Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Medical Review Panel revokes the Certificate of Medical Assessor Alexey Sidorov of

5 August 2024 and substitutes the determination that, as a result of injuries sustained in the accident, Ms Danica Murgoska (the claimant) suffered permanent impairment of 19%.

1. On 25 May 2019, the claimant, Danica Murgoska (Ms Murgoska), was born in Macedonia and came to Australia about 52 years ago.
2. Ms Murgoska alleges that she was injured both physically and psychologically in an accident which took place on 23 May 2019 (the accident).
3. QBE Insurance (Australia) Limited (the insurer) was the relevant third-party insurer.
4. A medical dispute has arisen about the degree of Ms Murgoska's whole person impairment (WPI) resulting from the psychological injuries alleged to have been sustained in the accident. This constitutes a medical assessment matter under Schedule 2, cl 2(a) of the Motor Accident Injuries Act 2017 (MAI Act).
5. 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.
6. The dispute was referred to the Personal Injury Commission (Commission) which then assigned it to Medical Assessor Alexey Sidorov for assessment.
7. Medical Assessor Sidorov issued his certificate on 5 August 2024 determining that Ms Murgoska had a 2% WPI arising from an exacerbation of a Major Depressive Disorder.

1. Ms Murgoska sought a review of the Medical Assessment under s 7.26 of the MAI Act (the Review) relying upon particulars set out in the application and the supporting documentation.
2. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of Schedule 1 of the PIC Act. As the Medical Assessment which is the of the Review was made on or after 1 March 2021, the new review provisions apply.
3. 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.
4. The new 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, consisting of Medical Assessor Christopher Canaris, Medical Assessor John Baker, and Legal Member Terence Stern to conduct the review of the Medical Assessment.
5. Part 5 of the PIC Act enables the 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.
6. 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 of assessment.
7. 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. Ms Murgoska's claim and entitlements to compensation are governed by the provisions of the MAI Act. An injured person can make a claim for both economic losses and

non-economic loss damages. 3. 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. The Guidelines now applicable are Version 10 which commenced on 15 September 2025 and apply to claims arising from motor accidents occurring after 1 April 2023, and therefore apply to this accident which occurred on 4 June 2023.
3. Permanent impairment is assessed in accordance with Part 6 of the Guidelines.
4. Causation of injury is addressed in cls 6.5, 6.6 and 6.7 of the Guidelines.

"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. Medical Assessor Alexey Sidorov attended to his assessment of Ms Murgoska on 23 July 2024 and issued his certificate on 5 August 2024, determining that the following injuries caused by the accident gave rise to a permanent impairment of 2%
   • Exacerbation of Major Depressive Disorder
2. The Medical Assessor took a pre-accident history at [8] of his certificate, and a history of the accident at [9].
3. He noted the history of symptoms and treatment following the accident at [10], and the current and proposed symptoms and treatment at [12]-[13].
4. He then set out the results of his clinical examination at [14]-[15] which are reproduced below:

[14] "Mental state examination Ms Murgoska presented as a woman appearing of stated age. She was wearing a hat. She was generally cooperative and settled, but mildly irritable. There was no evidence of overt self-neglect. There was no evidence of psychomotor disturbance or abnormal movements. Her affect was depressed and restricted. She described her mood as, "Last night I couldn't sleep." There was no evidence of formal thought disorder. She denied any current thoughts of self-harm, suicidal ideations or thoughts of harm to others. There were no psychotic symptoms present, such as delusions or hallucinations. She was oriented to time, place, and person. She had good insight and a good degree of rational judgment.

[15] Current functioning Ms Murgoska stated that she regularly showers and changes her clothes but needs some assistance from her husband. She stated that she continues to feel anxious in the car, worrying that she may get into another accident, particularly when she is driven by her husband. She stated that she does not leave home independently and unaccompanied and her husband takes her to the shops and to appointments. She stated that she did not have any regular hobbies or activities and was mostly staying at home. She stated that she had lost all of her friends, however, stated that she continues to maintain a good relationship with her husband and stated that he helps her as much as he can. She feels that she has become more forgetful since the accident. She reads books sometimes but finds it difficult to focus. There were no overt cognitive impairments noted during the assessment. She stated that she has not worked since the accident, and when asked why she could not continue working, she stated that, "My body has been so damaged, injured and bent," and "Who would employ me?"

1. The Medical Assessor set out his comments on consistency at [16], noting that there were multiple inconsistencies. He noted that Ms Murgoska had stated that she had no pre-accident psychiatric history and pointed out that this was not consistent with the records from her general practitioner, noting a history of family stress.
2. The Medical Assessor referred to the Arncliffe Medical Practice entry of 29 May 2019 when just after the accident, family stress was noted.
3. He noted that Ms Murgoska had denied any history and stated that she had no other problems in her life aside from the accident.
4. The Medical Assessor noted that in the insurer's submissions, there was a reference to the death of her son by murder in 2006. Ms Murgoska stated that it had happened in 2004 and that she did not want to talk about it.
5. The Medical Assessor referred to issues with Ms Murgoska's daughter and alcoholism.
6. Ms Murgoska denied the history to which he referred and insisted that she had been completely fine before the accident.
7. The Medical Assessor asked her about the prescription of Lovan, an anti-depressant which she had taken before the accident. She had said that "that is normal if you get a headache, you get a tablet". When pressed on this, she did not remember taking anti-depressant medications.
8. The Medical Assessor pointed out to Ms Murgoska that she appeared to have been significantly more impaired on assessment with Dr Rastogi compared to the assessment with Medical Assessor Hong, even though these assessments were only three months apart.
9. He enquired about any possible reasons for a deterioration.
10. Medical Assessor Sidorov, at [17], referred to documentation he relied upon during his assessment of Ms Murgoska, including the assessment certificate of Medical Assessor Hong of 14 July 2023.
11. The Medical Assessor referred to the report of Dr Richa Rastogi of 23 October 2024, wherein Dr Rastogi diagnosed Ms Murgoska with a Post-Traumatic Stress Disorder and Major Depressive Disorder with WPI at 17%.
12. Medical Assessor Sidorov noted the Medical Assessment Certificate of Medical Assessor Jones of 16 February 2021 in which he commented that Medical Assessor Jones had said that the Post-Traumatic Stress Disorder caused by the murder of her son was not a minor injury for the purposes of the act.
13. Medical Assessor Sidorov at [18] then set out his diagnosis and reasons. Based on Ms Murgoska's account, she met the diagnostic criteria for a Major Depressive Disorder based on a history of her experience of having a depressed mood most of the day, nearly every day, for more than a two-week period, experiencing a markedly diminished interest and ability to derive pleasure, significant appetite and sleep disturbance, feeling fatigued and low in energy nearly every day, feelings of worthlessness, helplessness and hopelessness with significant associated anxiety symptoms.
14. He noted also that she had previously been diagnosed with Post-Traumatic Stress Disorder and she continued to present with certain features of Post-Traumatic Stress Disorder.
15. At [19], the Medical Assessor dealt with causation. On the balance of probabilities, it appeared in part that Ms Murgoska's condition had been aggravated by the accident, however, given the veracity of her account, it cannot be relied upon due to the multiple inconsistencies and the information in the documentation about other likely contributors to her depressive illness, there were likely multiple other factors that had been involved in the development of her depressive symptoms prior to the accident.

Application for Personal Injury Benefits dated 11 June 2019

1. As to injuries received as a result of the accident, Ms Murgoska records "Head-aches that were not felt before, not able to sleep well due to pain, need to use pain medication, neck pain at all times, back pain to lower back, left leg pain at all times, before the accident, I would work together with husband, now with the pain I am not able to work, cleaning gardening, landscaping and other jobs."

PIC Certificate of Medical Assessor Matthew Jones dated 16 February 2021

1. Diagnosis and Reasons "Ms Murgoska reported a narrative and presented at assessment as consistent with having an ongoing psychiatric disorder, namely a Post Traumatic Stress Disorder, of moderate severity. She experienced immediate anxiety symptoms related to a potentially life-threatening accident and has persisted with symptoms of anxiety including hyperarousal and avoidance, particularly related to travel in s. She has physiological symptoms of anxiety associated with this as well as mood symptoms. She has not received adequate treatment and it may be that her condition improves considerably with further psychiatric and psychological intervention."
2. Causation and Reasons "Although Ms Murgoska had had previously experience of anxiety and/or depressive symptoms, her current disorder, given the timing, nature and development of symptoms, is consistent with having been caused by the accident."

Report of Dr Inglis Synnott, Psychiatrist, dated 13 January 2023

1. Differential diagnosis "Keeping in mind the precautions and acknowledging the limitations of the psychiatric classification system of DSM IV: Axis I Regarding the MVA, I have no confidence in assigning a psychiatric diagnosis; Axis II No prominent personality traits noted. Axis III She denied any significant medical problems. Medical reports note prior to the MVA she was treated for high blood pressure and high cholesterol. Also, she had problems with back pain and restricted movements prior to the MVA. Axis IV She denied experiencing any psychosocial stressors. Axis V GAF: Deferred."
2. Diagnosis "Ms Murgoska said she has experienced significant emotional/psychiatric symptoms since the MVA with no obvious or enduring improvement. She has consulted a GP, psychologist and psychiatrist and takes antidepressant medication. The GP notes indicate Ms Murgoska experienced significant psychiatric symptoms in the years before the MVA for which she consulted a GP and was prescribed antidepressant medication. As well, over the years, she likely drank excessive amounts of alcohol. Ms Murgoska denied having significant emotional/psychiatric difficulties (or treatment for emotional/psychiatric difficulties) prior to the MVA which is at odds (not consistent) with information in the medical documentation. Therefore, I have no confidence in the accuracy and veracity of her history including what she says about psychiatric symptoms or impairment attributed to the MVA, and whether her injuries have possibly stabilised."
3. Prognosis "For the reasons outlined above, I have no confidence in the accuracy and veracity of her history including what she says about her psychiatric symptoms or impairment attributed to the MVA. Therefore, I have no confidence in offering an opinion on her psychiatric prognosis."

Certificate of Medical Assessor Michael Li Ying Hong dated 14 July 2023

1. Diagnosis and Reasons "Ms Murgoska's medical records showed a long history of psychiatric illness and psychological/psychiatric treatment. She and has been on long term Lovan and was on Lovan when the accident happened. It appears she had prior alcohol problems, and not after the accident. Since the accident, she described having chronic depression and anxiety, and other psychological symptoms. I noted most of her current psychological symptoms were recorded in her file before the accident at some point, including nightmares. It is difficult to obtain a clear picture of her psychological symptoms or psychiatric impairment in the 12 months before the accident, as she cannot remember any of it. After the accident, she described having nightmares memories related to the car accident and suicidal thoughts and these appear to be the main new symptoms. The majority of her impairment arises from her physical injuries, which are not assessable in the PIRS. Ms Murgoska has been referred for the assessment of "Post traumatic Stress Disorder" in relation to the accident on 25/5/2019. Similar to the Panel, I have diagnosed:
   • Exacerbation of Persistent depressive disorder
   • Major depressive disorder from the accident

She does not have PTSD. To diagnose Posttraumatic stress disorder, all of the DSM-5 diagnostic criteria have to be fulfilled. The nature of the accident and Ms Murgoska's described response are not consistent with the PTSD criterion A description. Therefore, Ms Murgoska does not have PTSD."

1. Causation and Reasons "Ms Murgoska has a past psychiatric history and it is not possible to assess her pre-existing injury with certainty. Her file noted symptoms consistent with a Persistent depressive disorder. She described psychological decline since the accident and has had further psychological/psychiatric treatment. She developed an exacerbation of pre-existing Persistent depressive disorder and a new Major depressive disorder. She denied other major life events unrelated to the accident, such as domestic violence after the accident. I noted her daughter may be a source of distress. Overall, my view is that there is more than a negligible contribution from the accident to her current psychological injury, as she appeared to have developed some new symptoms, eg suicidal thoughts."
2. Conclusion "Degree of permanent impairment caused by the motor accident = 2%"

1. Diagnosis "Post Traumatic Stress Disorder and Persistent Major Depressive Disorder. Ms Murgoska still is very debilitated by anxiety and PTSD symptoms of avoidance, excessive irrational fears, avoidance and fear of driving, nightmares and hypersensitivity to noises and high stimulus environment. She displays marked safety and avoidance behaviours and remains fearful of her safety. She has stopped driving and is more home bound.

She has a secondary depressive disorder and impairments are attributed to pain currently. She remains very withdrawn and debilitated by fear and avoidance and entrenched depressive cognitions. She has a very poor prognosis.

I am of the opinion that she fulfills the diagnosis of PTSD characterised by Criteria A- exposure to life threatening event, accident where she felt her life was in Danger. Criteria B- recurrent intrusive dreams, flashbacks, dreams of accident and physiological reactivity. Criteria C- persistent avoidance of driving, avoiding accident site, inability to recall certain aspects of accident, decreased interest in activities, restricted range of affect. Criteria D- insomnia, irritability, difficulty with concentration, startled. Criteria E- lasting for more than a month. Criteria F: Causing significant distress. She qualifies for Major depressive disorder with anxiety manifesting with depressed mood, depressive cognitions, low self-esteem, loss of confidence and working memory deficits. The fear with chronic depressive cognitions and anxiety have impeded her functioning significantly. She qualifies for DSM 5 diagnosis of Major depressive disorder

1. 1. Depressed mood most of the day, nearly every day, as indicated by either ive report; 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day; 3. Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day; 4. Insomnia or hypersomnia nearly every day; 5. Psychomotor agitation or retardation nearly every day; 6. Fatigue or loss of energy nearly every day; 7. Feelings of worthlessness or excessive or inappropriate guilt; 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day; 9. Recurrent thoughts of death recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
2. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

1. The episode is not attributable to the physiological effects of a substance or another medical condition"

1. Prognosis "Her prognosis is guarded and poor."

Letter to Dr Goran Josifoski, Psychiatrist, dated 23 September 2021

1. The diagnosis is noted as "PTSD with partial response to Lovan."

Clinical records of Miranda Medical Centre dated 25 May 2019

1. Ms Murgoska was noted to be "very anxious and visibly upset and shaken".

Clinical records of Arncliffe Medical Practice (various dates)

1. A history of depressive symptoms is noted since the beginning of the clinical record in 2013. Ongoing depressive symptoms are noted in subsequent clinical entries through the years. She was noted to be treated with antidepressant medication prior to the accident. Subsequent clinical entries also note family stress, including in 2015, 2016 and 2017, as well as subsequent to the accident, for example, on 29 May 2019 and 17 September 2020.

1. The Panel summarises the relevant sections of submissions of the insurer dated 14 June 2022 by reference to paragraph numbers:

[1]-[13] The insurer sets out the background of the dispute.

[14] The insurer submits that the available evidence does not suggest that Ms Murgoska suffers from a degree of permanent impairment greater than 10% as a result of any physical or psychological injuries that may have been sustained in the accident. Accordingly, the insurer submits that its decision of 25 March 2022 is correct and ought to be affirmed.

[15] While the insurer continues to chase Ms Murgoska for provision of an executed authority to Medicare to enable proper review of her pre-accident conditions, the available records disclose the following relevant medical history:

(a) Poor sleep/insomnia, low self-esteem and depressed mood symptoms dating back to 2013, necessitating referrals to a psychologist and use of anti-depressant medications.

(b) Cervical spine and lumbar spine pain dating back to 2013 and 2014.

(c) Carpal tunnel syndrome resulting in left upper limb pain in 2014.

(d) Bilateral plantar fasciitis in 2014.

(e) GORD and irritable bowel syndrome.

(f) Shoulder pain dating back to 2015.

(g) Chronic pain syndrome from 2017.

[16] The insurer submits that this pre-accident history ought to be carefully considered when assessing the complaints and permanent impairment, if any, attributable to the accident, especially in circumstances where Ms Murgoska has failed to disclose her pre-accident history to the Medical Assessors in this claim.

[17] In particular, when Medical Assessor Wijetunga assessed Ms Murgoska in December 2020, Ms Murgoska '[did] not describe any relevant past medical history and has not consulted any allied health practitioners for treatment'. Ms Murgoska provided a similar history to Assessor Jones.

[18] The insurer submits that this history is inconsistent with the records from Arncliffe Medical Practice, which disclose a history of largely identical neck, shoulder, lower back, chronic pain and psychological symptoms in the years leading up to the accident, for which Ms Murgoska was in receipt of regular treatment and medications.

[19] In light of this inconsistency, the insurer submits that great care ought to be exercised in accepting Ms Murgoska's self-reporting unless it is supported by objective medical evidence.

[20] With respect to the accident, the insurer submits that the collision appears to have been a minor 'side-swipe' incident which did not necessitate the attendance of police or ambulance personnel at the scene.

[21] In particular, Ms Murgoska was not treated by ambulance at any stage, nor did she attend hospital for treatment following the accident. The insurer submits that this does not suggest the collision involved substantial forces, or that she sustained any significant injuries in same. Further, she has not served any expert evidence placing her alleged physical or psychological injuries above 10%.

[99] The insurer submits that Ms Murgoska has a relevant pre-accident history of psychological symptoms and complaints dating back to 2013.

[100] In particular, records from Arncliffe Medical Centre confirm that Ms Murgoska attended on 22 October 2013 with complaints of 'poor sleep, early morning wakening, low self-esteem, irrational fear'.

[101] On 15 November 2013, Ms Murgoska was diagnosed with 'depressed mood' and a GP Mental Health Care Plan was compiled. On 21 November 2013, Ms Murgoska was provided with Cognitive Behavioural Therapy and received counselling for her symptoms.

[102] On 6 December 2013, Ms Murgoska was referred to a psychologist and it was recommended that she 'continue anti-depressant medication Lovan'. On 16 December 2013, she was said to be 'stressed' and was receiving counselling.

[103] On 17 March 2014, Ms Murgoska was noted to be 'tearful, poor sleep'. Ms Murgoska was prescribed the anti-depressant, Valdoxan and she was referred to a psychiatrist.

[104] On 26 May 2015, Ms Murgoska reported "feeling tired... depressed mood... family stress, tearful, continue counselling with psychologist, continue antidepressant medication". On 3 November 2015, 27 November 2015,

2 December 2015, 6 July 2016, 14 September 2016, 18 October 2016 and 21 February 2017 she again reported symptoms of 'family stress' for which she was counselled.

[105] On 12 December 2017, she reported 'family stress, coping strategies chronic pain syndrome discussed... counselling'.

[106] The insurer submits that the pre-accident records confirm a longstanding history of consistent psychological complaints attributable to family stressors and chronic pain symptoms, for which Ms Murgoska was prescribed anti-depressant medication and underwent counselling. The insurer submits that this history ought to be carefully considered when assessing the degree of impairment, if any, arising from the accident.

[107] Following the accident, Ms Murgoska attended upon Miranda Medical Centre with complaints of being 'badly shaken was screaming after the accident and still very anxious and upset'.

[108] On 29 May 2019 Ms Murgoska reported complaints of "family stress, counselling". Significantly, there is no mention of the accident on this occasion and the insurer submits that the reporting of family stress is consistent with Ms Murgoska's pre-accident complaints.

[109] In a Certificate of Capacity dated 30 May 2019, Ms Murgoska's GP diagnosed "anxiety, insomnia". No psychological treatment was recommended.

[110] In her Application for Personal Injury Benefits dated 11 June 2019, Ms Murgoska makes no mention of psychological symptoms. On 10 May 2020, her GP diagnosed 'anxiety'.

[111] On 27 August 2020, Ms Murgoska's GP noted "normal sleep, low self-esteem, normal mood" (R21). On 17 September 2020, 23 September 2020 and 24 September 2020, "family stress" was again recorded with no mention of the accident.

[112] In a report dated 13 September 2021, Dr Goran Stevans, psychiatrist, Ms Murgoska reported symptoms of 'depression' since the accident. Ms Murgoska provided an inaccurate history that she broke her ribs in the accident and that she had never received psychological treatment prior to the accident. The insurer submits that this inaccurate history calls into question the accuracy of Dr Stevans' diagnosis and opinion.

[113] Medical Assessor Matthew Jones (Minor Injury Psychological) issued a Certificate dated 16 February 2021 wherein he diagnosed Ms Murgoska with PTSD as a result of the accident. Notably, Medical Assessor Jones took the following history from Ms Murgoska: "Ms Murgoska denied any history of mental health problems ever, including anxiety, depression and postnatal depression... she had not seen a psychologist or psychiatrist, or taken psychiatric medications".

[114] The insurer submits that this history is clearly inconsistent with the pre-accident records discussed above, which disclose a history of anxiety, family stress, depression and use of anti-depressant medications in the years leading up to the accident.

[115] The insurer confirms that the insurer's review application of the Certificate of Medical Assessor Jones was accepted on 9 July 2021 on the basis that there was reasonable cause to suspect that the assessment of Medical Assessor Jones was incorrect in a material respect (R8). The Review Panel is scheduled to assess Ms Murgoska on 17 June 2022.

[116] The insurer reserves the right to lodge further submissions and documents should the Review Panel issue their Certificate prior to the permanent impairment assessment being conducted.

[117] Nevertheless, on the current evidence, the insurer submits that Ms Murgoska has a highly relevant pre-accident history of identical psychological complaints that she has failed to properly disclose to the Medical Assessors in this claim. In light of the minor nature of the collision (which did not necessitate ambulance or hospital attendance), the insurer submits that any ongoing impairment is unrelated to the accident.

1. The Panel summarises the submissions of the insurer dated 6 July 2023 by reference to paragraph numbers:

[1]-[6] The insurer sets out the background to the dispute.

[7] The insurer submits that the available evidence does not support a finding that Ms Murgoska suffers greater than 10% permanent impairment as a result of the accident.

[8] In particular, the insurer submits that further pre-accident clinical records have been obtained that were not available to the previous PIC Medical Assessors, and that these are highly relevant to assessment of the psychological injury, especially Ms Murgoska's pre-accident condition.

[9] The insurer submits that Ms Murgoska has consistently denied any relevant pre-accident psychological history (including to Medical Assessor Jones, the Review Panel and Dr Synnott), and that this denial is inconsistent with the evidence so her self-reporting should not be relied on unless supported by objective evidence.

[10] The insurer refers to West Ryde Marketplace Medical Centre records showing pre-accident attendances, including:

(a) 20 Oct 2004 profound grief and Fluoxetine use after the accidental death of her only son;

(b) 21 Nov 2006 ongoing trauma from her son's death;

(c) 22 Mar 2007 IVF Australia correspondence noting a "fairly tragic recent past";

(d) 26 Nov 2008 presentation with "stress++ and alcohol problem";

(e) 8 Feb 2010 "Stress ++ daughter alcoholic";

(f) 20 Apr 2010 "Stress++... worried about her daughter stress++";

(g) 10 May 2010 "Stress++ from daughter, alcohol and violence++";

(h) 24 May 2010 ongoing stress about alcoholic daughter, grandchildren and marital conflict.

[11] The records confirm that Ms Murgoska was prescribed the anti-depressant Lovan from at least 30 March 2011, with the most recent script on

[12] The insurer refers to pre-accident notes from treating psychologist Goran Josifoski, including on 20 April 2015: significant worry about her daughter and grandchildren, insomnia, withdrawal, ruminations, anxiety, negative cognitions, depressive and physical symptoms, behavioural withdrawal, and a provisional diagnosis of Adjustment Disorder with Anxiety and Depressed Mood (DD: Major Depressive Disorder with Anxious Distress), with DASS-21 scores of severe depression and extremely severe anxiety and stress, and subsequent sessions in 2015 noting ongoing depressed/anxious mood and stress about her daughter and grandchildren.

[13] The insurer also relies on Powell Street Family Medical Practice pre-accident notes, including:

(a) 7 Nov 2016 alcohol use of 6 or more standard drinks "daily or almost daily";

(b) 5 Dec 2016 description of a controlling, financially coercive husband, past domestic violence, suicidal thoughts ("might be better"), and discussion of options and psychology;

(c) 12 Dec 2016 ongoing stress, controlling behaviour, locked alcohol, daily drinking;

(d) 9 Jan 2017 unchanged home situation and belief she wouldn't drink in excess if given free access;

(e) 3 Jul 2017 very high alcohol intake, education on alcohol-related health risks, and her belief she was not alcohol-dependent;

(f) Lovan prescriptions on 6 Dec 2018 and 31 Jan 2019;

(g) 17 Apr 2019 widespread pain and longstanding spinal and knee issues, while still working in a cleaning/gardening business.

[14] The insurer submits these pre-accident records confirm longstanding psychological symptoms and personal stressors requiring regular review and antidepressant use.

[15] The insurer submits the records show relationship conflict and excessive alcohol consumption pre-accident, and that Ms Murgoska reported she did not leave the house due to her husband's controlling behaviour and spent days "watching TV".

[16] The records from Powell Street confirm Lovan was prescribed just four months before the accident for "depression" present since at least 2016.

[17] The insurer submits the totality of the pre-accident records demonstrates a longstanding history of psychological complaints attributable to multiple personal and family stressors.

[18] Further, the insurer submits Ms Murgoska continued to report very similar psychological symptoms after the accident as before it; for example, on

29 May 2019 she attended her GP with "family stress, counselling" and made no mention of the accident.

[19] The insurer submits the clinical records therefore support a finding that pre-accident psychological symptoms and stressors were continuing in the post-accident period.

[20] While the Review Panel (Threshold Psychological) accepted that Ms Murgoska had Persistent Depressive Disorder at the time of the accident and that it was exacerbated by the accident, the insurer submits that the additional clinical records (not before the Panel) confirm the longstanding, continuing and identical nature of her complaints post-accident.

[21] The insurer submits the Medical Assessor is not bound by the Review Panel's earlier findings on causation or diagnosis, particularly in light of this further evidence regarding Ms Murgoska's pre-accident psychological symptoms.

[22] The insurer refers extensively to the report of Dr Inglis Synnott, Psychiatrist, of 13 January 2023. He had no confidence in assigning ay psychiatric diagnosis to the accident. He referred to the assessment of 10 January 2023 where Ms Murgoska denied experiencing significant medical or surgical problems before the accident. He also refers to that she denied experiencing significant emotional problems before the accident. He states that that was at odds with the medical documentation provided. This discrepancy raised reasonable questions about her veracity and the accuracy of her account. Dr Synnott referred particularly to the general practitioner notes, which indicated that Ms Murgoska experienced significant psychiatric symptoms in the years before the accident. The submission referred to Dr Symmott's conclusion that he had no confidence in the accuracy and veracity of Ms Murgoska's history, particularly regarding the accident and any psychiatric symptoms she attributes to it.

[23] The insurer submits that the additional pre-accident clinical records confirmed Ms Murgoska was suffering from ongoing psychological symptoms at the time of the accident necessitating the use of anti-depressant medication.

[24] The insurer submits that at least the pre-accident records confirm that there will need to be a not insignificant deduction for pre-existing impairment.

[25] The insurer refers to the Allied Health Recovery Requests completed by Mr Goran Josifoski, psychologist, who noted:

(a) 20 October 2022 PTSD and Major Depressive Disorder in the context of physical pain, memory problems, ruminations, anxiety, hypervigilance, upsetting memories of the accident, nightmares, poor sleep, emotional detachment, reduced socialisation and avoidance of driving; and

(b) 15 March 2023: Diagnosed PTSD and Major Depressive Disorder.

[26]-[27] The insurer submits that Mr Josifoski's conclusions are problematic and inconsistent.

1. The Panel summarises the submissions of Ms Murgoska dated 13 February 2024 by reference to paragraph numbers:

[1]-[2] These submissions are Ms Murgoska's application for further assessment of whole person impairment (WPI) arising from psychological injuries sustained in the accident on 25 May 2019. She has been assessed for her physical injuries and found to have 8% WPI.

[3]-[5] Her psychiatric impairment was assessed by Medical Assessor Hong on

11 July 2023. He diagnosed Major Depressive Disorder and exacerbation of Persistent Depressive Disorder caused by the accident and assessed 5% WPI. Medical Assessor Hong assessed current WPI at 5%. He then determined there was a prior psychiatric history but, instead of assessing pre-existing impairment in accordance with the Guidelines, assumed she had full psychiatric functioning at the time of the accident and assessed pre-existing WPI at 0%, then applied a 3% "treatment uplift" to reach 3% pre-existing WPI. He then subtracted this 3% from the 5% current impairment, leaving 2% WPI due to the accident.

[6] Ms Murgoska submits this methodology is fundamentally flawed and contrary to the Guidelines.

[7]-[9] Clause 6.31 of the Guidelines requires that only if there is objective evidence of pre-existing symptomatic impairment at the time of the accident is its value to be calculated and subtracted; otherwise, its possible presence must be ignored. For pre-existing psychiatric conditions, cl 6.218 further requires the assessor to estimate overall pre-existing impairment "using precisely the method set out in this part of the Guidelines" and subtract this from the current impairment rating. The Guidelines are clear: pre-existing psychiatric impairment must be assessed by calculating pre-accident functioning using the six PIRS classes, then subtracting that total from the current PIRS-based rating.

[10]-[12] Ms Murgoska submits that Medical Assessor Hong did not do this. He did not assess pre-accident functioning in the six PIRS categories, instead assuming "full psychiatric functioning" and concluding pre-existing WPI was 0%. He then adjusted that 0% for prescribed treatment (Lovan) to reach 3% pre-existing WPI. Ms Murgoska submits this is a fundamental flaw in the original methodology and turns now to the grounds for further assessment.

[13]-[14] The ground of this application is that Ms Murgoska's level of functioning in at least four of the six PIRS categories has deteriorated since Medical Assessor Hong's assessment. She relies on the report of Dr Richa Rastogi dated 23 October 2023.

[15] Clause 13 of the Motor Accident Injuries Regulation 2017 allows a further assessment on grounds of deterioration or additional relevant information, provided it is capable of having a material effect on the outcome of the previous assessment.

[16] Ms Murgoska submits Dr Rastogi's report is additional relevant information (it did not exist at the previous assessment) and shows a notable deterioration in her psychological injury sufficient to materially affect the 2% WPI assessment.

[17]-[18] Ms Murgoska set out the PIRS table of Medical Assessor Hong's findings where it demonstrates significant deterioration in the six assessable areas since July 2023.

[19] Most notably, Ms Murgoska now avoids social outings, is very isolated, prefers to stay at home, does not go out alone and is effectively home-bound, in contrast to the regular social and recreational activities with family found by Medical Assessor Hong.

[20]-[21] Dr Rastogi assessed 17% WPI. Ms Murgoska submits this increase reflects the deterioration from mild impairment in most PIRS categories to moderate impairment in social/recreational activities, travel, concentration/persistence/pace and severe impairment in adaptation. This deterioration in functioning is the basis on which this application is made.

[22]-[23] Ms Murgoska submits Dr Rastogi's report is additional relevant information and evidences significant deterioration in her psychological condition. This deterioration changes her impairment from 2% WPI to 17% WPI.

[24]-[25] Ms Murgoska submits any change to the level of impairment satisfies the "material effect" requirement of cl 13 (per Meeuwissen v Boden [2010] NSWCA 253). The change from 2% to 17% WPI therefore satisfies cl 13 and permits referral for further assessment.

[26] Ms Murgoska submits that on further assessment, the assessor must carefully apply cl 6.31: if there is no objective evidence of pre-existing symptomatic permanent impairment at the time of the accident, its possible presence must be ignored.

[27] If objective evidence of a pre-existing psychiatric diagnosis at the time of the accident is found, cl 6.218 must be followed: overall pre-existing impairment must be estimated using precisely the PIRS method and subtracted from the current rating.

[28] Ms Murgoska submits the previous assessor did not use "precisely the method set out" (i.e. a full PIRS assessment) when assessing pre-existing impairment before subtracting from the current rating; Ms Murgoska submits great care must be taken on further assessment so this error is not repeated.

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

[1]-[5] The insurer sets out the background of the dispute and submits that the application should be dismissed.

[6] Section 13 of the Motor Accident Injuries Regulation 2017 requires an applicant to demonstrate deterioration of injury and/or additional relevant information capable of materially affecting the outcome of the previous assessment.

[7] Ms Murgoska relies on a single document: the report of Dr Rastogi dated 23 October 2023, and submissions regarding that report.

[8] The insurer submits paragraphs 2-12 of Ms Murgoska's submissions do not concern deterioration or additional information, but complaints about Medical Assessor Hong's earlier psychological assessment.

[9] The insurer submits those paragraphs are irrelevant to the further assessment application and that it is inappropriate to seek a "review" of Medical Assessor Hong's Certificate long after the review period has closed.

[10] The insurer submits a further assessment application is not the proper mechanism to agitate alleged errors in the previous assessment; Ms Murgoska was legally represented when the Certificate issued and did not seek review under s 7.26 of the MAI Act

[11] In any event, the insurer submits the alleged "errors" in Medical Assessor Hong's Certificate are unfounded; he referred to the PIRS areas when discussing pre-existing impairment, assessed 0%, and then applied a 3% allowance for treatment effects consistent with cls 6.222-6.223 of the Guidelines.

[12] The insurer submits that even if the pre-existing deduction were removed, Ms Murgoska's psychological WPI would be 5%, and thus there is no material error.

[13] For these reasons, the insurer submits the Delegate would err by considering paragraphs 2-12 of Ms Murgoska's submissions for the purposes of the further assessment application and that they should be disregarded.

[14] The insurer concedes that, strictly, Dr Rastogi's report is "additional relevant information" as it post-dates Medical Assessor Hong's assessment, but submits the report does not evidence deterioration and is not capable of materially affecting the outcome of the previous assessment.

[15] The insurer makes the following preliminary observations regarding whether Dr Rastogi's report can materially affect the previous outcome:

(a) Unlike Medical Assessor Hong, it does not appear Dr Rastogi was provided with relevant pre-accident medical records (West Ryde Marketplace Medical Centre, Goran Josifoski, Powell Street Family Medical Practice); the insurer submits this omission fundamentally calls into question the accuracy and veracity of her opinion.

(b) She recorded that Ms Murgoska saw psychologist Mr Josifoski only after the accident; pre-accident records show consultations for social withdrawal, family disputes, poor concentration, anxiety, depression and loss of motivation.

(c) She recorded that Lovan was prescribed two to three years prior to the accident for "work related stressors" but was never commenced; Medical Assessor Hong recorded long-term Lovan use at the time of the accident.

(d) There is no mention of "work-related stressors" in the clinical records, contrary to what was reported to Dr Rastogi.

(e) The pre-accident records show longstanding psychological symptoms related to her son's murder in 2006, family conflict, alcoholism, financial coercion, controlling behaviour by her husband, suicidal ideation and depression, none of which are mentioned by Dr Rastogi.

(f) Dr Rastogi recorded there was "no history of... alcohol use"; this is inconsistent with records (including Powell Street Family Medical Practice) confirming longstanding alcoholism causing family disputes.

(g) She recorded that physically Ms Murgoska "has been well"; the insurer submits this conflicts with her previous reporting of severe, constant pain and physical debility to Medical Assessor Hong.

(h) The insurer submits it therefore appears Dr Rastogi was not provided with full evidence of physical complaints, and that, unlike Medical Assessor Hong, she could not properly separate physical from psychological restrictions as required by cl 6.215 of the Guidelines; accordingly the accuracy of her WPI assessment is in doubt.

(i) Alternatively, the insurer submits the report that Ms Murgoska has "been well" physically suggests improvement, not deterioration.

(j) Although Dr Rastogi states incapacity is due to combined physical and psychological impairments, her PIRS "Adaptation" rating does not distinguish between the two, contrary to cl 6.215.

(k) She declined to deduct any pre-existing impairment, stating there was "no evidence of pre-existing disorder"; the insurer submits this is inconsistent with the treating records and Medical Assessor Hong's Certificate.

(l) Credibility was a key issue before Medical Assessor Hong; he identified "many inconsistencies that cannot be reconciled".

(m) While apparently given Medical Assessor Hong's Certificate, Dr Rastogi did not address the pre-accident history or credibility issues; she noted only his diagnosis and 5% WPI and did not engage with the pre-existing deduction or final 2% accident-related WPI.

[16] The insurer submits that, taken together, the history provided to and used by Dr Rastogi is inaccurate and this calls into question the veracity of her opinion.

[17] Unlike Dr Rastogi, the insurer submits that Medical Assessor Hong had access to the relevant pre-accident psychological history and physical complaints and conducted a comprehensive, guideline-compliant assessment.

[18] The insurer submits any differences between Medical Assessor Hong and Dr Rastogi are explained by the broader material available to Medical Assessor Hong but seemingly not provided to Rastogi.

[19] The insurer submits that almost every key aspect of Ms Murgoska's self-reporting to Dr Rastogi (pre-accident history, physical symptoms, alcohol use, antidepressant use, pre-injury work hours) conflicts with the records.

[20] The insurer submits that, given the critical role of pre-accident records, noted inconsistencies, and physical injury impacts in Medical Assessor Hong's assessment, a report prepared three months later based on inaccurate and incomplete history cannot be capable of materially affecting that assessment.

[21] The insurer notes that Ms Murgoska seeks to compare the PIRS scales of Medical Assessor Hong and Dr Rastogi to allege deterioration.

[22] The insurer submits this is misconceived because any such comparison is inherently unreliable where Dr Rastogi's assessment is based on incorrect history and incomplete records.

[23] The insurer submits Medical Assessor Hong's PIRS assessment explicitly incorporated the correct pre-accident history and serious credibility concerns.

[24] By contrast, the insurer submits Ms Murgoska's solicitors did not provide the pre-accident records to Dr Rastogi, and her higher WPI is primarily due to largely accepting Ms Murgoska's self-reporting without awareness of earlier inconsistencies.

[25] The insurer therefore submits that comparing Medical Assessor Hong's and Dr Rastogi's PIRS scores does not accurately reflect Ms Murgoska's condition but merely reflects differing medical opinions and differing material before each psychiatrist.

[26] The insurer submits the Delegate should instead focus on Ms Murgoska's self-reporting to each examiner on 11 July 2023 and 23 October 2023 when considering deterioration.

[27] The insurer submits that comparison of the self-reporting reveals essentially identical psychological complaints and symptoms, not a deterioration over the three-month period.

(a) To Dr Rastogi, Ms Murgoska reported struggling with showers and meals, needing daily prompting, not cooking and relying on her husband for chores; Medical Assessor Hong recorded similar statements that she "cannot do anything now", cannot be left alone and is constantly worried.

(b) To Dr Rastogi, she reported stopping driving and relying on her husband; Medical Assessor Hong recorded she never had a licence, feared cars and travelled only as a passenger with her husband. Symptoms and restrictions are essentially the same.

(c) To Dr Rastogi, she reported social isolation, preferring to stay home and avoiding family; Medical Assessor Hong recorded she had "no friends" and only left home to see doctors, no longer talking to friends.

(d) To Dr Rastogi, she reported not doing chores or home maintenance and loss of motivation; Medical Assessor Hong recorded she "cannot do anything", has reduced enjoyment and motivation and "cannot recall doing anything day to day".

(e) To Dr Rastogi, she reported poor concentration and forgetfulness; Medical Assessor Hong recorded major problems with memory and concentration, forgetfulness, and leaving the washing machine off after loading it.

(f) To Dr Rastogi, she reported feeling like a burden and that her husband reduced her hours to care for her; Medical Assessor Hong recorded that her relationship was "not good" because she "cannot do anything". The insurer notes Dr Rastogi's reference to "reduced hours" implies some ongoing work, which, if anything, suggests improvement rather than deterioration.

[29] The insurer submits there is no material difference in self-reported symptoms between the two assessments, which is consistent with the short three-month interval.

[30] The insurer submits that Dr Rastogi's higher WPI reflects a different opinion based on the same self-reporting, without access to the pre-accident records and physical-injury context considered by Medical Assessor Hong.

[31] The insurer disputes Ms Murgoska's submission that her social isolation now significantly differs from that reported to Medical Assessor Hong; he had already recorded cessation of social events and leaving home only for medical appointments.

[32] The insurer submits Ms Murgoska's further assessment submissions overlook the incomplete history provided to Dr Rastogi and ignore the consistency of her own self-reporting to both doctors.

[33] The insurer considers it significant that only an IME report obtained by Ms Murgoska's solicitors is provided as "additional information", with no treating records or independent evidence of deterioration.

[34] The insurer notes Dr Rastogi assessed Ms Murgoska just three months after Hong and gave no explanation for any alleged deterioration, which is unsurprising given the identical symptoms reported; she simply expressed a different WPI opinion on the same complaints.

[35] The insurer therefore submits there is no material or significant difference in Ms Murgoska's self-reporting between the two assessments.

[36] Accordingly, the insurer submits that Dr Rastogi's report is not capable of altering the outcome of the previous assessment, particularly given the absence of pre-accident records and any engagement with Medical Assessor Hong's credibility findings.

[37] The insurer submits that Ms Murgoska's attempt (in paragraphs 26-28) to rely on alleged "errors" in Medical Assessor Hong's assessment to support the further assessment application is misconceived and confuses a review application with a further assessment application.

[38] The insurer submits only the report of Dr Rastogi may properly be considered as "additional relevant information" under s 13 of the Motor Accident Injuries Regulation 2017; any consideration of alleged errors in Medical Assessor Hong's assessment would be an irrelevant consideration and fail to address the statutory test.

[39] The insurer submits it is erroneous to suggest asserted errors in Medical Assessor Hong's WPI assessment can assist the Delegate in determining whether Rastogi's report is capable of having a material effect on the prior outcome.

[40] The insurer submits the application must be decided solely on whether the "additional relevant information" (Dr Rastogi's report) satisfies s 13 of the Motor Accident Injuries Regulation 2017. For the reasons above, the insurer submits it merely reflects a difference of opinion based on identical symptoms and incomplete history, and is not capable of materially affecting the prior assessment.

1. The Panel summarises the submissions of Ms Murgoska dated 28 August 2024 by reference to paragraph numbers:

[1] Ms Murgoska seeks a review of Medical Assessor Alexey Sidorov's medical assessment dated 5 August 2024.

[2] In his certificate and reasons, Medical Assessor Sidorov found that Ms Murgoska suffered an exacerbation of Major Depressive Disorder as a result of the motor accident on 25 May 2019.

[3] He then apportioned the degree of impairment caused by the accident at 2% WPI.

[4] Ms Murgoska submits this application is made under s 7.26(2) of the MAI Act on the basis that the medical assessment is incorrect in a material respect.

[5] Ms Murgoska submits the Medical Assessor used an incorrect methodology when apportioning impairment on page 9 of his reasons (para 24), as set out below.

[6] He assessed 15% current impairment (pp 7-8) and 6% pre-existing impairment (pp 8-9).

[7] He then incorrectly deducted 50% of the 15% current impairment for "causes unrelated to the accident".

[8] He treated this as 7.5% current impairment and then erroneously rounded it up to 8% WPI.

[9] He then deducted the 6% pre-existing impairment from this 8% WPI to arrive at a final assessment of 2% WPI due to the accident.

[10] Ms Murgoska submits this methodology is incorrect because it is contrary to the methodology in the Motor Accident Permanent Impairment Guidelines for assessing WPI, particularly psychiatric impairment.

[11] Ms Murgoska submits these errors render the assessment incorrect in a material respect.

[12]-[20] Ms Murgoska sets out relevant sections in the legislation and guidelines; these are not reproduced by the Panel.

[21] Medical Assessor Sidorov diagnosed Ms Murgoska with a Major Depressive Disorder in accordance with DSM-5 (para 18, p 6).

[22] With respect to causation, he stated that the causation of Ms Murgoska's Major Depressive Disorder is unclear; on the balance of probabilities it has, in part, been aggravated by the accident, but given the unreliability of her account and other likely contributors in the records, there are multiple other pre- and post-accident factors unrelated to the accident involved in the development of her depressive symptoms.

[23] Ms Murgoska submits that, having identified prior and subsequent unrelated factors, the Medical Assessor was required to apply cls 6.31 and 6.34, which require that any objective symptomatic unrelated permanent impairment at the time of, or subsequent to, the accident be calculated and its value subtracted from the current WPI.

[24] Ms Murgoska submits the Medical Assessor was also required to consider cl 6.218, which for psychiatric impairment mandates that where there is a pre-existing psychiatric diagnosis/condition, overall pre-existing impairment be estimated using precisely the PIRS method and subtracted from the current impairment rating.

[25] Ms Murgoska submits the Medical Assessor only partly complied: he assessed current impairment at 15% (pp 7-8) and pre-existing impairment at 6% (pp 8-9), but then departed from the methodology required by the Guidelines.

[26] Ms Murgoska submits that he then deducted 50% from the 15% WPI for "causes unrelated to the accident, such as family stress... and other unknown factors... given that her ive account... cannot be relied upon," which is not the method prescribed.

[27] Ms Murgoska submits this is an error because the Medical Assessor did not identify whether these "family stress" and "other unknown factors" are pre-existing or subsequent, nor did he separately assess them as pre-existing or subsequent impairment as required; instead he simply reduced current impairment by 50%.

[28] Ms Murgoska submits that, if any of these unrelated causes are pre-existing, he has apportioned for them twice: once in the 50% deduction and again in the 6% pre-existing WPI already assessed on pp 8-9.

[29] Ms Murgoska submits that if any of the unrelated causes are subsequent, the Medical Assessor was required to calculate their impairment value and subtract it from current WPI, which he did not do.

[30] Ms Murgoska submits the 50% deduction is also erroneous because it yields 7.5%, which the Medical Assessor then rounds up to 8% and treats as the current WPI after apportionment for unrelated causes; this rounding itself is flawed.

[31] Ms Murgoska submits that cl 6.39 does not permit rounding of WPI values at any stage of the assessment process; it allows rounding of regional impairment fractional values only. Rounding 7.5% to 8% WPI is therefore contrary to cl 6.39 and an error.

[32] Ms Murgoska submits that, having incorrectly calculated current impairment at 8% WPI and then subtracting 6% for pre-existing impairment to reach 2% WPI, the Medical Assessor's final figure is incorrect because the methodology leading to the 2% WPI is fundamentally flawed.

1. The Panel summarises the submissions of the insurer dated 23 September 2024 by reference to paragraph numbers:

[1]-[3] Ms Murgoska seeks review of Medical Assessor Sidorov's assessment, alleging it is incorrect in a material respect under s 7.26 of the MAI Act.

[4] The insurer submits there are no errors or mistakes in Medical Assessor Sidorov's assessment capable of materially affecting the outcome and that Ms Murgoska has failed to demonstrate otherwise. Accordingly, the insurer submits the review application should be dismissed.

[5] Ms Murgoska alleges one error: (a) Incorrect Method of Assessing Permanent Impairment.

[7] The insurer submits there are no material errors in Medical Assessor Sidorov's Certificate and makes the following submissions.

Alleged Error Incorrect Method of Assessing Permanent Impairment

[8]-[9] Ms Murgoska claims the Medical Assessor wrongly deducted 50% from the 15% impairment rating, rounded 7.5% to 8%, and then subtracted 6% pre-existing impairment to arrive at 2% WPI. She relies on cl 6.218 of the Motor Accident Guidelines (MAG), arguing that the Medical Assessor's failure to apply it was a material error.

[10] The insurer submits the Medical Assessor correctly applied cl 6.218 (pages 8-9 of the Certificate), calculating 6% pre-existing WPI. Ms Murgoska has not alleged any error with that table at paragraph 23 of the Certificate.

[11] The insurer submits the 50% deduction was unrelated to pre-existing impairment, and thus cl 6.218 did not apply.

[12]-[13] On page 9 of the Certificate, the Medical Assessor stated the 50% deduction was for "causes unrelated to the accident, such as family stress and other unknown factors... given that her account cannot be relied upon." On page 6, he further stated that Ms Murgoska's Major Depressive Disorder was only partly aggravated by the accident and was also influenced by multiple pre- and post-accident factors unrelated to the accident.

[14] The insurer submits the Medical Assessor appropriately identified both pre-existing and subsequent factors impacting Ms Murgoska's presentation.

[15] The insurer submits Ms Murgoska is incorrect in asserting the Medical Assessor treated those factors as pre-accident when he clearly stated they were "after the accident."

[16] At paragraph 23, the Medical Assessor properly calculated pre-existing impairment under cl 6.218 and then assessed subsequent impairment for post-accident factors unrelated to the accident.

[17]-[18] The insurer submits cl 6.34 of the MAG applies to subsequent impairment and requires calculation (where objectively evident), not subtraction, unlike cl 6.218 (pre-existing impairment). The insurer submits Ms Murgoska's argument that subsequent impairment must be subtracted is unsupported by cl 6.34, which only requires it to be calculated.

[19] While cl 6.218 prescribes a specific method for pre-existing impairments,

cl 6.34 does not specify a method for subsequent impairments.

[20] The insurer submits the Medical Assessor appropriately assessed pre-existing and subsequent impairment amid inconsistent self-reporting, credibility issues and unclear causation, matters also noted by Dr Synnott and other PIC assessors (pages 5-6 of the Certificate).

[21] The insurer submits Ms Murgoska's critique contradicts Wingfoot v Kocak [2013] HCA 43, which held that administrative decisions should not be examined "minutely and finely with an eye attuned to error."

[22]-[25] Alternatively, the insurer submits Ms Murgoska has not shown the 50% deduction to be a material error affecting the outcome. The insurer submits that even without the 50% deduction, the result remains below the 10% threshold. The Medical Assessor found 15% current WPI and 6% pre-existing WPI. Removing the 50% deduction would yield 9% WPI which is still below 10%. Therefore, the insurer submits any error in the 50% deduction is immaterial to the final outcome.

[26]-[28] The insurer submits there are no allegations of error in the Medical Assessor's clinical examination or his findings on Ms Murgoska's credibility and pre-existing history. Ms Murgoska's only argument relates to the 50% deduction for subsequent impairment, which is insufficient to justify review under s 7.26 of the Act. The insurer submits the deduction is immaterial and Ms Murgoska has not shown how its removal would alter the outcome.

[29]-[30] The insurer submits Ms Murgoska misstates Meeuwissen v Boden [2010] NSWCA 253; that case requires the error not be "immaterial," not that any change to impairment is material. The insurer submits the asserted error is immaterial and does not satisfy s 7.26(2) of the MAI Act.

[31]-[32] The insurer submits s 7.26 requires a reasonable suspicion that the assessment is incorrect in a material respect for referral to a Review Panel. For the reasons above, the insurer submits there is no material error and the alleged error is immaterial to the outcome.

[33] In Dominice v Allianz Australia Insurance Ltd [2017] NSWCA 171, the Court confirmed the Presidential Delegate acts as a gatekeeper to ensure review occurs only where there is reasonable cause to suspect non-compliance.

[34]-[35] The insurer submits Medical Assessor Sidorov's Certificate was well-considered, consistent with the AMA 4th Edition and MAG. Ms Murgoska was an unreliable historian with numerous inconsistencies and denied pre-existing symptoms contradicted by records. The Medical Assessor properly identified and calculated both pre-existing and subsequent impairments. The insurer submits the alleged error does not fall within the types identified in Dominice and the review application should be dismissed.

1. Medical Assessor Canaris and Medical Assessor Baker examined Ms Murgoska at the Personal Injury Commission's Medical Suites on 2 September 2025. The Medical Assessors were assisted by a professional interpreter of the Macedonian language who would appear to have competently interpreted.

1. Ms Murgoska is a 72-year-old married woman living with her husband. She was born in Macedonia but has been 52 years in Australia. She was born in a village. Her parents worked the land. She was the third of 6 siblings. She recalled a happy childhood. She completed year 8 of school and then worked on the family farm.
2. She came to Australia at age 20 on her own. She "was young and I thought I'd have a better life here." She married in 1973.
3. She said she was "working" and had "no pain" before the accident adding that she was on her way to work at the time of the accident.
4. She had a daughter aged 51 and son now deceased who would be aged 42 years if he were still alive. Her son was "lost" in 2004. She became upset when asked what happened to her son. The Medical Assessors decided not to pursue this further because her son had died many years ago and she had been able to continue her role as a mother to her surviving daughter, wife, and employee to the family business.
5. She said she did not drink and did not drink in the past. Her attention was drawn to records suggesting she drank too much. She denied ever seeing anyone for alcohol problems, going to AA, drinking spirits, or making home brew or wine. She said she did not drink excessively and she was not impaired because of her alcohol use that she described as similar to her community of origin.
6. She believes she did not see any mental health professionals until after the accident. Her attention was drawn to references of her seeing her psychologist in 2015/2016. She said she may have been seeing him because of her daughter. Apparently her daughter was living with them, and Ms Murgoska was caring for the baby who was "screaming a lot" necessitating her to provide support to her daughter and seek psychological advice as to caring for an unsettled infant.
7. She denied any history of conflict within the family.
8. She takes Coversyl for blood pressure.
9. She "worked all my life" in the sewing industry and later as a cleaner alongside her husband in the family's small business. Before her accident, she would be "working cooking cleaning gardening." She had worked as a seamstress and later in a cleaning job with her husband, but her husband did the bookkeeping and invoicing. She used to work "up to 12 hours a day" sometimes six days a week cleaning in commercial premises for this business. She used to knit and sew and do embroidery as hobbies in her spare time. She socialised with friends and family and went to church. She had no difficulties with travel before the accident

1. On 25 May 2019, she was a passenger in a ute driven by her husband when the ute was

t-boned by a car coming in from the left. The ute was in the middle lane and a car from the left hit the ute. She said that she "was in shock very frightened." Her husband helped her get out of the car. Police and ambulance did not attend. 2. The car was drivable, and her husband took her to the doctor the same day. 3. She sustained injuries to her shoulder and ribs ("The whole left side") of her body was reported as injured including her broken ribs.

History of symptoms and treatment following the motor accident

1. She was "in shock." She has had massages and physio and has "a bag full" of tablets. She could not remember what she took and for what reason.
2. She admits to sadness saying, "How else would I feel if I'm not healthy." She feels as though life was not worth living. She has had thoughts of harming herself but has not tried harming herself. She said she had pain which caused her to wake from sleep. She said she was frustrated by her pain which she had expected to resolve after the motor accident.
3. The Medical Assessors note the presence of her mood disturbance comprising depressed mood for most of the day nearly every day, markedly diminished interest and pleasure in almost all activities most of the day nearly every day, poor appetite with weight loss of 10kg, insomnia, evident psychomotor retardation at interview, fatigue, diminished ability to think or concentrate, and recurrent thoughts of dying.

Details of any relevant injuries or conditions sustained since the motor accident

1. Physical: She continues to contend with pain in her neck which she "can't tolerate" saying, "it's always there day and night it's always there." She "can't do what I was able to do before" such as attend to "personal things having a shower dressing or undressing I can't sit for very long." Pain also interferes with her sleep.
2. Psychological: She remains depressed. Her sleep is poor, and she would "get frights through the night and the pain is also interfering." She is "jumpy and fighting and screaming and reliving the accident." Her husband said she would call out in the middle of the night."
3. Her husband said that a doctor, a neurologist, had put needles in her neck (presumably a nerve conduction study) "and she dreams about this in her dreams It seems she also relives "the noise of the accident" which wakes her.

1. Physical: She is on Pregabalin 75mg BD PRN and Panadeine Forte one to two at night. She is also on Panadol Osteo. She is on Mobic 15mg daily. She has had surgery proposed "for her neck somewhere" but thus far has not been approved by the insurer. She may go ahead with this surgical treatment privately with a surgeon not funded by the insurer.
2. Psychological: She sees a psychologist, Goran Josefoski, fortnightly.
3. She is due to see another psychiatrist in September because her last psychiatrist now worked only online which she found it too difficult to access. She said she preferred

in-person psychiatric treatment and that she would attend with her husband on most occasions. 4. She takes Lovan (fluoxetine) 20mg daily as prescribed by her treating psychiatrist.

1. Ms Murgoska was assessed in person at the Commission's medical suites by Medical Assessors Canaris and Baker. A professional interpreter ably assisted with interpreting. Her husband was present as a support person throughout.
2. She was teary from the very outset of the interview as the nature of the assessment was explained.
3. She presented as a woman who looked older than her stated age who was conservatively attired. Her hair was coloured although grey hairs were growing out. Her nails were cut but not painted. Her hands were clean. While questioned about her nails, she indicated limitations in using her wrist. She provided the history documented above.
4. Her account was coherent and internally consistent. She was softly spoken, and her speech was slowed often with significant delay in responding to questions and sometimes with no response consistent with psychomotor retardation. At times, she had difficulty understanding questions which had to be repeated in her first language with the assistance of the interpreter
5. Her demeanour throughout the interview was depleted and downcast. Her facial expression was sad throughout most of the interview. She was often teary with very little reactivity all of which was consistent with a depressed affect. She described a sad and depressed mood.
6. The Medical Assessors noted her husband's interactions with her at the interview. While he did not interfere in the assessment, he spoke to her at intervals in an encouraging fashion with evident warmth.
7. No evidence of psychosis or cognitive impairment emerged.
8. She described rapid onset of fatigue. A diminished ability to think or concentrate, and recurrent distressing thoughts of dying. She did not report any suicidal plans or prior acts of self-harm.

1. Physical: She depends on her husband who helps her with showering and changing her clothes. Because she is "frightened in case I fall and make bigger damage." She showers daily and changes her clothes with similar frequency as well as brushing her teeth. She does not do any cooking, and her husband buys food and cooks. She said she did not cook or lift groceries as she cannot physically do so. Her daughter and granddaughter do some washing and cleaning around the house. These physical injury impairments are not assessable for psychiatric whole person impairment on current guidelines.
2. Psychological: She spends her days doing "almost nothing." She lacks appetite and has lost a lot of weight "maybe 10 kg or more" and currently weighs around 60kg. In relation to getting her hair coloured, she went to the hairdresser every two or three months taken by her husband and had last gone about two months ago which was consistent with her appearance. She did not do her nails anymore having stopped doing this after she was injured in the accident.

1. Physical: She feels unsteady when standing which undermines her confidence and contributes to her reluctance to go out. This physical injury impairment is not assessable for psychiatric whole person impairment on current guidelines.
2. Psychological: She does not go out socially saying, "I don't get along with a lot of friends." She said, "I'm embarrassed." She has been out only for doctor's visits over the last six months. She does not go to church anymore. No one from her church visits. Her daughter and granddaughter visit two to three times a week and she enjoys their visits. She has no hobbies now and no longer sews or does embroidery.

1. Physical: She said she was less sure of herself whist walking as she feared falling because of her unsteady gait. This physical impairment is not assessable for psychiatric whole person impairment on current guidelines.
2. Psychological: She never drove. She used to get around by public transport. She could not catch public transport now saying, "I'm not sure of myself." She came to the Commission by taxi accompanied by her husband. She is a fearful passenger. Her husband would drive her sometimes, but she is frightened "and I sometimes scream." She goes nowhere on her own and never without her husband or sometimes with her daughter.

1. Physical: No issues.
2. Psychological: She says she gets on well with her husband, her daughter, and granddaughter. However, she has lost contact with many friends and her church community because of her injury caused by the accident.

1. Physical: No issues.
2. Psychological: She finds it hard to think and does not have happy thoughts. She can remember bits of the past that were happy. She sometimes listens to SBS including the Macedonian program and the news read in Macedonian. She enjoys listening to young actors and singers' voices. She does not remember the words of any songs. She could learn lyrics from her favourite songs before the accident and the injury. She cannot get hold of a Macedonian paper. It is all on the internet and she has no interest. Her husband mentioned that she has a special Macedonian program on the radio which is singing only. She does like listening to 2UE and to songs. She enjoys these for a short time and then loses interest. She might listen for 15 minutes to half an hour. The Medical Assessors noted in this context her delayed responses to questions and her difficulty understanding some questions which needed to be repeated as she pace of her thoughts were slowed because of the injury

1. She has not worked since the accident. She said, "I don't feel fit to do it...both physically and mentally."
2. Physical: She said she "can't walk properly" and her ribs hurt. She has a headache "all the time." These physical impairments are not assessable for psychiatric whole person impairment on current guidelines.
3. Psychological: With regard to mental limitations that prevent her working, she said she was "forgetful." The Medical Assessors noted in this context her depressed affect and psychomotor retardation which on their own would have made it impossible for her to work or to undertake tasks requiring sustained attention as would be necessary in any workplace. She would not be safe handling cleaning chemicals because of these psychological symptoms that commenced for the first time after the accident and had not remitted at any time before the re-examination.

1. The Medical Assessors noted her initial denial that she had not had any mental health issues before the accident and they drew her attention to documentation in the medical file forwarded with this referral. They noted that she responded by saying she may have seen a psychologist because of concerns about her daughter, and noted that this was confirmed by some of the documentation.
2. The Medical Assessors were unable to explore the circumstances of the loss of her son or its impact upon her or issues related to entries related to reported depressed mood, prescription of antidepressants, alcohol intake, and complains she had made to her treating doctors about her husband restricting her, preventing her going out, and controlling her drinking. They noted, however, that the amounts she was said to be drinking at the time (5 to 7 drinks a day) were at most moderate levels of use and not out of keeping with her community of origin. The Medical Assessors also noted that while there was a report that her husband may have hit her in the past, he had not done so for many years and Ms Murgoska was able to be soothed by her husband during the re-examination. The couple demonstrated genuine affection between each other during the re-examination as she spoke about her life and the accident.
3. The Medical Assessors concluded that Ms Murgoska may have understated her pre-accident problems. However, they noted that at the time of the accident, she was working full time, had not separated from her husband and assisted her husband to work for many years in the family cleaning business where they would attend work sites together and complete the contracted corporate cleaning duties successfully for many years before the accident

1. The Medical Assessors noted extensive documentation including reports, medical records, and assessment certificates relating to physical issues.
2. The Medical Assessors noted numerous records in her general practice file (West Ryde Marketplace Medical Centre) relating to pre-accident psychiatric issues including a 2004 entry in her general practice records relating to the recent loss of her son for which she was prescribed fluoxetine.
3. There were entries as of 2006 noting that she had not recovered from the trauma of this event with an entry in 2008 noting a history of stress and problems with alcohol. There were further stresses in 2010 including a reference to her daughter who are said to be an alcoholic, references to alcohol and violence, concerns for her three young grandchildren, and conflict with her husband.
4. The Medical Assessors reviewed general practice records (Powell Street Family Medical Practice) in 2016 and 2017 noting complaints about her husband who was restricting her, forbidding her from going out with her friends, and closely monitoring and restricting her alcohol intake. He had also hit her in the past though not for many years.
5. At the same time, there was documentation of her husband's concerns about her alcohol use and his perception that she was very likely underestimating her alcohol intake. She was noted for example in 2016 to be drinking five or six standard drinks a day four or more times per week. Ms Murgoska was asked by the Medical Assessors about her use of alcohol and she said at this one point in time, she did not believe she was alcohol dependent. There are varying estimates of how much she was drinking in 2016 but in August 2016 she was noted to consume five to seven standard drinks daily. In 2018 and 2019, she was prescribed Lovan (fluoxetine). The Medical Assessor made direct enquiry as to whether Ms Murgoska had ever been treated for alcohol use disorder with medication like naltrexone or acamprosate. She reported she was not ever prescribed any medication for treatment of her use of alcohol. She added she had not ever attended Alcoholics Anonymous (AA) or undertaken an outpatient community-based detoxification program or an inpatient or residential rehabilitation program for use of alcohol.
6. Arncliffe Medical Practice records as of 3 September 2021 noted presentations with "family stress" in May 2019 and September 2020 and prescriptions for Lovan. Family stress also featured in presentations in November 2015, May 2016, October 2016, February 2017. There were entries in 2015 referring to poor sleep and depressed mood and she was advised at one point in 2015 to avoid alcohol. There were similar entries to depressed mood and poor sleep in 2014 and 2013. There were entries relating to physical issues such as back pain and carpal tunnel.
7. The Medical Assessors noted records from her treating psychologist, Goran Josifoski, with entries in 2015 relating to her concerns for her daughter and her grandchildren with reported low mood, sleep disturbance with initial and middle insomnia, social withdrawal and feeling low, difficulty with concentration, low motivation and lethargy resulting in a diagnosis of major depressive disorder with anxious distress. Her daughter had run away from home at one point, and it was suggested that her daughter might have borderline personality disorder because her daughter had started legal action to gain visiting rights with her grandchildren. In relation to alcohol, Ms Murgoska is noted to have denied using alcohol in a manner that would meet DSM-5-TR criteria for an alcohol use disorder. She also did not identify herself as a victim of partner abuse or domestic violence.
8. A K10 assessment at intake after the accident by her psychologist yielded results consistent with severe anxiety and depression while a DASS 21 assessment yielded scores in the severe range for depression and extremely severe range for anxiety and stress.
9. Post-accident records included allied health recovery requests, and included the following snapshot of signs and symptoms documented by the treating team before the re-examination as follows:

"Frustration with persistent bodily pain and restrictions on neck, shoulders, upper/middle/lower back, and left leg; procrastinating/neglecting home chores and other responsibilities due to bodily pains and movement restrictions and low mood and motivation to do things; ruminating on negative thought; short term memory problems; difficulty concentrating; finding it hard to think; pessimistic approach and thoughts (reported that she was an optimistic and bubbly person previous to the MVA); anxious and a racing mind; constant worrying; excessive fear; unwanted and upsetting memories of the MVA; intrusive thoughts and flashbacks of the MVA; emotional distress following exposure to reminders of the MVA and avoids thinking about distressing memories of the MVA; hyperarousal; hypervigilance; heightened startle reaction; agitation; irritability; anger; feeling like something bad is about to happen; difficulty falling asleep and staying asleep; disturbed sleep, taking medication for sleep; frequent nightmares and night terrors; guilt; emotional detachment; reduced socialisation with family and friends; decrease in outings and activities; not driving following MVA due to excessive fear of driving and bodily pains and movement restrictions."

1. The Medical Assessors further noted that she "denied any pre-existing factors directly relevant to the compensable injury."
2. The Medical Assessors noted correspondence from Dr Goran Josifoski Stevans, her treating psychiatrist, dated 13 September 2021. Dr Stevans saw her in relation to depression which had been present since the accident. Her sleep was disrupted by pain in her ribs and neck. She had nightmares related to cars and being in an accident. She was highly anxious in cars, her appetite was poor, and she had lost weight. She was irritable with poor concentration and had poor short-term memory. She said she had not seen a psychiatrist or psychologist previously (which was not correct). Dr Stevans diagnosed post-traumatic stress disorder with partial response to Lovan and recommended that she be referred to a psychologist for CBT.
3. The Medical Assessors noted the certificate of Medical Assessor Matthew Jones dated

16 February 2021 determining that Ms Murgoska suffered from post-traumatic stress disorder which was not a minor (threshold) injury. 4. The Medical Assessors noted the certificate of the review panel dated 9 August 2020. She acknowledged having previously had "depression from family reasons" and to having been intermittently on Lovan. Her presentation was considered consistent particularly in relation to pre-accident medical records. However, the accident was considered not to be in keeping with Criterion A of DSM-5 for the diagnosis of post-traumatic stress disorder and a diagnosis of persistent depressive disorder was substituted as well as a diagnosis of somatic symptom disorder which were both non-minor (non-threshold) injuries. 5. The Medical Assessors noted the certificate of Medical Assessor Michael Hong dated 14 July 2023. Medical Assessor Hong diagnosed an exacerbation of a persistent depressive disorder with a major depressive disorder. She had denied any prior history of psychiatric illness although depression, anxiety, domestic violence, and alcohol problems were noted at various times with the history going back to 2006 as well as being on Lovan since 2011. He assessed her impairment as 2% rating her as Class 1 for travel and Class 2 for all remaining categories. He noted that her pre-existing depressive disorder was an apparent remission with antidepressant medication which would equate to a prior 3% WPI after uplift for treatment effects. However, he saw no evidence to warrant any post-accident adjustment for treatment effects. 6. The Medical Assessors noted the certificate of Medical Assessor Sidorov dated 5 August 2024. Medical Assessor Sidorov diagnosed an exacerbation of major depressive disorder. Medical Assessor Sidorov conducted his assessment three months after Medical Assessor Michael Hong had seen her. He noted significant inconsistencies between her account and the medical documentation in relation to her denial of any prior history of psychiatric illness and a range of other stresses including what appears to be coercive control on the part of the husband and difficulties in her relationship with her daughter stating that she could not recall being prescribed antidepressant medication prior to the accident. Medical Assessor Sidorov rated her current whole person impairment as 15% but apportioned 50% of this impairment to factors unrelated to the accident such as family stress as described in the record and other unknown factors yielding an impairment of 7.5% rounded up to 8%. He then subtracted 6% for pre-existing impairment giving a final whole person impairment score of 2%. He made no adjustment for treatment effects.

1. Ms Murgoska's presentation was consistent with a diagnosis of chronic major depressive disorder.
2. In terms of DSM-5-TR criteria, the Medical Assessors note the presence of her mood disturbance comprising depressed mood for most of the day nearly every day, markedly diminished interest and pleasure in almost all activities most of the day nearly every day, poor appetite with weight loss of 10kg, insomnia, evident psychomotor retardation at interview, fatigue, diminished ability to think or concentrate, and recurrent thoughts of dying. In short, she satisfied eight out of the nine symptoms specified by Criterion A of which a minimum of five was required for the diagnosis.
3. Her symptoms cause her clinically significant distress and psychosocial impairment as evident in her inability to work, her social withdrawal, her poor concentration, and her diminished self-care consistent with Criterion B.
4. Her symptoms were not attributable to the physiological effects of a substance or to another medical condition consistent with Criterion C.
5. There was no evidence of schizoaffective disorder, schizophrenia, schizophrenia spectrum, or other specified or unspecified psychotic disorder consistent with Criterion D.
6. There had never been a manic episode or hypomanic episode consistent with Criterion E.
7. There was evidence of a pre-existing depressive condition which the Medical Assessors concluded was most likely a major depressive disorder which appears to have been in substantial remission at the time of the accident.
8. There was also evidence of a possible pre-existing alcohol use disorder however there was not any evidence that a DSM-5-TR alcohol use disorder was diagnosed and treated with either psychological or pharmacological therapies after her alcohol use was documented. Due to the absence of these confirmation factors a diagnosis of alcohol use disorder in compliance with DSM-5-TR criteria was not made.

1. There was evidence of a pre-existing major depressive disorder which had gone into substantial remission with treatment caused by a range of circumstances including the loss of her son and her daughter's difficulties before the accident.
2. There was evidence of pre-existing alcohol use which had not been formally diagnosed or treated as alcohol use disorder. Her consumption of alcohol had gone into complete remission prior to the re-examination. The placement of her consumption of alcohol into complete remission is inconsistent with a diagnosis of DSM5-TR defined alcohol use disorder because Ms Murgoska did not have any permanent impairment from her consumption of alcohol.
3. Whilst there were references to her son's loss and her daughter's difficulties the Medical Assessors noted that Ms Murgoska was not impaired in her capacity to work long hours, continue her marital relationship, provide care to her grandchildren whilst her daughter had access restrictions to the children.
4. For the above reasons, Ms Murgoska's pre-existing major depressive disorder in remission had caused no more than a minor deficit in keeping with normal variation in the general population in all areas of her activities of daily living before the accident.
5. An aggravation of symptoms due to depression emerged in the aftermath of the accident. Ms Murgoska suffered both psychological injury and physical injury with chronic pain. The Medical Assessors concluded from the above re-examination and assessment of the forwarded documents that the accident had contributed to the aggravation of her major depressive disorder.
6. Ms Murgoska's aggravated major depressive disorder was clinically significant. The aggravation of the major depressive disorder had caused more impairment in more of her activities of daily living because of the psychological injury alone.
7. Ms Murgoska was unable to work safely with the chemicals she was required to work with because of the psychological injury's impairing her concentration persistence, pace, and adaption after the accident. Ms Murgoska's activities of daily living were also impaired more than before the accident. The descriptors are documented for both the pre-existing condition and the aggravation of the major depressive disorder in the PIRS worksheets below.
8. The Medical Assessors agreed that an aggravation of major depressive disorder could be caused by the motor accident as assessed at the re-examination.
9. The Medical Assessors both agree that the accident did cause aggregation of Ms Murgoska's major depressive disorder which was in remission before the motor accident.

1. More than 5 years have elapsed since the accident. Over this time, Ms Murgoska has had treatment from a psychologist and a psychiatrist (although she is looking to change her psychiatrist). She is on an appropriate psychotropic regime. Her level of impairment is unlikely to change substantially or by more than 3% over the ensuing year.

Degree Of Permanent Impairment Psychiatric Impairment Rating Scale

She sees a psychologist and a psychiatrist and is on an antidepressant.

She spends her days doing "almost nothing." She lacks appetite and has lost a lot of weight "maybe 10 kg or more" and currently weighs around 60 kg. In relation to getting her hair coloured, she went to the hairdresser every 2 or 3 months taken by her husband and had last gone about 2 months ago which was consistent with her appearance. She did not do her nails anymore having stopped doing this after she was injured.

She does not go out socially saying, "I don't get along with a lot of friends." She said, "I'm embarrassed." She has been out only for doctor's visits. She does not go to church anymore. No one from church visits. Her daughter and granddaughter visit 2 to 3 times a week and she enjoys their visits. She has no hobbies now and no longer says or does embroidery.

She never drove. She used to get around by public transport. She could not catch public transport now saying, "I'm not sure of myself." She came to the PIC by taxi accompanied by her husband. She is a fearful passenger. Her husband would drive her sometimes, but she is frightened "and I sometimes scream." She goes nowhere on her own and never without her husband or sometimes with her daughter.

She says she gets on well with her husband, her daughter, and granddaughter. However, she has lost contact with many friends and her church community.

She finds it hard to think and does not have happy thoughts. She can remember bits of the past that were happy. She sometimes listens to SBS including the Macedonian program. She enjoys listening to young voices. She does not remember the words of any songs. She cannot get hold of a Macedonian paper it is all on the internet and she has no interest. Her husband mentioned that she has a special Macedonian program on the radio which is singing only. She does like listening to 2UE and to songs. She enjoys these for a short time and then loses interest. She might listen for 15 minutes to half an hour. The Medical Assessors noted in this context her delayed responses to questions and her difficulty understanding some questions which needed to be repeated.

With regard to mental limitations that prevent her working, she said she was "forgetful." The Medical Assessors noted in this context her depressed affect and psychomotor retardation which on their own would have made it impossible for her to work or to undertake tasks requiring sustained attention as would be necessary in any workplace.

Psychiatric Impairment Rating Scale Pre-existing/subsequent impairment

She had seen a psychologist and was on an antidepressant.

She denied any impairments in this category and the Medical Assessors did not find evidence in the documentation to support impairment.

She denied any impairments in this category and the Medical Assessors did not find evidence in the documentation to support impairment.

She denied any impairments in this category and the Medical Assessors did not find evidence in the documentation to support impairment.

There was evidence of past tensions in her marriage and in her relationship with her daughter. However, there was no evidence in the documentation that these were an issue at the time of the accident.

She denied any impairments in this category and the Medical Assessors did not find evidence in the documentation to support impairment.

She denied any impairments in this category and the Medical Assessors did not find evidence in the documentation to support impairment.

Apportionment pre-existing/subsequent impairment

1. While there was no evidence of any impairment greater than a minor impairment as defined by the PIRS guidelines at the time of the motor accident, there was evidence that this had given rise to more symptoms in the past which had been eliminated with treatment. Consequently, a 3% uplift for treatment effects applied to her pre-existing treated condition produces a pre-accident whole person impairment of 3% WPI.
2. Her whole person impairment was therefore 22% - 3% = 19%.

1. The Medical Assessors made no adjustment for treatment effects to impairment arising from the accident. The reasons for this is that Ms Murgoska's symptoms caused by the accident's aggravation of the major depressive disorder had not remitted and her impairments sustained had become permanent before the re-examination and would remain with or without treatment for at least the next 12 months.
2. For these reasons, no adjustment for treatment effect for the accident was made.
3. The assessment of whole person impairment for effects of treatment was assessed as 0% WPI.

Degree of permanent impairment caused by the motor accident = 19%

1. The Panel held a further meeting on 17 September 2025 at 11.00am when the members discussed the issues.
2. The Panel consulted further and considered the submissions of the insurer and the context of the death of her son early this century.
3. The Panel considered the difference between events which, by themselves, did not prevent her from continuing to work and being productive, such as the death of her son, and those events which had given rise to actual psychiatric conditions which have to be taken into account.

1. In relation to the insurer's submission at [15](e) of 6 March 2024:

"The pre-accident records show longstanding psychological symptoms related to her son's murder in 2006, family conflict, alcoholism, financial coercion, controlling behaviour by her husband, suicidal ideation and depression, none of which are mentioned by Dr Rastogi."

The Review Panel repeats that this was no doubt a significant event and caused Ms Murgoska significant grief at the time. For whatever reason, she was able to work through that grief and it was not a triggering event of the type that prevented her from working and getting on with her life after, no doubt, a period of grief.

1. In other words, the Panel believes that, on the balance of probabilities, although Ms Murgoska understandably grieved the death of her son in 2006 it did not become pathological probably because she was in fact able to work and, on the balance of probabilities, was able to recover from that traumatic event.
2. The insurer's submission at [15](e) also refers to "long standing psychological symptoms relating to ... family conflict, alcoholism, financial coercion, controlling behaviour by her husband, suicidal ideation, and depression...".
3. The Panel was able to draw the inference from its consideration of the records and documents which it has examined that although there were, no doubt, periods of difficulty in the relationship between Ms Murgoska and her husband, it was probably on the whole a loving relationship interspersed with periods of difficulties as are so many relationships.
4. The Panel draws support for this that Ms Murgoska and her husband were able to work together in the family cleaning business and worked together through long hours for many years, allowing the Panel to draw the inference overall that it was a reasonably workable and reasonably harmonious relationship on the whole.
5. The Panel has noted the opinion of Dr Synnott of 13 January 2023 and holds a different view and, in particular, believes that the history given by Ms Murgoska is consistent and was truthful.

1. The Medical Review Panel revokes the Certificate of Medical Assessor Alexey Sidorov of

5 August 2024 and substitutes the determination that as a result of injuries sustained in the accident, Ms Danica Murgoska (the claimant) suffered whole person impairment of 19%.