, rather than literal criteria.
4. The claimant provided submissions in respect of the permanent impairment dispute.[23]
5. The claimant relies upon the assessment of Dr Christopher Canaris as set out in his report of 9 July 2021 to support a whole person impairment of 17%.

1. Mr Taleb was assessed by Medical Assessor Baker and Medical Assessor Verma on

1. Mr Taleb is a 43-year-old married man living with his wife and two children, aged 13 and 11, in Saint Andrews. His wife works part-time as a pharmacist. He was born in the capital of Syria. He denied witnessing any civil war-like situations then and stated that things were relatively stable. He mentioned they were wealthy, had a stable income, and enjoyed a good childhood. He denied experiencing any traumatic incidents, adverse events, or abuse while growing up. He reported that his school experience was good, as his school was quite close to his house, and he performed academically well, ranking second or third.
2. Mr Taleb has five brothers and one sister. His father worked as a businessman, and his mother was a housewife. Two of his brothers are dentists, one is a civil engineer, and another graduated from a business faculty. His sister works in IT. He reported that most of his family is in Romania, one sibling is in France, and his sister is in Sweden. He completed Year 12 in Syria and then studied hospital management in Cyprus. He immigrated to Australia, completing a Computer Science degree in 2005 and receiving citizenship in 2008. He reported that his reason for migrating from Syria was his dissatisfaction with the government's management of the country and his desire to travel.
3. Mr Taleb wanted to pursue a career in Computer Science, which was another reason for migrating to Cyprus. After graduating, he returned to Cyprus several times before getting engaged and married. He has been married for nearly 25 years. He reported that at the time of the accident, he worked for NBM and Satellites, performing cabling work that required him to go on roofs and under houses, involving physical labour. However, he stopped working after the accident due to "bad injuries and started thinking of other avenues." He attempted to take courses and managed to complete a few. He obtained a certificate in CYSA+ Cybersecurity Analyst, taking three to four months to finish the material since it was a self-paced course. He mentioned that the training could be done in two to three weeks, but he took much longer. It took him about eight months to complete all the courses he enrolled in. He restarted working on 1 September 2021, approximately two years after the accident.
4. Mr Taleb currently works as a Support Worker in the Security Department, with a schedule from 9 to 5. He states that he has been able to work because the environment is quite supportive; he works from home four days a week and goes to the office one day a week. He denied having any past history of mental health issues, seeing a psychologist or psychiatrist, and also denied having any physical comorbidities before the accident. He denied consuming alcohol, using illicit drugs, gambling, or smoking.
5. Mr Taleb described himself as quite active before the accident. He enjoyed taking his kids out and was making plans for his life, including buying a second home and supporting his family.
6. Mr Taleb was involved in an accident on 27 November 2019. He reported that he was driving to work in the early hours of the morning at 5.00am. He mentioned that there was morning traffic, so he slowed down and then increased his speed according to the flow. However, during that time, another car came up behind him and rear-ended him. He stated that the seat belts restrained him and that the airbags did not deploy. He did not lose consciousness, and he extricated himself from the car on his own to check on the other driver as well. After checking on the other driver, they exchanged details and parted ways. He drove to work, but since he experienced significant pain in his knee, he could not continue working. He later saw his GP, who recommended that he consult a specialist for the injuries he had sustained.
7. Mr Taleb reported that he had started experiencing significant pain in his right knee and back. He described the pain as "electric shock, numbness and pins and needles at times". He added that the pain was often exacerbated by climbing stairs, carrying even light weights, being unable to stand for long periods, and sitting for extended periods, and he always felt that "something was displaced." Mr Taleb stated that ever since the accident, he was not the same person in how he usually dealt with things. He was more irritable and snappier with his kids and was no longer patient. His mood was often low and irritable. He clarified that the irritability and anger outbursts were due to his inability to perform simple tasks, like helping his wife make the bed.
8. Mr Taleb had previously enjoyed cooking traditional food, going for walks, jogging on the beach, and doing track walks. However, since "sitting and walking brought on a lot of pain", he did not engage in these once-pleasurable activities. He reported that another reason for not going out was his low mood as well. He further noted that "initially pain and then his mood" impacted his ability to cook. He also stopped going out for movies as he did not feel any joy in doing that. His sleep began to deteriorate, and he would sometimes "get up in pain, nightmares and sometimes without any reason". At times, he slept a lot, and his sleep often fluctuated with alternations in his sleep-wake cycle.
9. Mr Taleb had nightmares of "getting involved in a car accident, and the nightmares involved his vehicle going under the truck; another frequent nightmare he has was when all the cars would come towards him". He lost his desire to engage in day-to-day activities, even household chores. He often felt fatigued and had difficulty managing his emotions. He also noted that he was becoming increasingly forgetful and struggled with attention and concentration.
10. Mr Taleb began seeing a psychologist about one month after the accident and later saw a psychiatrist. He continued with his psychologist until October 2024, but the psychologist had a medical illness and could not see him anymore. He later started seeing another psychologist.
11. Mr Taleb reported that overall, there has not been any significant change in his symptoms. He continues to experience pain in his right knee and back. He cannot flex his right leg completely, which sometimes gets locked. His mood also remains mostly depressed and interspersed with bouts of irritability. He is frustrated about his claim regarding his physical injuries being rejected. He feels triggered and anxious about "everything". He continues to experience insomnia due to nightmares, spending a long time in bed to rest. He frequently gets up at "3 to 4 a.m. every night without reason". His appetite fluctuates, and his weight has increased from 80 to 110kg. There are themes of worthlessness, hopelessness, and helplessness because of his ongoing condition. He has stopped participating in his previous pleasurable activities, as he does not get any joy from them. He is triggered easily by things around him and feels as anxious because of the accident.
12. Mr Taleb reported that he had attended two psychiatrists. He attended the first psychiatrist for about six to eight months and saw the second psychiatrist only once, prior ot this re-examination. He is prescribed Duloxetine 120 mg and has been on it for a "long time".
13. He sees his psychologist once every week and has been seeing him since October 2024. His psychologist suggested doing EMDR, but he had not started this evidence-based trauma treatment before this examination. Mr Taleb is also prescribed Codeine, Celebrex, Pregabalin and Tapentadol, which are pain medications.

1. Mr Taleb was reviewed via videoconference. He engaged well during the re-examination and was cooperative throughout. He maintained good eye-to-eye contact. He presented as a 43-year-old man of Syrian background who looked his stated age. He was casually dressed in a grey T-shirt and was neatly groomed. He displayed some pain behaviours, especially when changing his posture during the assessment. He gave a clear account of his symptoms and difficulties, and he reported his mood to be depressed and angry, and his affect ranged from dysphoric to mild irritability.
2. His speech was coherent, relevant, spontaneous and normal in volume and tone. His thoughts were logical and goal-directed. He currently experiences ongoing low mood, lack of interest in activities, sleep disturbances, fluctuation in appetite, decreased weight, fatigue and intrusive thoughts. There was no evidence of any manic, psychotic or any perceptual abnormalities. He had insight into his condition, and his judgment was intact. He denied having any thoughts of harming himself, other suicidal ideas, plan or intent.
3. Self-Care and Personal Hygiene: Mr Taleb reported that he showers about twice each week. He has lost interest in showering and personal hygiene. He brushes his teeth every two weeks, as he has lost interest in dental hygiene. He does not see a reason to maintain personal hygiene. He has gained weight from 80 to 110kg, which he attributes to his fluctuating appetite and poor nutrition. Due to ongoing pain in his back and knees, he has been unable to perform household chores and cannot cook, as he cannot stand for extended periods. He mentioned having movement problems, along with back and knee pain, and thus needs assistance to shower, which his wife mainly provides.
4. Social and Recreational Activities: When Mr Taleb tries to watch soccer games, he does not enjoy it. He said watching the players makes him feel sad and depressed. He also enjoyed watching movies and reading before the accident. Since the accident, he has lost interest in these activities. Before the motor accident, he participated in social activities, but since the motor accident, he has lost interest and become a recluse, isolating himself and not participating in social events. When his friends contact him, he prefers not to socialise with them and opts to stay at home. He mentioned that he meets up with an old friend every second or third week. He said that this friend is insistent, and he would relent due to the social pressure he feels. Mr Taleb would go with this friend for coffee. This friend would also take him to the mosque on Fridays, but when that friend suggests going somewhere else afterwards, he declines. Mr Taleb reported that some people visit his family, but he prefers to remain in his room and not participate in group activities at home. If people message him, he usually does not reply. He attends Friday prayers about once each month. He added that this year he fasted for Ramadan for about 10 days of the holy month and celebrated Eid with his kids at home.
5. Mr Taleb once enjoyed playing soccer and participating in activities at the club; however, he has now stopped participating in these activities. He cannot play soccer due to physical injuries and does not participate in the club because he feels he would have to explain his pain.
6. Travel: Mr Taleb leaves his house to work in the city using public transport. He travels independently and does not have a support person. He drives to a local area for groceries at least once every two weeks. He has not travelled interstate or taken any vacations since the accident.
7. Social Functioning: Mr Taleb reported that his wife assists him significantly. While she is his main support person, she has also discussed separation, but the couple has not separated at the time of this re-examination, "due to the children". He has a positive relationship with his children, who have also noticed changes and frequently ask why he seems sad and cannot take them out to play or attend a movie. As a result, he tries to avoid the children because he experiences bouts of irritability and anger that he does not want them to see.
8. Concentration, Persistence and Pace: Mr Taleb stated that his attention and concentration are not optimal. He struggles with focus at one point, his manager suggested he take a few days off. He experiences distraction during meetings and when discussing multiple topics. He forgets daily tasks and gives an example of an issue regarding one particular domain where he discusses different matters and sometimes wanders into unrelated topics during conversations, which was noticed by his co-workers, who stopped him to bring him back to the issues needing resolution. He was slow in completing complex tasks and tried to avoid these issues by referring the issue to others to complete.
9. During this re-examination, he scored 3/3 on a three-word repeat test and 3/3 on a three-word recall. He mistakenly mentioned "benny" instead of "penny". He could state the days of the week in both forward and reverse order. He completed a 100-7 task up to five steps successfully. These findings were unremarkable and consistent with Mr Taleb's clinical presentation.
10. Adaptation: Mr Taleb works in cybersecurity, where he needs to determine the source of tickets before completing the requests. He sometimes begins working on a ticket before becoming distracted or delegating tasks to others. He stated that so far, he has not been put on any performance improvement plan, even though he requires assistance from his team members to continue in his role. He has to work longer hours, resolving tickets until 7.00pm to 9.00pm on most workdays, as his pace of work is slow. He is employed full-time.
11. Mr Taleb's presentation was consistent with the history given, documentation received and mental status examination.

1. Mr Taleb was involved in a motor vehicle accident on 27 November 2019 when his car was rear-ended. Mr Taleb reported sustaining both physical and psychological injuries from the accident. He reported experiencing a depressed mood, lack of interest in activities, persistent anhedonia, sleep disturbances, increase in weight, fatigue, lethargy, difficulty in attention and concentration. There were also addition trauma related symptoms of nightmares and intrusive thoughts that were insufficient in number for a diagnosis of posttraumatic stress disorder. The panel concluded that his presentation was consistent with the diagnosis of persistent depressive disorder. The diagnosis of persistent depressive disorder is based on DSM5-5-TR F34.1 criteria, which have been highlighted in bold below. Mr Taleb first developed a depressed mood soon after the motor accident and remains with a depressed mood at the time of this re-examination,

(a) depressed mood for most of the day, for more days than not, as indicated by subjective account or observation by others, for at least two years;

(b) presence while depressed of two or more of the following:

(i) poor appetite or overeating;

(ii) insomnia or hypersomnia;

(iii) low energy or fatigue;

(iv) low self-esteem;

(v) poor concentration or difficulty making decisions, and

(vi) feelings of hopelessness,

(c) during the two-year period of the disturbance, the person has never been without symptoms from the above two criteria for more than two months at a time;

(d) criteria for major depressive episode may be continuously present for two years, in which case patients should be given comorbid diagnoses of persistent depressive disorder and major depressive episode;

(e) Mr Taleb's psychological injury does not include this criterion. This criterion is not essential for the diagnosis of persistent depressive disorder;

(f) there has never been a manic episode, a mixed episode, or a hypomanic episode and the criteria for cyclothymia have never been met;

(g) the symptoms are not better explained by a psychotic disorder;

(h) the disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse or a medication) or a general medical condition, and

(i) the symptoms cause clinically significant distress or impairment in important areas of functioning.

1. The panel also noted significant additional trauma-related symptoms of nightmares and flashbacks. However, the presentation of these limited symptoms was insufficient to meet the criteria needed for the diagnosis of DSM-5-TR F43.10 post-traumatic stress disorder because of the following reason:

(a) the nature of the accident per se did not fulfil the diagnosis of post-traumatic stress disorder. He was rear-ended. He did not meet all the necessary criteria for the diagnosis of posttraumatic stress disorder, and the motor accident was insufficient to meet post-traumatic stress disorder criteria A.

1. Mr Taleb was independent and capable of working, playing soccer and participating in all his activities of daily living without impairment before the motor accident. He first developed his depressed mood and other psychiatric and psychological symptoms associated with the motor accident soon after the accident.
2. There is a clear temporal association between the motor accident and the onset of

Mr Taleb's symptoms. The nature of the motor accident could cause the diagnosis of persistent depressive disorder. 3. The Medical Assessors find that the motor accident did cause the psychological injury defined by the diagnosis of persistent depressive disorder. 4. The Medical Assessor notes that Mr Taleb's physical injuries and associated pain could contribute to loss of function and impairment in functioning. The Panel notes that physical injuries and pain from all causes are not included for assessment of a PIRS assessment of whole person impairment in accordance with current guidelines. The Medical Assessors has considered specific functions that were not included in the evaluation of whole person impairment.

1. Permanent impairment is defined in the AMA4 Guides (p 315) as follows:

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

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

1. Mr Taleb has received both psychiatric and psychological interventions which are evidence-based for his diagnosed psychological injury. He continues to receive regular psychological treatment and is also on high dose of antidepressant Duloxetine. Although, Mr Taleb has not experienced significant improvement in his psychological injury, his presentation is unlikely to change substantially or by more than 3% in the next year with or without medical treatment.

Mr Taleb has received both psychiatric and psychological interventions which are evidence-based for his diagnosed psychological injury. He continues to receive regular psychological treatment and is also on high dose of antidepressant Duloxetine.

Mr. Taleb reported that he showers about twice each week. He had lost interest in showering and his personal hygiene. He brushes his teeth every two weeks as he had lost interest in his dental hygiene. He does not see a reason to maintain his personal hygiene. He has gained weight from 80 to 110 kg, which he attributes to his fluctuating appetite and poor nutrition.

When Mr. Taleb tries to watch soccer games, he does not find enjoyment in this hobby. He said watching the players made him feel sad and depressed. Her also enjoyed watching movies and reading before the accident. Since the accident he had lost interest in these activities. Before the motor accident he had participated in social activities but since the motor accident he had lost interest and become a recluse, isolating himself and not participating in these social activities. When his friends contact him, he prefers not to go out and socialise with them. He opts to stay at home. He said that he would be asked to attend meetings with an old friend every second or third week. He said that this friend was insistent, and he would relent because of the social pressure he feels. Mr. Taleb would go with his friend for coffee. This friend would also take him to the mosque on Fridays, but when that friend suggests going somewhere else afterward, he declines.

Mr. Taleb reported that some people visit his family, but he prefers to remain in his room and not participate in the group's activities within his home. If people message him, he usually does not reply. He attends Friday prayers about once each month

Mr. Taleb leaves his house for work in the city, using public transport. He travels independently and does not have a support person. He drives to a local area for groceries at least once every two weeks. He has not travelled interstate or taken any vacations since the accident.

Mr. Taleb reported that his wife assists him significantly. Whilst she is his main support person, she has also discussed separation, but the couple have not separated at the time of this re-examination, "due to the children." He has a positive relationship with his children, who have also noticed changes and frequently ask him why he seems sad and cannot take them out to play or attend a movie. As a result, he tries to avoid the children because he has bouts of irritability and anger that he does not want them to see.

Mr. Taleb stated that his attention and concentration are not optimal. He struggles with focus at one point, his manager suggested he take a few days off. He experiences distraction during meetings and when discussing multiple topics. He forgets daily tasks and gives an example of an issue regarding one particular domain where he would discuss different matters and sometimes wander into unrelated topics during conversations that was noticed by his co-workers and they stopped him to place him back on the issues needing resolution. He was slow in completing complex tasks and tried to avoid these issues by referring the issue to others to complete.

Mr. Taleb works in cybersecurity, where he needs to determine the source of tickets before completing the requests. He sometimes begins working on a ticket, before becoming distracted or delegating tasks to others. He stated to date he has not been put on any performance improvement plan, even though he requires assistance from his team members to continue in his role. He has to work longer hours, resolving tickets until 7 p.m. to 9 p.m. most workdays as he pace of work is slow. He is employed fulltime.

Apportionment - pre-existing/subsequent impairment

1. The Medical Assessors did not make any apportionment as there was no pre-existing or subsequent impairment. Mr Taleb did not have any past history of any mental health issues.

1. The Medical Assessors found that the effects of treatment would not alter Mr Taleb's condition with or without medical treatment.

1. The Panel finds the claimant has sustained a whole person impairment of 7% as a result of a persistent depressive disorder caused by the acident.

[6] Section 7.26 of the MAI Act; claimant's bundle p 9.