MOTOR ACCIDENT INJURIES ACT 2017

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

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

1. The Review Panel revokes the certificate of Medical Assessor Alexey Sidorov dated 7 June 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a WPI of 9%:
   • post-traumatic stress disorder; and
   • substance use disorder (in remission).

1. On 16 July 2021 Mr Paul Leslie (the claimant) whilst driving his vehicle when the at fault vehicle failed to give way and collided with the front of the claimant's vehicle at an estimated speed of 50kph (the accident).
2. Mr Leslie has brought a claim for common law damages under the Motor Accident Injuries Act 2017 (the MAI Act).
3. Youi Pty Limited (the insurer) is the relevant insurer with liability to pay any damages to Mr Leslie under the MAI Act.
4. Section 4.11 of the MAI Act provides that there is no entitlement to damages for non-economic loss unless the degree of permanent impairment of the injured person as a result of the injury caused by the accident is greater than 10%.
5. This dispute is in relation to whether the degree of permanent impairment sustained by Mr Leslie as a result of the injury caused by the accident is greater than 10%. This constitutes a medical assessment matter pursuant to Schedule 2, cl 2 of the MAI Act.
6. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.[1]
7. The dispute as to permanent impairment in respect of the claimant's psychological injury was referred to Medical Assessor Alexey Sidorov. He issued a certificate dated 7 June 2024.

1. The Review Panel issued a Direction to the parties on 7 March 2025 (the Direction) requiring each party to file an indexed, paginated bundle of documents. In response to this Direction the solicitor for the claimant uploaded to the portal a bundle of documents paginated from pages 1 to 315 (claimant's documents). The solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 8 (insurer's documents).

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

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

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

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

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

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

1. The injuries referred to Medical Assessor Sidorov for assessment was:
   • Post-traumatic stress disorder
2. After making a deduction for a pre-existing condition Medical Assessor Sidorov issued a certificate dated 7 June 2024 in which he certified the following injuries caused by the accident gave rise to a whole person impairment (WPI) of 9%:
   • Post-traumatic stress disorder.[3]
3. Medical Assessor Sidorov assessed a current 15% WPI in respect of a post-traumatic stress disorder as follows:
   • Self-care and personal hygiene - Class 2
   • Social and recreational activities - Class 3
   • Travel - Class 2
   • Social functioning - Class 3
   • Concentration, persistence and pace - Class 2
   • Adaption - Class 3.
4. Medical Assessor Sidorov noted the pre-existing diagnosis of post-traumatic stress disorder and despite the claimant's assertion that he was symptom free and functioning well prior to the accident concluded there was evidence that he was experiencing active trauma and associated mood symptoms within one year prior to the accident. He found there was likely evidence of impairment in the categories of self-care and personal hygiene, social and recreational activities, social functioning, concentration, persistence and pace and adaption.
5. Medical Assessor Sidorov deducted 6% WPI for the claimant's pre-existing condition assessed as follows:
   • Self-care and personal hygiene - Class 2
   • Social and recreational activities - Class 2
   • Travel - Class 1
   • Social functioning - Class 2
   • Concentration, persistence and pace - Class 2
   • Adaption - Class 3.

1. The claimant has sought a review of the medical assessment of Medical Assessor Sidorov.
2. The application was lodged on 3 July 2024 within 28 days of the date on which the certificate of Medical Assessor Sidorov was made available to the parties.[4]
3. On 25 July 2024 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Review Panel (the Panel).[5]
4. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[6]
5. The review is by way of a new assessment of all matters with which the medical assessment is concerned.
6. On 21 May 2025 the Panel agreed an examination was necessary.

1. The Police Report described the accident as a "major traffic crash".

1. In the Application for Personal Injury Benefits dated 2 July 2021 the claimant outlined the following injuries:
   • Haemoptysis due to lung compression;
   • Neck and back pain, and
   • Worsening of mental health condition.[7]
2. He reported the following pre-existing conditions:
   • Post-traumatic stress disorder;
   • Anxiety, and
   • Depression.

1. Mr Leslie provided a statement dated 20 December 2022.[8] He reported sustaining a lower back injury in 2010 which progressively rendered him unfit for work until ultimately, he was placed on the Disability Pension.
2. He stated he was diagnosed with post-traumatic stress disorder, depression and anxiety after witnessing a shooting in or about 2012. He stated he managed the conditions intermittently with medication and psychotherapy. He stated those treatments ceased over seven years earlier. He states

"After relocating to Newcastle in 2020 for a fresh start, I can confirm that any related symptoms were well managed and did not impact my ability to complete domestic duties. At this time, I no longer required ongoing support and ceased all forms of treatment. I maintained good social functioning with family and friends whilst regularly participating in hobbies."

1. Mr Leslie states since the accident his self-care deteriorated, he struggles to sleep and experiences intrusive thoughts of the accident. He stated he is no longer motivated to prepare healthy meals. He no longer participates in recreational activities including fishing, going out for lunch or going to the beach. He is hypervigilant and stressed in public places and is apprehensive about leaving the house. He cannot drive independently and cannot use public transport due to his back condition. He described strain in his relationships, difficulty concentrating and loss of focus.

Sa-Cordeiro Medical Practice and Healthsure Medical Centre Jesmond

"Chronic back ache - disc pathology with nerve irritation over the last 10 years. Problem with depression/anxiety.

Life has turned inside out lately with loss of a job.

Unable to handle happy situations with depression and tearfulness. ...

"Nervous breakdown ... after being interviewed by CENTRELINK.

Dependent personality self-medicating with POT/alcohol for sleep"

"Homeless living in a motel (a) the entry on 23 August 2019 makes it clear that the claimant's ongoing psychiatric symptoms stem from the shooting he witnessed over a decade earlier in 2007 / 2008. The entry refers to the claimant being "very agitated" and experiencing "anxiety and panic in severe fear of everyone knowing that he witnessed a murder (shooting)". He continued to experience "fear of reprisals".;

(b) the entry on 26 August 2019 indicates that the claimant was "still very agitated over the revelation of having seen a murder";

(c) the entry on 30 August 2019 reiterates that the claimant's psychiatric symptoms are linked to his fear of the "shooters";

(d) the entry on 26 November 2020 confirms a diagnosis of "PTSD / depression", and

(e) the entry on 9 December 2020 confirms that the claimant's post-traumatic stress disorder began in 2008, at the time of the shooting.

1. The insurer submits that when read wholistically, and in context, it is clear that the claimant did not suffer a transitory period of psychiatric complaints in late 2020 / early 2021, as apparently alleged. Rather, the claimant's clinical records reflect an entrenched chronic

post-traumatic stress disorder / depressive condition which began over a decade earlier when he witnessed the shooting in 2007 and continued to the time of the accident. 2. The insurer refers to the Centrelink Form completed by Dr Phyu Hnin Lwin on 20 February 2021, four months before the motor accident, in support of a carer's allowance. Dr Lwin identified the following conditions of the claimant: * chronic pain due to disc prolapse; * post-traumatic stress disorder, and * depression.

1. The insurer submits Medical Assessor Sidorov stated that:

(a) he did not accept the claimant's claims that he had recovered from his pre-accident post-traumatic stress disorder or that he was functioning well prior to the accident.

(b) he concluded, from his review of the claimant's clinical records, that the post-traumatic stress disorder which started with the shooting in 2007 was still active in the twelve months prior to the motor accident on 19 July 2021.

1. It is submitted Medical Assessor Sidorov correctly applied his clinical judgment in finding that the chronic post-traumatic stress disorder which started in 2007, and which was still active in January 2021, would not have spontaneously resolved by July 2021.
2. The insurer submits that there is clear objective evidence of a pre-existing symptomatic psychiatric impairment at the time of the accident and that Medical Assessor Sidorov correctly found that the claimant's assessment of his pre-accident psychiatric condition was not reliable because it conflicted with the contemporaneous medical evidence. Furthermore, it is submitted Medical Assessor Sidorov applied his clinical judgment in assessing the likely pre-existing impairment.
3. The insurer submits Medical Assessor Sidorov complied with clause 6.41 of the Guidelines when he put the content of the clinical notes to the claimant and recorded his responses.

1. The claimant is a 52-year-old single disability support pensioner who was involved in a motor vehicle accident on 16 July 2021.
2. Before the accident, he "used to cook a lot - I did all the Christmas dinners - no problem".
3. He maintains that his Housing Commission home was in a filthy condition when he moved in.
4. He was not working at the time of the accident. He had stopped working some 10 years back "because the medication I was taking - you can't get a job if you're on morphine... the Palexia... for my back". He had "a prolapsed disc, crushed nerves - a slow progression over the years" from "lifting, carrying, moving" at work. He then went onto the Disability Support Pension. He denied that anything other than his back pain and his medication had stopped him working.
5. He says he drinks alcohol very rarely. He does not use drugs. He smokes heavily.
6. He said he smoked dope when he was young, but had not used it in recent years, including in the time prior to the accident. He denied other drug use. He arced up when his attention was drawn to material in the records contradicting this assertion.
7. He admitted that he had witnessed a shooting some 30 years ago which gave rise to post-traumatic stress disorder. However, he had subsequently worked as a transport manager and had fitted out a number of buildings. However, he maintained, "my pain was managed - I could manage as a human - I could live my life - life as normal". He maintained that he was socially outgoing denying any limitations in this regard.
8. He was asked to describe the incident involving the shooting. He was parked in his car and "saw people shooting". He does not know if the shooters saw him. They did not come after him. The incident was "concerning - worrying - I had my children in the car with Claire... she had come up for the weekend - my son was affected...". The Panel noted evidence in his documentation of prescriptions for various antidepressants, including Cymbalta (Duloxetine), Pristiq (Desvenlafaxine, and Aurorix (Moclobemide) for Endep (Amitriptyline - an antidepressant used in pain management), Quetiapine (a mood stabiliser/ antipsychotic/ anxiolytic) and Olanzapine (a mood stabiliser and antipsychotic).
9. He denied any other history of psychiatric illness before the shooting incident.
10. The Panel noted a reference in the documentation to a strong family history of schizophrenia.
11. He had broken up with his partner Claire some "30 odd years ago". He was vague as to the reasons saying he had separated from her before the shooting. He has two adult sons. He had been in a relationship at the time of the accident and had broken up with her three and a half years ago (that is, subsequent to the accident).
12. He grew up in a single parent family - he had one brother and one sister. His father was not in the picture at all. He "got a couple of beltings as every kid did" but denied abuse - his stepfather was on the scene for about three years. He left home at the age of 17 years.
13. His brother had a serious stroke and is physically dependent.
14. He completed a diploma in engineering from TAFE while at work. He worked as a transport manager and supervisor. He also drove trucks and witnessed accidents more severe than this. He had no other claims history despite his back injury.
15. He completed year 10 studying at home in a Community Support Scheme.

1. On the day in question, he had driven his son to work. It was dark. He saw a car and slowed down. The car drove out of the street and T-boned him from the left. Airbags did not deploy. He "just sat in the car and people came up to the car to see if I was alright - everything was a blur". He does not know if police or ambulance came - he "was in absolute shock". He had to call his son to pick him up - neither car was drivable.
2. He went to the hospital about an hour later, "after I started coughing up blood," and went to Campbelltown Hospital to be transferred to Liverpool Hospital, where he remained for two weeks. He had "whiplash" and "bruised lungs they said from blunt compression".

History of symptoms and treatment following the accident

1. He has been "not very good physically" saying he cannot take his pain medication. He "used to take Palexia for my bad back" but cannot take it anymore because of "serotonin syndrome". He is on Quetiapine, Venlafaxine, Prazosin, and Melatonin. He had previously been on Mirtazapine and Escitalopram which have been discontinued. According to the documentation on hand, he had also been on Fluoxetine and Sertraline.
2. He said, "It's this feeling and it's been ever since the accident - it's my chest - it's rage - it never goes away - this constant panic - anger that never goes away - not for one second... I'm forever yelling - I try to make my cereal, and I spill it and that makes me yell... I don't know why I'm like that over every single thing".
3. In short, he is very irritable; "I can't deal with anything - I just freak out over everything".
4. He complains of nightmares which are "constant all night every night... I take these tablets to get to sleep - I'm lucky to get two hours sleep before I wake up dripping with sweat... I sleep with a fan on me - the nightmares are absolutely crazy - I'm in a car accident and I can't get help and then I crawl up the road and then I'm in hospital and the doctors are panicking because I'm dying - I stay awake maybe three or four hours and I get another hour of sleep - the doctor gave me stronger medication but then I sleep longer through the nightmares... I'd rather not be here, and my mind just goes blank.
5. He feels as though life was not worth living, saying, "I'm tortured every minute of the day when I'm awake" what with "the feelings - the panic - the anger - it's like there's a war in my head... I try to make sense of stupid things in my head...".
6. He has been charged by police for "being angry and stupid" and "taken to hospital to see if I was crazy".
7. The Panel noted that he had been seeing a psychologist and had also consulted psychiatrists in the past.

Details of any relevant injuries or conditions sustained since the accident

1. The claimant was interviewed by Microsoft Teams. He was at his home in Newcastle. Medical Assessors Canaris and Singh were in their respective offices. A good audiovisual connection was established.
2. He presented as a man who looked older than his stated age who wore a hoodie which he kept over his head much of the time but on removing this revealed unkempt and matted grey hair. He had a grey stubble on his chin. He provided the account documented above. He smoked cigarettes during some of the interview. He provided the account documented above and below. His narrative was rambling, repetitive, and disorganised. At times, he shuffled through notes and other times walked around his home and outside. He denied any ongoing fear relating to the perpetrators of the shooting he had witnessed or bikies, saying, "The only thing I'm worried about is cars - doctors - anything to do with any of that stuff". His mood was dysphoric and his affect labile with an irritable edge. He denied suicidal ideation or thoughts of self-harm. Evidence of psychosis or cognitive impairment did not emerge.

1. He is currently much affected by his pain "which always gets worse - just to stand or move or walk - everything hurts - I can't sit in the one position for very long". He is presently on "some new tablets to try but they don't do anything... Celecoxib - they don't help... the only thing that helped was the really strong ones...".
2. He was much dependent on the support of his ex-partner Claire, who came up for a week at a time, cooking and cleaning for him. When she is not there, he is on the phone to her every day. He does no cooking and cleaning. He showers and changes his clothes every four to six days "when I have to". He had root canal treatment started on his teeth five years ago "and I couldn't go back to get it finished... I got holes that are hurting". He was vague as to who had been paying for his intended root canal. His appetite is poor ("I don't eat a lot"), but he has been on tablets that made him gain weight, although these have been changed, and he is again losing weight. He would "sometimes not eat for two days".
3. His ex-partner travels up by train to be with him. He occasionally travelled to see her - he says his youngest son would drive him down. He had been with a girlfriend up until three and a half years ago. He broke up with her "because of my head". His relationship with his sons is not good - he got angry with one son because he bought a motorbike. He said, "I can't be a father to my own children or grandfather...". It seems one of his sons may have called police on him "because I was angry and yelling" resulting in his being charged; "I had to go to court on Valentine's Day".
4. He describes himself as "confined to this house - to this yard - since the accident". He would "try to go to the shops here and there but that always goes bad..." Attributing this to "the people - the cars...". He tries to go to the shops when Claire is there and has occasionally tried to go to the shops but only with Claire on the phone. He spoke of having "tried everything - all this exposure therapy - it just doesn't work". He is very apprehensive of other drivers. He says his doctor is "in the middle of trying to organise a support worker to organise all these things for me".
5. He does not go out socially. "Not since the accident - I don't even play darts - I didn't have sports that I could do because of my back but darts was one of them" and he maintained that he played darts up to twice a week before the accident ("It was sort of seasonal") and he last played darts "four and a bit years ago...back down in Sydney".
6. He is now "a mess" and "stupid - my brain is spastic - I can't remember anything - I can't do anything - I put things in the wrong places - I put milk in the cupboard or tea in the fridge - I mess up everything I do - it doesn't make sense". He "can't watch the news - the television shows I like - the news are all about accidents and death - I try not to watch too much television or listen to the radio - that's about it". His memory "used to be perfect" but now he says he forgets things he is doing "or when I go to do something, I forget I was going to do it".

1. The Panel noted the inconsistency between the history he provided in relation to recent substance use and evidence in the records. The Panel drew his attention to an entry in September 2020 which stated that he was still smoking pot and that he was drinking Bourbon heavily. He emphatically denied that he smoked pot or drank Bourbon at this time.
2. The Panel drew his attention to his GP's records, indicative of active post-traumatic symptoms even in the time recently preceding his accident. The Panel also drew his attention to the history he provided in hospital in relation to his previous diagnosis of post-traumatic stress disorder noting he had stated this coupled with pain was the reason he was not working. He responded, "I could live my life - I was sleeping - I was working...". It was pointed out to him that the records suggested he was quite unwell. He replied, "I didn't think I was that bad - I could drive my car - I could do my shopping - I could live my life". He was referred to entries that suggested he was at times housebound. He said, "It was a slow progression with the painkillers - when I could finally get the Palexia and that, I could manage the pain".
3. In relation to his difficulties in 2020, he said he had accepted a Housing Commission home - he had been homeless. He found the house was "very neglected" attributing the neglect to the condition of his home.
4. The Panel asked how he came to be homeless. He said, "I was staying at Claire's and my son assaulted me... he lived at Claire's...". He had lived there over "the last couple of months". At the time, he was "living on a friend's property - moved to Claire's...". He moved from his friend's property for reasons that were not clear but "apparently people weren't supposed to stay there...". He had been on that property "for a long time... years here and there - I lived at my mother's...".
5. Due to his agitation, disorganisation, and chaotic presentation, the Panel was unable to thoroughly examine each point of inconsistency in relation to his account of pre-accident functioning and the available documentation.

1. The Panel considered a diagnosis of posttraumatic stress disorder and determined that the accident because of his physical injuries was in keeping with a Criterion A event as per the DSM-5-TR. It noted the presence of recurrent, intrusive, and involuntary recall of the accident manifested in nightmares and high anxiety in relation to motor vehicles (Criterion B) coupled with persistent avoidance of stimuli manifest in his avoidance of cars, his inability to watch news items involving motor vehicle accidents, and his difficulties going out of his house (Criterion C). There was evidence of negative alterations in cognitions and mood manifested in his perception that life was not worth living and his allusion to being "tortured" by "the war in my head" as well as his marked social withdrawal (Criterion D). There was clear evidence of marked alterations and arousal and reactivity marked by irritability and angry outbursts, hypervigilance, problems with concentration, and sleep disturbance (Criterion E). His disturbance caused clinically significant distress and psychosocial impairment as manifest in his presentation at interview and impairment in a range of aspects of his day-to-day life (Criterion G). Finally, there was no evidence that his disturbance was attributable to the physiological effects of a substance or to another medical condition (Criterion H).
2. The Panel noted evidence of a substance use disorder in apparent remission.
3. The Panel noted indications in the documentation and from aspects of the history of the presence of possible Cluster B personality traits but declined to make a diagnosis of personality disorder.

1. The Panel noted the presence of a prior post-traumatic stress disorder diagnosis and evidence of impairment associated with this in the documentation on hand. Nevertheless, given the nature of the accident and injuries sustained coupled with the presence of ongoing symptoms specific to that event, the Panel determined that the subject accident had given rise to an exacerbation of pre-existing posttraumatic stress disorder with the emergence of symptoms specific to the accident.

1. Given the passage of four years since the accident over which time he has had ongoing access to appropriate treatment, the Panel determined that the claimant's condition had stabilised and that his current level of impairment was permanent in that it was unlikely to change substantially or by more than 3% over the next year.

He was much dependent on the support of his ex-partner Claire who come up for a week at a time cooking and cleaning for him. When she is not there, he is on the phone to her every day. He does no cooking and cleaning. He would shower and change his clothes every four to six days "when I have to". He had root canal treatment started on his teeth five years ago "and I couldn't go back to get it finished... I got holes that are hurting". He was vague as to who had been paying for his intended root canal. His appetite is poor ("I don't eat a lot") but he had been on tablets that made him gain weight, although these have been changed, and he is again losing weight. He would "sometimes not eat for two days".

Comment: The Panel noted his unkempt and dishevelled appearance as well as his dependence on the regular support of his ex-partner Claire. It noted that he had deteriorated in his functioning in this category since seeing Medical Assessor Sidorov. Using clinical judgement, all this equated to Class 3.

He does not go out socially ("Not since the accident - I don't even play darts - I didn't have sports that I could do because of my back but darts was one of them") and he maintained that he played darts up to twice a week before the accident ("It was sort of seasonal") and he last played darts "four and a bit years ago...back down in Sydney".

Comment: The Panel noted his agitation and lability of affect which it determined would be a major barrier to social engagement.

He describes himself as "confined to this house - to this yard - since the accident". He would "try to go to the shops here and there but that always goes bad..." Attributing this to "the people - the cars...". He tries to go to the shops when Claire is there and has occasionally tried to go to the shops but only with Claire on the phone. He spoke of having "tried everything - all this exposure therapy - it just doesn't work". He is very apprehensive of other drivers. He says his doctor is "in the middle of trying to organise a support worker to organise all these things for me".

Comment: Using clinical judgement, the fact that is able occasionally to venture outside his home albeit with his ex-partner's support places him in Class 2 in this category.

His ex-partner travels up by train to be with him. He occasionally travels to see her - he says his youngest son would drive him down. He had been with a girlfriend up until 3 1/2 years ago. He broke up with her "because of my head". His relationship with his sons is not good - he got angry with one son because he bought a motorbike. He said, "I can't be a father to my own children or grandfather...". It seems one of his sons may have called police on him "because I was angry and yelling" resulting in his being charged because of which "I had to go to court on Valentine's Day".

He is now "a mess" and "stupid - my brain is spastic - I can't remember anything - I can't do anything - I put things in the wrong places - I put milk in the cupboard or tea in the fridge - I mess up everything I do - it doesn't make sense". He "can't watch the news - the television shows I like - the news are all about accidents and death - I try not to watch too much television or listen to the radio - that's about it". His memory "used to be perfect" but now he says he forgets things he is doing "or when I go to do something, I forget I was going to do it".

Comment: The Panel noted his agitation and lability of affect and his overall chaotic and disorganised presentation. It noted that his presentation was considerably worse than when seen by Assessor Sidorov. Using clinical judgement, it determined he had Class 3 impairment in this category.

While he had not worked for many years and was on the Disability Support Pension, he was manifestly not employable in any capacity whatsoever in his current condition and his levels of disorganisation and chaos as a historian. He was also not functioning in his role as homemaker, father, and grandparent. However, the Panel noted the contribution of pain which is not assessable for the purposes of whole person impairment. Using clinical judgement, it rated him as Class 4.

1. While the Panel noted the claimant's assertions that he was functioning well before the accident and that he had not been working because of pain from his physical injury, it considered the medical documentation which indicated significant presentations with agitation, anxiety, and panic symptoms as well as presentations linked to his fear of shooters. It noted also his NDIS application dated 13 January 2021 which documented social anxiety. On 20 February 2021 Dr Lwin reported the claimant had come in with a friend. Dr Lwin reported the claimant's son had been looking after him, but he had found a job and he needed a new carer. There was an application for a carer allowance dated 20 February 2021 which provided diagnoses of chronic pain due to disc prolapse, post-traumatic stress disorder, and depression and noted the presence of social anxiety. The latter paperwork confirms the presence of ongoing psychiatric symptoms and associated impairment although it is not clear from this how much is psychological and how much is physical in origin.
2. The Panel considered it significant that he had told hospital staff at the time of his accident that he was on the Disability Support Pension because of both his back injury and his post-traumatic stress disorder.
3. The Panel considered that the claimant was not a reliable reporter in relation to his

pre-accident levels of impairment. While it accepted that there had not been any mental health presentations documented between 20 February 2021 and the accident on 16 July 2021, it considered it improbable that symptoms and impairment that had been present for 30 years were no longer present as this was not in keeping with the natural history of chronic post-traumatic stress disorder. It considered it likely that symptoms and impairment evident over the 12 months preceding the accident would have been substantially present over that time. 4. The Panel assessed the pre-existing impairment as follows:

He had stated that he was independent in relation to these activities before the accident. However, the Panel noted an email from the claimant to his GP dated 18 January 2021 clarifying that he had a carer to help him with cooking, cleaning, and general assistance. While it would appear from this email that some of his impairment related to his chronic pain, the email also refers to his chronic depression, post-traumatic stress disorder, and anxiety. Using clinical judgement, the Panel determined this to be consistent with Class 2 in this category.

While he maintained that he was socially outgoing, the panel noted his NDIS application dated 13 January 2021 which noted that he needed assistance with "social interaction" because he had "social anxiety". The panel also noted the claimant's email to his GP dated 18 January 2021 relating to his NDIS application in which he referred to among other things his "phobia of people". In the absence of more specific information, using clinical judgement, the Panel determined this to be consistent with Class 2 impairment in this category.

He denied impairment in this category and there was no evidence in the documentation to suggest otherwise.

The Panel asked how he came to be homeless. He said, "I was staying at Claire's and my son assaulted me... he lived at Claire's...". He had lived there over "the last couple of months". At the time, he was "living on a friend's property - moved to Claire's...". He moved from his friend's property for reasons that were not clear but "apparently people weren't supposed to stay there...". He had been on that property "for a long time... years here and there - I lived at my mother's...".

Comment: The Panel noted that he had been in a relationship at the time of the accident. However, the history he provided in relation to his homelessness was consistent with Class 3 impairment in this category given reported violence and the instability of his life situation. It noted also in this context documentation in his clinical file that his mood in the months preceding the accident was labile and that he was drinking large amounts of bourbon and smoking cannabis. While it noted that the claimant disputed this history, the Panel considered that he was an unreliable historian in this regard.

While the claimant maintained that he functioned well in relation to this category, the Panel noted his chronic post-traumatic stress disorder with numerous presentations with labile mood and agitation as well as his heavy consumption of alcohol and cannabis coupled with substantial doses of opioid analgesics all of which was likely to cause substantial impairment in this category. The Panel considered the claimant to be an unreliable historian and using clinical judgement determined he had Class 3 impairment.

He was not working at the time of the accident. He had stopped working some 10 years back "because the medication I was taking - you can't get a job if you're on morphine... the Palexia... for my back". He had "a prolapsed disc crushed nerves - a slow progression over the years" from "lifting - carrying - moving" at work. He then went onto the disability support pension. He denied that anything other than his back pain and his medication had stopped him working.

Comment: The Panel noted documentation indicating that he had stopped work both because of pain and because of post-traumatic stress disorder. Using clinical judgement, it determined that he had Class 3 impairment in this category.

Apportionment - pre-existing/subsequent impairment

1. He has 22% whole person impairment of which 13% is attributable to pre-existing psychiatric injuries.

1. The Panel made no adjustment for treatment effects.

1. The Panel revokes the certificate of Medical Assessor Sidorov dated 7 June 2024 and issues a new certificate determining that the following injuries caused by the motor accident give rise to a WPI of 9%:
   • post-traumatic stress disorder
   • substance use disorder (in remission).

[5] Section 7.26 of the MAI Act; Claimant's bundle p 9.

[41]42 Insurance Australia Limited t/as NRMA v Richards [2023] NSWSC 909

[43] Australian Broadcasting Tribunal v Bond (1990) 170 CLR 321; [1990] HCA 33 at 367