1. The Medical Review Panel affirms the certificate of Medical Assessor Gerard Walsh of

18 September 2024 that the following psychiatric injuries sustained in the accident of

29 May 2020 gave rise a permanent impairment of 7%: * major depressive disorder.

1. On 29 May 2020, the claimant, Imran Khan (Mr Khan), was involved in a motor vehicle accident (the accident) when he was riding his motor scooter on a road when a car pulled out in front of him from his left-hand side and his leg caught the car's rear bumper, causing him to fall to the ground.
2. He has alleged that he has sustained injuries as a result of the accident, including psychological injuries, and this has led to the subject dispute.
3. Insurance Australia Limited t/as NRMA (the insurer) was the third-party insurer at risk.
4. A medical dispute about the degree of Mr Khan's whole person impairment (WPI) has arisen in connection with his claim. This constitutes a medical assessment matter under Schedule 2, cl 2(a) of the Motor Accident Injuries Act 2017 (MAI Act).
5. Mr Khan cannot claim damages for non-economic loss unless he can establish a degree of permanent impairment as a result of the injury caused by the accident, that is, more than 10% WPI.
6. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor: s 7.20 of the MAI Act.
7. The dispute was referred to the Personal Injury Commission (Commission) which then assigned it to Medical Assessor Gerard Walsh for assessment.
8. On 5 September 2024 and 10 September 2024, Medical Assessor Walsh assessed Mr Khan and on 18 September 2024, certified that psychiatric injuries sustained as a result of the accident, being post-traumatic stress disorder and major depressive disorder, gave rise to a WPI of 7%.

1. Mr Khan sought a review of the medical assessment under s 7.26 of the MAI Act (the Review).
2. On 28 November 2024, a delegate of the President of the Commission determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect and referred the matter to the Panel.
3. The review provisions provide that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission: s 7.26(5A) of the MAI Act. Accordingly, the President's delegate has convened this Panel to conduct the review of the medical assessment.
4. Part 5 of the Personal Injury Commission Act 2020 ( PIC Act) enables the Personal Injury Commission (Commission) to make rules with respect to the practice and procedure before the Commission including proceedings before a panel reviewing a decision of a Medical Assessor: s 41(2) of the PIC Act.
5. The Review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect. The Review is by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act. However, s 7.25 of the MAI Act provides that the review of a medical assessment can be made on the basis of any agreement by the parties as to the degree of permanent impairment from a particular injury and whether a particular injury was caused by the accident, without those matters having to be the subject of assessment.
6. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the PIC Rules.

1. Sections 5D and 5E of the Civil Liability Act 2002 (the CLA) apply to the MAI Act: s 3B(2) of the CLA.
2. However, s 4.11 of the MAI Act provides that no damages for non-economic loss may be awarded in respect of injury 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%.

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. Causation of injury is addressed in cls 6.5, 6.6 and 6.7 of the Guidelines.
3. Clause 6.6 of the Guidelines notes:

"6.6 Causation is defined in the Glossary at page 316 of the AMA 4 Guides as follows:

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

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

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

"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. Pre-existing impairment is addressed in cls 6.31, 6.32 and 6.33 of the Guidelines.
2. The evaluation of the permanent impairment may be complicated by the presence of an impairment in the same region that existed before the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value. If there is no objective evidence of the pre-existing symptomatic permanent impairment, then its possible presence should be ignored: cl 6.31 of the Guidelines.
3. Clause 6.32 of the Guidelines states:

"The capacity of a medical assessor to determine a change in physical impairment will depend upon the reliability of clinical information on the pre-existing condition. To quote the AMA 4 Guides (page 10): 'For example, in apportioning a spine impairment, first the current spine impairment would be estimated, and then impairment from any pre-existing spine problem would be estimated. The estimate for the pre-existing impairment would be subtracted from that for the present impairment to account for the effects of the former. Using this approach to apportionment would require accurate information and data on both impairments.' Refer to clause 6.218 for the approach to a pre-existing psychiatric impairment."

1. In AAI Limited t/as AAMI Limited v Jacobs [2024] NSWSC 371 (11 April 2024), decision of Elkaim AJ, his honour said in respect of causation at [40]:

"[40] Both parties referred me to a number of authorities, and both drew my attention to the decision of the High Court in Wingfoot Australia Partners Pty Ltd v Kocak (2013) 252 CLR 480; [2013] HCA 43. The following paragraphs [47] and [56] are most relevant:

'47 The function of a Medical Panel is to form and to give its own opinion on the medical question referred for its opinion. In performing that function, the Medical Panel is doubtless obliged to observe procedural fairness, so as to give an opportunity for parties to the underlying question or matter who will be affected by the opinion to supply the Medical Panel with material which may be relevant to the formation of the opinion and to make submissions to the Medical Panel on the basis of that material. The material supplied may include the opinions of other medical practitioners, and submissions to the Medical Panel may seek to persuade the Medical Panel to adopt reasoning or conclusions expressed in those opinions. The Medical Panel may choose in a particular case to place weight on a medical opinion supplied to it in forming and giving its own opinion. It goes too far, however, to conceive of the function of the Panel as being either to decide a dispute or to make up its mind by reference to competing contentions or competing medical opinions. The function of a Medical Panel is neither arbitral nor adjudicative: it is neither to choose between competing arguments, nor to opine on the correctness of other opinions on that medical question. The function is in every case to form and to give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.'"

"[46] In other words, it is obviously not enough to simply consider one side's material, but that does not mean that every dispute in the material needs to be described and particularly resolved. This, albeit imperfect, assessment did look at both sides and did reach a conclusion, including specifically on causation."

1. This decision has been extensively applied in decisions in the Commission (I note up to 13 cases in which Elkaim AJ's decision was applied).

1. Medical Assessor Gerard Walsh examined Mr Khan on 5 September 2024 and again on

10 September 2024. He issued his certificate on 18 September 2024. The injuries referred for assessment by Medical Assessor Welsh were: * psychiatric condition - major depressive disorder. 2. At [3]-[4] of his certificate, Medical Assessor Walsh summarised the submissions of the parties, noting that Mr Khan relied on reports of Dr Rastogi, Mr Port, psychologist, and

Dr Singh, psychiatrist, to argue that the psychiatric injuries sustained as a result of the accident exceeded 10% WPI. The insurer relies on the report of Dr Mason, who found that psychological impairment did not exceed 10%. 3. At [7], the Medical Assessor noted that Mr Khan attended the examination alone. There were Interpreters of the Urdu language available on both dates. 4. The Medical Assessor took a psychosocial and pre-accident history at [8] of his certificate, noting no psychological symptoms prior to the accident. 5. At [9], Medical Assessor Walsh took a history of the motor accident, noting that Mr Khan was riding his motor sooter in his course of work as a food delivery driver, a car pulled out in front of him from his left-hand side, his left leg caught the rear bumper of the car and he fell to the ground with the scooter falling onto the right side of his body. No police or ambulance attended the vehicle, and he could drive home. 6. Medical Assessor Walsh proceeded to take a history of symptoms and treatment following the accident at [10], noting two ankle surgeries, several injections and physiotherapy, and suicidal thoughts after the first surgery which has not occurred since. Mr Khan reported a low mood for a couple of years after the accident, nightmares, weight loss, and symptoms of anxiety. 7. At [11], the Medical Assessor noted that Mr Khan had a subsequent accident in March 2024 when a car tried to overtake him and he fell with the scooter falling on top of him. He stated that his anxiety symptoms had increased after the second accident in 2024. 8. The Medical Assessor records Mr Khan's current symptoms at [12], noting an 'off' mood, reduced appetite, nightmares, poor concentration, anxiety symptoms, and trauma symptoms. 9. Medical Assessor Walsh set out Mr Khan's current and proposed treatment at [13], noting weekly psychology sessions and medication (Desvenlafaxine 50mg daily, Panadeine Forte, and Mobic). 10. The Medical Assessor undertook a clinical examination of Mr Khan at [14]-[16] which the Panel reproduces below:

"14. Mental state examination as of Thursday, 10/09/2024

Appearance: The Claimant appeared his stated age and was reasonably groomed. He had mid-length back hair and a mid-length black beard. Behaviour: There was no psychomotor disturbance, and he appeared relaxed in his chair. There was good eye contact with the videoconference camera. Speech: Speech was spontaneous and was normal in volume, rate, rhythm, and prosody. Mood: He said his mood was "off", and he felt like crying for the last few weeks because he is experiencing pain. His mood improves for short periods when interacting with his sister. Affect: His affect was warm, reactive, and appropriate, with a restricted range. Thought form: The thought form was logical, with no formal thought disorder noted. Thought content: The main themes were about the effects of the injury on his life. There were no delusions noted. He does not have suicidal thoughts. Perceptions: There was no perceptual abnormality described, and he did not appear to be responding to any abnormality on observation. Cognition: Formal testing of cognition was not performed. The Claimant attended the assessment. A reasonable history was obtained, but he could not recall some timeframes, and he avoided answering direct questions about his Current Functioning in the first assessment. He managed the assessment, which lasted 1 hour on 05/09/2024 and then 1 hour 10 minutes on 10/09/2024.

Social activities/ADL: Current living situation: The Claimant lives with his sister, who works full-time. He does not have children.

Self-care and personal hygiene: He stated that before the injury, he was completely independent in bathing, grooming, household chores and shopping. He said he used to bathe and cook almost daily before the accident. The Claimant said a support person is required for some of the following activities. Bathing: He said he showers two times a week. He said it was difficult because of pain and fears that he would fall. Cooking: The Claimant said his sister often makes meals, but he orders food online when she is working. He said he no longer cooks because he walked away from food and forgot to turn the stove off 80% of the time he cooked and burnt food. Household chores: He reported that cleaners attend his home once a week to clean his room and shared areas downstairs. He said that since the surgery, he cannot clean because of pain. Shopping: He stated that his sister shops because it stresses him.

Social and recreational activities: He stated that before the subject injury, he had a network of friends with whom he would spend time socialising, playing cricket three times a week, running every morning or visiting friends. He said he used to enjoy cooking and dancing. Hobbies: He said he does not have hobbies. Exercise: He stated that he cannot run or play cricket. Other activities: The Claimant said he does not attend Pakistani celebrations. Frequency of socialising: He said he does not use social media or meet friends. He said that the last time he spoke to friends was two years ago. He said his sister tries to get him out to socialise, but he does not want to. A month ago, he went out for lunch and vomited due to stress. He said over the past two years, he went out socially 2 or 3 times. He feels that people in public are looking at him.

Travel: He stated that before the injury, he could travel anywhere without any problem. He said he has a licence but does not drive since the accident. He said he was frightened in the car. He fears that another car will hit. In a car with another driver, he asks them to slow down. He said he avoids public transport because he feels uncomfortable. He thinks people are judging him and laughing at him. He gets a taxi to go to appointments 1 or 2 times a week alone. The taxi driver will help him if he cannot get out of the taxi. He said his sister goes with him sometimes if she is not working. He last travelled to Pakistan in December 2023, for two weeks to stay with his family because he was stressed. He said he locked himself in his room and did not interact with visitors.

Social functioning: He stated that before the injury, he went out with family and friends often. Relationship with his partner: He said he was last in a relationship in 2020, but she ended it because of his mental health. He said he has not had a partner since. Relationship with children: He does not have any children. Relationship with siblings: He said he has 3 sisters in Sydney. He lives with one of his sisters and has a good relationship with her. 1 brother lives in Pakistan. He does not usually speak to them unless his sister telephoned them and made him talk to them. The last time was 2 months ago. He said in the last 4 years, he has spoken to them 7 times. Relationship with parents: He reported that he does not speak to his family despite their insistence. He said in the last 4 years, he has spoken to his parents a few times since the subject accident. Relationship with friends: He stated that he does not have any friends now and has not contacted them since the subject accident.

Concentration persistence and pace: He said his concentration was good before the subject accident. He said his concentration was currently poor. Since the surgery, he has had to write down reminders. He said that he does not pay attention to what people are saying. He said he cannot read for more than 2 or 3 minutes because he is always. He said he does not read, even in Urdu. He said his sister makes him come out for television once a week with his sister. He feels frustrated and angry without reason. He cries when asked about enrolling at Strathfield. He said he completed it in March 2024 and obtained a Diploma Automotive Certificate. He said his sister helped him. He was doing 2 days 7 or 8 hours. He had to attend in person. He said he had assignments at home once a week and he said he could not recall how many hours. He said he did not have an examination. He was not giving information.

Employability: He stated that there were never any issues with employment before the subject accident. Work: He said he last worked in January 2024 but was unsure if it was March 2024. He said he worked 20 hours per week doing deliveries then. The documentation noted that in May 2024 he sometimes worked up to 45 hours per week. He said he does not do that work anymore because he had a second accident."

"The first assessment on 05/09/2024 was challenging as he was answering questions in ways that avoided answering specific questions. In the second assessment, this occurred only occasionally. On 17/08/2023, in the IME with Dr Richa Rastogi, Psychiatrist and on 21/05/2024, in the IME with Dr Ashwinder Anand, Psychiatrist, it was documented that he was completely independent of selfcare, but his sister did the housework. On 21/05/2024, in the IME with Dr Ashwinder Anand, Psychiatrist, it was noted that the Claimant travelled to Pakistan in December 2023 for two weeks. He stated that he could get out and about using a scooter. However, at the assessment, the Claimant said he locked himself away in his room and did not go out. I did not have the opportunity to raise this discrepancy with the Claimant. But Dr Rastogi in 2023 noted he had not been able to use his scooter."

1. Medical Assessor Walsh then set out a summary of relevant documentation which he relied upon during his assessment of Mr Khan at [17] which is reproduced below:

"21/07/2022 - Clinical Records Peter Tingle, Consultant Occupational Psychologist, Clear Perspectives Psychology Services

He reported that he is only studying part-time and was struggling because of pain, poor concentration and depression. It was documented that "he has extremely poor prospects of finding and sustaining paid work ... or training because of his continuing severe pain episodes, poor sleeping, fatigue, and mental health difficulties including depression anxiety and social phobia".

14/02/2023 - Dr Jaspreet, Singh, Consultant Psychiatrist

This was a one-off appointment. Adjustment Disorder in the context of his accident in 2020 was documented. Low mood, poor motivation, poor energy levels, anhedonia, occasional thoughts of self-harm, disturbed sleep and feeling hopeless about the future were reported. It was recommended that he should have ongoing CBT sessions with his psychologist Simon Port and the antidepressant amitriptyline (Endep) for sleep disturbances and anxiety symptoms.

17/08/2023 - IME, Dr Richa Rastogi, Psychiatrist

There were more than 12 months of depressed mood, amotivation, avoidance, anhedonia, depressive cognitions, and loss of confidence.

Major depressive disorder There is no pre-existing disorder noted.

At the time of this assessment, there were no prescribed medications. He saw a psychologist, Mr Port, for eight sessions and a psychiatrist, Dr Singh, on one occasion. He had analgesia and physiotherapy

He had not worked since the accident. He changed his study course and was due to finish his light mechanical course however his course was delayed by three years. He has been studying Certificate 3 in Light Vehicle Mechanical Technology at Strathfield College since 2022, and he is about to finish his certificate. He has been studying full-time and attends two days in class and two days from home.

Class 1: He could shower independently and attend meals but has reduced motivation. He was living with his sister, and she managed all household chores. Class 3: There was social isolation, and he did not get too involved in social activities. He did not connect with friends, was less interested in doing things and was reclusive. He preferred to be at home alone. He stopped playing sports, lost friendships and stopped meeting his other sister in Sydney. Class 3: He stopped driving and riding a scooter. He used public transport due to pain and stiffness and his anxiety. Class 2: There was relationship strain and a feeling of being a burden on his family. Class 2: He could concentrate for short periods but felt overwhelmed easily due to anxiety. Class 3: His pace was reduced, and there was capacity to work part-time in a sedentary role. PIRS classes were 1,3,3,2,2,3 thus the aggregate was 14 and 13% WPI with 0% adjustment for pre-existing impairment and 0% for treatment effect. The final WPI was 13%. Maximum medical improvement was considered to have been reached.

01/02/2024 - Psychological Report, Simon Port, Psychologist, InnerCity Psychology Services

Treatment began in June 2022 and continued for 7 months. The diagnosis was Adjustment Disorder with Mixed Anxiety & Depressed Mood. He had elevated anger and mistrust of people, anxiety and panic, depression (including periodic fleeting suicidal ideation), avoidance, withdrawal, intrusions and adjustment issues. He had cognitive issues, low motivation, and anxiety symptoms.

21/05/2024 - IME, Dr Ashwinder Anand, Psychiatrist

He experienced a low depressed mood with prominent anxiety. His sleep was poor, especially with pain. He was irritable, had low frustration tolerance, and had flashbacks of the accident. His concentration was poor, and he struggled to focus. His motivation was poor, and he felt helpless and hopeless.

Adjustment Disorder with Mixed Anxiety and Depressed Mood

At the time of this assessment, the prescribed medications were analgesics. He saw the psychologist, Simon Port, for a few sessions but last saw him almost a year ago.

He was working for almost 40 to 45 hours per week during the holiday season doing Uber Eats. In addition to this, when he was not on holiday, he was studying at Strathfield College doing his automotive course. He did state that the accident affected his career plans, and he was not able to complete his course in 2021. He had to re-enrol in a different college at Strathfield in a mechanical course.

Self-Care. Class 2: He could self-care adequately by showering regularly but occasionally skipped a shower. He tried to do the chores around the house but found it a struggle. Recreational. Class 2: He previously enjoyed playing cricket and being social but struggled to do these following the accident. He spent most of the day watching movies. He kept in touch with his friends via phone, avoided social engagements and generally did not venture out much. Travel. Class 1: He travelled to Pakistan in December 2023, for two weeks. He stated that he can get out and about using a scooter. He has travelled overseas since the accident. Social Function. Class 2: His relationship with his sister was quite good and he kept in touch with his family in Pakistan. Concentration. Class 2: His concentration and focus were poor, and it was difficult to retain information. There were no issues with concentration noted over the assessment. Employability. Class 1: He worked almost 40 to 45 hours per week during the holiday season doing Uber Eats. He was studying at Strathfield College doing his automotive course. He did state that the accident affected his career plans, and he could not complete his course in 2021. He had to re-enrol in a different college at Strathfield in a mechanical course. PIRS classes were 2,2,1,2,2,1 thus the aggregate was 10 and 5% WPI with 0% adjustment for pre-existing impairment and 0% for treatment effect. The final WPI was 5%.

04/07/2020 to 24/07/2023 - GP Records, Alliance Medical Healthcare Centre

15/03/2021 - The first mention of mental health issues was noted in that he was "Very distressed, upset and confused". His mental health was noted to be at risk of deteriorating. 29/09/2021 - He had enrolled in another course that would start very soon but would need a deferral. His memory and understanding were noted to be poor, and he fixated on things. 08/06/2022 - He attended the psychologist Simon Port without obtaining a referral from his GP. It was documented that he was getting better insight into his anxieties. 17/09/2022 - He was noted to be very anxious. 24/05/2023 - He was approved for another 8 sessions of psychotherapy

Comments: There were no mental state examinations in these GP records and no mention of mood or trauma symptoms. He was not prescribed any antidepressants or psychotropic medications over that timeframe."

1. Medical Assessor Walsh provided his diagnosis and reasons at [19]:
   • post-traumatic stress disorder, as the circumstance of the subject accident is sufficient to meet criterion a. there are sufficient symptoms to meet criterion b to e, with sufficient duration longer than a month, causing significant distress and impairment, and
   • major depressive disorder, as he has had depressive symptoms since the subject accident of mood, appetite, and sleep disturbance.
2. At [20], the Medical Assessor provided his causation and reasons:

"There is a plausible mechanism of injury from the circumstances of the subject accident and the development of psychiatric injuries. The onset of symptoms was immediately after the subject accident and the themes of the symptoms are linked with the accident. association between the psychiatric symptoms and the subject accident. These symptoms remain active. The symptoms reported have remained over time since the subject accident and some of these symptoms worsened after the subsequent accident."

1. At [21], the Medical Assessor noted that the following injuries were caused by the accident:
   • post-traumatic stress disorder, and
   • major depressive disorder.
2. At [23], Medical Assessor Walsh provides his psychiatric impairment rating scale (PIRS) which are reproduced below:

Class 2 and not Class 1 was selected because Mr Khan reported better functioning in this area before the subsequent accident. This is supported by previous PIRS assessments before the subsequent accident indicating that he was functioning better with self-care but required assistance with chores. He had mild impairment. He reported that he was able to care for his hygiene but required help with house chores.

Class 3 and not Class 2 was selected because he has not engaged with his usual activities. Rarely goes out socially and is withdrawn. He had moderate impairment.

Class 1 and not Class 2 was selected because he can travel away from home without a support person and was able to travel overseas since the subject accident.

relationship ended, and his relationships are strained.

Relationship with his partner: He said he was last in a

relationship in 2020, but she ended it because of his

mental health. He said he has not had a partner since.

Relationship with children: He does not have any children.

Relationship with siblings: He said he has 3 sisters in

Sydney. He lives with one of his sisters and has a good

relationship with her. 1 brother lives in Pakistan. He does

not usually speak to them unless his sister telephoned

them and made him talk to them. The last time was 2

months ago. He said in the last 4 years, he has spoken to

Relationship with parents: He reported that he does not

speak to his family despite their insistence. He said in the

last 4 years, he has spoken to his parents a few times

since the subject accident. Relationship with friends: He stated that he does not have any friends now and has not contacted them since the subject accident. He stated that before the injury, he went out with family and friends often.

Class 2 and not Class 1 was selected because he was able to complete a course, albeit with help from his sister. He had mild impairment. He said his concentration has been poor since the subject accident. Since the surgery, he has had to write down reminders. He said he does not read, even in Urdu. He said that he does not pay attention to what people are saying. He said he cannot read for more than 2 or 3 minutes because he is always. He said his sister makes him come out of his room to watch television once a week with her. When asked about enrolling at Strathfield. He said that in March 2024 he obtained a Diploma Automotive Certificate, but his sister helped him. He was doing 2 days 7 or 8 hours of study a week and had to attend in person. He said he had assignments at home once a week and he said he could not recall how many hours those took

Class 2 and not Class 1 was selected because he could continue working until the subsequent accident. He had mild impairment. Work: He said he last worked in January 2024 but was unsure if it was March 2024. He said he worked 20 hours per week doing deliveries then. The documentation noted that in May 2024 he sometimes worked up to 45 hours per week. He said he does not do that work anymore because he had a second accident.

Mr Khan said a support person is required for some of the following activities. Bathing: He said he showers two times a week. He said it was difficult because of pain and fears that he would fall. Cooking: Mr Khan said his sister often makes meals, but he orders food online when she is working. He said he no longer cooks because he walked away from food and forgot to turn the stove off 80% of the time he cooked and burnt food. Household chores: He reported that cleaners attend his home once a week to clean his room, and shared areas downstairs. He said that since the surgery, he cannot clean because of pain. Shopping: He stated that his sister shops because it stresses him. He had mild impairment.

There did not appear to be a change in his social and recreational activities since the subject accident. He had moderate impairment.

He had no deficit, or minimal impairment. He can travel alone locally. He said he has a licence but does not drive since the accident. He said he was frightened in the car. He fears that another car will hit. In a car with another driver, he asks them to slow down. He said he avoids public transport because he feels uncomfortable. He thinks people are judging him and laughing at him. He gets a taxi to go to appointments 1 or 2 times a week alone. The taxi driver will help him if he cannot get out of the taxi. He said his sister goes with him sometimes if she is not working. He had mild impairment.

There did not appear to be a change in his social function since the subject accident. He had severe impairment.

He said that after the second accident, his concentration worsened initially but he can now concentrate for 40 minutes. There appeared to be a worsening of concentration since the subject accident. He had mild impairment.

He is not working at all now. He had severe impairment.

1. The Medical Assessor notes apportionment at [25] for the subsequent accident, noting that for the accident: from the PIRS calculations, 7% has been calculated. For the subsequent accident: 19% - 7%= 12% has been apportioned to the subsequent accident.
2. The Medical Assessor concludes at [27] that as a result of injuries sustained in the accident, Mr Khan sustained a 7% WPI.

1. The Panel summarises the documentation, materials, and medical records upon which it relies in its assessment of Mr Khan and which has not already been produced above.

1. The Panel reproduces the relevant sections of Mr Khan's statement:

"[30]After the accident I began experiencing feelings of hopelessness, worthlessness, and anxiety.

[31] I began seeking psychological treatment with Simon Port, Clinical Psychologist at The Hills Private Hospital around March 2023. I have attended approximately 17 sessions with him and continue seeing him to date.

[32] I also attended one appointment with Dr Jaspreet Singh, Psychiatrist on 14 February 2023, he recommended I continue seeking psychological treatment and suggested I take Endep 10mg for my insomnia and anxiety.

[33] After he prescribed it to me, I took it for about 1 week I did not find it very beneficial. I ceased taking it after the first prescribed amount because it was very difficult to get it reimbursed by the insurer and I could not afford it myself.

[34] My psychological condition continues to decline as a result of the motor accident and the impact it has had on my life.

[35] My mind is always racing, I feel like I am on edge, and this keeps me awake at night leaving me fatigued and tired in the morning.

[36] I relive the accident in my mind constantly, I experience episodes of anxiety and trauma as I remember the accident and the abuse I suffered from the other driver at the scene of the accident.

[37] I see myself trapped and alone, as though there is no way out of this dark place, making my future aspirations disappear from my life.

[38] I live with many limitations now which I fear will continue forever and stop me from returning to my old life or bettering my future. I am grieving the loss of my lifestyle.

[39] I have tried to become better and have attended a range of psychological treatment and anxiety management measures, but I continue to struggle causing me to feel hopeless.

[40] I have been left depressed and afraid of life, I cannot concentrate properly, I am always angry and defensive because this accident has turned my life upside down.

[41] The accident has caused me significant distress I suffer from chronic pain every day, and this keeps getting worse. I am scared to do anything in life in case I make the pain worse.

[42] I cannot better my future in such a state, I do not know how I can better my life with these injuries.

[43] I have lost relationships with my family and friends, including the relationships I had with my sisters and parents.

[44] I live with my sister, but it feels that I am alone, I do not talk to her much anymore or try to have conversations with her I prefer to stay alone.

[45] I have another sister in Sydney who I rarely call or visit anymore.

[46] In the event that I do speak with my family it often ends in an argument because as I am constantly angry and very easily irritated. My relationship with them is now very strained because of my hostility.

[47] I prefer to remain isolated for all activities because it reminds me of all the things I cannot do anymore.

[48] I remain psychologically unfit and restricted to undertake my pre-injury duties, including work, domestic duties, and travel.

[49] As mentioned, I live with my sister so she does the cooking and cleaning, I don't do much anymore I mentally and physically cannot.

[50] This makes me feel even worse about myself because I cannot help her, and she deals with her own physical issues.

[51] The insurer used to provide two hours per week cleaning assistance, but this has now ended despite my current injuries.

[52] I used to study and work very hard now I can only concentrate for short periods of time and lose focus easily.

[53] I had initially been diagnosed with adjustment disorder however my condition has my deteriorated significantly despite months of psychological and psychiatric treatment.

[54] Upon a recent appointment I had with Dr Richa Rastogi, Psychiatrist she diagnosed me with Major Depressive Disorder.

[55] I was never this way before the accident, and I had no pre-existing psychological problems. I was a happy person who worked and studied and had high hopes for my future.

[56] I enjoyed playing sports such as cricket and enjoyed being with my friends and family now all of this has become a farfetched dream and distant memory."

Application for Personal Injury Benefits dated 25 June 2020

1. On his Application for Personal Injury Benefits Form, Mr Khan described the accident as "Other driver is at fault he suddenly attempted to turn without indicator". He recorded injuries to "both legs and hand".

Report of Dr Rastogi dated 31 May 2022 (17 August 2023 report summarised above)

"He presents with adjustment disorder with depressed mood in context of limited movement, pain and vocational compromises. He has financial stress and concerned about his disability and career options in the future. He has not received any psychological treatment so far. His physical condition has also not been stabilised so far."

1. Causation - "Yes, your client has been diagnosed with adjustment disorder from the subject accident."
2. Prognosis - "He has not received any psychological treatment and prognosis is yet to be determined."

Insurer's further supplementary submissions dated 19 September 2025

1. The Panel summarises the submissions of the insurer dated 19 September 2025 by reference to paragraph numbers:

[2]-[4] The insurer submits the report of Dr Alice Chang, dated 19 October 2023, concerns Mr Khan's recovery from the May 2020 accident. The panel is directed to the last sentence of paragraph one: "He has returned to all activities without restrictions." In paragraph three of Dr Chang's report: she notes likely ongoing aches but that if he can perform normal activities without restriction, no further intervention is needed. The insurer emphasises these comments were made before the March 2024 accident.

[5]-[6] The next relevant document is the SIRA Rehabilitation Services Form completed 20 June 2024. Although post-March 2024, it records his pre-accident status and highlights his return to work and studies before March 2024, supporting the inference he was physically and psychologically capable of usual activities. As far as the insurer is aware, Mr Khan has not returned to work since the March 2024 accident.

[7] The insurer refers to specific sections of the abovementioned document:

(a) page 2 - under 'pre-existing factors', Ms Chau records that Mr Khan "had fully recovered before the current injury." This supports the insurer's position;

(b) page 3 - under Diagnosis/injury, "Anxiety/traumatic shock" is sourced to Dr Lam's 4 June 2024 capacity certificate, with psychological symptoms attributed to the March 2024 accident;

(c) page 9 - pre-injury psychological symptoms were "nil difficulties", while current symptoms include nightmares, flashbacks, depression, difficulty sleeping and avoidance, clearly linked to the March 2024 accident;

(d) pages 6-7 - pre-injury capacities for study, work, domestic activities and driving show no limitations, and none attributable to the May 2020 accident, and

(e) pages 10-15 - detailed pre-injury independence contrasted with post-March 2024 incapacity, supporting that he substantially recovered from the May 2020 accident.

[8] The insurer refers to the SIRA Rehabilitation Services Form dated

21 August 2024. Comments on pages 2 and 6-10 again confirm pre-injury capacity versus post-March 2024 issues.

[9] The Application for Personal Injury Benefits, dated 19 March 2024, demonstrates that at the time of injury he was a full-time Uber driver.

[10] The insurer refers to Mr Khan's statement of 27 June 2024, paragraphs 12-13, noting he rented and rode a motorcycle from January-March 2024. Although not fully aligning with Medical Assessor Walsh's record, both confirm he had returned to work before March 2024, supporting recovery from the May 2020 accident.

[11] The insurer submits the combined documents provide irrefutable evidence that by March 2024, Mr Khan had regained capacity for usual work, study and domestic activities. Despite some physical symptoms noted by Dr Chang, he had effectively recovered from the May 2020 accident and had returned to leading a full life.

[12]-[13] The insurer submits the March 2024 accident was a superseding event that overwhelmed any residual effects of the 2020 accident and that taken as a whole, the evidence does not support a finding that the May 2020 accident resulted in psychiatric permanent impairment exceeding 10%.

Insurer's supplementary submissions dated 12 August 2025

1. The Panel summarises the submissions of the insurer dated 12 August 2025 by reference to paragraph numbers:

[2] As a result of the subsequent accident of 18 March 2024, Mr Khan sustained a right tibial plateau fracture and PCL avulsion, treated by ORIF and arthroscopic ligament reconstruction on 22 March 2024. The insurer notes he told Medical Assessor Walsh he had not worked since that accident.

[3] The insurer sets out the documents upon which it relies.

[4] The insurer submits the listed material shows Mr Khan has had significant, persisting physical problems from the March 2024 accident, requiring protracted treatment and substantially impairing daily activities, work capacity and income, the significance of which cannot be downplayed.

[5] The insurer submits these consequences undoubtedly affect his mood and outlook. His mood is also likely impacted by the insurer's denial of liability for damages, which will probably remain unresolved while he continues to suffer problems from the second accident.

[6] In contrast, the insurer submits it is highly significant that by January 2024 Mr Khan had returned to his pre-accident role or similar, suggesting substantial physical and psychological recovery from the subject accident.

[7] The insurer submits there is no causal connection between the March 2024 accident and the subject accident. Rather, the March 2024 accident constitutes a true novus actus regarding both physical and psychological consequences.

1. The Panel summarises the submissions of the insurer dated 6 November 2024 by reference to paragraph numbers:

[1]-[3] The insurer sets out a background to the dispute, noting that the assessment was carried out over two days, being 5 September 2024 and 10 September 2024.

[4] At page 12 of his certificate, the Medical Assessor records that the first assessment on 5 September 2024 was challenging because Mr Khan avoided answering questions; during the second assessment this occurred only occasionally.

[5]-[6] The insurer submits that examples of inconsistencies were identified, including Mr Khan telling Dr Anand on 21 May 2024 that he travelled to Pakistan in December 2023 for two weeks and could get around on a scooter. However, Mr Khan told Dr Walsh he had locked himself away and did not go out. Medical Assessor Walsh noted he could not raise this discrepancy with

Mr Khan and also noted he had told Dr Rastogi in 2023 he could not use his scooter.

[7]-[8] The insurer notes Medical Assessor Walsh considered evidence of a second accident in March 2024, during which Mr Khan fell from his motor scooter after a car tried to overtake him. Mr Khan said he could not walk afterward, became more frightened of cars, initially had a two-minute concentration span which improved to 40 minutes, and experienced anxiety symptoms three times a week after that accident. The insurer submits Mr Khan had clearly recovered from the 29 May 2020 accident sufficiently to return to road travel on a motor scooter.

[9] The insurer notes Medical Assessor Walsh's further observations on page 12: Mr Khan said he last worked in January 2024 but was unsure if it was March; he said he worked 20 hours per week doing deliveries; documentation indicates that by May 2024 he sometimes worked up to 45 hours per week; he said he no longer worked due to the second accident.

[10]-[11] The insurer submits the Medical Assessor obtained clear evidence of

Mr Khan's return to travel and employment, which was important in allocating the appropriate PIRS classes. It further submits the assessor had the relevant documentation and evidence to assess social and recreational activities, travel, social functioning, concentration, persistence and pace, and adaption.

[12]-[13] The insurer submits the Medical Assessor's WPI rating of 7% is appropriate, with the reasons for each category clearly set out at pages 18 and 19. The Medical Assessor then calculated the present WPI and subtracted the pre-existing impairment, which the insurer submits was based on documentation and evidence from Mr Khan.

[14] The insurer submits the assessor's finding of less than 10% WPI, based on examination over two days and the parties' documentation, should not be disturbed and the review application should be dismissed.

1. The Panel summarises the submissions of Mr Khan dated 16 October 2024 by reference to paragraph numbers:

[1]-[5] Mr Khan provides a background to the dispute.

[6]-[7] Mr Khan notes s 7.26 permits an application to the proper officer for review by a panel of Medical Assessors and he relies on Meeuwissen v Boden (2010) 78 NSWLR 143; 56 MVR 453; [2010] NSWCA 253 (Basten JA) for the correct test: the medical assessment (not merely the certificate) may be incorrect in a material respect and that an error need not necessarily change the certificate to be "material".

[8]-[10] Mr Khan submits the Medical Assessor made material errors by failing to apply the Guidelines properly in assessing permanent impairment and he submits these errors satisfy the material error test under Meeuwissen and that these errors could have altered the percentage assessment if the assessment had been lawfully conducted.

[11] Mr Khan relies on Campbell J in Elliott v Insurance Australia t/as NRMA [2014] NSWSC 1848 that a "state of unease" about correctness may suffice to justify review.

[12] Mr Khan submits reasons must give "evident and intelligible justification" per IAG Limited v Sleiman [2017] NSWSC 1346.

[13] Mr Khan submits the errors outlined below would cause a delegate to have a state of unease about Medical Assessor Walsh's assessment.

[14]-[15] Mr Khan submits the Guidelines requires PIRS be used when assessing psychiatric permanent impairment (cl 6.203) and that while PIRS descriptors are illustrative, clear departures from those examples constitute error.

[16] Mr Khan submits Medical Assessor Walsh recorded a subsequent March 2024 accident affecting symptoms and concentration, and that cl 6.34 of the Guidelines restricts taking subsequent injuries into account unless there is objective evidence of a subsequent, unrelated permanent impairment.

[17] Mr Khan submits the Medical Assessor erred by treating the PIRS assessment as though assessing a pre-existing impairment and by the method he used to derive WPI.

[18]-[19] Mr Khan submits cl 6.218 (subtracting pre-existing impairment from current impairment) applies only where a pre-existing psychiatric diagnosis/impairment exists. He further submits the Medical Assessor effectively applied Clause 6.218 in reverse: although finding no pre-existing WPI, he assessed and then subtracted PIRS findings, which was inappropriate.

[20]-[21] Mr Khan submits the Medical Assessor should instead have applied cl 6.34 to account for any objectively evidenced subsequent impairment within a single current-impairment assessment. He submits the correct approach required apportionment or adjustment of each PIRS category to reflect the subject accident, not the method the Medical Assessor used.

[23]-[24] Mr Khan records the Assessor's PIRS history: prior to injury he had social networks, played cricket three times a week, ran, enjoyed cooking, dancing and socialising. The Medical Assessor's history shows loss of relationships and social activity since the subject accident.

[25]-[26] Mr Khan notes the Medical Assessor's internal inconsistency: an initial PIRS table rated social functioning Class 3, yet a later table (page 20) rated it Class 4 while saying "there did not appear to be a change in his social function since the subject accident." He submits this inconsistency is an obvious error: a finding of "no change" cannot coherently sit with a shift from moderate (Class 3) to severe (Class 4).

[27]-[31] Mr Khan submits Class 3 is defined as moderate impairment; Class 4 as severe (unable to form/sustain long-term relationships; pre-existing relationships ended; unable to care for dependants). On the facts taken by the Assessor, he submits that he ought to have been assessed at Class 4.

Mr Khan submits the contradictory findings demonstrate an error requiring review.

[32]-[35] Mr Khan records the Medical Assessor took a history that he cannot read for more than two to three minutes, needs reminders, required assistance to complete a diploma, and that his sister prompts him to attend study. The Medical Assessor allocated Class 2 (mild impairment, able to focus up to 30 minutes), but Mr Khan submits his own history better aligns with Class 3 (moderate impairment, unable to read more than newspaper articles; difficulty following complex instructions).

[36] Mr Khan submits the Medical Assessor's statement that concentration now reaches 40 minutes (post-second accident) is unexplained and conflicts with multiple earlier statements that he cannot read for more than two to three minutes. He further submits the Medical Assessor's truncated/incomplete notes (e.g. unfinished sentence about why he cannot read) undermine the credibility of the concentration findings.

[37]-[38] Mr Khan submits completion of a certificate course with sister's assistance does not demonstrate independent ability to concentrate for >30 minutes and he submits, on the evidence elicited by the Medical Assessor, the impairment is indicative of Class 3.

[39]-[40] Mr Khan submits the Medical Assessor's reasons do not provide "evident and intelligible justification" for selecting Class 2 and that it is unlikely Mr Khan can focus on intellectually demanding tasks for 30 minutes given inability to read for more than two to three minutes.

[41] Mr Khan submits repetition of the incomplete sentence across the report is a non-trivial defect integral to the concentration assessment. He further submits there is cause to suspect error in the Medical Assessor's concentration rating.

[42] Mr Khan submits the Medical Assessor made no allowance for treatment effects despite recording that psychological treatment "improves his mood because he feels relaxed," and yet adopted a 0% treatment adjustment.

[43]-[44] Mr Khan submits cl 6.223 of the Guidelines permits a Medical Assessor to increase WPI by up to 3% depending on treatment effectiveness; this calls for reasoned findings. He further submits the Medical Assessor gave no reasons for adopting a 0% adjustment, which is inconsistent with his own observations of treatment benefit.

[45]-[47] Mr Khan submits the Medical Assessor was required to explain the path of reasoning (relying on Wingfoot Australia Partners v Kocak (2013) 252 CLR 480; [2013] HCA 43; Frost v Kourouche [2014] NSWCA 39; (2014) 86 NSWLR 214; AAI Limited v Fitzpatrick [2015] NSWSC 1108).

[48] Mr Khan submits this failure to provide lawful reasons gives rise to a reasonable cause suspect that the assessment is incorrect in a material respect.

1. Medical Assessor Rikard-Bell and Medical Assessor Singh examined Mr Khan on behalf of the Panel via Audio-Visual Link on 8 October 2025. The findings of the Medical Members of the Panel are reproduced below.

1. An Urdu interpreter was provided who facilitated the assessment (CPN:2BV37B).

1. Mr Iman Khan is a 33-year-old man working three hours per day, five days per week at a pizza restaurant in a cashier role. He resides with his sister, aged 42, who works in administration and he has been living with her for the past seven years. Mr Khan is one of 11 siblings, with three sisters residing in Australia and his parents and other siblings residing in Pakistan. Mr Khan attended Peshawar College in Pakistan and he did well both at school and at university. He completed a masters of commerce and arrived in Australia in 2017. In Australia, he completed a Diploma in business, then worked as a laptop repairer in 2018.

1. Before the accident on 29 May 2020, Mr Khan had commenced further studies at Strathfield TAFE in mechanics and was working 20 hours per week as an Uber delivery driver. He was able to manage his self-care well and he related to friends and family. There were no restrictions with travelling and there were no issues with concentration.

1. Mr Khan presented as a pleasant man of Pakistani origin who appeared somewhat tense due to technical difficulties that were subsequently resolved. His command of English was reasonably good, with assistance from the interpreter when required. His hair was dark and thick and he wore a thick beard. He was neatly groomed and well presented, wearing a black shirt. His speech was normal in tone and volume. There was no abnormality of perception. Mr Khan's affect was reactive. He was a little anxious and irritated and described feeling some depression. His cognitive function appeared normal and his thoughts were logical. There were no delusional ideas and his insight and judgement appeared normal.

1. There is no history of serious illnesses, injuries or conditions before the first accident on

29 May 2020. Following this accident, there have been two surgical procedures on the left ankle on 17 June 2021 and 4 April 2022 by Dr Cheng. Following the second motor vehicle accident on 18 March 2024, he underwent surgery on 21 March 2024 for a fracture of the right tibial plateau and posterior cruciate ligament. The current medication is Endep 10 mg, Panadol and Nurofen as required. There is no family history of psychiatric illnesses and no drug or alcohol issues.

1. There is no history of anxiety, depression or need for treatment from mental health care providers.

1. There was a further motor vehicle accident on 18 March 2024 when riding a scooter, which resulted in an admission to Nepean Hospital and surgery to repair an injury to the right knee then discharged on 15 April 2024. There is no other history of motor vehicle accidents, Workers Compensation claims, insurance claims or legal issues.

1. On 29 May 2020, Mr Khan was riding his scooter as an Uber driver at the time of the accident. He had been working as an Uber driver for about two years while studying a mechanical course. He was working as an Uber driver for 20 hours per week and studying 20 hours per week. During the holiday break, he would work up to 40 or 50 hours. On the day of the accident, Mr Khan stated he noticed that a vehicle had pulled out in front of him on the left hand side and there was a collision when there was an impact with the rear bumper bar. The other driver stopped; however, she was very aggressive and unhelpful. She was threatening him and as a result, Mr Khan phoned his sister and the other driver contacted her husband. Mr Khan stated the situation was very unpleasant and said, "They were harassing me." At the time, Mr Khan's sister was pregnant and he was concerned about overburdening her. He was able to ride the scooter home, although there was damage and it could not be salvaged.

1. On 18 March 2024, Mr Khan was involved in a further motor vehicle accident while working as an Uber driver when a P-plate driver cut across his path, causing him to fall from his scooter. The scooter was badly damaged and Mr Khan injured his right knee. After the collision, Mr Khan was lying on the roadway and the police and ambulance attended. He was transported to Nepean Hospital for examination and treatment for a right fractured tibial plateau, avulsion fracture and posterior cruciate ligament injury. There was surgery on

21 March 2024 to repair the knee and discharged on 15 April 2024.

1. Mr Khan noticed that he was bleeding from his left foot and there was a lot of pain overnight; therefore, he presented to the hospital. In the hospital, he was investigated, but there was no specific treatment recommended. He consulted with the general practitioner either the following day or the day after and an X-ray and MRI showed an ankle injury. There was a consultation with Dr Suzuki, who noted left ATFL damage and he was referred for surgical treatment with Dr Cheng who performed a lateral ligament repair on 17 June 2021 and further surgery on 7 April 2022 with a fibula osteotomy and removal of screws. There was a slight improvement after the first procedure; however following the second procedure, there was still pain. Mr Khan received injections when the pain was not improving, which were problematic as he said, "there were too many injections. There was no improvement." He felt a painful sensation on his skin as cotton would irritate the skin on his ankle. There was significant depression following the first accident due to ongoing pain and discomfort with a low mood, suicidal ideation, weight gain, loss of enjoyment, social isolation and feelings of despair and hopelessness. Mr Khan explained that emotional difficulties related to the chronic pain caused him to feel depressed. There were no previous issues with anxiety or depression and the subsequent motor vehicle accident did not result in psychological difficulties. After the first motor vehicle accident, Mr Khan was prescribed desvenlafaxine for nine months and there were 17 sessions of psychological treatment in 2022 with Simon Port extending from early 2022 to April 2023. I asked Mr Khan about returning to studies and he said that in 2022, he continued his studies at Strathfield TAFE and obtained a Certificate III. With regards to returning to work, Mr Khan stated he did not work at all; however, it is documented that there may have been a few jobs over the following few weeks. He then said he could not remember how long it was before he returned to work, but it was only a month or two before he returned to delivery driving that the second motor vehicle accident occurred on 18 March 2024, and there was partial recovery.

1. Mr Khan described the second motor vehicle as of no significance from a psychological perspective and he has made a full recovery following surgical treatment on his knee. There is full function with no ongoing pain or discomfort from the second accident. Following the second motor vehicle accident, Mr Khan was able to continue TAFE studies and completed a management course from May 2024 to December 2024. There was a negligible impact from a psychological perspective, according to Mr Khan. There was no reported increase in anxiety or fearfulness and he denied worsening of depression after the accident of

18 March 2024. From May 2024 to December 2024, he commenced a management course at TAFE involving one full day of lessons per week, as well as weekly assignments with questions. Mr Khan stated he was able to complete the management course at the end of 2024. During 2025, Mr Khan has been able to work three hours per day, five days per week in a cashier role at a pizza restaurant, as he is required to pay rent to his sister; however, he is only able to work for three hours due to pain when standing.

1. Mr Khan has difficulty with sleep due to pain and there are constant triggers during the night. He goes to bed at 10.00 pm but will wake up consistently throughout the night. He may get up at midday and does not feel rested. There are no particular nightmares or flashbacks; however, the pain reminds him of the motor vehicle accident. He has difficulty dressing as socks will irritate the skin on his ankle and he will spend time massaging his ankle in an attempt to alleviate pain. Mr Khan rated the pain at a constant severe 8/10. He does not go out during the day and does not do a great deal, usually staying home. His sister will do all the cooking as Mr Khan is unable to stand for more than three hours. After dinner, he may prepare some other food, such as noodles or tea. Mr Khan is forgetful at times and worries he will leave the stove on. He does not have close friendships and there is no social interaction, although he may receive a call or visit from an acquaintance at times and the last social outing was approximately two years ago. There is no change to the routine on the weekend.

1. Mr Khan stated that pain is the major problem and that he has constant pain rated at a high level at 8/10, where 10 is the worst. He will use painkillers to reduce the pain, which causes constant stress. He may have additional pain twice per month in his back and shoulders, which is not significant compared to the left ankle pain. There is no residual pain following knee surgery after the second motor vehicle accident and the knee has fully recovered. He is able to stand for three hours, walk for 15 minutes and when sitting, he will constantly adjust his position due to pain. Mr Khan stated that the pain has impacted his brain and how he feels about himself. He is pessimistic about the future, as there are constant difficulties managing pain. He has lost 8kg in weight. Mr Khan's mood is constantly frustrated and low, with suicidal thoughts at times. He finds it hard to enjoy himself and he has lost interest in activities such as sports. He can become panicky when going out or if the pain is worse. He avoids socialising as he does not like talking about his difficulties. Mr Khan is in constant fear that the pain will never improve adequately. There are no OCD symptoms, although there are stomach pains at times. His mind can go blank at times and he feels forgetful.

1. Mr Khan is able to dress, feed and manage himself adequately; however, there are restrictions due to pain and he does not always shower regularly. He finds wearing clothes difficult and he eats takeaway meals. He is able to prepare simple meals when required, although his sister will do most of the cooking and cleaning at home, with whom he has resided for over the past seven years. Therefore, there is mild impairment of self-care and personal hygiene from a psychological perspective, as there is the ability to manage himself; however, pain is an added burden.
2. In terms of social functioning, Mr Khan has resided with his sister for the past seven years and their relationship is solid and positive, although there may be some strain as his sister will do most of the household chores and cooking. He attempts to earn some money so that he can pay rent and assist financially. There are no close intimate relationships and he has lost friendships. Therefore, there is mild impairment of social functioning.
3. In terms of concentration, Mr Khan said he loses focus at times and there will be occasions when his mind will go blank. Nevertheless, he was able to enrol in a course in 2022 and he obtained a Certificate III in mechanical studies, which required full concentration on one day per week and the ability to submit assignments online. He does not enjoy reading but is capable of completing complex tasks, even though he feels he is not functioning as well with concentration as previously. The Panel noted he reported to Medical Assessor Walsh that he was able to concentrate for up to 40 minutes. It was the panel's view that there was mild impairment of concentration, persistence and pace due to the fact that there are episodes when his mind will go blank and he is not as focused as previously.
4. In terms of social and recreational activities, there has been a dramatic decline in the ability to socialise. Mr Khan does not go to the movies or play sports such as badminton. He rarely interacts with friends and he said the major contributor is pain. He said he does not like going out as he experiences pain and he does not like talking about the accident or the pain that he experiences. Mr Khan is not socially active and has withdrawn from social contact. Therefore, without the symptoms of pain, there is moderate impairment of social and recreational activities.
5. In terms of adaptation, Mr Khan is currently working three hours per day, five hours per week at a pizza restaurant and there are limitations due to pain as he is only able to stand for three hours. He is working in a lesser role, less than 20 hours per week, as he is not able to ride a scooter. He has been able to continue with his studies. Therefore, there is moderate impairment of adaptation as he can work part-time in a lesser role and was still able to continue studies.
6. In terms of travel, Mr Khan was able to return to work as an Uber delivery driver on his scooter in early 2024. Therefore, it was the Panel's view that this suggested that he had returned to full function with no impairment of travel from a psychological perspective.

1. Mr Imran Khan was involved in a motor vehicle accident on 29 May 2020 and sustained a significant injury to the left ankle as noted by Dr Suzuki, who diagnosed an ATFL. There were two surgical procedures with Dr Cheng; however, the symptoms did not improve and on 20 September 2024, Dr Home noted 4% WPI regarding the left ankle injury. There was no indication of post-traumatic stress disorder as he did not describe nightmares or intrusive recollections and he was not in fear for his life being preoccupied with pain in his ankle. In addition, there were no internal negative emotions and no hypervigilance. Therefore, it was the Panel's view and confirmed by Mr Khan that he developed major depression following the first accident of 29 May 2020 with psychological distress as a result of chronic pain, loss of functioning and ability to resume work and usual activities causally related to the motor vehicle accident on 29 May 2020. In addition, it was the Panel's view that psychological treatment received from 2022 to 2023 with Simon Port was partially successful and that at the time before the second accident he had shown sufficient improvement to consider he had somewhat recovered psychologically as he was able to continue with studies which he completed in 2022, as well as consider further studies in 2024 and return to work in early 2024.
2. Mr Khan was then involved in a further motor vehicle accident on 18 March 2024, resulting in an injury to the right knee requiring surgery to repair an avulsion fracture of the tibia and posterior cruciate ligament. Nevertheless, despite the knee injury, Mr Khan successfully recovered and there are no ongoing issues with his right knee or additional psychological issues. Therefore, it was the Panel's view and confirmed by Mr Khan, that there was no diagnosable psychological injury attributable to the second motor vehicle accident of

18 March 2024. Mr Khan returned to his previous depressive state causally related to the first accident. Therefore, there was no exacerbation of psychological symptoms or added psychological conditions following the accident on 18 March 2024 and no requirement for an assessment of WPI related to the second accident.

1. In summary, following the motor vehicle accident of 29 May 2020, it is the Panel's view that Mr Khan developed major depressive disorder (F32.0) because there was an inability to continue with pre-accident activities due to pain, resulting in his chosen vocation as a mechanic becoming jeopardised. There was partial improvement with treatment following treatment from the first accident. Following the second accident of 18 March 2024 there was no diagnosable psychological condition attributable to the motor vehicle accident of

18 March 2024. 2. The criteria for major depression from the first accident and continuing according to DSM-5-TR are outlined below:

1. Symptoms over a 2 week period for most of the day, nearly every day, of a depressed mood and loss of interest or pleasure with: * Depressed mood * Markedly diminished interest or pleasure in activities * Significant weight gain * Sleep disturbance * Feelings of hopelessness and negativity about the future * Diminished ability to think or concentrate * Recurrent suicidal ideation 2. Clinically significant impairment in functioning in social, occupational and other important areas of functioning

1. Not due to substance use or other medical condition

1. Not schizophrenia or schizoaffective disorder 2. No episodes of mania or hypomania

1. Major depressive disorder persisting from first accident

Previous psychological counselling, nil current

Mr Khan is able to dress, feed and manage himself adequately; however, there are restrictions due to pain and he does not always shower regularly. He finds wearing clothes difficult and he eats take-away meals. He is able to prepare simple meals when required, although his sister will do most of the cooking and cleaning at home, with whom he has resided for over the past 7 years. Therefore, there is mild impairment of self-care and personal hygiene from a psychological perspective, as there is the ability to manage himself; however, pain is an added burden.

In terms of social and recreational activities, there has been a dramatic decline in the ability to socialise. Mr Khan does not go to the movies or play sports such as badminton. He rarely interacts with friends and he said the major contributor is pain. He said he does not like going out as he experiences pain and he does not like talking about the accident or the pain that he experiences. Mr Khan is not socially active and has withdrawn from social contact. Therefore, without the symptoms of pain, there is moderate impairment of social and recreational activities.

In terms of travel, Mr Khan was able to return to work as an Uber delivery driver on his scooter in early 2024. Therefore, it was the Panel's view that this suggested that he had returned to full function with no impairment of travel from a psychological perspective.

In terms of social functioning, Mr Khan has resided with his sister for the past 7 years and their relationship is solid and positive, although there may be some strain as his sister will do most of the household chores and cooking. He attempts to earn some money so that he can pay rent and assist financially. There are no close intimate relationships and he has lost friendships. Therefore, there is mild impairment of social functioning.

In terms of concentration, Mr Khan said he loses focus at times and there will be occasions when his mind will go blank. Nevertheless, he was able to enrol in a course in 2022 and he obtained a Certificate III in mechanical studies, which required full concentration on one day per week and the ability to submit assignments online. He does not enjoy reading but is capable of completing complex tasks, even though he feels he is not functioning as well with concentration as previously. The Panel noted he reported to Dr Walsh that he was able to concentrate for up to 40 minutes. It was the panel's view that there was mild impairment of concentration, persistence and pace due to the fact that there are episodes when his mind will go blank and he is not as focused as previously.

In terms of adaptation, Mr Khan is currently working 3 hours per day, 5 hours per week at a pizza restaurant and there are limitations due to pain as he is only able to stand for 3 hours. He is working in a lesser role, less than 20 hours per week, as he is not able to ride a scooter. He has been able to continue with his studies. Therefore, there is moderate impairment of adaptation as he can work part-time in a lesser role and was still able to continue studies.

1. There is no apportionment for pre-existing psychological injuries.

1. As a result of psychiatric injuries caused by the accident, Mr Khan sustained a WPI of 7%.

1. The Medical Review Panel held its first meeting on 21 August 2025.
2. The Panel met again to discuss the case at 2.00pm on 24 October 2025. On that occasion, the discussion was between Medical Assessor Rikard-Bell and Member Stern as Medical Assessor Singh was unable to connect on the telephone.
3. Medical Assessor Singh, however, has carefully read the proposed reasons before they were issued and has concurred with the conclusions which the Panel has reached.
4. The Panel individually and collectively arrived at the same WPI figure as Medical Assessor Welsh, but by a different process. Medical Assessor Welsh was of the view that there was a significant reduction of WPI for the subsequent accident of 12%, leaving WPI at 7%.
5. The Panel did not consider that there was any deduction justified as a result of the second accident.
6. The insurer submitted at [5] of the 12 August 2025 submission that it cannot be doubted that the physical injuries from the subsequent accident:

"...adversely affect his mood and outlook on life. Also likely to have upset him and to have affected his mood and outlook on life is the fact that, after he was injured, the insurer denied liability for damages in relation to that accident. It is submitted that situation is probably going to continue for as long as he has problems arising from the second accident."

1. The Review Panel considered the above submission and based on clinical impression of the Medical Assessors and the history that Mr Khan gave them, they formed a different view.
2. After the 2024 accident, Mr Khan reported to the Medical Assessors that he was able to continue his TAFE studies and completed a management course from May 2024 to December 2024.
3. The Medical Assessors formed the view that there was a negligible impact from a psychological perspective and that was what Mr Khan had told them. They accepted that this was consistent and correct.
4. The Medical Assessors commented that in their clinical judgement, there was no reported increase in anxiety or fearfulness, and he denied the worsening of depression after the accident of 18 March 2024. Further, they noted that from May 2024 to December 2024, he commenced a management course at TAFE which involved one full day of lessons per week as well as weekly assignments with questions.
5. The Medical Assessors therefore do not accept the submission that the March 2024 accident played a significant role as argued.
6. The Medical Review Panel concluded that Mr Khan suffered a 7% WPI as a result of major depressive disorder and psychological injury was caused by the accident of 29 May 2020.

1. The Medical Review Panel affirms the certificate of Medical Assessor Gerard Walsh of

18 September 2024 that the following psychiatric injuries sustained in the accident of

29 May 2020 gave rise a permanent impairment of 7%: * major depressive disorder.