MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; permanent impairment; review; insurer disputed causation and permanent impairment; alleged significant psychological condition before accident; Commission referred psychiatric condition to assess permanent impairment; Medical Assessor's (MA) certificate assessed 17% permanent impairment; referred for review; re-examination; claimant was cooperative and consistent; accident was capable of causing all referred injuries; 8% permanent impairment; different clinical findings; Held - different permanent impairment findings to original assessment; Review Panel revoked original certificate; permanent impairment not greater than 10%.

Issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. Revokes Medical Assessor Yu Tang Shen's certificate dated 10 April 2024, and
2. Certifies that the claimant's permanent impairment resulting from the injury caused by the accident on 14 August 2020 is 8% permanent impairment arising from:
   • other specified trauma and stressor-related disorder adjustment disorder

1. The claimant was injured in motor accident on 14 August 2020 during the pandemic in south west Sydney.
2. A dispute arose about the claimant's entitlements to non-economic loss damages under the Motor Accidents Injuries Act 2017 (the MAI Act).
3. The claimant applied to the Personal Injury Commission (the Commission) to resolve the dispute.
4. Medical Assessor Yu Tang Shen assessed the claimant and issued a certificate dated

10 April 2024. The Medical Assessor found the accident caused other specified trauma and stressor-related disorder and panic disorder with agoraphobia which was assessed as permanent impairment of greater than 10% being 17%. 5. The insurer applied under s 7.26 of the MAI Act to refer this assessment to a review Panel on the grounds that the medical assessment was incorrect in a material respect. 6. The Presidential delegate accepted the insurer's application. 7. The Commission's President constituted this Review Panel (the Panel) to review the above medical assessment (the Review). 8. Following rule 128(1) of the Personal Injury Commission Rules, 2021 (the PIC Rules) the Panel 'is to conduct and determine the proceedings in accordance with procedures determined by the Panel'. 9. The Panel met on 27 May 2025 to discuss how this matter will proceed.

1. The Panel is to conduct the Review in accordance with s 7.26 of the MAI Act.

Section 7.26(5A) provides that the Panel is to be constituted by two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission. 2. The Review is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) MAI Act. 3. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the PIC Act. The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128. 4. Version 9.3 of the Motor Accident Guidelines (Guidelines), effective from 6 December 2024, apply to the Review.

1. On 2 April 2025 the Panel directed the parties to file bundles that contained all material relied on for the purposes of the Review. The parties were also directed to provide submissions for the purposes of the Review. A joint bundle was subsequently filed.
2. At the first teleconference the Panel considered re-examination was required and Medical Assessors Canaris and Gupta would conduct this examination on behalf of the Panel via Microsoft Teams teleconference on 1 July 2025 with a Bosnian interpreter to assist the claimant.
3. The Panel also directed that the claimant provide any recent clinical notes from any GP or treating psychiatrist or psychologist to the Panel before the examination to be considered in this review.

1. If there is a dispute about whether the degree of permanent impairment of an injured person is sufficient for an award of damages for non-economic loss, damages may not be awarded unless the degree of permanent impairment has been assessed by a Medical Assessor under Division 7.5: s 4.12(1) MAI Act.
2. The method of assessing the degree of impairment is dealt with in s 7.21, which is in the following terms:

"7.21 Assessment of degree of permanent impairment

(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.

(2) Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.

(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.

(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent."

1. Clause 6.35 of the Motor Accident Guidelines states that psychiatric impairment is assessed in accordance with 'Mental and behavioural disorders' found in cls [6.201]-[6.228] of the Guidelines.
2. Pre-existing impairment is addressed in cls 6.31-6.33 of the Guidelines, and specifically

cl 6.218 for psychological conditions. Clause 6.34 deals with subsequent injuries. 3. The Guidelines state as follows with respect to causation of injury:

6.5 An assessment of the degree of permanent impairment is a medical assessment matter under clause 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 AMA4 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 AMA4 Guides as follows:

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

1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination.

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

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

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

1. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychiatric condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The motor accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

Degree of psychiatric impairment rating scale

1. Impairment is assessed following the Motor Accident Guidelines version 10 (the Guidelines) which include a chapter entitled "Mental and behavioural disorders." The assessment is to be undertaken in accordance with the psychiatric impairment rating scale (PIRS) and the AMA 4 Guides are to be used as "background or reference only."[1]
2. The PIRS requires a psychiatric diagnosis to be undertaken first in accordance with the current editions of either the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Statistical Classification of Diseases and Related Health Problems (ICD).[2]
3. The PIRS provides[3] for the consideration of any psychiatric condition present before the accident in question:

"In order to measure impairment caused by a specific event, the medical assessor must, in the case of an injured person with a pre-existing psychiatric diagnosis or diagnosable condition, estimate the overall pre-existing impairment using precisely the method set out in this part of the Guidelines, and subtract this value from the current impairment rating."

1. The PIRS provides in cl 6.219 for six areas of function:

(a) self-care and personal hygiene;

(b) social and recreational activities;

(c) travel;

(d) social functioning (relationships);

(e) concentration persistence and pace, and

(f) adaptation.

1. The PIRS then provides at 6.220 for five classes of impairment with a descriptor for each which is "illustrative rather than literal criteria" and which is based on:

"... a history of the injured person's pre-accident lifestyle, activities and habits, and then [an assessment of] the extent to which these have changed as a result of the psychiatric injury."

1. The impairment may be adjusted for treatment,[4] that is treatment such as medication being taken to treat the psychiatric condition.
2. Once all six areas of function have been categorised into a particular class, the median class score is determined, the aggregate score is determined and the median and aggregate is converted to provide a WPI percentage.[5]

1. Medical Assessor Shen gave a certificate and reasons dated 10 April 2024. The Medical Assessor certified that diagnoses of the following conditions
   • other specified trauma- and stressor-related disorder, and
   • panic disorder with agoraphobia

caused by the accident gave rise to a permanent impairment of 17%.

1. Before the accident, she said her relationship with her partner and children was good. She would be in contact with her siblings quite often on the phone. She had three to four close friends she saw frequently, and acquaintances. She was social and attended social events. She enjoyed activities outside of the home.
2. After the accident her relationships remain on track but she had reduced the frequency of contacts and become more distant. Her physical conditions affected her activities outside the home.
3. Before the accident she maintained personal cleanliness and domestic activities.
4. Before the accident she said she has seen a psychologist due to her anxiety at the onset of COVID-19, and not being able to see her children. She said she only saw the psychologist once, and the anxiety improved, and she denied any anxiety symptoms in the time leading up to the accident. I clarified if she meant she saw a psychiatrist on the same day of the subject accident, which she acknowledged.
5. The Medical Assessor asked about notes recording deterioration the year before the accident, with previous psychological therapy and antidepressant treatment, war-time exposure and refuge-seeking for a few years before moving to Australia. She acknowledged that.
6. She said she was involved in the subject accident when she had stopped at a T-intersection, and a vehicle rear-ended her, and her breast implant ruptured. She was restrained by her seatbelt. The airbags did not deploy, she did not hit her head and she did not lose consciousness. Her car was not written off.
7. The accident circumstances were not so severe as to meet Criterion A for a post-traumatic stress disorder diagnosis, as it was a minor crash, though she may have met the alternative diagnosis of other specified trauma- and stressor-related disorder, given she still suffers a post-traumatic stress disorder-like syndrome related to the subject accident.
8. Medical Assessor Shen considered that the claimant may have a major depressive disorder, but objectively she appeared to be on the milder end of the severity range, and in any case could be subsumed under the diagnosis of other specified trauma and stressor-related disorder.
9. The Medical Assessor found there was a plausible mechanism of injury from the circumstances of the accident and the development of her psychiatric injuries, and there is a temporal and thematic association with her psychiatric symptoms and the subject accident, such that the nexus between subject accident and psychiatric injury is maintained.
10. The Medical Assessor found that the claimant described symptoms consistent with her suffering from other specified trauma and stressor-related disorder and panic disorder with agoraphobia.
11. It was noted that the claimant had commenced psychological treatment and medication just before this assessment. Given her symptoms for the past four years and the ongoing pain, her symptoms and functioning had stabilised.
12. In assessing the PIRS the Medical Assessor assigned 2 for self-care and personal hygiene, 3 for social and recreational activities, travel was 2, as was social functioning, concentration persistence and pace was 3 and adaptation was 4. This led to an aggregate score 16, which resulted in permanent impairment of 17%.
13. Medical Assessor Shen assessed the pre-existing PIRS as 1 in all categories, which was assessed as permanent impairment of 0%.

1. Medical Assessor Alexey Sidorov provided a certificate dated 22 June 2022 in which he advised that Ms Lucanovic had suffered mood and anxiety symptoms, which did not amount to a psychiatric disorder, following the motor vehicle accident dated 14 August 2020.
2. That Medical Assessor noted that she had not worked since 2019. He reported that she felt sad because of COVID-19 restrictions at the beginning of 2020.
3. She had stated that she had seen a psychiatrist at that time but was not started on any medication. Ms Lucanovic had been referred for psychotherapy on 10 August 2020 by her treating general practitioner for depressive and anxiety disorder secondary to living circumstances. She was not on any medication for mental health at that time.
4. Psychiatrist Dr Inglis Synnott provided an independent medical examination report dated

10 January 2024. He noted that Ms Lucanovic had seen a psychologist on two occasions in 2012 because of relationship problems. He stated that there was no other psychiatric history. The report does not describe that she had been on her way to see a psychologist on the day of the accident. He advised that the diagnosis was adjustment disorder with anxiety and depressed mood and assessed her to have 6% whole person impairment (WPI). 5. Clinical documentation from psychiatrist Dr Goran Stevens was provided. According to this letter, Dr Stevens had diagnosed her with depression with anxious distress. He had advised continuation of psychotherapy and escitalopram 20mg. Dr Stevens had noted in his letter dated 19 March 2025 that Ms Lucanovic 's symptoms had been ongoing since the accident that she suffered on 14 August 2020. 6. Psychiatrist Dr Mukesh Kumar provided an independent medical examination report dated

30 June 2023. He referred to two or three psychological sessions during 2012 and noted she was on her way to the psychiatrist on the date of the accident because of ongoing pain. He considered Ms Lucanovic 's diagnosis to be post-traumatic stress disorder and assessed her to have suffered 19% WPI. 7. Treating psychologist Mr Zoran Protulipac stated in an email dated 11 May 2021 that Ms Lucanovic was suffering from chronic pain, depression, anxiety, and insomnia related to the motor vehicle accident. He stated that she had not reported any pre-existing condition or psychosocial issues. 8. Patient health summary from Ray Rickard Medical Centre printed on 19 November 2020 was provided. Documentation starts from 29 April 2019. According to this document, there were no consultations regarding mental health until the claimed motor vehicle accident. 9. Psychiatrist and psychotherapist Dr Gordana Jovanova provided a letter dated

14 August 2020. The therapist noted that Ms Lucanovic had last worked as a sales assistant. She had reported her main issue as chronic back pain, and her mood had gradually deteriorated over the last one year. She had reported that her back pain had been going on for 20 years, and she had suffered from low energy levels chronically. Reduced concentration, forgetfulness, and insomnia were described. 10. According to this letter, Ms Lucanovic 's past psychiatric history included being prescribed an antidepressant in 2008 and 2009 and having seen a psychologist in 2013 or 2014 for relationship issues. There was no reference to the accident. The letter did not refer to any symptom suggesting an acute stress disorder.

1. The claimant's submissions combined the physical and psychological injuries. Relevant to the psychological conditions the claimant relied on Dr Kumar's report dated 30 June 2023, which diagnosed post-traumatic stress disorder arising from the accident with permanent impairment at 19%.
2. The submissions acknowledge the claimant saw a psychologist in 2014 due to relationship issues. Shortly before this accident the claimant's GP suggested she seek psychotherapy to help deal with the consequences of a back injury and personal issues. The claimant was travelling to see the therapist when the accident occurred. She still attended the appointment, but treatment did not continue.
3. The claimant's pain arising from the accident resulted in stress, anxiety, depression, low mood, negative thoughts, flashbacks and post-traumatic episodes. The GP medicated the claimant to treat these conditions and she was referred to a psychologist. She began to see a psychologist in May 2021 and that treatment was substantial.
4. The claimant refers to her treatment and Dr Kumar's findings and the list of symptoms, which support a diagnosis of post-traumatic stress disorder.
5. The claimant made further submissions when the insurer applied for review of Medical Assessor Shen's assessment. Relevantly, in respect of the insurer's allegations of the claimant's inconsistency, the claimant says it was put to her that she had a history, which included past psychological assistance for personal issues. The claimant pointed out that the Medical Assessor had put these matters to her and this was acknowledged in the reasons.

1. The insurer also combined the physical and psychological conditions and submitted that the claimant had a long history of pre-accident conditions including mental illness, only listed one item in 2020 in the midst of the pandemic, which occurred shortly before the accident in a list of eight medical attendances and a GP's in 2014 about 'anxiety/depression'.
2. The insurer pointed out that the claimant's statement dated 8 August 2023 in submissions dated 18 December 2020 contain inconsistencies but did not refer to psychological conditions.
3. The insurer submits that significant weight should be given to the claimant's treating psychiatrist initially noting approximately an hour after the accident that the main reasons the claimant's GP referred her for treatment was due to chronic back pain, and psychiatrist Dr Synott's opinion on the claimant's credibility as supporting treating the claimant's symptoms and complaints with a high level of caution.
4. The insurer listed other attendances before and after the accident. The relevant aspects have been addressed in the evidence summarised above.
5. The insurer also referred to a lack of or delays in treatment after the accident as signifying that the claimant's accident related conditions had resolved.
6. The Panel also considered the insurer's submissions when it applied for a review of Medical Assessor Shen's assessment.

1. The claimant and Medical Assessors Canaris and Gupta met on Microsoft Teams for the examination.
2. The claimant was identified from her photograph on her NSW driver license. She was interviewed using the Microsoft Teams application with a good internet connection.

1. Ms Lucanovic was born in Bosnia. She says that she had a "normal childhood" and denies suffering from any form of abuse. She lived in Bosnia through the war but had to move to Serbia after being expelled from the country with her family. The family returned to Bosnia after the war. She says that she was very young at the time and denies experiencing any trauma from the events. On further questioning, she stated that their belongings had been destroyed when they were in Serbia. She denies any history of mental illness in her family.
2. She has been living in Australia since 1996, having arrived as a refugee. Ms Lucanovic was married and has two children. Her daughter is thirty-five years old who lives in Belgium, whereas her son is thirty-six years old and lives in Australia.
3. In 2003, she returned to Serbia, where she separated from her husband in 2007. She suffered abuse in that relationship. She returned to Australia in 2010, but her children stayed back. She returned to Serbia in 2011 and returned the same year. She stayed until 2017 and returned to Serbia. She travelled to and from Australia with a new partner in 2018. She has been living here permanently.
4. She denies any subsequent trauma.
5. She denies any history of major physical illnesses before the injury. She is known to suffer from hypothyroidism.
6. Ms Lucanovic denies that she uses alcohol or drugs.

1. Ms Lucanovic was injured in a motor vehicle accident on 14 August 2020. She was at a crossroad, waiting to turn left, when her car was rear-ended. She was the sole occupant of her Volkswagen Passat.
2. It was a sudden hit and she had not seen the vehicle coming before it hit her. Her airbags were not deployed. She did not suffer any head injury or loss of consciousness. She got out of the car independently and exchanged details with the other driver. She had been on her way to see a "psychologist" and drove for 20 minutes to half an hour to her appointment after the incident.
3. She says that she only went to the hospital two days later, where she found that the right breast implant had burst.

1. Ms Lucanovic says that she continues to suffer from pain in her neck, which radiates down to her right arm and hand. It is present all the time and says that it prevents her from doing things. She has had her breast implants replaced.
2. Ms Lucanovic says that she tries "to be good", but her mood is not "good". She says that she can cry without any reason or with "small things". She says that she feels anxious all the time. She had a panic attack on Boxing Day and had to attend the hospital. She says that she suffers from panic attacks "frequently".
3. She says that her sleep has improved with medication. She says that she has nightmares but was unable to explain them. She says that she dreams of cars or lights from behind. She says that these dreams wake her up, and she finds it difficult to fall back asleep afterwards.
4. Ms Lucanovic says that her appetite is reduced, and she sometimes forgets to eat. She has lost four or five kilos since the injury. She says that she jumps at loud sounds and gets overwhelmed by noise. She says that she feels scared of being reinjured when she goes out. Ms Lucanovic did not describe avoidance as such, but describes an inability related to pain and loss of interest in doing things.
5. She says that she does things when her partner or her children push her. She prefers to stay in bed most of the time. She says that she wants to get better. She says she would also like to return to work. She denies any active suicidal ideation, but there are times when she feels that she would be better off "not waking up".

1. Ms Lucanovic is on Thyroxine 100 micrograms. She was started on Venlafaxine XR by her psychiatrist, Dr Goran Stevens, whom she has been seeing since March 2025. She is on Venlafaxine XR 225mg along with Zolpidem 10mg at present. She sees psychologist Ms Danielle Savage. She has a mixture of telehealth and in-person appointments with Ms Savage.

1. Ms Lucanovic presented as a casually dressed lady who was easy to build rapport with. She appeared distressed at times but maintained good eye contact.
2. She appeared reasonably kempt and adequately nourished. Her mood was low, and her affect was restricted. Her speech was normal in rate, rhythm, tone, and volume.
3. Her thought content revealed that she has become hopeless about her future and has developed passive suicidal ideation. She was not suffering from any perceptual abnormalities. She was able to focus throughout the assessment and appeared well-oriented to time, place, and person. Her insight and judgement appeared intact.
4. Her mental state examination was consistent with her reported symptoms.

1. She rarely cooks now, because of the pain and her inability to concentrate on recipes. She says that she tries to manage her hygiene, but her partner has to remind her to take a shower sometimes.
2. She cleans her teeth regularly. She tends to wear clean clothes but can stay in the same clothes for three days sometimes. She used to go to the hairdresser but forgot to go twice, and now her daughter-in-law cuts her hair. Her partner gives her the medication.
3. She says that her partner manages their finances. She says that her concentration is reduced, and she has discussed that with her psychologist. She is not interested in watching TV or reading because of her forgetfulness. She is still receiving Jobseeker's payments but has a medical certificate stating she has no capacity to work.
4. She says that she drives only when she has to because of a loss of confidence. Her car was not written off, but she sold it afterwards. She bought a new Volkswagen Golf two years ago. She says that the mileage on her car is around 30,000 km. Her partner has a personal car and another vehicle for work. She travels 50 km to see her doctor in Newtown once a month. She can drive if her partner is unavailable.
5. She has travelled independently to Serbia in October last year. She stayed for five to six weeks. She says that she went to visit her mother and then to Belgium to see her daughter. She spent time with her mother in Serbia as the latter was sick. She says that she went sightseeing in Brussels when she was in Belgium. She says that she did not enjoy it much. She could not enjoy her granddaughter's company either.
6. She is close to her mother and children. She says that there is some strain on her relationship with her partner, but "it's okay". She says that they do not go out for meals or coffee because she has lost her desire to socialise.
7. She gets anxious and panicky in crowded places. She can go to the shops independently for essential items. She says that her son lives nearby and visits her with her family. She has lost touch with most of her friends.
8. She was not working at the time of the injury. She says that her partner had a cleaning business, which she had wanted to develop, but it was struggling owing to COVID-19. She was receiving Jobseeker payments at that time and had been on them since 2018.
9. This business is not doing as well, still, but she is not involved. The business has been going on since 2018. She was asked about her contribution to the business before COVID-19. She says that her contribution to the business, even before the pandemic, was minimal.
10. She worked as a sales representative for Marco Polo, a food retailer in Sydney, for three and a half years until 2017 and has not worked since. She had resigned from that job to open a beauty salon in 2017 but left it to her daughter to run in 2018 as she wanted to be with her partner.

1. The Panel noted the insurer's submissions that the claimant's presented inconsistently and that the Panel should treat her complaints with caution.
2. Although Ms Lucanovic initially denied any history of mental illness, on further questioning she stated that she had made an appointment to see a psychologist on the day of the accident.
3. At that time, she was in Australia on her own while her children were in Serbia. She says that she was stressed because of the COVID-19 and pandemic travel restrictions were in force at the time. She says that she had never suffered from any mental illness and had never seen a psychologist before that. The Panel noted there had been previous mental health references in her history but these had been intermittent and did not lead to any established pathologies.
4. The Panel considered that as the claimant was aware that her history was well documented and before the Panel that there were a number of possible reasons for the denial including the passing of time or seeking occasional help, which did not impugn her credit.[6]
5. The Panel noted too that the accident occurred during the COVID-19 pandemic in south-west Sydney, which it was known had led to reduced opportunities for the sick and injured people to have their conditions investigated and treated.

1. She was asked about the medical records, which indicate that she had a surgery on her back in 2022 for a back injury. She says that she had been seeing a surgeon for back pain since 2019 and had had back pain for some time before then. Her partner had persuaded her to see a surgeon in 2019. She was finding it difficult to sit and it impacted her to an extent. She says that she was fully functional despite that.

1. The Panel determined that the claimant's presentation was consistent with a diagnosis of other specified trauma and stressor-related disorder.
2. Ms. Lucanovic does not meet the full diagnostic criteria for post-traumatic stress disorder due to a lack of avoidance symptoms (Criterion C). However, she presents with clear trauma-related symptoms (including nightmares, anxiety, panic, hypervigilance, mood disruption, sleep disturbance, and functional impairment) that are clinically significant and clearly associated with a trauma.
3. It can also be ascertained from the documentation that Ms Lucanovic did not have a significant psychiatric history when she was injured in the accident. She had just been referred to consultant psychiatrist Dr Gordana Jovanova for emotional symptoms associated with chronic back pain.
4. Immediately after the accident she was able to attend and fully participate in a comprehensive psychiatric assessment, without exhibiting signs of acute stress despite getting to the appointment straight after the claimed accident. This supports the Panel's view that her condition does not meet the diagnostic criteria for post-traumatic stress disorder.
5. Thus, the most appropriate diagnosis under DSM-5 is other specified trauma- and stressor-related disorder, with partial post-traumatic stress disorder symptoms. This diagnosis allows recognition that she is suffering from a trauma-related condition but not full post-traumatic stress disorder.

1. Although Ms Lucanovic had been feeling stressed from COVID-19 restrictions and being away from her children, there is no documented history of mental illness or functional impairment in her clinical documentation.
2. Other than the symptoms her GP relied on to support the referral to Dr Jovanova her emotional symptoms only became noticeable after the subject accident. The Panel opines that the claimant's psychological injury arises as a consequence of that accident.
3. Before the accident there were no objective symptoms that could allow the Panel to assess pre-existing permanent impairment in accordance with cl 6.31 of the Guidelines.

Degree Of Permanent Impairment Psychiatric Impairment Rating Scale (PIRS)

1. The Panel's Medical Assessors determined the claimant's permanent impairment in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Guidelines.

1. She is independent with activities of daily living. She cleans her teeth regularly and tends to wear clean clothing, but she can often go several days without changing her clothes. Her partner sometimes needs to remind her to shower. She often forgets appointments, such as her hairdresser's, and now relies on her daughter-in-law to cut her hair. Although she previously cooked more regularly, she now avoids it, saying she struggles with pain and finds it difficult to focus on recipes.
2. This is consistent with Class 2.

1. Her social and recreational activities have reduced considerably. She no longer socialises, does not go out for meals or coffee, and avoids crowded settings due to anxiety and panic. Although she maintains some contact with her immediate family and has travelled overseas recently, she describes a lack of enjoyment and loss of interest in these experiences. She has become disengaged from friends.
2. The decline in social engagement and diminished enjoyment is consistent with Class 3 impairment.

1. She continues to drive but does so only when necessary and lacks confidence. She reports selling her previous car after the accident, but she has continued to drive, accumulating approximately 30,000 km on her current vehicle over the past two years. She can drive to appointments on her own if her partner is unavailable and has recently travelled unaccompanied to Serbia and Belgium. Although she describes anxiety associated with travel, particularly crowded environments, she remains capable of undertaking it when required.
2. This equates to Class impairment in this category.

1. She reports a strained but ongoing relationship with her partner and remains close to her children and mother. She has, however, withdrawn from her friends,
2. This equates to Class 2 impairment in this category.

1. She reports experiencing some cognitive difficulties, specifically with concentration and memory. She struggles to follow television programmes or read for enjoyment and has discussed forgetfulness with her psychologist. She is concordant with her medication and did not describe forgetting her appointments.
2. Using clinical judgement, the Panel rated her as Class 2 in this category.

1. She has not worked since 2017. She was receiving Jobseeker payments before the accident and describes only minimal involvement in her partner's business. She is currently medically certified as unfit for employment. Although she expresses a desire to return to work, her functional capacity is limited by both psychological and physical symptoms.
2. The Panel determined that this equated to Class 2 impairment for the psychological injury.
3. The claimant's impairments, in numerical order, were 1, 2, 2, 2, 3, and 3, with a median score of 2 and an aggregate of 13, equating to a whole-person impairment of 7%.
4. The Panel made no deduction for pre-existing impairment. The Panel considered that 1% uplift for the impact of treatment was applicable.
5. Therefore, WPI is 8%.

1. Other specified trauma and stressor-related disorder

Venlafaxine XR 225mg, Zolpidem 10mg and Psychotherapy.

She is independent with activities of daily living. She cleans her teeth regularly and tends to wear clean clothing, but she can often go several days without changing her clothes. Her partner sometimes needs to remind her to shower. She often forgets appointments, such as her hairdresser's, and now relies on her daughter-in-law to cut her hair. Although she previously cooked more regularly, she now avoids it, saying she struggles with pain and finds it difficult to focus on recipes.

Her social and recreational activities have reduced considerably. She no longer socialises, does not go out for meals or coffee, and avoids crowded settings due to anxiety and panic. Although she maintains some contact with her immediate family and has travelled overseas recently, she describes a lack of enjoyment and loss of interest in these experiences. She has become disengaged from friends. The decline in social engagement and diminished enjoyment is consistent with Class 3 impairment.

She continues to drive but does so only when necessary and lacks confidence. She reports selling her previous car after the accident, but she has continued to drive, accumulating approximately 30,000 kilometres on her current vehicle over the past two years. She can drive to appointments on her own if her partner is unavailable and has recently travelled unaccompanied to Serbia and Belgium. Although she describes anxiety associated with travel, particularly crowded environments, she remains capable of undertaking it when required

She reports a strained but ongoing relationship with her partner and remains close to her children and mother. She has, however, withdrawn from her friends

She reports experiencing some cognitive difficulties, specifically with concentration and memory. She struggles to follow television programmes or read for enjoyment and has discussed forgetfulness with her psychologist. She is concordant with her medication and did not describe forgetting her appointments.

She has not worked since 2017. She was receiving Jobseeker payments before the accident and describes only minimal involvement in her partner's business. She is currently medically certified as unfit for employment. Although she expresses a desire to return to work, her functional capacity is limited by both psychological and physical symptoms.

The Panel determined that this equated to Class 3 impairment for the psychological injury.

List Classes in Ascending Order Median Class Value

Apportionment - pre-existing/subsequent impairment

1. The Panel has considered the evidence relating to the claimant's pre-accident psychological history that included her medical history, family history and relationship breakups.
2. Ms Lucanovic had no impairment of her day to day functioning prior to the accident.
3. The Panel has given weight to its medical members' opinion who, following a thorough examination of the claimant's pre-existing functioning, were satisfied there was no pre-existing psychiatric condition at the time of the accident, which could be assessed as permanent impairment.
4. There were no relevant events other than the accident.

1. The claimant has had the benefit of counselling and medication fluoxetine since the accident.

1. Degree of permanent impairment caused by the accident 8**%.**
2. Permanent impairment ratings take symptoms into account, however the percentage permanent impairment is not a direct measure of disability.
3. A finding of zero percent permanent impairment indicates that there was an injury caused by the accident and that there may be continuing symptoms, however, relevant Guides and Guidelines rate the associated impairment at 0%.

1. The Panel gives weight to the opinion of its medical members that as a result of the accident the claimant developed other specified trauma and stressor-related disorder. The Panel agrees with and adopts the reasons given by its medical members in their re-examination report in support of this finding.
2. The Panel is satisfied that the accident made a material contribution to the development of this disorder, and that but for the accident the claimant would not have developed this conditions.
3. The Panel has considered the class descriptors for each category of functioning in the PIRS and has evaluated the history provided by the claimant when the Panel's medical members re-examined her.
4. The Panel also notes that the clinical judgment of its medical members, both of whom are psychiatrists, is the most important tool in the application of the PIRS: cl 6.217 Impairment Guidelines. The Panel has given weight to the findings of its medical members with respect to the class they assigned for each PIRS area of functioning, and agrees with and adopts their findings, and the reasons they have given in support of those findings.
5. The Panel has found that the degree of permanent impairment of the claimant that has resulted from the conditions caused by the accident is 8%, and that the permanent impairment is not greater than 10%.
6. Given those findings, the Panel revokes Medical Assessor Shen's certificate dated

10 April 2024 and issues a new certificate certifying that the degree of permanent impairment of the claimant that has resulted from the other specified trauma and stressor-related disorder caused by the accident is not greater than 10%.

[4] See clauses 6.222 - 6.223 of the Guidelines.

[5] See clauses 6.225 - 6.228 and table 17.

[6] Stevens v DP World Melbourne Ltd [2022] VSCA 285 [44]