1. The Medical Assessor determined that the motor accident caused a specific phobia of driving and an adjustment disorder with mixed anxiety and depressed mood.
2. The Medical Assessor concluded that the motor accident caused significant functional restrictions in travel, social and recreational activities and adaptation. The assessment for adaptation included a comment by the claimant that he was unable to work "because of fear and pain".

1. The parties provided separate bundle of documents for the Panel's consideration.

1. The ambulance records following the 2014 motor vehicle accident noted an initial GCS score of three improving to 12 over a period of 10 minutes.[8] The hospital records noted a GCS score of 13 on arrival which improved to 15 over time.[9]
2. Dr Hampshire, psychiatrist was qualified by the claimant's lawyers and provided a report dated 30 April 2015.[10] The doctor diagnosed post-traumatic stress disorder caused by the motor accident and assessed whole person impairment due to the psychological injury at 26%.
3. In an assessment dated 5 October 2015 Medical Assessor Cameron noted the 2014 motor accident caused mild traumatic brain injury with soft tissue injuries to the spine and left shoulder. The Medical Assessor noted inconsistent presentation with pain preventing him from moving multiple body parts. An assessment was made of 1% impairment due to the soft tissue injury to the left shoulder.
4. Medical Assessor Synnott provided a certificate dated 12 May 2016 when he diagnosed post-traumatic stress disorder and an adjustment disorder with anxiety and depressed mood and assessed impairment at 8%.[11]
5. A Review Panel issued a medical assessment certificate dated 10 October 2016 assessing 22% whole person impairment.[12] It is sufficient to quote the reasons of the Panel on adaptation to note the serious nature of the psychological symptoms at that time. The Panel stated:

"The Panel considered that overall Mr Tariq would not be able to work or study but part of this impairment arose from his physical injuries. Focusing only on his psychiatric injuries, the Panel considered that the combination of loss of interest and drive, loss of self-esteem and confidence, difficulties with travel and interacting with people as well as concentrating would cause severe impairment of his functioning in this area."

1. In December 2016, Dr Abu-Arab, clinical psychologist, noted the July 2014 motor accident with consultations commencing in January 2015. The doctor diagnosed chronic post-traumatic stress disorder with a secondary diagnosis of major depression and recommended further psychological consultations.
2. Dr Abu-Arab assessed whole person impairment of the psychological injury at 19% as a result of the 2014 motor accident.[13]
3. The claimant provided a statement dated 3 February 2017 for the purposes of his damages assessment for the 2014 motor accident. In that statement the claimant referred to loss of concentration, difficulty recalling information, easily distracted, emotional difficulties, being abusive and rude, negative thoughts, isolation, or loss of motivation and depression.[14]
4. In May 2017, Dr Herald, orthopaedic surgeon, noted left knee chronic meniscal tear, left shoulder bursitis and a chronic pain syndrome and opined that the symptoms were predominantly related to the chronic pain. [15]
5. In a report dated 17 July 2017 Dr Herald noted that the claimant was walking with a stick in the May 2017 consultation, was unable to walk and recommended a multidisciplinary approach under the management of a pain specialist.[16]
6. Assessor Stoten provided reason in September 2017 assessing the damages from the 2014 accident at $399,083.90. The damages included an award of $200,000 for future loss of earnings.[17] The Assessor declined to accept the claimant's evidence as reliable unless it was otherwise corroborated.

1. The ambulance records refer to the motor accident noting the driver of a cab turning left onto Parramatta Road when the vehicle was T-boned on the right-hand side of the vehicle.[18]
2. The claimant was discharged from hospital on 24 July 2019. The history noted that the claimant lost consciousness, woke up in hospital and was amnesic to events and complained of neck, chest and left shoulder pain.[19]
3. A certificate of capacity dated 15 August 2019 noted various physical injuries and an acute stress disorder.[20] A report from Dr Lim dated 15 August 2019 noted various symptomatology including flashbacks, anxious to drive, memory loss, and impaired concentration.[21]
4. The claim form dated 22 August 2019 noted the motor accident as causing various physical injuries. There was no reference to any psychological condition at that time.[22]
5. On 30 August 2019 the general practitioner (GP) referred the claimant for psychological treatment with a diagnosis of post-traumatic stress disorder.[23]
6. There are multiple certificates of capacity provided by the GP noting the recovery of injuries from the 2014 motor accident and certifying various physical injuries and post-traumatic stress disorder caused by the motor accident.[24]
7. In a report dated 3 December 2019, Dr George, consultant psychiatrist, noted complaints including nightmares, flashbacks light sensitivity and arousal.[25] The doctor diagnosed post-traumatic stress disorder and chronic pain disorder.
8. On 10 March 2020 Dr George noted recent escalation in deliberate self-harm as a result of worsening distress with superficial wrist injuries.[26]
9. On 20 April 2021 the claimant declared to the Department of Immigration and Border Protection that there were no physical or mental conditions which prevented him from attending a mainstream school, gainful employment or living independently now or in the future.[27]

1. Dr George, psychiatrist was qualified by the insurer and provided a report dated

29 June 2021.[28] The doctor diagnosed the claimant with a chronic adjustment disorder with mixed anxiety and depressed mood of variable degree, incorporating elements of chronic post-traumatic stress disorder. 2. Dr George was concerned over the claimant presentation and suggested psychometric evaluation to assess the validity of the claimant's presentation. 3. Ms Carmody, psychologist, was qualified by the insurer and undertook psychometric evaluation of the claimant. In a report dated 4 November 2021 psychologist concluded that the claimant was malingering based on his reported symptoms on 24 of the 25 scales. The psychologist concluded that the claimant was:

(a) endorsing fictitious symptoms;

(b) endorsing symptoms that are inconsistent with a genuine psychiatric patient;

(c) endorsing exaggerated symptoms;

(d) endorsing unusual somatic complaints that are unlikely in genuinely mental ill patients, and

(e) endorsing unusual memory and cognition complaints are not accountable even by person sustaining a brain injury.

1. Dr George provided a supplementary report dated 2 December 2021 commenting on the psychometric evaluation undertaken by Ms Carmody.[29] Dr St George stated:

"Based on the comprehensive report of Ms Erin Carmody (psychologist) of "Need A Psych", I do not believe that any clinical diagnosis can be made of Mr Tariq's presentation at all. According to Ms Carmody's reports, Mr Tariq failed 24/25 tests of malingering. She provided totally compelling evidence, indicating that Mr Tariq does not appear to have a valid claim, based on her conclusions.

1. Dr Frank Chow was qualified by the claimant and provided a report dated 17 March 2023.[30] The doctor noted the previous motor vehicle accident in 2014 when the claimant sustained psychological and physical injuries. The doctor obtained a history that by 2017 the claimant had fully recovered, was able to return to study and engage in hobbies and workers part-time taxi driver.
2. Dr Chow diagnosed a persistent depressive disorder caused by the motor accident and had been unable to return to taxi driving due to pain and anxiety. The doctor assessed moderate impairments (Class 3) for Self-care, Social and recreational activities and adaptation and assessed whole person impairment at 15%.
3. Dr Andrew Keller, occupational physician, was qualified by the insurer and provided a report dated 12 April 2023.[31] The doctor noted ongoing complaints of pain in the shoulders and spine and opined that any physical injuries caused by the accident would have resolved in 2019.
4. Dr Inglis Synott, psychiatrist, was qualified by the insurer and provided a report dated

7 July 2023.[32] The doctor noted complaints of pain in the lower back, right knee and right shoulder as well as intermittent pain in the left knee, left shoulder, neck and pain between the shoulder blades. 5. Dr Synott noted psychiatric symptoms which included feeling scared, anxious, hungry, depressed, anxious and worried because nothing is getting better. The doctor noted the claimant had completed a degree in accounting and had applied for at least 200 jobs but had been unsuccessful. 6. Dr Synott noted that the claimant described sufficient psychiatric symptoms to meet the diagnostic criteria of a post-traumatic stress disorder with the symptoms of anxiety and depression subsumed into the broader diagnosis. 7. Dr Synott noted the opinion of Ms Carmody and commented unless there was a challenge to that report, he had no confidence in offering an opinion on psychiatric matters relating to the motor accident including diagnosis and determining impairment.

1. Medical Assessor Lim issued a medical assessment certificate dated 9 February 2022 when he assessed an adjustment disorder caused by the motor accident.[33] A history was noted that the claimant commenced a degree in accounting in 2018 which he completed in 2020.[34]
2. The Medical Assessor noted the claimant presented with clinically significant mood and anxiety symptoms which are perpetuated by the ongoing pain that the claimant reported experiencing and the associated restrictions this had to his functioning.
3. Medical Assessor Assem issued a medical assessment certificate dated 6 December 2022 when he assessed injuries to the thoracic spine, lumbar spine and right shoulder which were minor injuries for the purposes of the MAI Act.[35] The Medical Assessor found that the claimant suffered a tear to the posterior horn of the medial meniscus which was not a minor injury for the purposes of the MAI Act.
4. Medical Assessor Assem noted ongoing complaints of pain in the upper and lower back radiating to the posterior aspect of both thighs and pain in the inner aspect of the right knee.
5. Medical Assessor Fitzsimons issued a medical assessment certificate dated

11 February 2024 with a diagnosis of a possible head injury with possible brief unconsciousness. The Medical Assessor noted that the initial low GCS score recorded by ambulance at the scene was apparently due to behavioural and cooperation problems as the score rapidly rose with no significant concern about the claimant's head injury at the hospital as he was discharged rapidly.[36] 6. Medical Assessor Berry issued a medical assessment certificate dated 22 February 2024 when he assessed soft tissue injuries to the cervical spine, lumbar spine, right shoulder and right knee caused by the motor accident.[37] The Medical Assessor assessed whole person impairment of the physical injuries at 7%.

Claimant's submissions dated 26 April 2024[38]

1. These submissions opposed review of the medical assessment certificate on the basis that the insurer had not discharged the statutory onus in relation to the identification of error.
2. The claimant noted that the assessments of Medical Assessors Assem, Berry and Mason showed significant physical and psychological injuries caused by the motor accident and the use of the word "alleges" by the insurer was misleading and inflammatory.
3. The claimant submitted that the Medical Assessor referred to the material presented by both parties, obtained an appropriate pre- and post-accident history from the claimant, undertook a thorough assessment, referred the claimant to consistent reports and specifically referenced the DSM-V criteria for the psychological diagnoses.
4. The claimant referred to cl 6.31 of the Guidelines and noted the evidentiary onus in establishing the existence of objectively demonstrable pre-existing symptomatic impairment.
5. The claimant noted that the insurer has tried to tar the claimant as being a malingerer in accordance with the questionable findings of its own medico-legal expert. He submitted that there is no evidence or persuasive arguments showing error in the medical assessment certificate.

Insurer's submission dated 1 September 2023[39]

1. The insurer noted that the claimant alleged a number of physical injuries and a psychiatric condition.
2. The insurer referred to the relevant pre-accident history of physical and psychological injuries arising from a motor accident on 28 July 2014. The insurer noted that this is a serious motor vehicle accident with an initial GCS of 3/15 which gradually improved to 12/15.
3. The claimant was assessed by Dr Hampshire psychiatrist in April 2015 who diagnosed post-traumatic stress disorder and assessed impairment at 26%. In May 2016 Medical Assessor Synott diagnosed the claimant with post-traumatic stress disorder and assessed an impairment of 8%.
4. In October 2015 Medical Assessor Cameron noted inconsistencies in the claimant's demonstrated range of motion in the left shoulder, the lumbar spine as well as limited voluntary movement in the left knee.
5. In October 2016 a review panel noted poor concentration, dizziness, vertigo and increasing anxiety, a loss of relationship, thoughts of suicide and the cutting of wrists on two occasions and assessed whole person impairment at 22%.
6. Section 85A particulars dated 25 October 2016 noted ongoing pain limitation in the neck and back and ongoing psychological and psychiatric symptoms.
7. Dr Abu-Arab, treating psychologist, provided a report dated 12 December 2016 wherein he noted ongoing bad dreams, difficulty sleeping, usable walking stick, worsening memory and concentration, anxiety and cessation of driving. A diagnosis was made of post-traumatic stress disorder.
8. In September 2017 Assessor Stoten assessed damages to the claimant slightly under $400,000 with observations about the claimant's credibility.
9. The insurer noted that the claimant departed Australia on 12 March 2020 and returned on

2 March 2022. 10. The insurer submitted that the claimant has a detailed history of psychological diagnosis and complaints following the 2014 motor accident. There was no complaint of psychological symptoms in the application for personal injury benefits form dated 22 August 2019. 11. A history obtained by Dr George in December 2019 noted recovery of the pre-existing psychological condition in late 2016 which was inconsistent with the assessment in late 2017. 12. The insurer referred to the records from the Department of home affairs which confirmed the claimant underwent a medical examination on 3 April 2020 and reported no mental, cognitive or intellectual injuries and denied a history of psychological psychiatric disorder. That history is inconsistent with the pre-accident records. 13. The insurer referred to the claimant's responses to a home affairs medical assessment concerning the absence of physical or mental conditions affecting full employment or living independently. 14. It was noted that the same responses were provided at a later medical examination on

19 April 2021. 15. Dr George provided a report dated 29 June 2021 when he queried the claimant's assertion that he recovered from the pre-existing post-traumatic stress disorder symptoms and considered there were questions over the claimant's presentation. Dr George recommended psychometric testing but otherwise diagnosed a chronic adjustment disorder as a result the motor accident. 16. Ms Erin Carmody, clinical psychologist provided a report dated 4 November 2021 when she noted:

(a) the claimant's report symptoms were substantially worse than those usually found in people suffering from an adjustment disorder;

(b) the impact of the claimant's findings is that the profile was absurdly elevated and not medical possible with the reported symptoms inconsistent with its claimant statements during interviews, and

(c) the claimant's profile was similar to the average findings on patients with malingering profiles and considered the correct diagnosis was malingering.

1. Dr George provided a further report dated 2 December 2021 when he noted the report of Ms Carmody and opined that he could not make any clinical diagnosis.
2. Medical Assessor Lim issued a certificate dated 9 February 2022 when the claimant was residing in Pakistan and confirmed that he completed his accounting degree after the subject accident. The Medical Assessor noted the claimant confirmed that he lives alone and manages his activities of daily living apart from restrictions associated with the physical pain. A diagnosis was made of an adjustment disorder and noted that the claimant appeared to significantly underplay the severity of the psychological symptoms that emerged following the 2014 motor accident.
3. Dr Inglis Synnott, psychiatrist, provided a report dated 7 July 2023 when he noted the report of Ms Carmody and opined that he had no confidence in offering an opinion on psychiatric matters relating to the subject motor accident.

Insurer's submissions dated 2 April 2024[40]

1. These submissions sought leave to review the medical assessment.
2. The insurer referred to cl 6.213 of the guidelines and submitted that the Medical Assessor failed to properly set out the diagnostic criteria for the psychological diagnoses.
3. The insurer otherwise referred to the inconsistencies in the certificate concerning the comment that the mental state examination showed no evidence of any psychiatric condition and the claimant's ability to travel to and from Pakistan on a number of occasions in the post-accident period.
4. The insurer noted internal inconsistencies and erroneous use of the psychiatric impairment rating scale (PIRS). The insurer noted the following with respect to the PIRS scales:

The observation by the Medical Assessor that the claimant had recently underwent a haircut and how the self reporting of only showering once per week was related to the accident.

The insurer referenced the opinion of Dr George and Ms Carmody with respect to the concerns about malingering but accepted the claimant's self-reporting that he "does not go out".

The insurer submitted that the reasons appear to be inconsistent with the claimant's reported travel by buses and trains and as a passenger in a taxi and the international travel in the post-accident period.

The insurer noted that the medical assessor referred to pain when assessing this aspect which was inconsistent with cl 6.215 of the Guidelines.

1. The insurer submitted that the Medical Assessor failed to have due regard to the claimant's pre and post-accident medical history considering the review panel certificate dated

6 October 2016 which assessed 22% whole person impairment as a result of the 2014 accident. 2. The insurer submitted that there were inconsistencies by the Medical Assessor in expressing agreement with the remarks of Dr George and Ms Carmody of the suspected or diagnosed malingering without further comment as to why the Medical Assessor elected to accept the claimant's self-reporting. 3. The insurer otherwise noted inconsistencies with respect to the claimant's travel to Pakistan and the observation by the Medical Assessor, that he did not consider there was evidence of a psychological condition on mental state examination but elected to make a diagnosis.

1. The Panel determined that the claimant be re-examined by both Medical Assessors. The examination report is as follows.

The claimant is a 31-year-old divorced man who prior to the accident was working as a carpet contractor and cab driver.

He admitted to a previous motor vehicle accident in 2014. He was passenger in a car driven by a friend. He injured his left knee and had hit his head on the pillar of the car. He also injured his back. He had physiotherapy and medication. He also saw a psychologist - he could not recall how long. He had an incident when he had cut his wrist with a kitchen knife on 2 occasions - he had wanted to die. He was off work - he could not remember how long saying, 'It's been almost 8 or 9 years' since that time. The Panel noted documentation indicating diagnoses of posttraumatic stress disorder and major depressive disorder for which he had attracted a whole person impairment for psychological injury of 22% after being assessed by a Review Panel in October 2016 with finalisation of his claim in September 2017. It also noted the flagging of issues pertaining to consistency of presentation in relation to that claim.

The Claimant does not remember how long he had struggled after the first accident but seems to have started his diploma in management in 2017 and got back to work around the end of 2017 or the start of 2018.

He continued as a student doing an online diploma in management.

He denied any other history of psychiatric illness. before his 2014 accident.

He had been otherwise medically well. He does not drink alcohol, does not smoke, or use drugs.

He denied any history of problems with the law. He had no other claims history.

He knew of no family history of psychiatric illness.

He hails from a town close to Islamabad in Pakistan. He has an older brother, a younger sister, and a younger brother. His father was a government employee working as a construction builder. His mother also worked in a technical design department for the government. Both have retired from their government jobs, but his father still runs a construction business.

He described a happy childhood. He completed year 10 and then completed an associate diploma in chemical engineering in 2011 followed by some short courses and did some unpaid work in fashion modelling but otherwise did not work in Pakistan

He had come to Australia in 2014. He said he had an uncle who lived in Canada "and there was a trend to go overseas" and he decided to come to Australia.

He married in February 2015 'but things were not good - I told her about my condition - we had a lot of issues and eventually we got separated'. It seems they were together for '10 months max'. He has not had any relationships since then.

He worked a mix of contract carpeting, driving cabs, and studying before the second accident saying he felt well, looked after himself, went out socially, and the like.

On the day in question (24 July 2019), he was driving towards Parramatta and had come to an intersection. He had stopped to turn left, and a car came from the right and T-boned him. He said he could not recall everything as it had been six years since the accident. He thinks that airbags deployed. He said police and Fire Brigade attended and had to cut the car to get him out and he does not recall just how they did it. An ambulance took him to Westmead Hospital.

He discharged himself the next day and had some scans. He wanted to go home saying he was 'not comfortable there" saying, "I had a bad experience - I needed to pee - I asked a nurse for a bottle - she took 45 minutes - I got aggressive - I didn't stay'.

The Panel noted in this context his behaviour as reported by the ambulance crew who attended on him consistent with significant distress and/or agitation.

He was in pain for a few days and saw his GP who referred him to another doctor,

Dr Lim, in Parramatta because his GP said he did not do CTP work.

He 'had pain in my whole body... the impact was very hard... the way I was hit was huge... I had pain in my whole body... I had more pain on my right side... in the start it was both shoulders, both knees - my neck'.

The Panel asked about the psychological side of things. He said, 'It was scary - after I was not going out anywhere - the ambulance sirens... that was like recalling my accident time - I was living very close to Parramatta Road in Auburn - every time I heard the sirens, I recalled what was happening to me - sometimes [when] I'm sleeping, I had dreams... of the accident... like it could be much worse - you never know - I could have died...'.

He had physiotherapy, psychological sessions (he could not remember whom he saw), and medication. He had been on gabapentin, Valdoxan, and melatonin. He is not on any medication 'because the insurance is not paying Dr Lim and the other doctors don't prescribe those medicines... they stopped in 2022'. He thinks he improved with treatment and declined since stopping it. While he does have health insurance, it apparently does not cover accidents.

He did see a psychiatrist - Dr St George - at the same place that's he saw Dr Lim.

The Panel asked him how he was faring now. He admitted to some improvements in his neck pain and right shoulder. His left knee had in the past improved but was again a problem. He still had headaches. He spoke of improvements in a range of physical issues.

He is not sleeping well but could not articulate what woke him. He said, "I have too much [sic] dreams but when I wake up, I don't remember anything". He knows he has been dreaming 'because my brain is very active and I have headaches'.

He sometimes feels 'like I think it was a dream but mostly I don't remember'.

He still recalls the accident saying, 'It's a bad memory... the pain and suffering I could avoided but I can't do much about it'.

He is puzzled 'Why my sleep is disturbed - why my social life is gone - why I get aggressive with small things... I get stress and panic, and my left leg starts shaking without my control...'.

His mood is 'alright' but small things trigger me. He admitted to an incident in 2019 when he had cut his wrist with a kitchen knife - he was feeling angry rather than suicidal.

His motivation is low, but he says he cannot keep on like this.

There have been no subsequent accidents or injuries.

The Panel noted numerous issues relating to consistency in the documentation many of which had been flagged by Assessor Mason and attempted to engage the claimant in relation to these. For example, he said that he disclosed his accident and his medication when he reapplied for his visa to re-enter Australia. He does not know why there had been no mention of this by the Department of Home Affairs in his visa application which was for a 485 visa which gave him full working rights. He had applied for a 485 visa which gave him full working rights while noting that he is now on a student visa. He reiterated his contention that he had made a full recovery from his earlier accident. In relation to his ability to complete his Bachelor of Business course, the Panel noted this contention that that the time of the accident he had had largely completed his course by the time of his accident and then completed his studies online overseas. The Panel also noted the seemingly remarkable recovery from his earlier psychological injury in which he had attained a whole person impairment of 22% in 2016 but was unable to obtain further information on this score. It noted that consistency issues had emerged in relation to that event. That said, the claimant was difficult to engage in relation to the question of consistency making assessment of this aspect of his presentation difficult. His propensity to deliver noninformative answers added to the difficulty of interrogating all areas relating to this issue. The Panel considered that a further interview would be unlikely to resolve this.

The claimant was interviewed by Microsoft Teams. He was on his own at his home in Punchbowl. Assessors Canaris and Singh were in their respective offices. A good audiovisual connection was established. His head and shoulders were visible. He presented as a dark-complexioned man with a beard who looked well-groomed. He provided the history documented above. He was a difficult historian in that he often gave noninformative answers and his responses had an evasive quality. That's said, the Panel noted his capacity to focus over the course of the interview and in particular to keep track of answers he had previously given with responses of the lines of, 'Like I said before...'. His demeanour was depleted, and he emanated an air of resignation. There was no evidence of psychosis or cognitive impairment.

He tried to get back to driving cabs and in an accounting job 'but my focus was not good'. He applied for a few jobs in 2022 and 2023 and went through a few screening interviews but did not get accepted after he disclosed his problems. He worked only 3 or 4 days for a friend who was an accountant. He says he has not been accepted for work because of disclosing his history of injury although he would 'love to give it a try'. He was 'not sure' whether he would face any obstacles if he did find work. He supports himself now with help from his father - he is not on Centrelink as he is not eligible. He says he is looking for work - he would like office-based work as driving a cab would be difficult. He started a 2-year diploma course which is online a few months ago. He has not completed any assignments so far. He did go through a few lectures last week but 'after that I didn't touch anything'. He found it 'definitely hard' saying, 'I was going through the lectures and like I said my focus is not very good and I lose concentration'. He would have put in 20 to 25 minutes at a time and thinks he may have completed 2 lectures each lasting 30 or 40 minutes. The Panel considered that he would be unlikely to return to full-time work over the near future.

He spends his day 'mostly in my room' - he now has a roommate. He is not on the lease. His father pays the expenses. He lives in a 2-bedroom apartment with 3 people. He would 'mostly spend time on my mobile phone watching YouTube. He does not read or watch TV. His concentration is "OK - if I'm watching something - I can go 10 - 15 minutes - can't focus much - reading is not very good... if I'm reading, I start getting headaches...'. When he watches TV, he finds he would 'lose interest'. He can remember much of what he watches 'but I forget the names'. The Panel noted that he embarked on his Bachelor of Business degree but had largely completed this at the time of his accident and deferred this after his second accident online completing his course online in 2020 while overseas. This appeared a somewhat more plausible explanation then what he had provided to Assessor Mason. The Panel also noted his capacity to maintain focus over the course of the interview keeping track of previous responses.

He would go out 'sometimes later at nighttime' for a walk around the block which he would do 2 or 3 times a week and sometimes more. He would sometimes walk to a nearby park. He has not been out socially with anyone 'for a long time' which might have been last year for an Eid celebration. He goes to mosque sometimes but has not been '4 or 5 months'. He says he has 'lost the interest' in going out. He has friends visit 'but everyone is so busy - the guy I live with is a good friend - I used to know his family in Pakistan - other friends might visit once in a while'. He enjoys such visits. He does not have any hobbies.

He does not have a car. The Panel asked if he still drove. He said, 'I think I can but last time I tried it was hard for me... I felt like I was losing control of the car... the traffic around me wasn't good... it was back in 2023'. This had been while driving a cab. He said his physical condition contributed to his difficulties because he had pain. If he is a passenger, he would sit in the back 'but it's not comfortable' because of 'both' physical and psychological issues 'and it's in my head that I'll get hit by a car'. He can manage journeys on public transport but prefers trains saying he is not comfortable on buses because he is anxious. He can walk to the station and is comfortable on trains and last made a trip to Bankstown. The Panel asked him about his journey to Pakistan. He found the flight physically uncomfortable, and he then found himself stuck because of Covid getting back in March 2022. He did not do much in Pakistan because of lockdown. He did not drive while in Pakistan saying the traffic there is much worse than here.

He tries to do his laundry which he might do once a fortnight. He does not do any cooking ('I used to be a good cook... it's been a very long time'). He said he had 'lost interest'. At his home, his other friend does the cooking, and a cleaner comes once a week as his housemates both work. He would shower or change his clothes 'sometimes once a week - sometimes once a fortnight'. He would eat 'like max once a day' and 'not like before... I feel like I want to eat but then I feel full - if it's left over, I don't throw it away'. He thinks his weight has been constant. He recalled a time when he had not been eating for 2-3 days at a time, but this has improved. Most of the grocery shopping is done by his friends but he sometimes will go to the local Woolworths in the evening which is close by. The Panel noted that he looked well right nourished and reasonably groomed.

He was divorced before the accident and did not have a partner at the time of the accident. His circle of friends has lessened since his accident. However, he still has friends in Australia of whom 'one is living with me and 2 other friends'. He gets on reasonably with them. He talks with his mother once a week - he gets on well with her. He also talks to his dad when he contacts his mother.

The Panel considered a range of diagnoses including posttraumatic stress disorder, persistent depressive disorder (dysthymia) with anxious distress, adjustment disorder, and specific phobia (driving) while noting also significant disagreement among clinicians both as to diagnosis and presentation on mental state examination. Nevertheless, it concluded on balance that there was sufficient evidence on current mental state examination of a significant psychiatric illness. It determined that a diagnosis of persistent depressive disorder (dysthymia) with anxious distress best described his current presentation.

In terms of DSM-5-TR criteria, the Panel noted the presence of depressed mood for most of the day for more days than not over several years preceding (Criterion A) with evidence of poor appetite, insomnia, low energy, and loss of concentration (Criterion B) which have never been absent for any significant period (Criterion C). He may at times have satisfied criterion for a major depressive disorder although this is not essential to the diagnosis (Criterion D). There was no evidence of a manic, hypomanic, or cyclothymic presentation (Criterion E) or evidence of schizophrenia, schizoaffective disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum or other psychotic disorder (Criterion G). His symptoms were not attributable to the physiological effects of a substance or to another medical condition (Criterion G) and cause him clinically significant distress and psychosocial impairment including some loss of self-care, impairment with work, social and recreational activities, and concentration, persistence, and pace (Criterion H).

The Panel considered that the anxious distress specifier captured posttraumatic symptoms including his anxiety in cars. It did not consider that his reported anxiety in cars had the intensity to warrant a specific phobia diagnosis bearing in mind that Criterion C of the diagnosis requires that the phobic object or situation 'is actively avoided or endured with intense fear or anxiety'. While it was true that the claimant avoided being in cars, he was able to be a passenger and had in fact attempted to return to work as a taxi driver. While he reported that he found this difficult because of anxiety, he also found it difficult because of pain indicating that his symptoms did not attain the requisite intensity threshold.

The claimant's persistent depressive disorder came on in the aftermath of a significant motor vehicle accident following which he contended with physical injuries including pain. He further provides symptoms specific to that event indicating that it had more likely than not contributed substantially (ie, in a more than trivial fashion) to its emergence.

Degree Of Permanent Impairment Psychiatric Impairment Rating Scale

The determination as to permanent impairment is made in accordance with the American Medical Association's Guides to the Evaluation of Permanent Impairment (Fourth Edition) and Part 6 of the Motor Accident Guidelines.

1. Persistent depressive disorder (dysthymia) with anxious distress

No current treatment but has in the past seen psychologists and psychiatrists and been on psychotropic medication.

He tries to do his laundry which he might do once a fortnight. He does not do any cooking ('I used to be a good cook... it's been a very long time'). He said he had 'lost interest'. At his home, his other friend does the cooking, and a cleaner comes once a week as his housemates both work. He would shower or change his clothes 'sometimes once a week - sometimes once a fortnight'. He would eat 'like max once a day' and 'not like before... I feel like I want to eat but then I feel full - if it's left over, I don't throw it away'. He thinks his weight has been constant. He recalled a time when he had not been eating for 2-3 days at a time, but this has improved. Most of the grocery shopping is done by his friends but he sometimes will go to the local Woolworths in the evening which is close by. The Panel noted that he looked well right nourished and reasonably groomed.

He would go out "sometimes later at nighttime" for a walk around the block which he would do 2 or 3 times a week and sometimes more. He would sometimes walk to a nearby park. He has not been out socially with anyone 'for a long time' which might have been last year for an Eid celebration. He goes to mosque sometimes but has not been '4 or 5 months'. He says he has "lost the interest" in going out. He has friends visit "but everyone is so busy - the guy I live with is a good friend - I used to know his family in Pakistan - other friends might visit once in a while". He enjoys such visits. He does not have any hobbies.

He does not have a car. The Panel asked if he still drove. He said, 'I think I can but last time I tried it was hard for me... I felt like I was losing control of the car... the traffic around me wasn't good... it was back in 2023'. This had been while driving a cab. He said his physical condition contributed to his difficulties because he had pain. If he is a passenger, he would sit in the back 'but it's not comfortable' because of 'both' physical and psychological issues 'and it's in my head that I'll get hit by a car'. He can manage journeys on public transport but prefers trains saying he is not comfortable on buses because he is anxious. He can walk to the station and is comfortable on trains and last made a trip to Bankstown. The Panel asked him about his journey to Pakistan. He found the flight physically uncomfortable, and he then found himself stuck because of Covid getting back in March 2022. He did not do much in Pakistan because of lockdown. He did not drive while in Pakistan saying the traffic there is much worse than here.

Comment: Notwithstanding his anxiety in relation to driving, he is able to make journeys for example walking to his local Woolworths and he is able to catch trains. The Panel noted that pain contributed to his difficulties driving which it excluded from its assessment of his functioning in this category.

He was divorced before the accident and did not have a partner at the time of the accident. His circle of friends has lessened since his accident. However, he still has friends in Australia of whom 'one is living with me and 2 other friends'. He gets on reasonably with them. He talks with his mother once a week - he gets on well with her. He also talks to his dad when he contacts his mother.

Comment: His fundamental relationships are intact.

He spends his day 'mostly in my room' - he now has a roommate. He is not on the lease. His father pays the expenses. He lives in a 2-bedroom apartment with 3 people. He would "mostly spend time on my mobile phone watching YouTube. He does not read or watch TV. His concentration is 'OK - if I'm watching something - I can go 10 - 15 minutes - can't focus much - reading is not very good... if I'm reading, I start getting headaches...'. When he watches TV, he finds he would 'lose interest'. He can remember much of what he watches 'but I forget the names'. The Panel noted that he embarked on his Bachelor of Business degree but had largely completed this at the time of his accident and deferred this after his second accident completing his course online in 2020 while overseas. This appeared a somewhat more plausible explanation then what he had provided to Assessor Mason. The Panel also noted his capacity to maintain focus over the course of the interview keeping track of previous responses.

He tried to get back to driving cabs and in an accounting job 'but my focus was not good'. He applied for a few jobs in 2022 and 2023 and went through a few screening interviews but did not get accepted after he disclosed his problems. He worked only 3 or 4 days for a friend who was an accountant. He says he has not been accepted for work because of disclosing his history of injury although he would 'love to give it a try'. He was 'not sure' whether he would face any obstacles if he did find work. He supports himself now with help from his father - he is not on Centrelink as he is not eligible. He says he is looking for work - he would like office-based work as driving a cab would be difficult. He started a 2-year diploma course which is online a few months ago. He has not completed any assignments so far. He did go through a few lectures last week but 'after that I didn't touch anything'. He found it 'definitely hard' saying, 'I was going through he lectures and like I said my focus is not very good and I lose concentration'. He would have put in 20 to 25 minutes at a time and thinks he may have completed 2 lectures each lasting 30 or 40 minutes. The Panel considered that he would be unlikely to return to full-time work over the near future

Psychiatric Impairment Rating Scale - Pre-existing/subsequent impairment

The Panel noted the diagnoses of posttraumatic stress disorder and major depressive disorder arising from his 2014 motor vehicle accident. It noted that the claimant had started his diploma of management in 2017 getting back to work in early 2018 which was quite soon after finalisation of his claim. The Panel nevertheless determined that it had no evidence to contradict his contention that he had made a complete functional recovery.

He had married after his first accident, but this relationship broke down in its aftermath before the subject accident.

Apportionment - pre-existing/subsequent impairment

His overall whole person impairment of 7% requires a deduction of 1% for pre-existing impairment.

He is not having treatment and so no adjustment for treatment effects applies.

Degree of permanent impairment caused by the motor accident

1. The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[41]
2. The Panel, comprised of two specialist medical practitioners, is not required to choose between competing medical opinions and is required to form its own opinion: Insurance Australia Group Ltd v Keen[42] and Insurance Australia Ltd v Marsh.[43]
3. The Panel adopts the detailed examination findings made by both Medical Assessors with the additional further short observations.
4. We are cognizant of the respondent's submission and supportive evidence that the claimant is malingering. The assessment of this issue was difficult given the way the claimant did not respond to the questions of the Medical Assessors. Whilst we have reservations regarding the claimant's credit including the significant and immediate recovery following the earlier motor accident when he recovered significant damages after he was assessed with a high level of permanent impairment, the response to the Immigration Department on re-entry to Australia and the opinion of Dr Carmody, we were not prepared to find that the applicant was intentional dishonest and malingering. The evidence relied upon by the Respondent has not convinced us to the appropriate threshold that the applicant was and is malingering. However, that is not to say that the Panel expresses reservations concerning the acceptance of the entirety of the claimant's account of the effect of his ongoing symptomatology.
5. Clauses 6.214 and 6.215 of the Guidelines note that the assessment of psychological injury does not include any allowance for "impairment due to physical injury" and "impairments due to somatoform disorders or pain".
6. The claimant's physical injuries and pain affect the assessments for the various PIRS categories. These have been expressly considered by the Medical Assessors and commented upon where appropriate.

1. The certificate issued by Medical Assessor Mason dated 6 March 2024 on the degree of permanent impairment is revoked. The new certificate is attached at the commencement of these Reasons.

[1] See Division 7.5 and Schedule 2 cl 2 of the MAI Act.

[24] Insurer's bundle, pp 565-722 and pp 860-910.

[40] Insurer's bundle, p 3.[41]