MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of medical assessment; whole person impairment (WPI); exacerbation of pre-existing post-traumatic stress disorder; pre-existing impairment; claimant receiving disability support pension at date of accident; prior workers compensation claim; prior mood stabilisation medications; pre-existing bipolar affective disorder; rear end collision; pre-accident NDIS support; borderline personality disorder; long-term cognitive problems; exacerbation of chronic post-traumatic stress disorder; exacerbation of possible cluster B personality; Held - medical assessment certificate revoked; WPI assessed at 8%.

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

1. The Review Panel revokes the certificate of Medical Assessor Melissa Barrett dated

10 September 2024 and issues a new certificate that, the following injuries caused by the motor accident give rise to a permanent impairment of 8% and is NOT GREATER THAN 10%: * exacerbation of pre-existing post-traumatic stress disorder.

1. Lisa Peacock (the claimant) is a 57-year-old woman who was injured in a motor vehicle accident on 24 November 2020. Following the accident the claimant lodged an application for personal injury benefits and, it having been determined that she had sustained a non-threshold injury, sought a concession from the insurer that the injuries caused by the motor vehicle accident left her with a greater than 10% whole person impairment (WPI).
2. After conducting an internal review, the insurer declined to make this concession and consequently the claimant lodged an application for assessment of degree of permanent impairment.
3. The claimant was examined by Medical Assessor Melissa Barrett on 26 August 2024, who in a certificate dated 10 September 2024, determined that the injuries caused by the motor vehicle accident gave rise to a permanent impairment of 4% as a consequence of an exacerbation of pre-existing post-traumatic stress disorder.
4. The claimant sought a review of this certificate and, in a decision dated 13 November 2024 President's Delegate Tajan Baba, determined that there was a reasonable cause to suspect that the medical assessment was incorrect in a material respect. The matter was then referred to this medical review panel.
5. Directions were issued to the parties to upload all the material which was before Medical Assessor Barrett and this has now been done.
6. 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 the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply.
7. The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (the Commission).
8. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
9. 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 matter solely based on the written application.
10. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.

1. The Medical Review Panel Examination took place via audiovisual link through the MS Teams platform, organised by the Commission. Present were: the claimant, Dr Chris Rickard-Bell and Dr Matthew Jones. The claimant was at home and although her disability support worker was present in the house, she was not present for the assessment.
2. It was explained to the claimant the purpose and nature of the assessment and the fact that it would not be confidential, nor would there be any treatment provided by the Panel. The claimant acknowledged that she understood the above and agreed to continue with the assessment voluntarily.

1. The claimant is a 58-year-old woman who is living in Port Macquarie, NSW, where she has lived since 2017. She lives in her family home with her mother, who is aged 80, and is well for her age, also her brother who is three years younger and is a Station Commander in the NSW Fire Brigade.
2. The claimant reported that she is working four hours per week in disability support work. She reported that she upskills people to assist them in attaining their educational goals. She has the same clients from week to week and her clients travel from Kempsey to Port Macquarie on a Thursday, where she sees them. The Medical Assessors asked for examples of what her work entailed, and she said she will help a young man she has as a client with questions. She reported she assisted him with his homework and proudly announced that he "topped NAPLAN." She also assisted him with his artistic pursuits. She also has an 18-year-old client whom she is helping with her HSC and transitioning to work. She reported the 18-year-old has autism spectrum disorder and visual processing difficulties and the fourteen year-old has autism spectrum disorder.
3. The claimant reported she has been employed in disability support work from 2018 to currently. She utilises an ABN and is subcontracted, and her clients' plan managers pay her. The Medical Assessors asked the claimant about her background and how she found herself in this work and she reported she was originally an art teacher. She then went on to say that she is a "creative coach" for her clients.
4. The Medical Assessors asked if the claimant received any other income, and she reported that she sometimes runs workshops for authors and has undertaken two of these in the last two years. She went on to say that she had undertaken 39 years of journaling her own life, however this has never published. She did this until she "stopped", but it was unclear when this was.
5. The claimant also reported that she is receiving the Disability Support Pension and that because she is self-employed, she submits a profit and loss statement. She reported that her disability support payment does not usually get adjusted (therefore she normally does not earn above the threshold). She went on to say that she can only work up to six hours per week.
6. The claimant went on to say that she had "zero capacity after November 2020", referring to the subject motor vehicle accident. She then reported that in March 2021 she started working a few hours and got back to some art teaching, art tutoring and disability support work. The claimant reported she is not receiving any insurance company payments and that these ceased after a "set amount of time."
7. On enquiry, the claimant reported she had been receiving the Disability Support Pension since 2003. She reported she had had a workplace injury due to bullying and harassment, while working at a company called Trilogy, and had "not been able to settle for a few months." She reported she then went back to full-time work and then received, "make-up pay after that." She reported that prior to the bullying and harassment situation, she was earning approximately $90,000 per year. She reported she ended up receiving "no compensation" related to this work injury, presumably referring to a lump sum payout.
8. The Medical Assessors asked her how long she was off work with her work injury, and she reported that she went back to work in 2003, stating she had worked in business development in a digital agency. She said this work was mainly in sales. She reported she stayed in this employment for approximately two years. She then said she was "head hunted and went to the next company."
9. An unusual experience occurred early in the assessment of the claimant. There was the simple task of clarifying a timeline based on when she believed things happened, her date of birth, and how old she was. It became confusing and unclear, with the claimant being unable to reconcile the age she knew she was at the time she was working with a certain employer. There was a clear consistency of around four to six years. Ultimately, the claimant conceded that she was unable to do the simple mathematics and said she "can't do numbers."
10. Regardless of these inconsistencies, the claimant went on to say that at the age of twenty-nine she worked in business development in a PR company. She said at the time a client was starting an e-commerce software company, and they offered her a role as director and to work in fundraising. The business operated in Australia and the United States and ultimately the business was sold in around 2003. Again, there was some confusion about the dates and The claimant reported she needed, "to use a pen to work it out", relating to simple maths with respect to her date of birth and how old she thought she was when certain events had occurred. She again conceded that with respect to numbers she was unable to do counting with proficiency, nor any bookkeeping. She said she had never been able to do these tasks. She reported she had always had problems with simple mathematics.
11. The Medical Assessors attempted to understand if the claimant was receiving any statutory worker's compensation payments and she said she did not know. She reported however she was at the business development company as a digital agent for a few months but was not liking it. She reported she stopped working there and started to assist with bringing up her niece who was born in 2003. She reported she did this for sixteen years during the times her brother would work his shifts. She said this was her main occupation during that period. She also said, however, at the same time, she had a "small micro business" which involved treatment with spiritual healing such as Reiki and Pranic Healing. She said she was a practitioner of "energy healing." She said that her work would take place in people's homes or in a nature spot, and she also had her healing room. She reported she worked in Victoria and New South Wales. She said around that time she was living between Victoria, Port Macquarie and also in Sydney. She said her niece lived on the Central Coast with her mother and her brother lived in Port Macquarie. She also said that she and her mother were helping bring up her niece in Sydney.
12. So, to clarify, the Medical Assessors confirmed that for sixteen years the claimant was receiving the Disability Support Pension and had her microbusiness. She spontaneously added that in 2014 she started the Animal Link Foundation which was a Facebook group that brought together volunteers from around the world who made crafts for animals' rehabilitation, for example back wraps and substitute pouches. She said that they would be made out of wool. She also reported that various veterinarians would donate vitamins, medicines and food, particularly during natural disasters. She reported she had good relationships with veterinary practices. She stated that it was not a registered charity and said that she had had some money from selling the e-commerce company, of which she was part owner. The claimant reported that Animal Link was operational for approximately seven years.
13. The Medical Assessors attempted to understand her involvement with the e-commerce company. She said she was involved with the e-commerce company for about four years. She said that by 2000 she was involved with this and then she and another director had the opportunity to go to the United States. The claimant reported she stayed in Australia and continued to work at Trilogy, which was supposed to be for six months. She and the other director ultimately sold the e-commerce company.

1. The claimant reported that she is prescribed Lamotrigine (a mood stabilising anti-epileptic medication) and takes 100mg twice a day. She is also prescribed Escitalopram (an SSRI antidepressant) and takes 20mg each morning. She also is prescribed Quetiapine (a mood stabilising antipsychotic) at a high dose of 700mg per night, as well as some extra when required. She reported that her general practitioner is Dr Meena, and her psychiatrist is Dr Candice Jensen, whom she sees every few months. She started seeing Dr Jensen, "A couple of years ago."
2. The claimant reported she had been on the Lamotrigine for a couple of years and said it was "just for mood stabilisation." She reported she had been on the Escitalopram, "Since the car accident." She reported she had been taking Quetiapine since about 2003. She said this assists her with sedation at night and also with panic attacks in the middle of the night. She said it, "Just keeps [her] nervous system slower."

1. The claimant reported that she had "extreme stress" at the age of 19. She said at the time she was studying full-time university, working and also working in the holidays. She had up to three jobs. She said it was the first time she was out of home and she had "no skills." She said during a period of mental health distress she took herself to three psychiatric hospitals, but was not admitted, and it was not until the fourth hospital, a private hospital, that she was admitted. This was at Mount St. Margarets at North Ryde. She was in this hospital for approximately a month and then went back to full-time work. When asked about the diagnosis, she reported "They said it was bipolar." She then said that she was extremely stressed, not grounded and in her "head a lot", at the time.
2. The claimant reported that she was started on Lithium (a mood stabiliser used in bipolar affective disorder) and took this until 2023 or 2024 (this is over 35 years). The Medical Assessors asked if the claimant experienced any side-effects and she said that indeed she had side-effects and had them for a long time. She said she had a metallic taste in her mouth and had weight gain. In consultation with her Psychiatrist, Dr Jensen, they then decided to switch her from Lithium to Lamotrigine (another mood stabilising medication). She said that they also decided to increase the dose of Quetiapine. With respect to Lamotrigine, she reported, "Yeah, it's good."
3. The Medical Assessors asked if there were any other hospitalisations for mental health reasons, and she reported that at the age of twenty-nine she was in a psychiatric hospital for approximately two weeks. She reported that the symptoms she presented with, "Could have been Bipolar", however she was treated for hyperthyroidism. She said she, "Got better."
4. The claimant reported she had had no other psychiatric hospital admissions. She did however see long-term psychiatrists including; Dr Merory in Bellevue Hill for several years, and Dr Kirkby after her admission to Mount St. Margarets. She said Dr Kirkby was, unfortunately, "way too far away." She reported that from about the age of 20 until about 2002, she saw Dr Merory, who unfortunately passed away from diabetes. She named several other psychiatrists she had seen over the years, including Dr Rosalie Wilcox in Sydney, Dr Amour in Port Macquarie, and Dr Kathryn Black who was based on the North Shore, however she saw her via telehealth. After seeing Dr Black, she started seeing Dr Jensen.
5. There was some confusion in the Medical Assessor's minds with respect to the claimant's attitude towards her mental health problems. On the one hand, she had been taking mood stabilising medication for over three and a half decades that apparently was causing side-effects and yet she seemed to be uncertain about her diagnosis, stating that the first time she went to hospital was because she was extremely stressed and the second time was for hyperthyroidism. The Medical Assessors asked the claimant why she had seen a series of psychiatrists, quite consistently, over a few decades and she said that she did this to "optimise medications." She said she did this, "to keep working and keep functioning." The Medical Assessors directly questioned whether the claimant believed she had bipolar affective disorder and she said she thinks she was misdiagnosed. She went on to say that she had had a trauma at the age of nineteen which involved a sexual assault, and she felt like she was "losing [her] mind from that." She reported that she "didn't want to tell middle-aged men about it". She simply stated that she "never came off mood stabiliser." She then went on to spontaneously say that she did believe she had post-traumatic stress disorder and that this started with her worker's compensation case at Trilogy.
6. The Medical Assessors asked the claimant how her mood had been over the years, and she reported that there were periods when something has happened and she has reacted, which she described as stress, but she gave an example of stopping her regular activities because of this stress. She nonetheless said she, "still soldiered on." She reported that when she started on Quetiapine in about 2002, she was then able to sleep regularly. She remembers not being able to sleep when she was nineteen. She reported that from 2002 onwards, for many years, she had a similar dose of Quetiapine.
7. When she met Dr Jensen her Quetiapine dose was 325mg per day. She added that after the car accident this dose went up to 650mg. She said it has, "climbed since." She said this medication helped with her sleep, nightmares and flashbacks. She said she became sedated enough to go to sleep, however was "alert and awake enough because of PTSD." She agreed that her current Quetiapine dose of 700mg was a high dose, however stated that it was "better than 675mg", clinically. She reported she can still wake at 2.00am or 4.00am with nightmares and flashbacks.
8. The Medical Assessors explored other psychiatric diagnoses that had been mentioned in the documents. She reported that when she was in Melbourne, at one point a doctor thought she had borderline personality disorder. She commented that there was a previous sexual assault trauma when she was fourteen. With the doctor who diagnosed her with bipolar personality disorder she started with a psychological program called "Act with Love." She said she had already partaken of courses because of her spiritual healing interests and had skills such as mindfulness.
9. The claimant denied any episodes of deliberate self-harm in the past. She did however state that since the car accident she has had intrusive thoughts of suicide which have come and gone for the last four-and-a-half years. She said she does not act on this. When asked why she thought these were occurring, she said it was, "Because of the loss of [her] life."
10. The claimant reported that prior to the motor vehicle accident she was living in Port Macquarie and seeing Dr Black, who was at North Shore Hospital, via AVL. She reported that she was, "really traumatised" and was unable to talk in the appointments because she was crying. She underwent some CBT, however found that stories about other clients, which were being used as examples in her CBT, "triggered" her. She reported that in discussion with Dr Black, Dr Black decided to stop therapy. The claimant then started seeing Dr Jensen in Sydney also via telehealth.
11. At the time of the car accident, the claimant was living in the same house with her mother and her brother. She was receiving the Disability Support Pension, still doing some spiritual healing and also doing disability support work. She reported that from June 2020 (about five months before the motor vehicle accident) she was deemed to be fit for full-time work. She said she was working four days a week and also doing "art shifts." She would work full-time during school holidays and also have three extra clients for whom she assisted for six hours a week, via video lessons.
12. As an aside, the claimant reported she had a graduate diploma in writing and said she had always studied since school and "liked" to do workshops. She also reported that she had undertaken years of study in spiritual healing. She said her spiritual healing does not have a religious base and she likes to think of it as being more "grounded."

1. The claimant confirmed the date of accident as 24 November 2020. She reported she was stationary at a roundabout and six cars back from the intersection. She said a car came over the bridge behind her and collided with the rear of her vehicle. When she got out of her hatchback, the back door (the boot) seemed to be, "out a little." She said the other car was an old Jaguar and appeared to be significantly damaged. When asked if her car hit the car in front, she said that it did not because she "always covers [her] brakes".
2. The claimant reported that her and her mother received whiplash and at the time of the accident she, "flung [her] arm in front of mum." The claimant reported that she heard her own head crack on the headrest. She asked if her mother was okay and then got out of the vehicle. She took a photograph of the other driver's licence and triple 0 was called (by her brother, whom she contacted). She said members of the fire brigade came to clear up the liquid from the car and then an ambulance came and paramedics assessed the drivers and The claimant's mother. At the time of the accident the two of them were travelling to the RSPCA to drop-off donations. She reported her car was driveable after the accident, but ultimately required repairs to the value of over $3500 which was the write-off value.
3. After the accident, the claimant and her mother went home. She said her mother was okay, but a bit sore. The claimant reported she woke-up the next day with severe pain around her neck and shoulders. She described herself as being, "in agony." She said she had never experienced that much pain before. She said she went to see her general practitioner and underwent a "concussion test." She confirmed that there was no loss of consciousness at the time of the accident. Her general practitioner was Dr Zhu. She also reported that at the time she was, "having a lot of fear around driving."
4. The claimant then went to see her general practitioner, Dr Rees, and at the time was reluctant to go back to driving. She reported that her concussion symptoms continued into January and, as there was no neurologist in Port Macquarie, her general practitioner referred her to a neurologist in Forster/Tuncurry. She said she was tremulous around that time. She commented that she had not seen a neurologist for the last few years.
5. The claimant then spontaneously added details of her medicolegal journey. She said that the neurologist commissioned by her solicitor, from Sydney, assessed her with 2% WPI for neurological injuries. She believes this was in 2022. She also went to see an orthopaedic surgeon in Kogarah in 2022 or 2023 who awarded her 0% or 2% for orthopaedic injuries. She also saw a psychiatrist, Dr Kumar, who assessed psychiatric WPI as 24%.
6. The Medical Assessors asked if the claimant had gone to see Dr Cassimatis, as mentioned in the documents, and she confirmed that she had. She said that Dr Cassimatis took a thorough history and she oddly commented that she found Dr Cassimatis "healing" and that he told her, "Don't let PTSD rule your life." Dr Cassimatis also indicated to her that she may have ADHD and told her that this was the first time in her life that she had experienced post-traumatic stress disorder. The Medical Assessors indicated to the claimant that they had not had access to Dr Cassimatis' report and she smiled and said that she thinks that the insurance company had "buried it" because it was favourable towards her.
7. The Medical Assessors also explored her history of involvement with a trauma counsellor, Mr Jan Wetzel, in Port Macquarie. She had seen him from 2018 for about three years. She said this was before the accident and she underwent Eye Movement Desensitisation and Reprocessing Therapy (EMDR), which she said, "didn't work." She commented that she, "did so many sessions." She then commented that she had, "Always gone to somebody" referring to regular clinical contact.

1. The Medical Assessors asked the claimant why she went to see the trauma counsellor in the first place (and that treatment lasted three years) and she said that, as she was bringing up her niece, she wanted advice. She said that her niece's mother had drug and alcohol problems. The Medical Assessors pointed out that normally people did not see trauma counsellors or receive any EMDR therapy for simple care or parenting advice and she said that she received the treatment for "just life." She reiterated that her treatment was centred around "stress around my niece."
2. The Medical Assessors enquired of the claimant regarding her NDIS status. She reported that she was receiving NDIS support prior to the motor vehicle accident, and that in May 2019, she had a declared two-year budget of $96,000 for the upcoming two-year period. She stated that the conditions she received NDIS funding for were: post-traumatic stress disorder and bipolar affective disorder. (Comment: This is in contrast to her stating that she did not believe that she necessarily had bipolar affective disorder and that she agreed with Dr Cassimatis that her diagnosis of post-traumatic stress disorder was the first occurrence of this and was subsequent to the motor vehicle accident).
3. The claimant spontaneously commented that with respect to her NDIS funding she does not, "use it how most people use it." She was unable to clarify what this meant exactly, however said that she utilises the funding for "things [she] can't concentrate on, anymore." She gave an example that, prior to her NDIS funding, she would employ an accountant to help her with her bookkeeping, but after the accident she used NDIS support for banking, accounting, bookkeeping and general administration. The claimant was initially somewhat evasive when asked about what particular services she was approved for with respect to NDIS, but eventually said she was receiving IT support as well as mentoring and peer support. She also received assistance with her paperwork. She reported that the two-year period ended in May 2021. She also reported she was studying two Certificate III TAFE courses and she needed support with this. She said this was because there were some questions that were very, "logical and scientific." She went on to say that she graduated four days before the car accident. She commented that she did not need personal care and personal hygiene assistance, however she and one of her support workers would go for walks. In summary, she reported that she required NDIS support for "daily living."
4. The claimant implied that a similar amount of funding continued, covering the period of the accident, however she said she spent two years' worth of funding in eighteen months, "because of the motor vehicle accident".
5. The Medical Assessors asked the claimant about her current NDIS arrangements, and she said she receives six hours per week from her support person, Kirsty (who was present in the house at the time of the assessment). She described her as, "really friendly." The claimant went on to say that she is struggling to communicate, "socially and in the community." The claimant could not be particularly specific about what support Kirsty provided but said she "just supports [her]." She said she still needs assistance with invoicing and administration assistance. She also said that they will go for coffee and have a chat. She commented that Kirsty was leaving her employ/service soon. She also reported that since 2023 she has used some funding for personal training. She still does this. She also continues to receive tech support and said this is for two hours a week. She went on to say that she does her "apps" but said she is "super forgetful". She uses ChatGPT. In general, she said she was, "not well."
6. The claimant was unsure of her current NDIS budget details but did give as an example that the previous $14,000 that was allocated for mentoring and IT, is now reduced to $1500.
7. The Medical Assessors tried to get an understanding of her weekly support needs, and she reported that she has time with Kirsty, five to six hours a week, two hours per week body building with a personal trainer, and tech support between two and four hours a week. She said however this costs $40 return in a taxi for her attend the tech support office. She went on to say that she is, 'Not utilising as much as [she] could." She said she finds it difficult to turn up to appointments because she does not get paid for them.

1. The documents provided some scant but relevant, information in respect to the pre-motor vehicle accident psychiatric history.
2. The letter of Dr Rana dated 19 December 2021 to the claimant's cardiologist confirms a past diagnosis of borderline personality disorder, bipolar disorder, depression/anxiety, and a GP mental health care plan was developed and dated 12 March 2013.
3. The correspondence from the claimant treating GP to Dr Black, dated 27 November 2020, notes a history of anxiety, borderline personality disorder, depression, post-traumatic stress disorder and, more recently, on 27 February 2017, anxiety.

1. The Medical Assessors attempted to ascertain some of the claimant's day-to-day functional capacity. With respect to self-care and personal hygiene she said she has, "a lot of issues with personal care." When asked what she meant by this, she went on to say that she struggles with cooking, and she sometimes forgets the toaster is on and then needs to reheat it. She said she has forgotten to put sugar in her mother's tea and has left the oil cooking on the stove. She then went on to say that she no longer wears make-up, and she will forget whether she has had a shower or not. She referred to the large signs that she puts out for herself (see her statement) to remind her of things, and she said that she will miss the large signs that she puts out for herself. She then said she has, "constant intrusive thoughts." She is embarrassed about her, "change in conversation." She went on to say that she has, "piles everywhere" and that she has not dusted her bedroom. When asked why she, said she just forgets. She said she is not able to organise herself in the manner she used to. She said this is why working is so hard for her.
2. Given the apparent cognitive difficulties the claimant was reporting, the Medical Assessors asked if she had seen a neurologist or a neurological occupational therapist and she said she had not. She said she has seen an occupational therapist, who was a driving specialist, who performed a driving test on the claimant. There was a driving assessment around the beginning of 2024 by Mr Neville (noted in the documents). In this assessment, Mr Neville was complimentary about her apparent organisation (having a folder with all of the necessary documents present), that she drove with attention and competency, and she passed various pre-driving cognitive tests. The driving test was for over forty minutes. The claimant seemed unable to acknowledge her competency in this regard to the Medical Assessors and stated that she would not go on a "road test", however it appears that this assessment was indeed a road driving test. The claimant indicated that she had been recommended to have driving lessons, however said she was not able to. The Medical Assessors did not understand her logic, given that a driving test would be more stressful than a driving lesson. She stated that she would find the driving assessor kinder and more supportive than a driving instructor. This lack of logic was not reconciled during the assessment.
3. The claimant went on to say that she had had two years of fear about driving. She spontaneously added that, when she is a passenger, she instructs people who are driving to keep their hands in the right position. She said that she will put her hands over her face when she is a passenger. She went on to say that she does not walk her dog because of fear of traffic. She said her "whole life is within fifteen minutes."
4. With respect to her travel capacity, the claimant reported she has a reluctance to drive since after the accident. She said this has got worse because she has been avoiding it. She said she now restricts herself. She said every week she will travel into town with Kirsty, however said Kirsty will drive. She reported she experiences fear when in taxis and when her mother is driving and, sometimes, she even sits in the back. She has a fear that cars will impact their vehicle. She then said she is "one-hundred percent certain" she will "crash when in a car." She then reported that she walks everywhere and if she has to cross a street, she will wear headphones. She then spontaneously added that she is anxious when out in public and that her "life is within one kilometre."
5. The claimant went on to say that she is ruminating about the car accident. She said she has a feeling that, "something is going to happen." She added that she has "flashbacks of the sound of the crash."
6. The claimant reported her gym is 300m away and she will go to the shops with Kirsty to have a coffee. She said that she does her administrative work while they are in the café.
7. The Medical Assessors asked the claimant about any friendships. She said that she has one eighty-year-old female friend. She had other friends and commented she had, "a lot relationships in wildlife", stating that she had six-hundred people on her wildlife Facebook database. She commented that her family loves her, however there are "strained relationships." She said she feels, "stressed and impacted in [her] head all the time." She said the experiences "grief from the life [she] used to have."
8. The claimant reported she is not currently in a personal relationship. Her last relationship was in 2019 for about five months, however said, "It wasn't going to go anywhere." She reported she had never had children. She reported at one point she had lived with a partner. She also had a relationship from high school. She commented that she had done a lot of dating around 2018/2019 to find a life partner and that she had, "always had boyfriends." She reported she is, "not in a state to give them the somebody [she] used to be."
9. With respect to her financial capacity, the claimant reported that she has sufficient savings to pay for a very cheap house. She said she is very good at saving and tends to save fifty percent of her income. She has this is invested in term deposits.
10. The Medical Assessors asked the claimant what she did to pass time, and she reported she will scroll on her phone, she will watch Netflix, and she will play with her dog. She said she has tried to train her dog as a personal assistant dog, however the dog did not pass the public access test. She said this was partly because of her dog's breed, which is cattle dog. She said that her dog will get off the couch every two minutes and described that he was "naughty". She said that her family bought her dog as a puppy for her and she described her dog as, "one hundred percent emotional support" and she feels better around it.
11. The Medical Assessors asked the claimant what she watched on Netflix, and she reported she will, "flick a lot." Otherwise, she likes to watch talent shows and real estate shows but spontaneously added that she keeps rewinding television shows and movies. She said she gets distracted by her thoughts and does not watch right through a show. She said she does like to read Facebook posts but spontaneously added that she will re-read articles and stated, "books are worse."
12. The Medical Assessors tried to gauge the general impact of the claimant's various difficulties in her life and asked her what the most traumatic things in her life had been and she immediately responded, "One hundred percent the PTSD from the car accident." She said she has had physical pain since the accident and was just working to pay for treatment. She said that her "brainstem is sore" and she feels like it is wiggling around. She has shoulder pain in both shoulders and, at night, this pain is between 8 to 10 out of 10. She said she gets poor sleep. She said with respect to her ankles, she had "heaps of nerve pain after the accident", however this has settled down somewhat.
13. The Medical Assessors attempted to ask the claimant about other traumas in her life, including the sexual abuse when she was 14 and the sexual assault when she was 19. She said there was no legal action related to these. She said when she was 14, she was examined and touched in an inappropriate way whilst in hospital, on her breasts and her private parts. She commented that this did not affect her schooling. When she was 19, she was raped and after this she had flashbacks of what happened to her when she was 14. When asked, she described the sexual assault as like a date rape and she had been followed into her house by a friend. She said it took time for her to find help about this, but she finally found it at the fourth hospital she tried to access (Mount St. Margaret's). With respect to the bullying and sexual harassment that occurred at Trilogy, this was a WorkCover case. She reported that she was assessed as having a 2% psychological injury. There was no lump sum settlement about this.

1. The claimant was seen via audio-visual link and she was in her home. The assessment had a duration of almost two hours. She was a middle-aged, Caucasian woman who wore spectacles and had a light-coloured top. There was no overt make-up but no gross signs of neglect. She had brown hair which was tied back. She was polite, cooperative and attentive and focused and concentrated well throughout the assessment. She was animated at times and displayed no abnormal movements. Her speech was somewhat fast and frenetic, but otherwise normal in tone and volume. There was no evidence of formal thought disorder or delusional thought processes. Her mood was essentially anxious, and her affect (expressed emotion) was highly reactive. There were no indications of dysphoria or distress, and she was responsive to, and utilising of, humour. There was no evidence of any perceptual abnormalities.
2. Although the claimant appeared cognitively intact from an assessment perspective, there were clearly reported long-term cognitive problems, particularly with respect to simple mathematics. It was hard to assess the claimant's judgement, however it did not appear acutely impaired. There were questions with respect to the claimant's insight, particularly with respect to her complicated long-term mental health history, with apparent playing down of pre-accident difficulties and focus on post-accident difficulties which were reported as attributable to the motor vehicle accident.

1. The Medical Assessors conferred for a lengthy period given the complexity of the claimant's history and her reported history and presentation at assessment. Additionally, the whole Panel discussed and reviewed the examination report on 10 September 2025.
2. The claimant has longstanding mental health problems including what appears to have been a first presentation for bipolar affective disorder at the age of nineteen. There was a further admission to hospital, also likely due to bipolar affective disorder, at the age of twenty-nine. Of interest, she has seen several psychiatrists over the years and she herself said she has "always seen someone." She has taken mood stabilising medication since the age of 19 (in excess of thirty-five years) and was taking a relatively high dose of antipsychotic mood stabilising medication prior to the motor vehicle accident. (The Medical Assessors note that this dose has increased subsequent to the motor vehicle accident). The claimant has been receiving the Disability Support Pension since the early 2000's for mental health reasons and has been receiving NDIS funding, on her report, approximately $96,000 for every two years, since around mid-2019 (eighteen months prior to the motor vehicle accident). She spent a lengthy period (approximately 16 years) primarily caring for her niece, receiving the Disability Support Pension and operating a micro-business on the side. She was able to complete some TAFE studies prior to the motor vehicle accident, with funded NDIS support. She was not in a relationship at the time of the motor vehicle accident. Prior to the motor vehicle accident, the claimant reported that she had some charitable interests and hobbies, she was able to drive freely, and she had worked at times in disability support and mentoring. The claimant reported that not long before the accident she had increased her work capacity, however there is little in the way of evidence to support this, apart from her self-report.
3. The claimant continues to receive the Disability Support Pension, continues to receive NDIS funding and support, continues to see her psychiatrist, and continues to take psychiatric medications. She also continues to work part-time at a low level, although she reports she requires some support in this regard now. There is a history of teenage sexual trauma, longstanding serious mental illness (over three decades) and a work-related injury involving bullying and sexual harassment (approximately twenty years ago). There are documented long-term diagnoses of bipolar affective disorder and post-traumatic stress disorder and there is also consideration given to there likely being longstanding cluster B personality vulnerabilities.
4. The Medical Assessors came to the conclusion that indeed the motor vehicle accident, although relatively minor in nature, exacerbated pre-existing mental health problems. Although the accident itself likely did not constitute a traumatic incident such that would satisfy criterion A under DSM-5, the Medical Assessors considered it reasonable that the accident was an exacerbating factor of her previous post-traumatic stress disorder but also exacerbated less specific mental health factors such as her personality vulnerabilities and longstanding problems with anxiety and depression. At the Medical Review Panel Assessment, the claimant did not report any symptoms of, or present at mental state examination as, having any acute manifestations of her bipolar affective disorder.
5. The Medical Assessors considered that the claimant had stabilised from a psychiatric perspective and was unlikely to change in her level of WPI by any significant degree in the upcoming twelve months. As such, she had a permanent psychiatric impairment.
6. The Medical Assessors have assessed WPI as described in the tables below. There is an assessment of pre-existing WPI and of current WPI.

The Panel considered that given the claimant was receiving a disability support pension and NDIS funding of around $48,000 per year to support her and assist her in "daily living", and that she was not showing herself to live by herself or independently, we opine that the claimant was unable to live independently without regular support. She was requiring assistance with respect to basic day-to-day activities such as house administration tasks and had a regular support person. Although likely at the lower end of this class, the Medical Assessors could not ignore the high level of support that the claimant was being provided.

The claimant did not describe a florid social and recreational life prior to the accident, however had some degree of independence and interests. An example would be her involvement in the animal wildlife charitable Facebook group. She still required NDIS support for "daily living" which, on the balance of probabilities, had some social and recreational component. Utilising clinical judgement, this is a class 2 mild impairment.

Minor deficit attributable to the normal variation in the general population.

The claimant reported she was driving freely and in fact enjoyed driving. She was driving at the time of the accident. There is no evidence of anything other than a class 1, minor deficit.

Minor deficit attributable to the normal variation in the general population.

The claimant reported she had various Facebook friends through her charitable animal group. There was no reported tension in any of her close family relationships. She did not have a partner. Utilising clinical judgement, there is a class 1, minor deficit.

The claimant reported challenges with basic mathematics and required assistance with IT mentoring, assistance with invoicing and bookkeeping, and required educational support to graduate her TAFE course. This is a consistent class 3, moderate impairment for concentration, persistence and pace, as it is below the level of functionality consistent with a class 2, mild impairment. It should be noted, the presence of the Disability Support Pension and the sizeable level of NDIS funding for support with "daily living" supports that there was more than a mild impairment in this category. Utilising clinical judgement, the Medical Assessors considered that there was a class 3, moderate impairment.

The claimant reported that she was certified fit for work for several hours a week, for a very long period, and was receiving the Disability Support Pension for many years. She reported she assisted with the bringing up of her niece (who is now twenty-two and would have been approximately aged seventeen at the time of the motor vehicle accident). Although The claimant has had long-term low-level certification for employment over years (only several hours per week) she reported that she had had slightly increased capacity in the six months leading up to the motor vehicle accident. Taking into account that she also reported she had been assisting in the raising of her niece, the Medical Assessors considered that utilising clinical judgement, there was a class 3, moderate impairment, consistent with being able to perform less than twenty hours per week, but in a lesser demand role than standard employment.

1. The Medical Assessors agreed that in addition to the calculations utilised in the PIRS, this is broadly consistent with a level of WPI commensurate with long-term receiving of the Disability Support Pension and high levels of NDIS funding.

1. Exacerbation of chronic post-traumatic stress disorder

3. Exacerbation of possible cluster B personality vulnerabilities

Although the claimant reported a worsening of functioning in this category, she still finds herself being a class 3, moderate impairment, consistent with still being unable to live independently without regular support, but generally capable of day-to-day functioning such as showering or cooking, however reportedly requiring some degree of prompting. She does not require supervised residential care. She had several hours a week of assistance from a support person through NDIS. Utilising clinical judgement, her current level of impairment is consistent with a class 3, moderate impairment.

The claimant reported she is able to leave her place of residence. She reports little in the way of social or recreational activities, however does enjoy playing with her dog and watching television. There was an impression that the claimant felt unable to go out without a support person, although she did report that she did go for walks alone, albeit not long ones.

The claimant reported she is able to go out of the house by herself and walk in her local area without a support person. She is able to travel as a passenger in a motor vehicle, however reported that she experiences considerable anxiety. She adeptly passed a driving assessment in 2024 but reported she did not go on to avail herself of driving lessons to consolidate this capacity. Utilising clinical judgement, there is a class 2, mild impairment in this category.

Although the claimant reported she continues to get along with her close family members, with some strain, she did indicate that there had been some degree of social withdrawal and loss of contact with others, particularly with cessation of involvement in her charitable animal Facebook group. The claimant continues to not be in a primary relationship. Utilising clinical judgement, there is a class 2, mild impairment with the loss of some friendships.

Although the claimant concentrated and focused well for the two-hour assessment, she reported an inability to complete movies or television shows. She reported she continues to require assistance with respect to bookkeeping and invoicing for the disability support work that she continues to perform part-time. She continues to have a longstanding difficulty with simple mathematics. She reported she finds herself re-reading articles and having difficulties focusing on a book. Utilising clinical judgement, there is a class 3 moderate impairment.

The claimant reported she continues to perform approximately six hours per week of disability support work, while at the same time receiving her own disability support. She continues to receive the Disability Support Pension and receive considerable NDIS funding. Utilising clinical judgement, there is a class 4, severe impairment consistent with working less than twenty hours per fortnight at a reduced pace. She is no longer assisting with the care of her niece, to the Medical Assessors knowledge.

1. Apportionment for pre-existing impairment has been made utilising the tables above. There is insufficient evidence for any adjustment for subsequent impairment.
2. With respect to any adjustment for treatment effect, the claimant has received long-term psychiatric treatment for her bipolar affective disorder, which appears to have not been particularly active prior to the accident, nor subsequently. There is no adjustment for treatment effect with respect to this, (or alternatively, an equivalent adjustment for treatment effect prior to the accident, and currently, which numerically cancel each other out). For her other mental health problems, such as her longstanding post-traumatic stress disorder, which has been exacerbated, she reported that her previous therapy was not particularly effective. There is no adjustment for treatment effect for her pre-existing WPI. With respect to her current treatment, the claimant reported no particular therapeutic benefit and therefore no treatment effect is applied to her current WPI.

Therefore, her current WPI is 19% - 11% which equals 8%.