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

1. The Review Panel confirms the certificate of Medical Assessor Rikard-Bell dated

1. Thomas McKenzie (the claimant) alleges injury from a motor accident occurring on

1 March 2021. The claimant was the passenger in a vehicle driven by his mother when a vehicle collided with them. 2. A claim was subsequently lodged upon QBE Insurance (Australia) Limited (the insurer), the compulsory third party insurer of the vehicle considered at fault. The claimant seeks payments of statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act). 3. A dispute has arisen between the parties as to whether the claimant has suffered a psychological injury caused by the motor accident and whether any such injury is a "threshold" injury for the purposes of the MAI Act. 4. A threshold injury determination is an important one in terms of an injured person's entitlements under the MAI Act. If a determination finds that the motor accident has caused a non-threshold injury then the gateway to ongoing statutory benefits and an entitlement to claim damages is opened. 5. An application was lodged with the Personal Injury Commission (Commission) seeking a determination of the dispute. 6. Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter including whether "the injury caused by the motor accident is a threshold injury for the purposes of the Act". 7. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act. This means that the matter is determined at first instance by a Medical Assessor. 8. The dispute about whether the injury caused by the motor accident is a threshold injury, is a medical dispute, as defined by s 7.17 of the MAI Act, and a medical assessment matter: Schedule 2, cl 2(e) of the MAI Act. 9. Medical Assessor Christopher Rikard-Bell issued a certificate and reasons dated

13 October 2023, which certified that the motor accident caused the claimant to suffer

post-traumatic stress disorder, which is a threshold injury for the purposes of the MAI Act.

1. The insurer sought a review of the medical assessment in accordance with s 7.26 of the

MAI Act. On 13 December 2023 the President's delegate determined that there was reasonable cause to suspect the medical assessment was incorrect in a material respect. As such the review application was accepted and referred to a Review Panel (the Panel). 2. Section 7.26(5A) of the MAI Act provides that a review panel consists of two Medical Assessors and a Member assigned to the Motor Accidents Division of the Commission. 3. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect 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) of the MAI Act. 4. Rules 127 and 130 of the Personal Injury Commission Rules 2021 (Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the Rules. 5. The Panel met via video conference on 13 January 2024 and determined that a

re-examination of the claimant was required. A medical examination was arranged to take place on 10 February 2025 with Medical Assessor Newlyn and Medical Assessor Friend via Microsoft Teams. The claimant failed to attend that appointment, apparently due to ill health. A further examination was arranged to occur on 10 March 2025. The examination took place as scheduled. 6. The Panel reconvened via videolink for a second teleconference on 24 March 2024.

1. The term "threshold injury" is defined in s 1.6 of the MAI Act. It provides that a threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness: s 1.6(1)(b).
2. Section 1.6 also provides that the regulations may exclude or include a specified injury from being a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (Regulation) further defines threshold psychological or psychiatric injury to include acute stress disorder and adjustment disorder. For the purposes of cl 4 'acute stress disorder' and 'adjustment disorder' have the same meanings as in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013: cl 4(3) of the Regulation.
3. Part 5 of the Motor Accidents Guidelines (Guidelines) are made pursuant to s 10.2 of the

MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by a motor accident is a threshold injury for the purposes of the MAI Act. 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 Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. 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:

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

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

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

(d) a careful and thorough physical and/or psychological examination

(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the assessment of threshold psychological or psychiatric injury. These clauses provide:

"Threshold psychological or psychiatric injury assessment

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

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

5.12 Where the symptoms associated with the injured person's psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury."

1. Medical Assessor Rikard-Bell described the claimant to be pleasant but found it difficult to engage with the examination. Following the examination and consideration of the evidence, the Medical Assessor confirmed his opinion that the claimant had suffered post-traumatic stress disorder caused by the accident.

Claimant's submissions made to Medical Assessor Rikard-Bell (undated)

1. The claimant submitted that he was awaiting a formal diagnosis of post-traumatic stress disorder, with such disorder not being a threshold injury for the purposes of the MAI Act. It is submitted that the insurer had not sought clarification or a diagnosis from the claimant's treatment providers in breach of cl 5.5 of the Guidelines.

Insurer's submissions made to Medical Assessor Rikard-Bell dated 1 February 2023

1. The insurer submitted that there was no evidence to suggest the claimant had sustained a non-threshold psychological injury caused by the motor accident. The insurer noted that despite the application for personal injury benefits (claim form) asserting he was seen at Moree Hospital the insurer had been unable to locate any ambulance or hospital records.
2. The insurer refers to the records of general practitioner, Dr Hamze, who issued a certificate of capacity dated 2 August 2022 (17 months post accident) that includes a diagnosis of 'anxiety due to being a passenger in a low speed MVA last year'. The insurer notes that no details as to how the diagnosis was reached are provided. The insurer further submits that the clinical notes of the GP as at 29 November 2022 do not include any complaints of psychological symptoms.

Insurer review submissions dated 7 November 2023

1. The insurer submits that the Medical Assessor failed to provide sufficient reasons for his conclusions. Specifically, it is submitted that the Medical Assessor failed to set out how the claimant meets the diagnostic criteria for a diagnosis of post-traumatic stress disorder.

1. The claimant submits the Medical Assessor included a clear rationale for the diagnosis of post-traumatic stress disorder, noting the Medical Assessor stated that he had formed the view that the claimant met the necessary diagnostic criteria. The claimant also refers to various sections of the report that takes note of history and symptoms that fit within the diagnostic criteria.

1. The Panel has considered all documentation provided by the parties in their respective bundles lodged in compliance with Panel directions dated 12 November 2024.

Application for personal injury benefits dated 12 August 2022

1. The claim form includes a list of injuries of injury to back, knees and "psychological injuries".
2. The certificate of capacity signed by Dr Hamze includes a diagnosis of "anxiety due to being a passenger in a low speed MVA last year".

GP clinical file - Pius X Aboriginal Corporation (Dr Hamze)

1. The recorded consultations centre largely around unrelated respiratory symptoms, with a background of asthma. There are no comments regarding the claimant's psychological state and there does not appear to be a consultation recorded that corresponds with the certificate of capacity.
2. However, a letter dated 3 July 2024 addressed to "to whom it may concern" states the claimant was reviewed via telehealth on that day and is noted to have been suffering with a lot of mental and emotional stress and was struggling to cope. It is stated that this was reflected in his behaviour and performance at school. It is stated the claimant requires review by a paediatrician and child psychologist for further assessment and management.

Department of Education - Moree Secondary College

1. A letter addressed to the claimant's mother dated 16 November 2023 from Moree Secondary College notes a formal caution to suspend due to "unsafe and dangerous behaviour". An earlier caution was given on 2 May 2023 for inappropriate behaviour towards another student. Some aggressive behaviour was noted in a questionnaire of Cardiff High School in June 2023. Records also demonstrate suspensions in May 2023 (continued disobedience), 18 August 2022 (continued disobedience) and 10 June 2021 (disrespectful behaviour, continued truancy, swearing at staff). A suspension warning was received on 12 August 2021 due to disrespectful behaviour towards others.
2. A further formal caution was given on 1 March 2024 due to persistent disobedience and disruptive behaviour.
3. Reports from 2023 vary with records of difficulties in the classroom with behaviour, and some records of "commitment and determination". He is noted to sometimes not engage in the class work. He achieved "Ds" and "Es" in his subjects. Similar results are recorded for 2022 and 2024.
4. Records from Moree East Public School include a history of prior suspensions. For instance a suspension occurred in November 2020 for aggressive behaviour due to inappropriate language towards teachers including threats and derogatory names. He was suspended on 21 June 2019 for aggressive behaviour.
5. Intelligence scale testing was carried out on 27 August 2020. Scores were generally said to be lower than most children his age. Cognitive functioning test (FSIQ) produced tests indicating an "extremely low range" compared to other children his age.

1. The claimant was 16-years-old at the time of the appointment on 10 March 2025. He said he preferred to be called Tom. He was examined using MS Teams videoconferencing. He was at home in Moree with his mother, Kylie Munro. On 10 February 2025, he had not attended a scheduled panel assessment because of anxiety. On this occasion he stayed in the assessment interview for 50 minutes before withdrawing.
2. An indigenous teenager, he was wary of talking to strangers and his mother spoke for him when he became inarticulate. His mother mitigated his inability to express himself by providing corroborative history. His mother provided history during his absence. He did not verify her statements.

1. The claimant's mother described Tom as tall for his age - taller than his father.
2. His mother said that he was a healthy kid before the 1 March 2021 Motor Vehicle Accident (MVA) apart from asthma for which he used a puffer as needed.

1. Intellectual assessment in primary school had shown him to have a mild intellectual disability.
2. He was bullied early in primary school and by Year 5 had difficulty attending school because of placement for help with his disability. His mother described her son's disability as "a bit of dyslexia".
3. After the 1 March 2021 MVA, his school attendance declined, and his mother said he had not attended high school since 2023. She did not agree with the school record of attendance.
4. His mother said that his sleep disorder made it difficult for him to attend school because of tiredness.
5. He did not want to be around people who were not his family.
6. His mother disagreed that he had been suspended for aggressive and non-compliant behaviour despite the Medical Assessors asking her about prior suspensions.
7. His NAPLAN scores in 2021 and 2023 showed he was below national and school average in all areas.
8. He had not been involved with the Clontarf Foundation for many years.

1. The claimant's father lives with his parents at 'the other end' of Moree. He has lived 'on and off' with Ms Munro.
2. The claimant's father has lived with his parents for six months because of 'housing complications'. He works mainly as a farmhand.
3. He has no mental health issues.
4. Ms Munro's family is described as supportive. Her youngest brother has dyslexia. There are no mental health issues in the family.
5. Ms Munro said that before the 1 March 2021 MVA she was a youth worker and disability support worker.

1. Ms Munro stated that the motor accident occurred when Ms Munro was driving and Tom was a passenger.
2. Two other vehicles collided, trying to avoid an elderly lady and then collided with Ms Munro's car.
3. Ms Munro said she was 'jammed in' when the other two vehicles hit her car.
4. Her head hit the roof. She lost consciousness briefly. She panicked when she recovered consciousness because there was 'smoke' in the car.
5. She said she 'grabbed the little ones from the back seat'.
6. The claimant ran away to his grandparents.
7. Ambulances and police came to the scene and the family was taken to the hospital. Her parents took their grandson to the hospital.
8. Ms Munro said she had whiplash as did Tom. Ms Munro said that she and her children stayed with her parents for two to three months because she was 'in a bad way'.
9. She had whiplash symptoms, anxiety, and panic attacks. She had problems sleeping and spent the day resting in bed. She was prescribed medicine for her mental health symptoms for two years.
10. Ms Munro said she did not drive for a year after the MVA. She still does not like loud noises. Because of her anxiety and panic attacks, she did not work for two years. Now she works in a casual job cleaning motels and as an aged care worker.
11. Tom's brother is four years younger and has recovered from the accident.
12. Tom's sister is 10 years younger and has recovered from the accident.
13. Ms Munro began to cry when asked about the effect of the accident on her younger children. She commented they had been through a lot. Tom's brother and sister were now "fine".
14. They had some issues with schooling soon after the MVA. They were anxious in the car after the accident but are no longer worried about travelling in the car.

1. Pregnancy: Ms Munro reported a normal pregnancy and birth with Tom.
2. Gestation: The claimant was a full term baby who weighed nearly 9 pounds [4kg].
3. Infant Problems: No problems were recalled in the claimant's infancy.
4. Milestones: Ms Munro said her son's motor, speech, and toileting milestones were within normal limits.
5. She did not recall any problems with her son's preschool behaviour. He was nice to people and had many friends, and he did not have any attention problems.
6. Trauma History: No childhood sexual or physical trauma was reported.

1. The claimant has a girlfriend he has been seeing for the past eight months. He said a girl he knew had connected them on Snapchat. His girlfriend comes to visit him but he does not visit her.

1. Ms Munro said her son used cigarettes and vaped which he did outside the house. She had attempted to get him to stop but he continued to smoke.
2. Ms Munro suspected her son got cigarettes from his grandmother. Extended family members may have provided vaping equipment when they visited.
3. Ms Munro did not believe her son was using alcohol or recreational drugs,

1. The claimant was not an angry child before the 1 March 2021 MVA.
2. He now gets angry if he does not get what he wants. When angry, he goes outside until he is calmer.

1. The claimant and his mother denied significant psychiatric symptoms before the

1 March 2021 MVA. She said she did not think he had any developmental delay.

1. Ms Munro said that her son was an average child. He played footy, visited friends and had good relationships. He had no problems travelling in the car and she thought he was doing as well as he could in school.

1. Initially, the claimant said he did not remember anything about the accident. Questioned again, he said he remembered that "a car hit us".
2. He recalled jumping out of the passenger seat and running to his grandparents' house. He said he was scared and that he had hurt his neck.
3. Ms Munro said that when her son arrived at his grandparents' house, he fell to the ground and could not speak. Her parents then came to the accident site and then took their grandson to hospital.

History of Symptoms Following the Motor Accident

1. The claimant said that since the accident he has been scared in cars.
2. He thought about the accident when he heard cars and loud noises. He panicked when there were loud noises.
3. He said he could not sleep and went to bed between 3 and 4am.
4. He did not have nightmares.
5. He was unsettled and could not understand why he had trouble getting to sleep.
6. He had lost connection with friends because he did not leave the house.

History of Treatment Following the Motor Accident

1. Ms Munro said that she had taken her son to see their family doctor for a check-up after the accident.
2. Tom had sometimes consulted the family doctor, for asthma problems, after the accident.
3. The Review Panel asked Ms Munro why the clinical notes of the general practitioner did not record the accident. She could not explain the absence of any record of the accident, but she insisted that she had discussed it with the family doctor.
4. Ms Munro said that she could not drive for a year after the 21 March 2021 MVA. On further questioning, she said that she expected her father had driven her and her son to visit the general practitioner when she could not drive.
5. Ms Munro gave her son Panadol for pain.
6. Attempts to refer her son for counselling failed. Ms Munro said her son 'refused everything'.
7. Recently, she had arranged for a male indigenous counsellor to come to the house, and there had been two brief counselling sessions. She hoped to involve men in the community to mentor her son.
8. She was unaware of her son's high school referral to Headspace in May 2021.
9. Ms Munro said Tom did not have specific treatment for his whiplash symptoms.

Details of Any Relevant Injuries or Conditions Sustained Since the Motor Accident

1. No relevant injuries or conditions have been sustained since the 1 March 2021 MVA.

1. Ms Munro said her son remained anxious when travelling in a car and was "on the lookout".
2. He could be irritable about cars coming towards them.
3. His significant school refusal began after the 1 March 2021 motor accident, and had worsened since 2023.
4. An attempt at modifying his sleep pattern had failed.
5. His avoidance of social interaction outside his extended family continued. He did interact with his extended family.

1. The claimant attends the general practitioner when 'forced' by his mother.
2. He is not prescribed a psychotropic medicine.
3. He has recently received two at-home counselling sessions from a male indigenous counsellor. Ms Munro arranged the counselling because she wanted her son to interact more with the broader community.
4. She proposes using mentoring to reintegrate her son in the community.
5. There are no physiotherapy or exercise programs in progress.

1. Appearance: The claimant is a tall indigenous teenager.
2. Grooming: His hair was pulled back from his face.
3. Clothes: He was dressed in casual clothing.
4. Activity: He sat quietly some distance from his mother and after 40 minutes asked to leave the room, finally leaving after 50 minutes. He did return to say goodbye when asked. No psychomotor retardation or agitation observed.
5. Movements: No tics or vocalisations reported.
6. Aggression: His acts towards peers and property are reported in the record but denied by his mother.
7. Impulse control: He began asking to leave the interview 15 minutes after it began. He is not accident-prone.
8. Interaction: He was anxious and taciturn. His mother signalled that her son wanted to leave a couple of times before he eventually left. Mother and son interacted positively, and he appeared to have a good relationship with her.
9. His facial expression is appropriate to verbal content.
10. He made eye contact when talking to the medical assessors.
11. Facial Expression: Anxious.
12. Language use. His rate of speech was appropriate but his volume was low. There was speech hesitancy. His answers were short.
13. Affect: Anxious.
14. Perceptions: No anomalies reported.
15. Sensorium: Clear.
16. Concentration: Developmentally appropriate from clinical observation.

1. Piagetian developmental level appropriate for age with Formal Operations accomplished (> 12).
2. School documents record a mild intellectual disability.

1. The claimant lives with his mother, brother and sister in a house in Moree.
2. Ms Munro said the family had an old dog that did not go for walks and was looking to buy a new one. Her son helped feed the old dog.
3. She said that her son lost weight after the accident. Because of his sleep disturbance, he eats when he wakes in the late afternoon and snacks overnight until he goes to bed between 2 and 4 AM.
4. He misses breakfast and lunch. After his late afternoon meal, he watched movies.
5. The claimant showered daily. The claimant said he helped his mother with chores now and then. He sometimes went to the shop with her and might help her with shopping.
6. The claimant was not actively involved in a school social network.
7. He no longer has contact with friends outside his extended family. A mutual friend connected him with his girlfriend using Snapchat. She visits but he does not visit her house.
8. The claimant said that he sometimes played with his sister and brother. When he visited his father, they might walk together or go fishing. Ms Munro took her son to visit his father.
9. Ms Munro said there was a large extended family on both sides, with her grandparents having 12 children and currently 13 grandchildren.
10. The family would get together to go fishing, and her son would go with them but did not talk to them much.
11. Ms Munro said her son had a niece and nephew who really loved him. He liked to be around those little ones. He does not go out for meals or to movies.
12. Before the motor accident, he was keen on footy but has not played it since and was not involved with the Clontarf Foundation. He follows the South Sydney Rabbitohs rugby league team because his cousin, Tyrone (Ty Ty) Munro, plays for the team. In 2023, Tom wrote that his cousin was his favourite person.
13. The claimant and his mother said he was anxious as a car passenger and had problems practising driving on his Learners licence to qualify to take his driving test.
14. Soon after he began the relationship with his girlfriend, he went with her by train to visit her sister in Newcastle. However, within two days of arriving in Newcastle, he was anxious and asked his mother to come and take him home, which she did.
15. The claimant has a 240cc motorbike. Since the 21 March 2021 MVA, he has ridden the bike three or four times, usually with his aunt in a paddock outside Moree during extended family outings.
16. He is not a reader but can watch an entire movie if interested. He connected with his girlfriend on Snapchat but no longer uses the app. He plays motorbike games on his phone and PlayStation. He does not play multiplayer games.
17. The claimant has some problems in completing tasks.
18. The claimant works on tasks at an average pace.
19. Scholastic attendance has deteriorated since the 1 March 2021 MVA. According to his mother, he has not attended school since 2023.

1. The history obtained was reliable and consistent with the psychiatric mental status examination.
2. The Review Panel has reviewed the documentation referred by the Personal Injury Commission and found inconsistencies in the reports provided when compared with the history and examination obtained from the claimant and his mother on 10 February 2025. His mother did not agree that her son was suspended from school for aggressive behaviour before the MVA.

V43.6 Car passenger injured in a collision with a car

DSM-5-TR Diagnostic Criteria for Posttraumatic Stress Disorder

A. The claimant was exposed to threatened death in the following way:

• Directly experiencing a traumatic event (the 1 March 2021 motor accident) with a significant fear response.

1. Presence of the following intrusion symptoms associated with the traumatic event, beginning after the motor accident:
   • Recurrent memories of the motor accident.

1. Persistent avoidance of stimuli associated with the traumatic event, beginning after the motor accident, evidenced by:
   • Avoidance of or efforts to avoid external reminders by avoiding talk about the motor accident, including leaving the medical assessor assessment interview early.

1. Negative alterations in cognitions and mood associated with the traumatic event, beginning or worsening after the motor accident, evidenced by the following:
   • Persistent negative emotional state with persistent fear.
   • Markedly diminished interest or participation in significant activities such as league football.
2. Marked alterations in arousal and reactivity associated with the motor accident, beginning or worsening after the motor accident, evidenced by the following:
   • Hypervigilance.
   • Sleep disturbance.
3. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
4. The disturbance causes clinically significant distress or impairment in social and academic functioning.
5. The disturbance is not attributable to the physiological effects of a substance or another medical condition.

1. The claimant's mother did not describe significant developmental delay and said his learning disability was related to dyslexia rather than intellectual disability.
2. Testing undertaken prior to the accident suggests some intellectual difficulties.
3. He had been bullied in primary school but did not have a significant problem with attendance.
4. She did not believe he had mental health issues before the 1 March 2021 motor accident.
5. The Panel notes the behavioural issues that pre-date the motor accident, evidenced by suspensions from school.
6. The claimant's description of his mental state at the accident was one of being scared and he and his mother described his fleeing the site of the accident because of his fear.
7. The claimant, his mother and his siblings lived with maternal grandparents for three months after the accident because his mother could not care for herself and her children.
8. The claimant developed anxieties about cars and avoided groups other than his extended family. He stopped playing rugby league. He could attend extended family functions including fishing with his family but avoided other group interactions.
9. His mother said that he had ridden his motorbike no more than four times since the accident and only with the extended family.
10. He developed initial insomnia and now has symptoms similar to a circadian rhythm sleep disorder with a non-24-hour sleep-wake cycle.
11. He spends most of his time at home. He has difficulty travelling by car and is not progressing in learning to drive.
12. He travelled by train to Newcastle with his girlfriend, but within two days, he asked his mother to take him back to Moree.
13. With his intellectual disability, his description of his trauma symptoms was minimal, but his account reached criterion for a diagnosis of post-traumatic stress disorder caused by the 1 March 2021 motor accident. The claimant has a documented history of behavioural issues, however, the description of difficulties and symptoms experienced post-accident are consistent with the motor accident, and it is accepted that the psychological symptoms arose from the injuries sustained in the motor accident.
14. The insurer submitted that Medical Assessor Rikard-Bell had failed to provide satisfactory reasons for how the claimant would meet criteria for the diagnosis of

post-traumatic stress disorder. Because the claimant has an intellectual disability he has difficulty explaining and reporting symptoms. This also accounts for the lack of complaint within the general practitioner records, with the consultations largely centred on ongoing concerns of a respiratory nature. The Panel noted that on this occasion the claimant and his mother provided a history of symptoms that satisfied diagnostic criteria for post-traumatic stress disorder with recurrent memories of the accident, avoidant behaviours, persistent anxiety and heightened arousal, and was accepted by the Medical Assessors as consistent when applying their clinical judgment.

1. The Review Panel found the accident WAS the cause of the following claimed psychiatric injury:
   • Post-traumatic Stress Disorder

1. The Review Panel determined that the claimant has a diagnosis of post-traumatic stress disorder arising from the injuries sustained in the motor accident.
2. Post-traumatic Stress Disorder is not an Acute Stress Disorder or an Adjustment Disorder, and is therefore not a threshold injury.
3. The certificate of Medical Assessor Rikard-Bell is therefore confirmed.