Issued under Part 3.4 of the Motor Accidents Compensation Act 1999

1. The Review Panel revokes the certificate of Medical Assessor Jones dated 4 July 2024 and certifies that the degree of the claimant's permanent impairment as a result of the psychological injuries caused by the accident on 29 October 2017 is not greater than 10%.

1. Tanja Uzelac (claimant) was injured in a motor vehicle accident at Bass Hill on 29 October 2017 (accident). She subsequently made a claim for damages under the Motor Accidents Compensation Act 1999 (MAC Act) on Insurance Australia Limited t/as NRMA Insurance (insurer).
2. There is a dispute between the claimant and the insurer as to whether, for the purposes of

s 131 of the MAC Act, the degree of her permanent impairment as a result of psychological injury caused by the accident is greater than 10% (dispute). The dispute is a medical assessment matter for the purposes of Part 3.4 of the MAC Act: s 58(1)(d) MAC Act. 3. The dispute was assessed by Medical Assessor Jones. On 4 July 2024 the Medical Assessor certified that: persistent depressive disorder (and probable panic disorder) caused by the accident gave rise to a permanent impairment of 15%; and the impairment is greater than 10% (Assessment). 4. The insurer applied to the President of the Personal Injury Commission (Commission) to refer the Assessment to a review panel for review in accordance with s 63. On 5 September 2024 a delegate of the President accepted the application and referred it to a review panel. This panel (Panel) was subsequently constituted to conduct the review of the Assessment (Review).

1. The Panel is to conduct the review in accordance with s 63 of the MAC Act. Section 63(3) provides that the review panel consists of two medical assessors and a member assigned to the Motor Accidents Division of the Commission.
2. The Review is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 63(3A) MAC Act. Although styled a "review", the Panel is determining afresh the medical assessment matters referred to it: Frost v Kourouche (2014) 86 NSWLR 214; [2014] NSWCA 39 at [9] per Leeming JA (Beazley P and Basten JA agreeing).
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128.
4. Version 5 of the Medical Assessment Guidelines (Assessment Guidelines), effective from

12 February 2021, apply to this review as does version 1 of the Motor Accident Permanent Impairment Guidelines effective from 1 June 2018 (Impairment Guidelines).

1. In accordance with directions made by the Panel on 16 May 2025 the insurer filed a joint bundle. Each party filed submissions for the purposes of the Review.
2. On 11 November 2025 the claimant filed an application to lodge additional documents (claimant's ALAD). The documents in question were a report of Ms Danijela Savic, psychologist, dated 28 May 2024 and updated clinical notes from Dr Kuljic. For the reasons given by the Panel on 19 November 2025 the claimant was given leave to rely on these documents. The parties were given an opportunity to file submissions addressing the documents that were the subject of the application.
3. The insurer thereafter filed an application to lodge additional documents dated 27 November 2025 (insurer's ALAD). The insurer's ALAD contained written submissions dated

27 November 2025, together with written submissions dated 11 November 2023, 29 July 2024 and 11 June 2025. 4. The insurer's ALAD was addressed in directions issued by the Panel on 28 November 2025. The Panel recorded in those directions that in response to its 16 May 2025 directions the insurer filed submissions dated 11 June 2025. The Panel noted that the insurer's submissions dated 27 November 2025 did not address the documents the subject of the claimant's ALAD. The leave given to the insurer was to file submissions that address only that material. The parties were given notice the Panel would not consider the insurer's submissions dated 11 November 2023 and 29 July 2024. To the extent those submissions were relied on they should have been incorporated into the insurer's submissions dated

11 June 2025. 5. The Panel informed the parties that if the insurer's position was that its 11 June 2025 submissions did not address the arguments and evidence it wanted the Panel to consider in the Review, it was to inform the Panel in writing by 2 December 2025. The Panel informed the parties it would otherwise proceed on the basis that the insurer only relied on the 11 June 2025 submissions. No response was received from the insurer and no further written submissions were filed.

1. The Panel convened on 21 August 2025. The Panel discussed the dispute and the evidence. The Panel determined that a re-examination of the claimant was required. It was agreed the re-examination would be conducted by the medical members of the Panel on 20 October 2025. The re-examination on 20 October 2025 was abandoned due to technical issues experienced by the interpreter. The examination was re-scheduled to take place on 15 December 2025.
2. The Panel re-convened on 21 January 2026. The members of the Panel discussed the

re-examination findings and agreed on the outcome of the Review as recorded in the certificate and these reasons.

1. No damages may be awarded for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident is greater than 10%: s 131 MAC Act.
2. Section 132 of the MAC Act deals with the assessment of impairment. If there is a dispute about whether the degree of permanent impairment of an injured person is sufficient for an award of damages for non-economic loss, such damages may not be awarded unless the degree of permanent impairment has been assessed by a Medical Assessor under Part 3.4.
3. The method of assessing the degree of impairment is dealt with in s 133, which is in the following terms:

(1) The assessment of the degree of permanent impairment of an injured person as a result of the injury caused by a motor accident is to be expressed as a percentage in accordance with this Part.

(2) The assessment of the degree of permanent impairment is to be made in accordance with -

(a) Motor Accidents Medical Guidelines issued for that purpose, or

(b) if there are no such guidelines in force - the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition.

(3) In assessing the degree of permanent impairment under subsection (2) (b), 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.

See Part 3.1 for Motor Accidents Medical Guidelines".

1. Permanent impairment is to be assessed in accordance with the Impairment Guidelines. Clause 1.3 of the Impairment Guidelines states that they apply to the assessment of the degree of permanent impairment that has resulted from an injury between 5 October 1999 and 30 November 2017. 21. Clauses 1.5 - 1.7 of the Impairment Guidelines address causation of injury.
2. Impairment caused by mental and behavioural disorders is assessed in accordance with

cl 1.201 - 1.228 of the Impairment Guidelines: cl 1.35 of the Impairment Guidelines. 3. In order to measure impairment caused by a specific event, Medical Assessors 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 cls 1.201 - 1.228 of the Guidelines, and subtract this value from the current impairment rating: cl 1.218 of the Impairment Guidelines. Clause 1.34 of the Impairment Guidelines deals with subsequent injuries. 4. Chapter 11 of the Medical Assessment Guidelines sets out the assessment procedure including, at [11.1]-[11.5], the assessor's role.

1. Causation of injury is addressed at cl 1.5 of the Impairment Guidelines as follows:

1.5 An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) 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 motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues.

1.6 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.

1.7 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."

1. In Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 (Owen), Campbell J held at [27] that:

"Given that the task of the Medical Review Panel in determining the causation question is not solely a medical determination within the expertise of the assessors constituting the Panel, the position has, with respect, been aptly put by Johnson J in Ackling at p. 500 [87] that the Assessors will derive practical assistance from this part of the permanent impairment guidelines. But it is well to emphasise that the question to be assessed is one of legal causation involving mixed questions of fact and law arising principally from the law of negligence as modified by Civil Liability Act 2002, s.5 D.(See s.3B(2))."

"...in general terms (subject to 5D Civil Liability Act 2002) it is sufficient if the injury ... was caused or materially contributed to by the motor accident. The motor accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible."

1. On 4 July 2024 Medical Assessor Jones certified that persistent depressive disorder (and probable panic disorder) caused by the accident gave rise to a permanent impairment of 15% and that the impairment was greater than 10%.
2. In his reasons, the Medical Assessor recorded the claimant's psychosocial and pre-accident history. There was no history of mental health problems or treatment prior to the accident. There was a prior motor accident in 2002. The claimant was demonstrably upset when describing the subject accident. She described pain in her neck, back and shoulders following the accident. With respect to her physical injuries the claimant reported she: "did not feel any better"; has no energy; is in pain every day; and has functional limitations.
3. The claimant reported she was treated by Dr Kuljic, psychologist. Her sleep was "very bad", she had bad dreams, her appetite was "not good", and her energy levels were low. The claimant reported that most of the day she lies in bed. She does not want to do anything and felt helpless. She had no desire to socialise and was not getting on with her husband or children.
4. In the opinion of the Medical Assessor the claimant presented as "somewhat disproportionately distressed and vague in her recollection of some elements of the history and very much presenting a disability focused narrative." He diagnosed persistent depressive disorder with depressed mood and panic disorder.
5. Medical Assessor Jones recorded that:

"Although [the claimant] reported symptoms consistent with the construct of Post Traumatic Stress Disorder, given the contention about the severity of the accident, it is hard to confirm a diagnosis of this.

Given the prominence of pain in her clinical presentation (and the discussion by others regarding this), it is also impossible to rule out a Somatoform Symptom Disorder or Chronic Pain Disorder. This is obviously a complicating factor however does not negate the current presence of a Persistent Depressive Disorder."

1. The Medical Assessor was satisfied the persistent depressive disorder with depressed mood and panic disorder were caused by the accident. He found there was a 15% permanent as a result of the accident. The Panel has evaluated the reasons given by the Medical Assessor for the classes he assigned for each area of functioning in the Psychiatric Impairment Rating Scale (PIRS).

1. The bulk of the documentary evidence relied on by the parties for the purposes of the Review is contained in a joint bundle filed by the insurer. In addition to this material there is surveillance footage and the documents that were the subject of the claimant's ALAD.

1. Contrary to what is recorded in the index to the joint bundle, the certificate of Medical Assessor Myers dated 22 January 2019 is not contained in the bundle. Rather, there are two copies of the certificate and reasons dated 22 August 2019 issued by the panel that conducted a review of Medical Assessor Myers' assessment. That panel recorded that Medical Assessor Myers certified that injuries to the claimant's cervical spine, lumbar spine, thoracic spine, right shoulder and left shoulder had resolved and did not give rise to any impairment.
2. The panel certified that soft tissue injuries to the claimant's cervical spine, lumbar spine, thoracic spine, right shoulder and left shoulder caused by the accident gave rise to a whole person impairment which was not greater than 10%.
3. In its reasons, the panel recorded that the claimant was re-examined by two of its members, Medical Assessors Kenna and Fitzsimons. The claimant reported pain in her neck, shoulders and back following the accident. She had been referred to a pain clinic and a psychologist.
4. The panel determined there was no permanent impairment of the claimant's cervical spine, lumbar spine, or thoracic spine and assessed a 3% impairment of her right shoulder and a 2% impairment of her left shoulder. The combined accident caused impairment was 5%.
5. In circumstances where neither party referred to Medical Assessor Myers' assessment in their submissions and the assessment was the subject of a review, the Panel did not request a copy of Medical Assessor Myers' certificate and reasons.
6. On 30 July 2021 Medical Assessor Paisley certified that post-traumatic stress disorder and major depressive disorder caused by the accident gave rise to a permanent impairment of 9% and that the impairment is not greater than 10%.
7. In her reasons, the Medical Assessor recorded the claimant denied any pre-accident psychiatric history and said that she was mentally well prior to the accident. She moved from Croatia to Australia in 2000. She was working prior to taking maternity leave and was on maternity leave when the accident occurred. The following history of the accident is recorded in the Medical Assessor's reasons:

"...she was returning from a market with four of her friends. She was in the back left passenger seat. Her friend was driving at approximately 60 km/hr when she drove into the car in front of them. The driver had assumed that the car in front would have proceeded through the orange lights but they suddenly stopped instead. [The claimant] remembered feeling shocked, fearful, panicked and shaky after the collision. She was able to remove herself from the vehicle. Emergency services did not attend the scene. The car was driveable after the accident."

1. The claimant reported that after the accident she began to experience insomnia, tiredness, irritability, depressed mood and anxiety. She was more prone to anger outbursts and frequently slammed doors, threw things and fought with her partner. The claimant said she never felt relaxed. She had nightmares relating to the accident. She worried excessively about having another accident and accidents happening to her loved ones. She had recurrent intrusive memories about the accident accompanied by anxiety symptoms including dry mouth, sweating, fear of passing out and weakness. Hearing sirens and going past traffic lights triggered anxiety. She tried to avoid the scene of the accident. She experienced suicidal thoughts but had no intentions or plans to act on them. She became more nervous, withdrawn and preferred to be alone. Her appetite was reduced but there were no weight changes. The claimant reported a reduced capacity to experience pleasure and felt hopeless. She had difficulty concentrating and complained of poor memory and distractibility. She reported being hypervigilant and fearful and increasing tension in her relationship with her partner. She was referred by her GP to a psychologist and psychiatrist.
2. The Medical Assessor diagnosed post-traumatic stress disorder and major depressive disorder. Those conditions were caused by the accident. The classes assigned by the Medical Assessor to each area of functioning in the PIRS have been considered by the Panel and the Medical Assessor's reasons have been evaluated.
3. On 9 January 2024 a delegate of the President referred Medical Assessor Paisley's assessment for further assessment, being satisfied there was additional relevant information about the injury and deterioration of the injury, such as to be capable of having a material effect on the outcome of the previous assessment. The dispute was thereafter assessed by Medical Assessor Jones. That assessment is the subject of this Review.

1. In a claim form dated 10 November 2017 the claimant provided the following description of the accident:

"...I was a back seat passenger behind the front seat passengers and approaching a set of traffic lights and a vehicle in front of ours. When the colour at the traffic lights changed from green to orange and the car in front of ours suddenly stopped and the driver of our vehicle travelling with a speed of approximately 60K/H hit the car from behind.

I consider that the driver of our vehicle that caused the accident."

1. The claim form records the claimant suffered injuries to her neck, back, shoulders, anxiety, insomnia and fear as a result of the accident. There is also reference to a motor vehicle accident in 2002 that resulted in neck, left shoulder and upper back injuries. A certificate dated 7 November 2017, completed by Dr Tomka, describes neck, shoulder and back injuries.

1. An NSW Police report dated 10 January 2018 contains a description of the accident and details of the vehicles and drivers involved. The accident was described as a "minor traffic crash". The report records the claimant, a passenger, had attended a doctor the following day complaining of a sore neck and back.

1. Dr McIntosh provided a "Collision and Biomechanics Report" to the insurer dated 7 August 2020. Ther report refers to the evidence provided to and considered by Dr McIntosh. A number of colour photographs of the vehicles involved in the accident are contained in the report. Dr McIntosh's comments about the photographs have been considered.
2. In Dr McIntosh's opinion the mechanism of the accident is not consistent with the claimant "suffering the alleged injuries". His reasons at [78]- [90] have been considered. In Dr McIntosh's opinion the forces applied to the claimant would have been very low magnitude and "tolerated without injury". In his opinion, the range of motion of the cervical and thoraco-lumbar spines and shoulders would have been less than normal range. The crash was "in the severity range tolerated by volunteers without injury".

1. A report from AHC Investigations dated 14 August 2020 relates to surveillance conducted on 27 July 2020. The report records that during 12 hours of surveillance approximately 19 minutes of video footage of the claimant was obtained. The report includes a summary of the footage, including that the claimant was seen walking, driving a vehicle, and shopping.
2. The Panel has viewed and evaluated the surveillance footage taken on 27 July 2020. The footage is approximately 19 minutes long. As described in the related investigation report, the claimant is seen walking along the street, driving a vehicle (on a number of occasions) and grocery shopping (at two venues).

1. The claimant has given a statement dated 28 January 2020. The statement includes details of her education and training, employment history and work duties, her pre-accident health and claims history. Reference is made to a motor vehicle accident in 2002. The claimant states that she injured her neck, left shoulder, and upper back in this accident. She made a claim that was subsequently settled. She did not take any time off work, and her injuries fully resolved. The claimant states that she was not experiencing any ongoing symptoms from these injuries at the time of the subject accident, and that she was "fit and healthy and ... was ready to resume [her] previous employment after spending time with [her] children on maternity leave". She states that she had:

"...never previously experienced anxiety or feelings dizziness and sweating or episodes where [she] struggled to breathe and [her] chest and throat become tight with fear".

1. The claimant described her pre-accident lifestyle, including the domestic duties she performed and the social and recreational activities she undertook. At [109] - [125] she provides a description of the accident. She states she was "in shock', "emotionally overwhelmed", and confused. She experienced neck, shoulder and back pain following the accident. She had difficulty sleeping and was "upset and destressed by the accident".
2. Details of post-accident treatment are recorded in the statement, together with the ongoing physical symptoms. The claimant states she is frustrated by the pain, and "no longer feels[s] safe and secure in [her] own body". Since the accident she has struggled with strong feelings of fear and anxiety. She was referred to a psychologist and psychiatrist and prescribed antidepressant medication. The claimant described her psychological symptoms at [186] - [201].
3. At [224] the claimant states that the emotional upset she has experienced as a result of her injuries would "make it difficult for [her] to undertake new work in an unfamiliar environment or in a role that requires [her] to learn new skills."
4. The statement records details of the claimant's post-accident employment and loss of income and includes details of accident caused injuries and disabilities. Her disabilities are said to include stress, depressed mood, mood swings, crying bouts, anger bouts, broken sleeping pattern, lethargy, reclusive habits, loss of self-esteem, loss of confidence, and loss of concentration. The physical impact of her injuries is described at [227] - [237]. The impact on her activities of daily living is recorded in a table at [238]. At [239] - [247] the claimant describes the psychological impact of her injuries and at [248] - [257] she describes her post-accident lifestyle. Domestic assistance needs are described in detail at [258] - [267].

1. Mr Fraser gave a statement dated 15 September 2020. Mr Fraser was the driver of the vehicle in front of the vehicle in which the claimant was traveling at the time of the accident. His partner, Sarah Nguyen, was the owner of the vehicle and a passenger at the time of the accident. He describes being stationary at a set of lights, with his foot on the brakes, when he felt a car "hit [him] from behind causing [his] car to jolt forward from the impact". He did not hear skidding or braking before impact. He was not injured as a result of the accident.
2. Mr Fraser "estimate[d] the damage to both vehicles to be minor. Both vehicles were drivable and [both drivers] drove from the scene at the same time". He was not able to estimate the speed of the vehicle that collided with his stationary vehicle. He stated that "[t]he damage was minor so I don't think it was travelling very fast". Police and Ambulance did not attend the scene. "As far as he knew" nobody sustained any injures at the time of the accident.

1. Ms Nguyen was the owner of the other vehicle being driven by Mr Fraser. In her statement dated 15 September 2020 Ms Nguyen stated that the impact of the collision "while not hard, still caused the car to jolt forward" a distance estimated to be "less than 1m". She states that after the accident she walked to the front of the car and inspected the damage, which was "very minor with only a small dent on the rear of [her] car and the front of the other car". She took photographs at the scene. She recalled seeing passengers in the other vehicle. She states that she "had no reason to pay any attention to the rear seated passengers and due to the minor impact [she] had no reason to believe they were injured". The balance of the statement has been considered by the Panel.

1. Dr Protulipac, clinical psychologist, reported on 25 October 2019. The report contains a history that as a result of the impact from the accident the claimant sustained injuries to various regions of her body and developed a significant psychiatric illness. The report includes details of the claimant's symptoms and treatment. The claimant reported difficulties with self-care and personal hygiene, and that her relationship with her husband "has undergone severe crisis". There is reference to chronic pain and poor psychological health.
2. Dr Protulipac recorded results from "a battery of psychological assessment instruments" and diagnosed chronic post-traumatic stress disorder and moderate major depressive disorder. In his opinion there was a direct causal link between these conditions and the accident. The accident caused a "severe loss of functionality and general life satisfaction and had a severe, negative impact upon her ability to enjoy life." There was a "significant loss of employment capacity and a loss of ability to materialise her ambitions and fulfil her pre-injury potential." The doctor recorded that the claimant's "symptoms of trauma will continue to haunt her for a long time however may ease with time and treatment."
3. In a separate report Dr Protulipac recorded the classes he assigned to each PIRS area of functioning and his assessment of a 22% permanent impairment. The doctor's reasons for his assessment have been considered.
4. Dr Mastroianni, consultant occupational physician, reported to the claimant's solicitor on

6 November 2019. The claimant reported neck, shoulder and back symptoms. The doctor diagnosed whiplash disorder of the cervical spine, cervical and lumbar spondylosis and disc disease aggravated by the accident, and bilateral shoulder tendonitis and bursitis as a result of the accident. The claimant "also describes post-traumatic stress disorder". The claimant was not fit for work as a shop assistant and had capacity for part-time work with limitations in terms of the physical tasks she can perform. She required further treatment. The doctor assessed a 22% permanent impairment. 5. Dr Mitchell, occupational physician, reported to the insurer's solicitor on 16 December 2020. The claimant reported ongoing pain in her neck, back and shoulders following the accident. In the doctor's opinion there was an absence of any objective clinical evidence of abnormality in the neck or back, and "only" early degenerative changes identified in each shoulder, with no apparent medical cause for the severe symptoms reported. The claimant was fit for suitable work that would avoid any aggravation of the reported symptoms. The examination findings were "relatively normal". In the doctor's opinion there was "obvious inconsistency" during examination of her shoulders. The doctor diagnosed "widespread pain of an apparent soft tissue nature". While the prognosis was good ongoing symptoms were likely to be reported. No further investigations were required and no future treatment indicated. 6. An activities of daily living assessment dated 22 February 2021 was prepared by Jasmine O'Brien, occupational therapist. The report records the claimant reported "pain across the back of her neck, both shoulders and 'all over [her] back'", that she was no longer able to enjoy the activities that she used to with her family and friends, and that she relied on her mother to help with caring for her children. She had not worked since the accident. Recommendations were made for past gratuitous assistance. Ms O'Brien did not support any future assistance. 7. Dr Kuljic, consultant psychiatrist, reported to the claimant's solicitor on 15 September 2023. The history recorded by the doctor has been considered. The claimant reported no pre-accident impairments regarding self-care and personal hygiene, social and recreational activities, travel, social functioning/relationships, concentrations/persistence/pace, and employability/adaptation. Following the accident she felt "panicky", was shaky, felt choking and palpitations, and hyperventilated. She experienced ongoing pain in her head, neck, shoulders, upper and lower back. 8. Dr Kuljic recorded the claimant's reported psychiatric symptoms and her post-accident treatment. The doctor diagnosed major depressive disorder, panic disorder, and unspecified trauma and stress related disorder. In his opinion these conditions were caused by the accident. The claimant's capacity for work had been impaired. She required ongoing treatment. The doctor assessed a 15% permanent impairment. The Panel has evaluated the doctor's PIRS assessment, including the classes allocated and the associated reasons. 9. Dr Rikard-Bell, psychiatrist, reported to the insurer's solicitor on 11 March 2021. The doctor recorded the claimant's pre-accident history and functioning, details of the accident, her subsequent symptoms, functioning, and treatment. In the doctor's opinion there:

"...appeared to be a significant disconnected [sic] between what appears from the history to be an extremely minor motor vehicle accident and the devastatingly reported disabling pain and emotional distress displayed by [the claimant] at interview."

1. In Dr Rikard-Bell's opinion the claimant had developed a chronic pain syndrome. He diagnosed an adjustment disorder with anxiety and depression secondary to chronic pain. Treatment had not been effective. The doctor stated that "perhaps this is because there is a chronic pain condition which is likely to be reinforced by further psychological treatment." The diagnosed condition was causally related to the accident. In Dr Rikard-Bell's opinion the claimant would be able to undertake pre-accident duties if it were not for the symptoms of pain.
2. Dr Rikard-Bell reported again on 15 March 2024. The doctor referred to his earlier report, including the history and examination findings. The claimant reported "overwhelming and excruciating pain with pain in her neck, shoulders and back" which appeared to be spreading and becoming worse. Her mood was low, and she was highly anxious. The claimant's reported functioning is recorded and has been considered by the Panel. The doctor stated:

"[i]f one accepts that there is no significant underlying physical injury that could be explained by the motor vehicle accident and that the pain syndrome persists, it is most likely there is a diagnosis of somatic symptom disorder with predominant pain, persistent."

1. In terms of the diagnosis recorded in his earlier report, the doctor stated that the adjustment disorder was secondary to the somatic symptom disorder and causally related to the somatic symptom disorder rather than the accident. Ongoing treatment was not indicated from a psychological perspective.

1. Dr Tomka's report to the insurer dated 29 November 2017 records a diagnosis of whiplash injury to the neck, injury to the shoulders, and injury to the upper and lower back. Physiotherapy was recommended. The doctor recorded that the claimant's presenting problems had "no impact" on self-care and personal hygiene and employment/study. There was a "moderate impact" on domestic duties.
2. In a report to Dr Tomka dated 7 December 2017 Dr Guirgis, consultant orthopaedic surgeon, recorded a history of the accident. Dr Guirgis diagnosed injuries to the claimant's cervical spine, shoulders, lumbar and thoracic spine. In his opinion, the claimant was unfit for full

pre-injury duties. 3. In a report to Dr Tomka dated 19 September 2018 Dr Guirgis repeated the diagnoses recorded in his earlier report. The claimant was advised to continue conservative treatment. She was unfit for pre-injury duties and needed "home help". She was fit for suitable duties. 4. Dr Guirgis reported to the claimant's former solicitors on 20 September 2018. The doctor recorded a history of the accident and the claimant's subsequent complaints. Injuries to the cervical spine, shoulders, thoracic spine and lumbar spine were diagnosed. The claimant was considered to be totally unfit for work. She needed domestic assistance. The doctor assessed a 17% permanent impairment as a result of the cervical spine, lumbar spine and shoulder injuries. Various radiological reports are attached to the doctor's report. 5. Dr Guirgis reported to a different firm of solicitors on 16 July 2019. The doctor was asked to comment on Medical Assessor Myers' assessment. He did not agree with it for the reasons recorded in the report. 6. Dr Giblin, orthopaedic surgeon, reported to Dr Tomka on 11 September 2019. It is recorded that since the accident the claimant has reported neck pain, bilateral shoulder pain, pins and needles in the hands and low back pain with some radiation into the right thigh. Radiological investigation findings are noted. In the doctor's opinion the claimant "seems to have" an aggravation of underlying degenerative change of her cervical and lumbar spine and pain in both shoulders due to a combination of rotator cuff disease and her neck pain. 7. Dr Tomka reported to the claimant's solicitors on 14 October 2019. The claimant attended the doctor's practice the day after the accident with neck, shoulder and back symptoms. She was referred to Drs Guirgis and Giblin. Injuries to her left shoulder in 2010 and 2013 had resolved completely and she was able to continue with her work "in a full capacity". As a result of the injuries she sustained in the subject accident the claimant could not go back to work as she had lifting, bending, and kneeling restrictions and cannot work above the head. She was not able to perform domestic chores and required assistance. She required conservative treatment. The claimant had, in the doctor's assessment, impairments of her cervical spine, lumbar spine and shoulders that gave rise to a 14% permanent impairment. 8. Dr Kuljic reported on 19 November 2019. It is recorded that the claimant reported symptoms of major depressive disorder and panic disorder as a consequence of a motor vehicle accident. There was no pre-accident psychiatric history or treatment. The claimant developed a panic attack immediately after the accident which continued over time progressing into panic disorder. She had bodily injuries with chronic pain which impacted her professional and family functioning and caused the depression. 9. Dr Kuljic addressed the diagnostic criteria for major depressive disorder by reference to the claimant's symptoms. He described the impact on the claimant's functioning and her treatment. 10. Danijela Savic, psychologist, reported on 28 May 2024. Among other things the report refers to the claimant's symptoms, treatment, and reported functioning. It also includes Ms Savic's opinion about diagnosis and the claimant's functioning.

1. The joint bundle contains radiological investigation reports relating to the claimant's neck, shoulders, and right wrist. The reports have all been considered.

1. Dr Tomka's certificate dated 7 November 2017 has been considered, as have the allied health recovery requests (AHRR) dated 10 November 2017, 6 December 2018 and 11 April 2018.
2. The clinical records from Liverpool Family Medical Centre were printed on 6 July 2020. A medical certificate dated 5 May 2010 records the claimant was unfit for work because she was suffering a "panic episode". A note recorded on 6 May 2010 records that the claimant was "depressed and more anxious". It is also recorded that she:

"...says lost interest in almost all hobbies she used to enjoy before

and lately began to exp some episodes of fast breathing usually followed by sense of diz. and light headedness

said feels that she cannot take a full deep breath in most of the time she gets such episodes then gets some panic

1. Clinical records from Health Check Family Medical Practice were printed on 13 July 2020. The first entry relates to an attendance on 29 April 2002. The notes recorded at that time refer to an "MVA on 25 April 2002", that the claimant was the left rear seat passenger, that she "hit from seat with head". The claimant reported that she was anxious, and had pain in her head, left shoulder, neck, back, and experienced "flashbacks to MVA".
2. On 3 June 2002 the notes include reference to persisting neck and "mid & LBP, L shoulder pains". There are similar entries on: 18 June 2002, 13 August 2002, 5 November 2002,

19 November 2002, 10 December 2002, 21 January 2003, 25 February 2003, 6 May 2003,

1 July 2003, 5 August 2003, 27 August 2003, 19 November 2003, 11 December 2003,

5 February 2004, 20 April 2004, 6 July 2004, 12 July 2005. The notes during this time include reference to the claimant being anxious and having "flashbacks". On 27 July 2004 she was referred to Dr Zepnic "re anxiety, flashbacks re to MVA". 3. There is only one entry in the notes for 2006 (20 April 2006) and two entries in 2007 (28 June and 11 July). After the entry on 11 July 2007 the next entry was made on 4 February 2013. There are then notes relating to consultations in 2014, 2015, 2016, 2017, 2018 and 2019. The notes recorded in 2017 - 2019 do not refer to the accident or accident-related injuries. The last note in the patient records relates to a consultation on 14 August 2019 and includes the following history: "[e]arly July 2019 car door closed on left thumb". 4. The Health Check Family Medical Practice records include various test results, radiological reports, referrals, prescription records, and reports from specialists and allied health professionals. There are also documents relating to a damages claim made with respect to the motor vehicle accident on 25 April 2002. 5. Dr Tomasevic's report of 24 July 2002 refers to the 2002 accident, the claimant's subsequent complaints and treatment. The doctor diagnosed soft tissue musculoligamentous injuries to the neck, back and left shoulder.

1. Dr Giblin reported to Dr Tomasevic on 26 November 2002. He recorded the claimant complained of pain in her neck, back and left shoulder and had been off work. On

9 December 2003 Dr Giblin reported that the claimant complained of symptoms in her neck, back and left shoulder. She was working full time as a shop assistant in a chicken shop performing normal duties but reported she has to sit down on occasion because of her symptoms. The claimant's soft tissue symptoms were likely to persist "for some time". 2. In a report dated 15 July 2004 Dr Giblin recorded that the claimant's "chief complaint" was her low back. The claimant was "not a surgical proposition". Conservative treatment was recommended. 3. Clinical records from Bathurst Street Medical Practice were printed on 21 August 2020. The first entry in the progress notes is dated 23 August 2016. The claimant attended the practice on 30 October 2017 and reported being in a motor vehicle accident the day before. She reported pain in her neck, back, and shoulders. Similar complaints were recorded in November 2017, February 2018. Lumbo-sacral back pain was said to be the "reason for contact" in various entries made in December 2017, January 2018, February 2018, March 2018 and April 2018. 4. On 2 May 2018 Dr Tomka recorded:

1. There are ongoing complaints of neck and back pain in May, June, July, August, September 2018 and in entries made in 2019 and 2020. In addition to neck and back complaints, there is reference to shoulder pain in October, November, December 2018 and in various entries recorded between January and December 2019. On 3 August 2020 it was recorded in the notes that the reason for contact was "Pain - back - lumbo-sacral". The last entry in the notes was recorded on 21 August 2020.
2. The records from Advanced Liverpool Medical Centre were printed on 11 September 2020. The records include details of investigation requests, prescriptions, test and investigation reports and predominantly relate to the claimant's pregnancy. The first consultation referred to in the patient notes was on 14 March 2007.
3. The Fairfield Hospital records largely relate to pregnancies. They include reference to the following:

(i) 2 March 2020 anxiety disorder - treated with anti-depressant - post car accident

(ii) Responses to the Edinburgh Depression Scale questionnaire dated 2 March 2020.

(iii) 6 March 2020 - "Mental health issues, Anxious mood... Had a major car accident in 2017...which triggered anxiety and depression. Saw psychologist twice, medicated with antidepressant. Medication ceased by GP when pregnancy know..."

1. Dr Kuljic's records include the doctor's notes. The first entry relates to a consultation on

21 January 2020. There is reference in the notes recorded by the doctor to: anxiety, panic attacks, depressed mood, "anxious in traffic", insomnia, "scared of traffic, fears new accidents", pain, disturbed sleep, "constant neck and back pain". The last entry is dated

4 September 2023. That note includes reference to: the claimant's mood being "quite bad", insomnia and interrupted sleep, "gets easily stressed, can't cope with stress", low energy levels. 2. The updated clinical notes from Dr Kuljic, the subject of the claimant's ALAD, include the referral to the doctor and reports from the doctor addressing matters such as diagnosis and treatment. The progress notes describe the claimant's reported symptoms between 2019 and September 2025. 3. Reports from Dr Kuljic to Dr Tomka record the claimant's symptoms, treatment (including medication) and her progress. A referral from Dr Tomka records the claimant's presenting problem is "anxiety, low mood, depression, mild insomnia". Past history included "[a]nxiety - panic attacks on/off [d]epression". There is a further referral dated 12 May 2023 in the same terms. A referral dated 8 October 2019 states the claimant is depressed. A referral dated

17 November 2020 records that she has "depression". 4. Dr Tomka's notes commence in early 2010. The notes are handwritten and difficult to read.

1. The bundle includes Medicare notices of charge dated 24 February 2018 and 5 February 2019, a list of travel expenses, pharmacy invoices, employment documents from Aldi (including a job description), Centrelink records, and the Medicare prescribing history and patient history. This material has all been considered.

1. The insurer relies on written submissions dated 11 June 2025. After referring to background matters and the legislative framework the insurer addresses what it argues are deficiencies in Medical Assessor Jones' assessment. The insurer's case, as reflected in the submissions, is that:

(a) causation of injury is in issue;

(b) it relies on Dr Rikard-Bell's opinion, including his opinion that the claimant has a somatic symptom disorder with predominant pain;

(c) the PIRS must not be used to measure impairment due to somatoform disorders or pain;

(d) the reliability of the claimant's evidence is in issue and the inconsistencies between her evidence and the documentary evidence need to be addressed;

(e) the claimant does not satisfy the DSM-5 diagnostic criteria for a persistent depressive disorder and panic disorder;

(f) each PIRS area of functioning should have been rated class 2, representing mild impairment, apart from adaptation with respect to which there was no impairment (class 1). This yields a median class score of 2 and an aggregate score of 11 in class 2 resulting in a 5% whole person impairment, and

(g) the claimant's permanent impairment as a result of any accident caused psychological injury is not greater than 10%.

1. The claimant relies on written submissions dated 26 June 2025. Like the insurer, the claimant addresses matters relating to purported errors made by Medical Assessor Jones. Various authorities relevant to the standard and content of reasons required by a Medical Assessor are referred to.
2. The claimant's case on causation is that she was otherwise well prior to the accident, she developed psychological symptoms following the accident, and there have not been any significant subsequent events.
3. It is evident the claimant supports and relies on the findings made by Medical Assessor Jones with respect to the psychological condition he diagnosed (persistent depressive disorder with probable panic disorder), causation, and impairment, including his PIRS assessment.

1. Medical Assessors Mason and Doris (Medical Assessors) re-examined the claimant by AVL link on 15 December 2025, the 20 October 2025 re-examination having been abandoned due to technical issues experienced by the interpreter. A Serbian interpreter was present throughout the re-examination on 15 December 2025. The findings of the Medical Assessors following the re-examination are set out below.

1. The claimant lives with her de facto husband, children, and mother. She is not currently employed outside of the home. She last worked as a store assistant and occasional assistant manager until November 2015 when she commenced parental leave.

1. The claimant was born in Croatia. She grew up there with her parents and brothers. She is not aware of any history in her family of serious mental disorders. Her father passed away 12 years ago. Her mother has lived with her for several years. Her brothers both reside in Australia.

1. The claimant described a positive upbringing in her family. She said that she received good grades at school and made friends easily. She said that though she lived in an area of Croatia that was not affected by the war in the former Yugoslavia, her family relocated to be closer to family in Serbia when she was aged 16 or 17. She described managing this change without difficulty and making new friends. The claimant completed school at age 18.
2. After completing her education, the claimant worked as a care assistant at an aged care facility. At age 22 she migrated with her family to Sydney and has lived there since then. During the first few months in Sydney the claimant attended an English language course. She then obtained work at a cooked chicken shop where she worked for four or five years. The claimant subsequently obtained work as an assistant at a supermarket and worked there until starting parental leave in November 2015.
3. The claimant has been with her current partner for 18 or 19 years. She has one close friend who she sees every week.

1. The claimant denied any significant health problems during her childhood and adolescence. She could not recall any significant health problems or injuries before the subject motor accident.
2. The claimant was asked about a previous motor accident in 2002 which is mentioned in the documents. She was unable to recall broad details of the accident such as where she was seated in the vehicle and whether the vehicle she was in was hit by, or struck, another vehicle. She recalled sustaining injuries to her back, neck and shoulders. She said that she received treatment with medication, physiotherapy and hydrotherapy. She denied any psychological injury due to this accident. She said that after two years her symptoms resolved.

1. The claimant could not recall consulting with a health professional about a mental health problem before the accident. Specifically, she could not recall being assessed by her General Practitioner (GP) complaining of anxiety and flashbacks related to the motor accident of 2002 or being prescribed St John's Wort as treatment for this.
2. The claimant could not recall the period in 2010 when she consulted with her GP and complained of psychological symptoms consistent with panic disorder and/or a major depressive episode and a subsequent referral for psychological treatment. The claimant could recall consulting about blood pressure problems and headaches at that time, though not about mental health problems.

1. The claimant is a non-smoker. She denied drinking any alcohol, using illicit substances or gambling.

1. The claimant said that she is currently prescribed amitriptyline 150mg for her psychological symptoms. She is also prescribed the analgesic medications Norgesic and Panadol Extra, the antispasmodic Baclofen, and Pariet for gastroesophageal reflux.

1. The claimant said that at the time of the accident she was on maternity leave. She was preparing to return to work and had been put on an upcoming roster. Before the accident she had two children. She said that she was in good health and was devoted to looking after her children. She reported she had no problems with her self-care and maintaining personal hygiene. The claimant said that she was able to travel independently without difficulty. She said that she had good relationships with family and friends and no difficulty socialising.

1. The claimant could recall the accident though said that it was difficult for her to talk about. She said she was travelling with her husband and two friends. She was seated in the rear behind the passenger seat. When the car she was in hit a vehicle in front she "was scared and shocked". She said, "I couldn't breathe". The claimant said that she got out of the vehicle and was still struggling to breathe. She was not aware of any serious injury to herself or anyone else at the time. She subsequently went back into the vehicle and was driven home.
2. The documents before the Panel indicate a low velocity accident with little damage to either vehicle.

History of Symptoms and Treatment Following the Accident

1. The claimant said that in the evening following the accident she developed pain in her back. The following day she consulted with a doctor. She was given a prescription for pain relieving medication, referred for imaging studies, and for physiotherapy. Despite treatment she experienced persistent pain.
2. The claimant said that in the days following the accident she had disturbance of her sleep. She experienced "flashbacks" which she explained as being intense recollections of the accident. She said that she expected these symptoms to resolve, though they did not.
3. The claimant said that she was referred for psychological treatment to psychologist Dr Protulipac and commenced psychological treatment in October 2018. She was referred to psychiatrist Dr Kuljic and came under his care in November 2019. She commenced medication including escitalopram and then amitriptyline. Since 2023 the claimant has had psychological treatment with a psychologist, Ms Savic.

1. Since the accident the claimant has had a caesarean section operation. There have been no further injuries or conditions of relevance.

1. The claimant said that her mental health "is getting worse and worse". She said, "this accident destroyed my life". She reported persistent pain in her back, neck and shoulders which has become more intense over the last few years. This impairs her in activities of daily living including household chores.
2. The claimant said that she experiences panic attacks two or three times per week. These sometimes occur spontaneously and sometimes if she is reminded of the motor accident. She said, "I can't get those thoughts out of my head" and explained that the thoughts related to the motor accident and, "I feel like it is happening again".
3. The claimant described her mood as miserable, sad, or down most of the time. She denied getting pleasure from any activity, including time with her children or other family and friends. She described having passive thoughts of not continuing with her life though denied any active desire or intention to harm herself or attempt to end her life. The claimant described having low motivation for any activity.

1. The claimant said that she does not sleep at all. On further enquiry she described recurrent middle insomnia. She experiences unpleasant dreams with content relating to motor accidents. She described her appetite for food as low. She is not aware of any change in her weight.
2. The claimant described some arguments with her partner. She has a friend who visits her two or three times a week, though described a general social withdrawal.

1. The claimant is prescribed the antidepressant and analgesic medication amitriptyline at a dose of 150mg daily. She meets with her psychiatrist, Dr Kuljic, every three months. She has individual psychotherapy with her psychologist every two or three weeks.

1. The claimant joined the AVL re-examination from her solicitor's office. She had been driven to the office by her brother. Her self-care appeared reasonable. She managed an interview of approximately 90 minutes duration. At several times during the interview the claimant stood up and stretched her back for a few seconds before sitting again and continuing with the interview. She communicated effectively with the assistance of the interpreter. She appeared to understand English when instructed how to disconnect from the video connection at the end of the interview when the interpreter had disconnected.
2. The claimant was tearful and emotionally upset when talking about the motor accident. She appeared downcast in her affect. Her mood was objectively and subjectively low. She described passive suicidal ideation, though denied ever having any active suicidal intent. Her thought form appeared normal. There were no delusions and no abnormal perceptions consistent with hallucinations. Her thought content revealed pre-occupation with the effect of the motor accident on her life, and concern about her physical symptoms.
3. The claimant was fully alert and orientated at interview. Her recall of historical material was incomplete such as the details of previous accidents and health problems. She managed a lengthy interview including communicating through an interpreter and sustained her concentration adequately. The claimant was able to understand and follow some instructions in English from Medical Assessor Mason to end the video-link.

1. The claimant said that she showers every two weeks. She is inactive much of the time during the day. She spends most of her time in her room alone at home. She sometimes prepares food for her children. The claimant sometimes takes her children to school by car or walks with them. She goes to shops with her partner, mother or sometimes on her own. She is limited in her ability to undertake domestic tasks or to sit for prolonged periods due to pain, as demonstrated at assessment.
2. The claimant has a close friend who visits two or three times each week. She supports her children in their sports by regularly attending their training or matches.

1. The claimant could not recall some historical information relating to previous injuries and medical treatment or had only vague recollection. She was unable to confirm whether she was or was not the individual in surveillance pictures and video supplied by the insurer.
2. Having viewed the surveillance footage and re-examined the claimant the Medical Assessors are satisfied it is the claimant seen in the footage that is described earlier in the Panel's reasons.

1. Following the DSM-5-TR system, the claimant has an exacerbation of a pre-existing somatic symptom disorder with predominant pain due to the motor accident. This disorder has become persistent. The claimant has somatic symptoms that are distressing and result in significant disruption of daily life (Criterion A). The claimant has excessive thoughts, feelings, and behaviours related to the somatic symptoms with disproportionate and persistent thoughts about the seriousness of her symptoms (Criterion B). The somatic symptoms have been present for several years (Criterion C).
2. The claimant has a pre-existing panic disorder which was exacerbated by the subject accident. She has continuing symptoms consistent with this. She has recurrent unexpected panic attacks characterised by an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes. During such an attack she experiences feelings of choking, sensations of shortness of breath or smothering, chest pain or discomfort and fear of dying or losing control (Criterion A). The claimant has a significant maladaptive change in behaviour and avoids situations which may precipitate an attack (Criterion B). The disturbance is not attributable to the physiological effects of a substance or another medical condition (Criterion C). The disturbance is not better explained by another mental disorder (Criterion D).
3. The claimant has developed a major depressive disorder. This has become chronic and now meets criteria for a persistent depressive disorder with anxious distress. The claimant has depressed mood for most of the day, for more days than not for at least two years (Criterion A). She has poor appetite, insomnia, low energy and poor concentration (Criterion B). During the last two years she has not been without these symptoms for more than two months at a time (Criterion C). The claimant has met criteria for major depressive disorder continuously over the last two years (Criterion D). There has never been a manic or hypomanic episode, or any suggestion of a schizophrenia spectrum disorder (Criteria E and F). The symptoms are not attributable to the physiological effects of a substance or another medical condition. (Criterion G). The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion H).
4. The Medial Assessors considered the diagnosis of post-traumatic stress disorder due to the motor accident. The documentary evidence indicates a minor motor accident at low velocity with limited damage to either vehicle. The claimant was not aware of any serious injury to herself or anyone else at the time. She described symptoms consistent with experiencing a panic attack shortly after the accident.
5. Criterion A of the DSM-5-TR diagnostic criteria for post-traumatic stress disorder requires:

"Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:

2. Witnessing, in person, the event(s) as it occurred to others.

3. Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.

4. Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse)."

1. This necessary criterion is not met. The claimant does not, in the opinion of the Medical Assessors, have post-traumatic stress disorder.

1. The motor accident of 29 October 2017 caused an exacerbation of pre-existing somatic symptom disorder with predominant pain and panic disorder. These disorders caused psychological distress and led to the development of a major depressive disorder which has become chronic and is now a persistent depressive disorder. The assessment of the claimant's current and pre-existing impairment does not include the impact on her functioning as a result of the somatic symptom disorder and pain: cl 1.215 Impairment Guidelines.

2. Persistent Depressive Disorder with Anxious Distress

Amitriptyline 150mg; individual psychological therapy

The claimant said that she showers every two weeks. She spends most of her time in her room alone at home. She sometimes prepares food for her children. She is limited in her ability to do domestic tasks or to sit for prolonged periods due to pain. As a result of her assessable psychological injuries she has a moderate impairment.

The claimant watches her children playing in their football teams. She last did this two weeks prior to the assessment. She meets with a friend at her home two or three times each week. She occasionally goes to shops with her mother or partner. She does not need a support person to attend social events. Her impairment in this domain is mild.

The claimant can drive on her own in her local area such as to shops or to her psychologist's practice. She occasionally takes her children to school by car, or she walks. She can travel as a passenger in a car for longer distances. She does not need a support person to travel in a familiar area. She has a mild impairment.

The claimant lives with her husband, children and mother. The youngest child has been born since the accident. A friend visits two or three times a week. She meets with her brothers, nieces and nephews every month or two. There has been loss of some friendships since the accident. Her impairment is assessed as being mild.

The claimant said that she does not read or watch television. She is able to drive. She sustained concentration adequately for a lengthy re-examination and could follow instructions to disconnect from the video link in English. She is assessed as having moderate impairment.

The claimant was on parental leave from her work role at the time of the accident. She was looking after her two children in a home with her partner and mother. She is now looking after her three children with support from her partner and mother. She has some impairment in domestic tasks due to pain. She could work at least 20 hours a week as an assistant in a supermarket. She has a mild impairment in adaptation due to her psychological injury.

List Classes in Ascending Order Median Class Value

Psychiatric Impairment Rating Scale - Pre-existing Condition

The claimant said that she had no impairment in her self-care and personal hygiene.

The claimant said that she was able to socialise without difficulty and did so regularly.

The claimant denied any difficulty with travel before the motor accident in October 2017.

The claimant described positive relationships with her partner, mother and children as well as some friends.

The claimant denied any difficulty with concentration of persistence.

The claimant said that before the accident she was devoted to her children and able to adequately look after them and carry out other domestic tasks. Prior to going on maternity leave she had been working.

List Classes in Ascending Order Median Class Value

Apportionment - pre-existing/subsequent impairment

1. The claimant had a pre-existing panic disorder and somatic symptoms disorder. Her description is of no impairment secondary to these at the time of the motor accident. The Medical Assessors are not satisfied there is objective evidence of a pre-existing symptomatic psychological permanent impairment at the time of the accident. There is no subsequent impairment.

1. The claimant described a general worsening of her mental health over the last few years despite treatment. There is no adjustment for the beneficial effects of treatment.

Degree of permanent impairment caused by the motor accident

1. When re-examined by the medical members of the Panel the claimant denied experiencing any psychological injury as a result of the motor vehicle accident in April 2002. She could not recall consulting with a health professional about a mental health problem before the subject accident. While her statement refers to the 2002 accident it contains no reference to psychological symptoms, injury or treatment as a result of that accident. Further, she stated she had never previously experienced anxiety.
2. The Panel has given weight to the records from the claimant's treating doctor that contain references to her reporting psychological symptoms following the 2002 accident, including that she was anxious and experienced flashbacks in relation to the accident. These symptoms are recorded in the Health Check Family Medical Practice clinical notes in the period from 29 April 2002 until 2005. She was referred by her GP to Dr Zepinic in July 2005 "re anxiety, flashbacks re to MVA".[1] The Panel has also given weight to the reference to the claimant being "depressed and more anxious" in the Liverpool Family Medical Centre patient notes recorded on 6 May 2010.
3. The Panel is satisfied the claimant did experience psychological symptoms prior to the accident. For the reasons given by the medical members of the Panel in their re-examination findings the Panel is satisfied that she had a pre-existing panic disorder and somatic symptom disorder.
4. For the reasons that follow the Panel is not satisfied there is objective evidence that there was a pre-existing impairment within the meaning of cl 1.31 of the Impairment Guidelines.
5. The claimant told the medical members of the Panel when they re-examined her that prior to the accident she: had no problems with her self-care and maintaining personal hygiene; was able to travel independently without difficulty; had good relationships with family and friends; and had no difficulty socialising. There is no reference in the records from treatment providers of the claimant reporting psychological symptoms in the 12 months prior to the accident. Finally, the Panel has given weight to the clinical judgment of its medical members who were satisfied there was no pre-existing impairment.
6. The Panel is satisfied that following the accident on 29 October 2017 the claimant experienced psychological symptoms including fear, anxiety, depression and panic attacks. Clinical notes made by Dr Tomka on 2 May 2018 record that the claimant reported anxiety driving a car. She was referred to Dr Protulipac, psychologist, by Dr Tomka. Dr Protulipac's report of 25 October 2019 records details of psychological symptoms reported by the claimant since he first assessed her in October 2018.
7. The Panel finds the accident caused an exacerbation of the pre-existing somatic symptom disorder with predominant pain and the panic disorder and that these disorders caused psychological distress and led to the development of a major depressive disorder which has become chronic and is now a persistent depressive disorder. The diagnostic criteria for each of these conditions is satisfied for the reasons given by the medical members of the Panel in their re-examination findings. The Panel agrees with and adopts those reasons.
8. The Panel has considered the classes assigned to each PIRS domain of functioning by Medical Assessors Jones and Paisley and Drs Protulipac, Kuljic and Rikard-Bell. The Panel notes that the clinical judgement of its medical members, both of whom are psychiatrists, is the most important tool in the application of the PIRS: cl 1.217 Impairment Guidelines. Further, the evaluation of impairment should only consider the impairment as it is at the time of the assessment: cl 1.21 Impairment Guidelines.
9. Medical expertise and clinical judgment play a central role in applying the PIRS[2]. Consequently, the Panel has relied on the expertise and judgement of its medical members in the assessment of the claimant's impairment and given weight to their findings.
10. The Panel agrees with and adopts the precise examination findings and conclusions of its medical members based on their examination of the claimant, and their specific findings with respect to each PIRS area of functioning and permanent impairment.
11. The Panel finds that the claimant has a permanent impairment of 7% as a result of the accident caused psychological injuries. It follows that the degree of the claimant's permanent impairment as a result of those injuries is not greater than 10%.
12. The Panel revokes Medical Assessor Jones' certificate dated 4 June 2024 and issues a new certificate that reflects its findings.

[2] Georges v Musico [2025] NSWSC 1085 at [62].