MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; threshold injury dispute; claimant was the rear-seated passenger in a motor vehicle driven by her daughter; the insured vehicle collided with the rear of the vehicle in which the claimant was travelling; claimant developed pain in her neck, shoulders, and back; claimant attended physiotherapy which was not of much benefit; claimant has seen a specialist for her neck and back; claimant has been referred to a psychiatrist; Medical Assessor (MA) certified that claimant suffered a major depressive disorder with anxious distress which is not a threshold injury; insurer's review application granted on basis that MA did not reveal a clear path of reasoning particularly on causation; claimant re-examined; Held - Review Panel satisfied that claimant's psychiatric injury caused by the accident; that injury was a major depressive disorder which is not a threshold injury; certificate confirmed.

Certificate issued under s 7.26(7) of the Motor Accident Injuries Act 2017 (the Act)

1. The Review Panel confirms the certificate dated 31 August 2024 by Medical Assessor Samson Roberts.

1. The subject motor accident occurred around 1:40pm on 10 December 2022 on the Hume Highway at Yagoona. The claimant was the rear-seated passenger in a motor vehicle driven by her daughter in the right lane. The claimant was seated behind the driver. As the vehicle slowed behind the traffic, and came to a complete stop, the at-fault driver of the insured vehicle collided with the rear of the vehicle in which the claimant was travelling. The claimant recalls thinking they were going to die because the impact created a "big massive sound". The claimant's son came to the accident scene and drove them home in the car that had been involved in the accident.
2. Two days after the motor accident, the claimant developed pain in her neck, shoulders and back. She took Voltaren and Panadol and saw her general practitioner. She was prescribed Lyrica but could not tolerate it. She had X-rays and ultrasound and attended physiotherapy which was not of much benefit. She has seen a specialist for her neck and back. She has been referred to a psychiatrist.
3. QBE Insurance (Australia) Limited (the insurer) indemnifies the owner and/or the driver of the at-fault vehicle for liability to pay the claimant any damages under the Motor Accident Injuries Act 2017 (Act). The insurer denied liability for payment of statutory benefits after 26 weeks on the basis that it assesses a threshold injury. That refusal was confirmed upon internal review in relation to both physical and psychological injury.

1. As there is a dispute between the parties about whether the injury caused by the motor accident is a threshold injury under Schedule 2, cl 2(a) of the Act, the claimant was referred by the Commission to Medical Assessor Samson Roberts for determination of the dispute. Medical Assessor Roberts certified on 21 August 2025 as follows:

The following injury caused by the motor accident:

• major depressive disorder with anxious distress,

is not a THRESHOLD INJURY for the purposes of the Act.

The injury referred for assessment was post-traumatic stress disorder with mixed depression. Medical Assessor Roberts did not think the nature of the accident, as described by the claimant and in the documents, accords with Criterion A of the DSM-5 diagnostic criteria, nor did the other symptoms fulfill the relevant criteria. Medical Assessor Roberts thought that the claimant's anxiety about travel was not reflective of a diagnosis of phobic condition.

1. The insurer made an application under s 7.26 of the Act for referral of Medical Assessor Roberts to a Review Panel on the grounds that the medical assessment was incorrect in a material respect. The insurer relied upon the particulars set out in the application and supporting documentation.
2. The insurer brought the application within the time prescribed by s 7.26(10) of the Act and

cl 34 of Procedural Direction PIC 7 (28 days). 3. The insurer submitted that the Medical Assessor failed to consider relevant evidence, outlined by the insurer's submissions, which addressed causation, and therefore failed to disclose a clear path of reasoning by which he reached his opinion on the claimant's injuries. 4. The insurer notes that Medical Assessor Roberts gave his reasons for causation as follows:

The history as presented by Ms Issa reflects the causative role of the motor accident in her psychiatric injury. "No other factors were identified as contributing to the causation of her condition" (insurer's emphasis).

The insurer submits that Medical Assessor Roberts' reasons do not satisfy the requirements.... to provide a path of reasoning which allows the reader to follow what evidence was considered and the manner in which the determination was reached.

1. Additionally, the insurer submitted, the path of reasoning provided does not adequately demonstrate consideration of the medical evidence included in the claimant's submissions bundle, and highlighted by the insurer's submissions, to raise an issue of causation regarding the claimant's psychiatric symptoms.
2. The insurer submits that Medical Assessor Roberts' certificate does not reference nor demonstrate the consideration of either the claimant's GP or psychologist's records (insurer's emphasis) in the provided path of reasoning nor throughout the entirety of the certificate.
3. The insurer's review application was opposed by the claimant on various grounds. As those submissions were not accepted by the President's delegate, it is not necessary to state them in detail. Briefly, in response to the insurer's argument that there was no evidence of psychological symptoms after 22 August 2023, the claimant submitted that the review application must fail because:

(a) Medical Assessor Roberts addressed the insurer's concerns and highlighted fundamental aspects of the clinical notes demonstrating ongoing psychological complaints; and

(b) The insurer failed to address the question of materiality.

Particulars are given in support of each of those submissions.

1. President's delegate Stephanie Wigan issued a Determination of an Application for Review of a Medical Assessment on 5 December 2024 which stated the satisfaction of the President's delegate there is a reasonable cause to suspect the medical assessment in correct in a material respect. The basis of the satisfaction of the President's delegate was stated to be the Medical Assessor's failure to disclose a clear path of reasoning by which he reached his opinion on the claimant's injury and particularly the issue of causation regarding the claimant's psychiatric symptoms.
2. Consequently, the review application was accepted and was referred to the Panel, which is to reassess the psychiatric injury that was referred to the Medical Assessor, which was as follows:
   • psychiatric condition - post-traumatic stress disorder with mixed depression. Medical Assessor has diagnosed: major depressive disorder with anxious distress.
3. What has been referred for assessment in these proceedings is Psychiatric condition - PTSD with Mixed Depression.
4. The Panel notes that the Medical Assessors on the Panel are required, in accordance with the Guidelines, to determine if the claimant has a psychological or psychiatric injury caused by the accident and then make a diagnosis of that injury.
5. The Medical Assessors may, in their clinical judgment, diagnose a condition that is the same as, or different to, the diagnosis of Medical Assessor Roberts, or the diagnoses of the treating doctors or Medico-legal experts qualified by the parties, or the particular diagnosis that may have been included in the Application or Reply form, or referred for assessment.

1. A medical assessment matter is determined in accordance with Division 7.5 of the Act. The matter is determined at first instance by a Medical Assessor and, on review, by a Review Panel consisting of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Personal Injury Commission (Commission).
2. Part 5 of the Personal Injury Commission Act 2020 (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.[1]
3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the 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.[2]
4. The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[3]
5. All members of the Review Panel had no previous involvement with the claimant or with this matter.

1. Causation of injury is addressed in the Guidelines as follows:

"6.5 An assessment of the degree of permanent impairment is a medical assessment matter under cl 2(a) of Schedule 2 of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person's impairment is related to the accident in question is therefore implied in all such assessments. Medical Assessors must be aware of the relevant provisions of the AMA 4 Guides, as well as the common law principles that would be applied by a court (or the Personal Injury Commission) in considering such issues.

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 biological 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 contributed to the worsening of the impairment, which is a non-medical determination.

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

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

1. See Briggs v IAG Limited t/as NRMA Limited.[4] See also Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956,[5] wherein his Honour Justice Wright stated at (35):

"The question of causation of injuries was not dealt with in Part 5 of the Guidelines but causation was addressed in Part 6, which related to assessment of permanent impairment. There is no reason to think that different principes were intended to be applied when a medical assessment was being made in relation to causation of minor injuries."

1. Wright J then described the Panel's role in a medical review which is to:

"Consider whether the motor accident did cause or contribute to (the claimant's condition). This requires, not a consideration of material derived as a result of an internet search... but rather a consideration of the material referred to in 5.6 of the Guidelines, namely all the evidence available to the Panel, including all relevant findings derived from:

(1) a comprehensive, accurate history, including pre-accident history and pre-existing conditions;

(2) a review of all relevant records available at the assessment;

(3) a comprehensive description of the injured person's current symptoms;

(5) diagnostic tests available at the assessment, noting that imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. The Motor Accident Injuries Amendment Act 2022 (MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From that date, the MAI Amendment Act provides that a "minor injury" is known as a "threshold injury" and "minor injuries" are known as "threshold injuries".
2. The definition of what constitute a minor injury has not been amended and continues to apply to a threshold injury.
3. Any reference in these reasons to "minor injury" is a reference to a "threshold injury" and any reference to the word "minor" referring to the injury alleged to have occurred in the accident is a reference to "threshold".
4. A threshold injury is defined in s 1.6 of the Act and includes a "soft tissue injury" or "psychological or psychiatric injury that is not a recognised psychiatric illness".
5. Part 5 of the Motor Accidents Guidelines (the Guidelines) are made pursuant to s 10.2 of the Act. The Guidelines contain the procedure for assessing whether an injury caused by the accident is a threshold injury for the purposes of the Act.
6. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly provide:

"5.3 The assessment will determine whether the injury related to the claim is a soft-tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.

5.4 Diagnostic imaging is not considered necessary to assess threshold injury.

5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.

5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:

1. comprehensive accurate history, including pre-accident history and pre-existing conditions;
2. a review of all relevant records available at the assessment;
3. a comprehensive description of the injured person's current symptoms;
4. a careful and thorough physical and/or psychological examination;
5. diagnostic tests available at the assessment.

Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. The parties have presented their respective bundles of documents upon which they rely. The Review Panel (Panel) has read all the documentation. If a particular document is not referred to by the Panel, this does not mean that the Panel, or a Panel Member, has not read it, nor taken it into consideration. The same principle applies to parties not referring to, nor specifically relying upon, a document in their own bundle and submissions.
2. The fact that evidence is not referred to in these reasons does not mean it has been overlooked. It is not required that each piece of evidence be mentioned. The Panel is not required to "analyse every piece of information from every opinion contained in a document with which it was provided". The Panel has come to its own conclusions and has taken its own history.

1. The claimant relied upon the following material which the Panel has considered:

Claimant's submissions in reply opposing insurer's review application

Claimant's submissions in support of threshold injury made to Medical Assessor Roberts

• The claimant submits that the subject accident caused her psychological injury which is not a threshold injury within the meaning of s 1.6 of the Motor Accident Injuries Act 2017 (MAI Act).
• The claimant contends that the subject accident has caused the following psychological injuries:

(a) post-traumatic stress disorder with mixed depression and anxiety.

(b) sleep disorder - insomnia

The claimant relies upon the opinions of her treating GP, Dr Mounther Tommalieh and her treating psychologist Ms Shayma Almoty who provided the following diagnosis:

"Post-traumatic stress disorder with mixed depression and anxiety in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Particulars are given in support of those submissions by reference to Ms Almoty's report.

• The claimant submits that the DSM-5 diagnostic criteria for PTSD are satisfied on the basis of Ms Almoty's reporting the claimant's psychological symptoms as follows:

(a) Irritable;

(b) reduced frustration tolerance;

(c) frequent rumination and associated negative mood;

(d) appetite disturbance;

(e) panic episodes;

(f) anhedonia;

(g) insomnia due to pain and rumination;

(h) increased cigarette smoke (one pack per day);

(i) flashbacks;

(j) recurring nightmares with startled waking;

(k) impaired memory, focus and concentration;

(l) hypervigilance while in the car; and

(m) fear avoidance.

Ms Almoty reported significant impairments in the claimant's capacity with respect to work, home and community on page 2 and 3 of her report.

Report of Shayma Almoty of the Centre for Well-being

Dr Bisht describes the history of injury since the accident and the last appointment, the treatment history, past medical history, family history, employment history and social history, as well as the mental state examination. Dr Bisht gives a diagnosis of major depressive disorder with anxious distress as per DSM-5. Dr Bisht expressed opinions as to the claimant's need for future treatment, care/domestic assistance and future earning capacity, which are not of direct relevance for the Panel's consideration. Dr Bisht assesses 15% whole person impairment utilising the PIRS as follows:

GP referral to Dr Blagoje Kuljic, consultant psychiatrist

GP referral to Dr Feriberg, respiratory and sleep disorder specialist

The Panel notes that no reports from Dr Kuljic or Dr Feriberg are in evidence.

Clinical records of orthopaedic surgeon, Dr Alan Dao

1. The Panel notes that it issued the following direction on 10 August 2025 as stated in the Medical Panel Review report dated 30 August last:

On or before 1 October 2025, the claimant is to upload up-to-date records from the treating GP and psychologist and/or psychiatrist, from two years prior to the motor accident to the present date, to the extent they have not already been provided.

No further documents were provided. The claimant's solicitor indicated that medical records from the consultant psychiatrist Dr Kuljic had been requested but not provided.

1. The insurer relied upon the following material which the Panel has considered:

Insurer's reply submissions, threshold injury dispute in the first instance

• The insurer notes that the claimant relies on the opinion of Ms Shayma Almoty who diagnosed the claimant with PTSD with mixed depression in accordance with DSM-5. The insurer submits that Ms Almoty's diagnosis is based on information and a history that is not consistent with the medical evidence and therefore does not satisfy the DSM-5 Diagnostic Criteria for PTSD. Particulars are given in support of that submission by reference to the Criterion A and the absence of ongoing symptom.
• The insurer submits that the claimant has not suffered any psychological injuries which are non-threshold injuries, noting that the claimant's injuries do not satisfy the DSM-5 Criteria for PTSD.

1. The report of the Medical Assessors Gerald Chew and Himanshu Singh is as follows:

Assessment was attended by the claimant, Ms Issa, only over a video conference. She was present at her solicitors' office. The assessment was conducted by medical assessors Gerald Chew and Himanshu Singh, who joined the assessment over the team's meeting and were located in their respective offices.

1. Psychosocial history and pre-accident history

Ms Issa was born in Lebanon on 1 August 1966. She had a normal childhood. She grew up in a big family, which included her parents and her six siblings. She came to Australia with her parents when she was 4 years old. She denied any trauma or abuse growing up. She attended school up until year 10 and got married in 1988. Ms Issa stated that she had an accident more than 25 years ago. She was not able to tell the exact year, but she noted that it was a long time ago. She was driving, and someone hit her from behind. She put in a claim for physical injuries. She had injuries to her neck and back. She received treatment with physiotherapy and medications. She did not require any surgeries. She received compensation following that accident. She denied any psychological injuries sustained in the motor vehicle accident.

Ms Issa denied any previous psychiatric history. She denied being previously diagnosed with anxiety, depression or any other mental health issues. She denied ever receiving counselling or medications for her mental health.

Ms Issa has been a smoker. She used to have a few smokes a day, maybe one a day, sometimes five to ten in a week, but her smoking has gone up, and since the accident, she has been smoking one and a half packs a day. Her anxiety is what makes her smoke, and the smoking helps her to keep calm.

She denied a history of alcohol use. She denied any illicit substance use.

Ms Issa stated that she has worked in the past. She used to work at Woolworths as a supervisor and at Kelly Country (Swayne), a factory that would make men's suit. Her husband opened a manufacturer's clothing and she was helping him there. She last worked at a family fruit shop. She stopped working when she was diagnosed with thyroid cancer. She developed nodules around her neck and had breathing problem. This was around 15 years ago. She was put on some medications, but she does not remember the name, and she has been on the disability support pension since then. She stopped working then and did not work after that. She stated that her thyroid is stable, mainly, but the levels start playing up sometimes, and then the dose of the medication needs to be changed.

She stated that she was not very sure of the symptoms, but at times she starts feeling lazy and tired, and then she knows that she needs to get her levels checked, which has caused some amount of anxiety at times, but with adequate treatment with medication, she feels fine. She stated that she has never experienced depression before the accident. It is mainly the anxiety when she would get a bit edgy and worried about things. However, it never takes the form of full form anxiety as she is experiencing now. She added that before this accident, she did not know what anxiety was.

Ms Issa stated that before the accident she was involved actively in her household duties. She would be cooking regularly and do other household chores. She would spend time with her grandchildren and look after them, take them to the park. She has seven grandchildren who would regularly visit her. She stated that since the accident the grandkids do not come to her as often.

Ms Issa stated that on 10 December, she was involved in a motor accident. She was not sure of the year. She said 2023 and stated that it has been three years. When asked again, that cannot be 2023, and the date we have on record is 10 December 2022, she agreed with that. She stated that her daughter was with her and they were going down to the shops. Her daughter slowed down and due to the traffic and the car behind her slammed her from the back, their car was stationary and she was sitting behind the driver's seat on the back seat.

Her daughter had her work and her gym stuff in the car seat next to her, and she had the car seat at the back next to her. The other car hit them, and she panicked. Her daughter went down and spoke to the other driver. Her daughter called her son to pick them up. Her daughter could not drive back home. Her son came and drove her and her daughter in the same car. The car was repaired later.

Ms Issa stated that there were no visible injuries. She went a bit forward and on the side. She held the back of the front driver's seat where her daughter was sitting. There were no airbags deployed. However, the whole bonnet went in. There was no police or ambulance at the scene of the accident.

1. History of symptoms and treatment following the motor accident

Ms Issa stated that she was shaking and felt terrified after the accident, this continued for few hours and probably for the whole day. She felt nervous. She did not get any pain for two days. When she experienced the pain, she decided to see her GP which was around three days after the accident. She experienced pain in both her shoulders, her neck, and her lower back. Her GP prescribed her Voltaren and Panadol. She went back to her GP a few times after that as she continued to experience pain. She was referred to a physiotherapist and had sessions for three months. She had to get the claim approved by the insurance to have physiotherapy sessions. Later, the insurance company stopped it.

Ms Issa stated that gradually she started to notice psychological symptoms. She was not sure of the onset but stated that it would have been six to seven months or maybe more when she experienced these mental health symptoms. She spoke to her GP, who advised her to see a psychologist, and she attended the sessions. Ms Issa initially noted anxiety, she could not sleep and experienced heavy breathing. She stated that she cannot explain what she felt, but she had never had this feeling before, and it was very uncomfortable and uneasy. She could not handle anyone. She would often have fight with her daughter and argue with her husband. She stated that if the accident did not happen, she would not be in a state like this.

Ms Issa reported that she had nightmares and, in the nightmares, she was going to die. She was in the car with her daughter. The sound of a car being hit by another one was like an explosion, and it would scare her. She was in the back of the car and again felt that the accident was happening, and that would wake her up. She felt as if she was going to die, and she was tossing and turning, thinking about the accident. She would often feel the accident happening again. She also had flashbacks of how it happened and would have the sound of the collision in the back of her head. She would feel scared thinking about it. She would often think about why it happened and how it changed her life. She did not want to see anyone and wanted to stay at home and not to talk to anyone.

Ms Issa stated that she saw the Psychologist around three times after she got the referral from her GP. She was also started on Escitalopram 10 mg by her doctor. She continued to take her thyroxine and the dose of which has been titrated depending on her levels.

In regards to her thyroid, Ms Issa stated that her thyroid was checked before the accident and the dose was adjusted. She was on 100 mcg, but it was dropped down and increased again later and eventually she has been on 75 mcg for quite some time.

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

Ms Issa denied any other relevant injuries or conditions sustained since the accident.

Ms. Issa is currently 59 years old. She lives with her husband and daughter in Laguna. She has been married for 37 years, and her 26-year-old daughter, who lives with her, has a 4-year-old granddaughter. Ms. Issa stated, "I am a bit foggy at the moment." She reports ongoing pain that can be severe, requiring painkillers. The pain is in her neck and back, with her back being worse than her neck. Shoulder pain persists as well. She feels scattered and unable to sit comfortably with her children; she prefers to be away from everyone. Despite trying to push herself to spend time with her family, she finds it difficult. Ms. Issa also mentioned feeling very depressed for over two years. She cannot be around others, as she is easily triggered and feels sensitive. She prefers staying at home because she feels safer and better there. She said her family is doing well, her mother is healthy, and her father passed away four years ago after an illness. She expressed a desire to improve, to be happy again, and to reunite with her family. She feels helpless because nothing seems to help her. She experiences anxiety about most things. Recently, she tripped over something and fell when she missed a step, feeling unbalanced. This incident has made her sad and anxious. She sometimes feels sad or tearful without reason, and she struggles to find joy or pleasure in activities. She prefers staying calm and avoids talking to others. Occasionally, she becomes irritable. She reports low motivation and energy, with decreased interactions with her grandchildren and less enjoyment in activities she used to love. Ms. Issa mentions that she has good days and bad days; some nights she sleeps well, while others she cannot sleep, tossing and turning and sweating excessively. She often thinks about the accident. She tries to go for a walk every 3 to 4 weeks for some personal space but only drives locally and avoids long trips due to anxiety. On some days, she does not want to leave her home. She denied any thoughts of self-harm or suicide and did not report symptoms of mania or psychosis. Additionally, Ms. Issa reports a decline in her concentration and memory, has become more forgetful, and notices an increase in cigarette smoking to help manage her anxiety. She feels unmotivated and less enthusiastic, involving herself less with her grandchildren.

Ms Issa continues to see her GP on a regular basis. She was on Valium for her anxiety. She has been on Loxalate and stated that her medication has been changed. She has a script for another medication named Paroxetine 20 mg. She has not started it yet. She had a psychiatrist appointment with Dr Kuljic around 3 weeks ago and is going to see him again on 5 December. She is not receiving any current psychology sessions and only had 3 sessions in the past.

Ms Issa was seen over a video conference. She attended the appointment by herself. She was dressed casually wearing a pink top and appeared clean. There were no signs of agitation or retardation. Her speech was spontaneous with normal rate, tone and volume. She reported a disturbed sleep and appetite. She reported nightmares and flashbacks and avoidance due to the accident. She described low levels of motivation and energy.

She reported ongoing anxiety about driving and worrying being in another accident. She denied having any active or passive suicidal thoughts, intents or plans. There were no thoughts, intents or plans of harming others. There was no evidence of formal thought disorder, no delusional pattern of thinking and no perceptual abnormalities. She described difficulty with her focus or concentration. She had an intact judgement and had reasonable insight into her issues and was help seeking.

Ms Issa mentioned that she has her good days; some days, if she sleeps well, she feels better than others. However, there are days when she can't sleep and keeps tossing and turning at night, overthinking a lot. She tries to go for a walk to have some space.

Ms Issa said she is always awake in the mornings and struggles to get back to sleep. She has a coffee and a cigarette, and by the time her granddaughter gets up, she heads to the backyard for some gardening before sitting down to watch TV. She showers occasionally, depending on how she feels, usually about twice a week. Sometimes she cooks or does dusting and folds the laundry.

She spends time with her granddaughter, having coffee and cereal. In the afternoon, she might sleep again, watch TV, walk in the backyard, or read a book. She finds it hard to focus, forgets things easily, and her memory is poor; her mind often feels foggy. She might read a few chapters but then has to stop.

Sometimes she goes to the park with her family, but she can't be around large crowds. She doesn't attend family functions, even if her family invites her, nor does she go to barbecues or fishing trips.

Ms Issa stated she does not have much of a social life. She has four children - two sons and two daughters - who occasionally visit her. She reported having a strained relationship with her husband; they have not been in the same room for the past two and a half years because she often snoring and tossing and turning, feeling too embarrassed to discuss it or be near him. She sleeps in a separate room with her granddaughter. She also mentioned having frequent arguments with her husband.

She is quite moody, and others tell her she often argues and seems angry. Her mental health and her relationship have deteriorated.

Ms Issa doesn't go out often. She might visit the corner shop for groceries, the chemist, or her doctor. She drives locally on her own but doesn't venture far. When someone else is driving, she clutches the handle tightly because she feels scared and anxious as a passenger. She hasn't been on any trips interstate or overseas, and there are days when she prefers not to leave her home.

Ms Issa said her appetite has decreased; she might only eat one meal a day and snacks at other times. She denied having any thoughts of self-harm or suicide.

Ms Issa's presentation was mostly consistent with the information provided in the documents, the previous IME.

The panel noted that the record stated that Claimant's psychologist, Ms Almoty saw her on three occasions in which she made complaints relating to her alleged psychiatric symptoms on 18 July, 1 August and 22 August 2023.

The panel noted that this coincides with the time that Ms Issa mentioned terms of her origin of symptoms which she noted earlier was 6 to 8 months after the accident. This probably correlates with the history given by Ms Issa and the duration between the injury and the onset of her psychiatric symptoms.

The panel noted that Ms Issa does not have a significant past psychiatric history. There is no significant family history or drug and alcohol history. Ms Issa developed psychiatric symptoms following the accident on 10 December 2022, roughly around 6 to 8 months post-accident. The panel noted that there can always be a delayed onset of symptoms following an accident, which coincides with the duration mentioned by Ms Issa. Ms Issa reported a series of symptoms that have continued despite receiving some treatment from a psychologist, her GP, and being on antidepressant medication. The symptoms that she is currently presenting with are low mood, lack of pleasure in previously enjoyable activities. Her symptoms currently meet the DSM-5-TR criteria of major depressive disorder as:

• She reported depressed mood most of the day, nearly every day.
• She described a markedly reduced/lowered interest in previously enjoyable activities.
• Significant decrease in appetite.
• Insomnia nearly every day along with nightmares.
• Fatigue nearly every day.
• Feelings of worthlessness about one's situation.
• Diminished ability to think or concentrate and poor focus and lack of memory.
• The symptoms have caused clinically significant distress or impairment in personal, occupational, social areas of functioning. The episode is not attributable to physiological effects of a substance or another medical condition and the symptoms have been present during the same two-week period and represent a change from previous functioning.

The Panel noted that there is a direct temporal relationship between the onset of the psychiatric symptoms and the accident. In the opinion of the panel, the psychiatric injury is caused by the car accident. There is no other possible explanation of the psychiatric symptoms and the psychiatric injury apart from the car accident. There is no pre-existing history, and no other factors were identified as the cause of her current condition. The panel thinks that the accident caused a psychiatric injury which is a major depressive disorder as per DSM-TR.

1. The following injuries WERE caused by the motor accident:
   • Major depressive disorder

The following injuries WERE NOT caused by the motor accident:

The panel noted that Ms Issa does not fulfil the criteria of post-traumatic stress disorder. She does not meet the criteria A of PTSD as she was not exposed to a serious accident or injury or actual or threatened death in the accident.

_"For the purposes of this Act, a threshold injury is, subject to this section, one or more of the following - _

(a) a soft tissue injury,

(b) a psychological or psychiatric injury that is not a recognised psychiatric illness."

"A Threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness."

"2) Each of the following injuries is included as a threshold psychological or psychiatric injury for the purposes of the Act

(a) acute stress disorder

(b) adjustment disorder

1. In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5)"

The assessment of whether the injury is a 'threshold injury' is not a direct measure of symptoms or disability. A finding that the injury is a 'threshold injury' indicates that there was an injury caused by the motor accident and that there may be continuing symptoms, however the injury satisfies the definition of a threshold injury under the Act and the Regulation.

1. The following injuries are not threshold injuries:
   • Major depressive disorder"

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[6] It is not the role of the Panel to correct error in the decision of the original Medical Assessor.
2. The Panel is not required to choose between competing medical opinions and is required to form its own opinions.[7] The Panel adopts the findings and opinions of the Medical Assessors who concur with one another.
3. The Panel met on 20 August 2025 to consider the following:

(a) the nature of the dispute and the matters in issue;

(b) whether any additional documents are required, and

(c) whether a re-examination is necessary.

1. The Panel reconvened on 3 December 2025 to consider its findings and to finalise its decision.
2. The Panel finds, as a matter of factual determination and as a matter of factual non-medical judgment, the motor accident could have caused, and did cause, the claimant to suffer a major depressive disorder, but not post-traumatic stress disorder, for the reasons stated in the examination report.

1. For the above reasons, the Panel confirms the certificate of Medical Assessor Samson Roberts dated 21 August 2025.

[4] Briggs v IAG Limited t/as NRMA Insurance [2022] NSWSC 372.

[5] Insurance Australia Limited t/as NRMA Insurance v Trkulja [2023] NSWSC 956.

[7] Insurance Australia Group Limited v Keen [2021] NSWCA 287 and Insurance Australia Group Limited v Marsh [2021] NSWCA 31.