Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. revokes the certificate of Medical Assessor Chew dated 31 October 2024, and
2. certifies that the psychological or psychiatric injury caused by the motor accident on

30 December 2018 is not a threshold injury for the purposes of the Act.

A statement setting out the Panel's reasons for the assessment is included with this certificate.

The certificate and reasons were first issued to the parties on 19 December 2024. The claimant sought the correction of an error in order 1 and the insurer did not object. The Panel has, as a result, issued this replacement certificate correcting the obvious error.

1. Mohammed Msallam was involved in a motor accident on 30 December 2018. He was apparently driving a motor vehicle and was stationary at traffic lights when another vehicle ran into the back of his.
2. Mr Msallam says he injured his neck, back, left and right hand, arm and shoulder and right and left legs in the accident. The claimant also alleged he has developed a chronic pain syndrome, right sided tinnitus, hearing loss and psychiatric or psychological conditions as a result of the accident.
3. Mr Msallam made a claim for statutory benefits and then damages against GIO, the third-party insurer of the vehicle he says caused his accident and his injuries.
4. A medical dispute about whether the claimant's injuries were threshold injuries arose in connection with the claims and Mr Msallam referred that dispute to the Personal Injury Commission (the Commission) for assessment.
5. On 31 July 2023, Medical Assessor Hong diagnosed the claimant had an adjustment disorder and determined that Mr Msallam's psychological injuries were threshold injuries. The claimant lodged an application for a further medical assessment which was permitted and on 31 October 2024, Medical Assessor Chew also determined that the claimant's psychological injuries were threshold injuries.
6. The claimant has lodged an application with the Commission seeking a review of Medical Assessor Chew's decision. On 18 December 2024, Ms Baba, a delegate of the President determined there was reasonable cause to suspect a material error in the assessment and allowed the Review. The President's delegate convened a different Panel to conduct the Review. The current Panel was convened on 15 July 2025.
7. The assessment has been complicated by the fact that the claimant had an earlier accident on 6 August 2018 and he had made a claim in respect to injuries sustained in that accident. The claimant referred a medical dispute about permanent impairment to the Commission in that claim and that dispute was on Review and also before this Panel.

1. On 18 June 2025, the previous Panel had issued directions to the parties in both disputes for the production of documents relevant to the Reviews.
2. The current Panel met on 3 September 2025 and reported to the parties the next day. The Panel noted the issue of causation and contribution raised by the insurers both claims and determined that the Panel would hear both Review Panel proceedings together.
3. The Panel refers to the summary of the procedural matters contained in paragraphs 36 - 41 in the related proceedings involving NRMA and adopts that summary into this decision.

1. Mr Msallam's claim against the GIO is governed by the provisions of the Motor Accident Injuries Act 2017 (the MAI Act). This legislation provides a scheme for the compulsory third-party insurance of all motor vehicles registered in New South Wales and a scheme of statutory benefits (under Part 3) and compensation by way of lump sum damages (under Part 4) for persons injured in motor accidents in New South Wales.
2. While almost all injured persons are entitled to some statutory benefits in accordance with Part 3 of the MAI Act, there are some disentitling provisions and limits to the amount and extent of benefits payable. One of these restrictions is that if the only injuries sustained by the injured person are "threshold" injuries, the injured person cannot receive statutory benefits beyond 26 weeks after the accident.[1]
3. For those persons injured due to the fault of the owner or driver of a motor vehicle in the use or operation of that vehicle, a claim for damages can be made however, damages cannot be recovered if the claimant's only injuries are "threshold" injuries.[2]

1. A threshold injury is defined in s 1.6(1) of the MAI Act as a "soft tissue injury" and "a psychological or psychiatric injury that is not a recognised psychiatric illness".
2. Section 1.6(4) provides that regulations may be made to exclude or include a specified injury as a threshold psychological or psychiatric injury. Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the Regulation) says a threshold injury includes an acute stress disorder and an adjustment disorder.
3. Section 1.6(5) says that the Motor Accident Guidelines (the Guidelines) may provide the method of assessment for threshold injuries. The Guidelines[3] provide:

"[5.10] In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.

[5.11] The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), published by the American Psychiatric Association."

1. The Guidelines provide the method of determining whether an injured person's mental health disorder is a recognised psychiatric illness or not. If the claimant has a disorder that is not recognised in the DSM-5-TR, that injury must be a threshold injury.
2. The method set out in the Guidelines (DSM-5-TR) also provides for the diagnosis of an adjustment disorder or acute stress disorder. While they are both psychiatric illnesses recognised in DSM-5-TR, they are both threshold injuries in accordance with the Regulation.

1. If there is a dispute about whether an injured person's injuries are threshold injuries or not, that matter is declared a medical assessment matter which may be referred to the Commission for determination.[4]
2. Chapter 7, Division 7.5 of the MAI Act provides for medical assessments by the Commission including provisions relevant to an original medical assessment such as Medical Assessor Hong's, further medical assessments such as Medical Assessor Chew's and the review of medical assessments by this Panel.[5]
3. Where there is evidence establishing that the accident caused a non-threshold injury, at any time after the accident, a finding must be made that the accident caused a non-threshold injury even if the injury has healed, or the claimant has recovered from the injury, or the condition is in remission at the time of the medical assessment.[6]

1. Medical Assessor Chew examined the claimant on 31 October 2024 and issued his certificate the next day. The Medical Assessor confirms at [2][7] that he was asked to assess an adjustment disorder persistent depressive disorder. He noted at [3] and [4] that Medical Assessor Sidorov diagnosed a persistent depressive disorder in respect of the 6 August accident and that Medical Assessor Hong has diagnosed an adjustment disorder in respect of the current accident.
2. Medical Assessor Chew has a history of the claimant being 52 years of age, living on his own, in receipt of the Disability Support Pension following an electrocution accident and that he is an Australian citizen.
3. The history was given that the claimant was born in Palestine and grew up on the Gaza strip but says he was not exposed to conflict (treatment records suggest to the Panel he was exposed to conflict). The claimant said he lived in Russia from 1990 to 1997 where he qualified as a doctor and returned to Russian 2010 for three years in order to obtain his master's degree (the Panel notes other histories suggest he returned to Russia earlier than that and stayed for two years only). The claimant said at the time of the accident he had been preparing to sit the exams in order to practice in Australia but was driving taxies and Ubers (the Panel notes the claimant indicated at the re-examination that he sat the Australian Medical Council AMC exams after the 6 August 2018 accident and before the 30 December 2018 accident).
4. The claimant said he was electrocuted at work as a cleaner in 2012 (the Panel notes this date is wrong) and had pain in his left arm, shoulder and leg which resolved by 2017. The claimant initially denied any psychiatric injuries before the accident but then confirmed he did have post-traumatic and anxiety symptoms before the motor accident.
5. He gave a consistent history of the Newington College accident (6 August 2018) and said he developed anxiety, nightmares, hyper vigilance and anxiety about driving after this accident.
6. The claimant described the current accident as an impact from the rear by a car attempting to drive around his stationary vehicle.
7. The claimant said he went straight to his doctor with worsening neck and shoulder pain. He said he developed issues with Glaucoma and had surgeries in 2019, 2020 and 2021. The claimant said he currently has pain in his neck, shoulder, headaches and face and has ongoing anxiety and poor sleep. He sees his psychologist monthly and has been prescribed mirtazapine.
8. Medical Assessor Chew noted the claimant was able to live independently, drive in his local area and that in 2022 he travelled to Gaza to visit family and remains in communication with them. He did note the claimant reported becoming more socially withdrawn.
9. Medical Assessor Hong diagnosed an adjustment disorder made chronic because of ongoing pain but gave limited reasons. He said Mr Msallam did not have an ongoing persistent depressive disorder.

1. The claimant says at [12] that the medical examination took 15 minutes, five minutes for the claimant to confirm his identity and 10 minutes for the remainder of the discussion.
2. The claimant submits at [14] - [15] that Medical Assessor Sidorov had diagnosed a persistent depressive disorder in the first accident exacerbated by the second accident. The claimant says the Medical Assessor has not explained why the claimant did not have another significant injury such as a post-traumatic stress disorder or other depressive disorder and that the reasons are "opaque".
3. The claimant submits at [19] that the criteria from DSM 5 were not outlined and addressed and that at [20] the claimant understand the reasons.
4. The claimant then submits that the Medical Assessor has not considered the common law test of causation or the 2007 "Permanent Impairment Guidelines" treatment of causation.

1. The insurer's first submissions dated 16 December 2024 document at [1] the history of the medical assessment process in this matter. The insurer submits at [3] that other Medical Assessors have diagnosed adjustment disorder and that Medical Assessor Chew has given reasons for why the claimant did not have a persistent depressive disorder. The insurer says the Medical Assessor is not under a duty to consider other disorders.
2. The insurer submits at [3.8] - [3.11] that the Medical Assessor had the report of Medical Assessor and his previous reasons which are not vague or opaque.
3. The insurer says at [3.12] - [3.15] that Medical Assessor Chew was required to assess threshold injury not impairment and that the Permanent impairment guidelines are not relevant.
4. The insurer lodged additional submissions dated 8 July 2025 summarising all of the medical assessments completed in respect of Mr Msallem's two accidents noting that four of them diagnosed an adjustment disorder and only one (Medical Assessor Sidorov) diagnosed a different disorder namely a persistent depressive disorder arising from the first accident.
5. The GIO says this supports a finding that the claimant has sustained a threshold injury only.

1. The Panel adopts the Review of Evidence documented at paragraphs 49 - 157 in the decision in the related (NRMA claim) proceedings.

1. The claim form was signed as true and correct on 26 March 2019. The claimant was, at that time 48 years of age. He disclosed his NRMA accident and provides details of the accident. He says he was stationary at red traffic lights and saw a red vehicle behind him. He heard a beep from that vehicle, but the light was still red. He then felt a "bump" and a "bang noise" from the red vehicle which then drove off.
2. Mr Msallam listed his injuries as:

(a) neck;

(b) arms;

(c) shoulders;

(d) hands / sweating / numbness;

(e) head;

(f) back;

(g) pain radiating from back to both legs, and

(h) psychiatric / psychological injuries.

1. He disclosed the following injuries from the previous 2018 accident namely "neck, shoulders, hands, back, psychiatric/ psychological".
2. Mr Msallam said he had not been away from work as a result of the accident and that he was a part time taxi driver earning $250 a week and that he was also receiving the disability support pension.
3. A copy of the claimant's damages claim has also been provided along with the insurer's liability notices. In addition, the claimant's request for an internal review and the internal review decision has also been provided.
4. The police report appears to have been based on the claimant's report only as the police may not have attended the scene of the accident. The police report says the claimant was stationary at a red traffic light and that the car behind him went to go around the claimant's vehicle collided with the rear offside of the claimant's vehicle and then made a left turn in front of the claimant in breach of a red traffic light. The report says, "the collision caused small dint and red coloured scratches to rear offside of the Toyota."

RE-EXAMINATION FINDINGS - MEDICAL ASSESSORS CANARIS AND BAKER

1. The Panel adopts the re-examination findings documented at paragraphs 158 to 220 of the statement of reasons in the related proceedings (relating to the NRMA claim).

1. The Panel refers to the finding made in relation to the reliability of the claimant's evidence found at paragraphs 221 - 228 of the reasons in the related Review Panel proceedings and adopts those findings into these reasons.

1. Before undertaking an assessment of whether the claimant's injuries are threshold or not, the Panel must first determine what the injury was that was caused by the accident.
2. Causation is determined by considering whether the accident could have caused or materially contributed to an injury or worsening of a condition and whether it did in fact cause or materially contribute.
3. The Panel notes the accident was a rear-end collision caused by another driver who attempted to go around the claimant who was driving his car but stationary at the time at traffic lights. The claimant was able to drive away and the police report suggests there was very little damage to his car. Emergency services did not attend, and the claimant did not go to hospital.
4. Whilst the Medical Assessors are of the view that most people would be unlikely to have developed a psychiatric disorder as a result of this accident, the Medical Assessors note the claimant's long pre-accident history and his vulnerability to further injury. It is the clinical judgment of the Medical Assessors that the circumstances of the claimant's

30 December 2018 accident, could have caused or materially contributed to a further psychological injury. 5. The claimant has been diagnosed by Medical Assessor Gorman as having sustained a number of physical injuries some of which are still symptomatic. The Panel notes Mr Msallam first reported the car accident to the doctors at Alzahraa Medical Centre on 24 and 25 January 2019. It was not mentioned to Dr Mazzaferro at Arncliffe until 22 March 2019. The claim was not made until 25 March 2019 but psychological or psychiatric injury was listed as one of the injuries sustained in the claim form. 6. Based on the report to Alzahraa about three weeks after the accident and noting the psychological symptoms do not often present immediately after an event, the Panel is satisfied that the claimant did develop psychological symptoms after the accident on

1. The Panel adopts into these reasons the findings recorded at paragraph 233 to 255 in the reasons of the related (NRMA) review in particular paragraph 253 and also paragraphs 305 to 314.
2. The claimant has been diagnosed as suffering from a major depressive disorder after the accident on 6 August 2018 being a recurrent episode of mild severity.
3. It is the clinical judgment of the Medical Assessors that the consequences of the

6 August 2018 accident had not fully remitted when Mr Msallam was involved in the accident on 30 December 2018. 4. Mr Abaie records on 3 April 2019 an increase in symptoms after the 30 December 2018 accident as does Ms Dawidar in August 2023. The claimant's medication was adjusted to a higher dose after the accident. It is the clinical judgment of the Medical Assessors based on the symptoms reported by the claimant to his treating psychologists; the list of injuries included in his claim form and the claimant's history at the re-examination that the claimant's major depressive disorder was exacerbated by the current accident. 5. It is the clinical judgment of the Medical Assessors however that the 30 December 2018 accident only temporarily exacerbated the claimant's major depressive disorder. The medical records indicate that the claimant's complaints of symptoms and his overall medication regime continued after the 30 December 2018 accident and the claimant's level of functioning has not changed after this accident when compared to the claimant's level of functioning after the 6 August 2018 accident and before the current accident. 6. The Medical Assessors considered but discounted the possibility of a post-traumatic stress disorder due to the minor nature of the accident. The Medical Assessors also discounted the diagnoses of adjustment disorder and persistent depressive disorder for the same reasons as set out in the related decision. It is the Medical Assessors preferred diagnosis of a major depressive disorder with the 30 December 2018 accident causing a recurrent episode.

1. An injury which exacerbates or aggravates a pre-existing condition is still an injury.
2. Mr Msallam has been diagnosed with a major depressive disorder as a result of the

6 August 2018 accident. A major depressive disorder is not a threshold injury within the meaning of s 1.6(1) of the Act as it is a disorder recognised in the DSM-5-TR. A major depressive disorder is also not a threshold injury within the meaning of the Regulation because it is not one of the two disorders specified as threshold injuries in cl 4(2). 3. Mr Msallam's injury from the 30 December 2018 accident was an injury which exacerbated a pre-existing Major Depressive Disorder. Decisions of two other Panels, Todev v AAI Limited t/as GIO and AAI Limited t/as GIO v Hoblos[9] determined that if the evidence establishes that a later accident caused or materially contributed to a worsening of a pre-existing non-threshold condition, that aggravation or exacerbation injury will also be a 'non-threshold' injury. The Panel is not aware of any decisions coming to an alternative view and follows the reasoning held by those Panels. 4. Following the Panels' reasoning in Todev and Hoblos, Mr Msallem's exacerbation injury is not a threshold injury. 5. As the Panel has come to a different outcome to that of Medical Assessor Chew it follows that his certificate should be revoked.

[1] Sections 3.11(1) and 3.28(1) of the MAI Act. Note that due to the date of the claimant's accident he is only entitled to 26 weeks of statutory benefits whereas had his accident occurred after 1 April 2023 he would be entitled to 52. At the time he made his claim the terminology adopted in the legislation for a threshold injury was a "minor" injury. For simplicity the term threshold injury will be used in this decision.

[3] The current version of the Guidelines is version 9.3.

[4] Schedule2, clause 2(e) in the MAI Act.

[5] Sections 7.20, 7.24 and 7.26 of the MAI Act.

[6] See Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6.

[7] The numbers in square brackets are a reference to the section number in the Medical Assessor's reasons.

[8] The numbers in square brackets are a reference to the paragraph number in the submissions. While the

[9] See [2023] NSWPICMP 108 and [2023] NSWPICMP 210.