MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC); assessment of threshold injury; Medical Assessor (MA) diagnosed adjustment disorder caused by the accident (threshold injury); claimant's application for review under section 7.26; previous diagnoses of post-traumatic stress disorder considered; claimant examined by MA's of Review Panel; Held - diagnosis of adjustment disorder; psychological injury caused by accident; threshold injury; post-traumatic stress disorder considered and Review Panel not satisfied DSM-5-TR criterion have been met at any stage post-accident; MAC confirmed.

Issued under Division 7.5 of the Motor Accident Injuries Act 2017

The Review Panel confirms the certificate of Medical Assessor Surabhi Verma dated

1. On 18 May 2023, Boghos Teghlian (claimant) was a front seat passenger in a vehicle that was hit by a reversing truck (accident).
2. Mr Teghlian made a claim for statutory benefits under the Motor Accident Injuries Act 2017 (MAI Act) on Allianz Australia Insurance Limited (insurer).
3. A dispute has arisen between the insurer and Mr Teghlian as to whether his psychological injuries are "threshold injuries" within the meaning and for the purposes of the MAI Act.
4. Whether Mr Teghlian has suffered threshold injuries as a result of the accident affects his entitlement to both statutory benefits and damages: see ss 3.11, 3.28 and 4.4 of the MAI Act.
5. The dispute was referred to Medical Assessor Surabhi Verma. On 4 July 2024, Mr Teghlian was assessed by Medical Assessor Verma, who issued a certificate also dated 4 July 2024. The Medical Assessor concluded that the injury caused by the motor accident, being adjustment disorder with anxious mood, is a threshold injury for the purposes of the MAI Act
6. Mr Teghlian lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Verma's assessment under s 7.26 of the MAI Act. On 18 September 2024, a delegate of the President determined there was reasonable cause to suspect that the medical assessment was incorrect in a material respect, based on the delegate's opinion that the Medical Assessor had not provided a clear path of reasoning. Accordingly, the delegate referred the application to a review panel.
7. This Review Panel (the Panel) has been constituted to conduct a review of Medical Assessor Verma's certificate dated 4 July 2024.

1. A threshold injury is defined in s 1.6 of the MAI Act and includes a "soft tissue injury" or a "psychological or psychiatric injury that is not a recognised psychiatric illness".
2. Section 1.6(4) of the MAI Act provides that the regulations may exclude or include a specified injury from being a threshold injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) further defines threshold injury as follows:

"4 Meaning of 'threshold injury', section 1.6(4) of the Act

(2) Each of the following injuries is included as a threshold injury for the purposes of the Act -

Note - See section 1.6 (5) of the Act in relation to the making of Motor Accident Guidelines for or with respect to the assessment of whether an injury is a threshold injury.

(3) In this clause acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association in May 2013."

1. Sub-section 1.6(5) provides that "[t]he Motor Accident Guidelines may may provision for or with respect to the assessment of whether an injury is a threshold injury for the purposes of this Act".
2. The Motor Accident Guidelines (the Guidelines) are made pursuant to s 10.2 of the MAI Act. Version 10 of the Guidelines is effective from 15 September 2025.
3. Part 5 of the Guidelines sets out the procedure for assessing whether an injury caused by the accident is a threshold injury for the purposes of the MAI Act, and provides the following general provisions for assessment:

"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 must 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. Relevantly, cls 5.10 to 5.12 regard threshold psychological or psychiatric injury assessment and provide:

"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. Pursuant to Schedule 2, cl 2(e) of the MAI Act, whether the injury caused by the accident is a threshold injury for the purposes of the Act is a medical assessment matter. A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act, at first instance by a Medical Assessor,[1] and on review by a review panel.[2]
2. Section 7.26(5A) of the MAI Act provides that the 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 that is alleged to be incorrect and is to be by way of a new assessment of all matters with which the medical assessment is concerned: s 7.26(6) of the MAI Act. The function of the medical assessor is to form his or her own opinion on the medical question in dispute by applying their own medical experience and expertise; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[3]
4. Part 5 of the Personal Injury Commission Act 2020 (PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a panel reviewing a decision of a Medical Assessor: s 41(2) PIC Act. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5. A review panel determines how it conducts and determines the proceedings.

1. On 14 May 2025, the Panel was convened in this matter. On 15 May 2025, the Panel made directions for provision of a bundle of documents and written submissions from each of the parties for the purposes of the Review.
2. On 6 August 2025, the Panel met to discuss the proceedings and determined that a medical examination of Mr Teghlian was required. Mr Teghlian was advised of the arrangements. The Panel also determined that additional documents potentially relevant to the Review were required to be produced and made directions accordingly.
3. Following the medical examination, Senior Medical Assessor Mason and Medical Assessor Yates provided their examination report to the legal member of the Panel. The Panel then discussed the medical examination and determined its findings.

1. On 4 July 2024, Medical Assessor Verma examined Mr Teghlian and issued a certificate dated same. The threshold injury dispute to be assessed was noted by the Medical Assessor as "Threshold injury - psychological injury including but not limited to post-traumatic stress disorder". The Medical Assessor concluded that the motor accident caused an adjustment disorder with anxious mood which is a threshold injury for the purposes of the MAI Act.
2. In addition to her medical examination, the Medical Assessor considered the documentation before her, including a report of Dr Richa Rastogi dated 9 April 2024.
3. The Medical Assessor referred to the submissions of both parties, including Mr Teghlian's submission that his treating psychologist had diagnosed post-traumatic stress disorder, and the insurer's submission that it disputes Mr Teghlian satisfies the diagnostic criteria.
4. The Medical Assessor referred to the circumstances of the accident and his reports to his general practitioner (GP) shortly after the accident. This included Mr Teghlian reporting that he started experiencing "nightmares about the accident" and intrusive thoughts of the accident on a day-to-day basis. He outlined his other symptoms and his treatment from a psychologist.
5. The Medical Assessor respectfully disagreed with Mr Teghlian's previous diagnosis of post-traumatic stress disorder, as she did not believe his presentation is consistent with this diagnosis.
6. The Medical Assessor opined that Mr Teghlian met the DSM-5 criteria for adjustment disorder, being criteria A, B(1), C, D and E.
7. She opined that post-traumatic stress disorder was less likely as he did not sustain a significant injury, nor was he exposed to actual or threatened death or sexual violence. In support, Medical Assessor Verna referred to the certificates issued by Medical Assessor Adam Rapaport dated 4 April 2024 regarding Mr Teghlian's physical injuries caused by the accident, and Medical Assessor Michael Steiner dated 10 April 2024. Accordingly, Medical Assessor Verma held there was no evidence to substantiate criteria A for post-traumatic stress disorder.
8. Medical Assessor Verma also opined that Mr Teghlian had cross-cutting symptoms of post-traumatic stress disorder however does not have "clinically significant distress or impairment in social, occupational or other important areas of functioning". While there has been an impairment in his ability to work as long as he used to pre-accident, he attributed this to back pain. He also continues to be supported well by his family and socialises with them. She opined that Mr Teghlian did not satisfy criterion D for post-traumatic stress disorder.
9. The Medical Assessor opined that Mr Teghlian had an adjustment disorder with anxious mood caused by the accident. The Medical Assessor concluded that this diagnosis is consistent with the definition of threshold injury in s 1.6 of the MAI Act and Part 1, cl 4(2) of the Regulations.

1. Mr Teghlian's submissions dated 18 June 2025 and 7 August 2025 have been considered by the Panel.
2. Mr Teghlian submits that he suffers from a non-threshold psychiatric injury diagnosable under the DSM-5 criteria as a result of the accident.
3. Mr Teghlian's submissions describe the accident to have occurred while he was a passenger in a vehicle driven by his wife on 18 May 2023. They were driving down High Gate Street in Auburn at approximately 45 to 50 kmph when a truck, which was parked on the side of the road, began reversing. This caused both vehicles to collide. Emergency services, including police and paramedics, attended the scene, however Mr Teghlian was not transported to hospital.
4. Mr Teghlian subsequently attended a GP at Workers Doctors in Parramatta in June 2023.
5. Relevantly, Mr Teghlian submits he has sustained post-traumatic stress disorder as a result of the accident and says that he meets the criteria set out in the DSM-5.
6. Mr Teghlian submits that, following the accident, he commenced psychological treatment at Insightful Mind in Parramatta. In a report dated 13 November 2023, Mr Teghlian's treating psychologist, Carl Neilsen, diagnosed Mr Teghlian with post-traumatic stress disorder.
7. Mr Teghlian submits that, at an unspecified time, he commenced attending treatment with Diane Sibilant, psychologist, and has attended approximately ten sessions to date. He continues to consult her.
8. Mr Teghlian submits that he continues to take prescribed medication to treat his psychological condition, including fluoxetine and melatonin to assist with sleep.
9. Mr Teghlian also submits that he was examined by Dr Richa Rastogi on 9 April 2024, who diagnosed Mr Teghlian with post-traumatic stress disorder in recovery. Dr Rastogi opined that Mr Teghlian had "experienced PTSD and anxiety as a result of the accident", and that he continued to present with ongoing symptoms such as flashbacks, nightmares, startled responses, hypervigilance and arousal.
10. Mr Teghlian relies on his statement dated 18 June 2025 to support his submission that his injuries have continued to deteriorate.
11. Mr Teghlian submits that, while Dr Rastogi opined that his psychiatric injury was in remission at the time of her assessment, Mr Teghlian has continued to attend psychological treatment and remains reliant on psychiatric medication. He submits that he experiences ongoing symptoms which continue to develop and impede upon his daily living.
12. Mr Teghlian submits that the Panel should consider the previous diagnoses made by his treating doctors and any relevant medico-legal reports and determine the extent those diagnoses were accurate at the time they were made. Mr Teghlian refers to David v Allianz Australia Insurance Limited [2021] NSWPICMP 227 and Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6 to support his submission that it is accepted that a claimant can still be determined to have a non-threshold injury even where the claimant does not meet this criteria at the time of the assessment.
13. Mr Teghlian submits that his referral in July 2025 for psychiatric treatment shows the deterioration of his psychological condition, as he had only been referred for psychological treatment at the time of his assessment by Medical Assessor Verma.

1. The insurer relies on submissions dated 8 July 2025. The insurer submits that Medical Assessor Verma's certificate contains no errors, and that any psychological injury suffered by Mr Teghlian as a result of the accident is a "threshold injury" within the meaning of the MAI Act.
2. The insurer submits that Mr Teghlian does not meet the DSM-5 diagnostic criteria to support a diagnosis of post-traumatic stress disorder.
3. Relevantly, the insurer refers to the diagnosis of Carl Neilson, psychologist, dated 13 November 2023. It submits that Mr Teghlian does not satisfy criterion D of the DSM-5 criteria for post-traumatic stress disorder as Mr Neilson only referred to one alteration in his cognition and mood. As such, the insurer submits that this diagnosis is not valid.
4. The insurer also refers to the diagnosis by Dr Richa Rastogi, psychiatrist, dated 9 April 2024. The insurer submits that, with respect to criterion A, the subject accident did not pose any threat to Mr Teghlian's life. The insurer relies upon the certificates of Medical Assessors Rapaport and Stiener which found that only threshold physical injuries were caused. The insurer also submits, with respect to criterion D, that 'insomnia, irritability, difficulty with concentration, startled' is not sufficient to meet at least two of the requirements as required by the DSM-5. The insurer further submits that Dr Rastogi failed to expressly verify the presence of criterion E or refer to criterion H. For these reasons, the insurer submits that Dr Rastogi's diagnosis should be given little weight.
5. The insurer notes that no evidence has been presented from Diane Sibilant and her diagnosis is therefore unknown. It is also not clear the basis on which Mr Teghlian commenced treatment with her and submits it may be due to some other psychological stressor(s).
6. The insurer refers to the statement by Mr Teghlian that he is continuing to use psychotropic medications. The insurer submits that these medications are typically designed to be used for extended periods and, noting the accident occurred just two years ago, Mr Teghlian's continued use of such medication is not necessarily an indication of the status of his mental state.
7. The insurer submits the certificate of Medical Assessor Verma dated 4 July 2024 should be given substantial weight. The insurer refers to her conclusions as to why a diagnosis of post-traumatic stress disorder was not applicable.
8. The insurer submits that Medical Assessor Verma's speculation that Mr Teghlian's chronic pain, which he was experiencing before the accident and which was exacerbated after the accident, is a substantial contributing factor to his mental health. The insurer submits that this calls into question issues of causation.
9. The insurer submits that it is clear from the reasoning provided by Medical Assessor Verma that she was of the opinion that Mr Teghlian at no stage following the accident satisfied the DSM-5 criteria for post-traumatic stress disorder. Further, irrespective of any fluctuation or change in symptoms, the insurer says the fact that Medical Assessor Verma opined that there was no exposure to actual or threatened serious injury precludes a diagnosis of post-traumatic stress disorder under the DSM-5 at any time.
10. Likewise, the insurer submits there is no evidence within the certificate, or elsewhere, to suggest Mr Teghlian at any stage following the accident suffered from symptoms sufficient to satisfy criterion D of post-traumatic stress disorder or that there had been a change in the areas of function relevant to that criterion.
11. The insurer references cls 5.3 to 5.12 of the Guidelines and submits that a plain reading requires an assessment of the injured person's current condition, rather than whether he at any stage had a non-threshold injury.

1. On 18 June 2025, Mr Teghlian provided a bundle of documents being the material relied on by him for the purposes of the Review. A further bundle of documents was provided by Mr Teghlian on 7 August 2025.
2. On 8 July 2025, the insurer provided a bundle of documents being the documents the insurer sought to rely upon for the purposes of the Review which had not already been provided in Mr Teghlian's bundle.
3. The submissions in respect of the application before the delegate were considered by the Panel, along with all bundles of documents.
4. In conducting this Review, the Panel has sought to follow and implement the words of Justice Basten in Rahman v Insurance Australia Ltd (t/as NRMA Insurance) [2022] NSWSC 107, where his Honour recognised that there is no general law principle requiring an assessor to refer in reasons accompanying a certificate to all the documentation to which he or she has had access.
5. Accordingly, and in endeavouring to carry out its statutory function and promote the objects of the legislation under which it operates and guiding principles, the Panel has not referenced or summarised all records relating to Mr Teghlian's symptoms or injuries: see ss 3 and 42 of the PIC Act. If some of those medical records or reports are not referred to in the Panel's review, it should not be assumed that the Panel was unaware of that medical material or that the Panel failed to take the material into account.

1. Mr Teghlian's application for personal injury benefits dated 21 June 2023 has been considered. This lists his injuries as "left elbow abrasion, lumbar spine aggravation, glass in/around eye, PTSD".

1. The Liability Notice - benefits after 52 weeks issued by the insurer on 20 September 2023 has been considered. The insurer determined that Mr Teghlian's injuries caused by the accident came within the definition of "threshold injury" in the MAI Act.
2. In respect of his psychological injuries, the insurer acknowledged that Mr Teghlian's GP had reported a diagnosis of post-traumatic stress disorder on his certificate of fitness, and that his psychologist had made a diagnosis of post-traumatic stress disorder in the Allied Health Recovery Request (AHRR) dated 21 June 2023. However, it determined that these diagnoses did not adequately address the requirements of criterion D in the DSM-5.

Certificate of Determination - Internal Review

1. The Certificate of Determination - Internal Review dated 2 November 2023 prepared by the insurer has been considered. This maintains the decision that Mr Teghlian's injuries met the definition of "threshold injury" for the purposes of the MAI Act.
2. In respect of his psychological injuries, the internal review determined that criterion D was yet to be satisfied by Mr Teghlian's treating psychologist, noting that the AHRR completed by Connor Waterhouse did not satisfy the requirement of two or more of the criteria listed under criterion D.
3. The internal reviewer held that the evidence before him also did not demonstrate satisfaction of criterion G.

1. Mr Teghlian has provided a signed statement dated 15 January 2024, and a supplementary statement dated 18 June 2025.
2. In his statements, he sets out a description of the accident which is consistent with his submissions.
3. He describes his alleged physical injuries and pre-accident injuries, and the investigations and treatment post-accident. In his supplementary statement, Mr Teghlian says that his condition has continued to decline.
4. He states that he is now taking medications that he did not require previously, including Fluoxetine 20mg for his depression and Melatonin 2mg to help him sleep. He also reports having begun taking medicinal cannabis to help relieve his symptoms, in the form of cannabis oil or smoking.
5. In his supplementary statement, he says that he struggles to sleep at night and most recently he was awake until about 5.00am. He experiences nightmares and has an ongoing fear that something bad is going to happen to him.
6. He states that the accident has affected him mentally and caused him serious psychological problems which he did not have prior to the accident. He reports flashbacks of the accident "all the time" and "hav[ing] memories of what happened which causes a change in my mood every time". He reports imagining the truck crashing into him and thinks about "how bad and scary it was".
7. Mr Teghlian says he has flashbacks of the accident and associates daily living with danger.
8. He reports avoiding questions or talking about the accident, as he falls into a depressed state when reminded of it.
9. He states that he does not look forward to going out with his wife or family anymore and rarely goes out.
10. He states that he finds himself in a low mood "most of the time" with no motivation to exercise, work or go out. He prefers to stay on his own.
11. In his supplementary statement, he says he has lost motivation and enjoyment in his day-to-day life and is constantly fatigued and mentally exhausted. He is irritable and prefers to be isolated. He says he has grown tiresome of his life and lost his spirit.
12. He says he is uncomfortable and jumpy around cars and becomes startled when he hears loud noises. He has avoided the accident site to date. He did not drive before the accident and now no longer feels safe as a passenger.
13. He states his appetite has reduced and that he does not feel like eating a lot of the time.
14. He commenced psychological treatment with his treating psychologist at Insightful Mind in Parramatta in around June 2023 and has had approximately ten sessions to date. He also had three sessions with Dr Ben Dickson, psychiatrist, at Workers Doctors but has not seen Dr Dickson since August 2023. Mr Teghlian says he has been diagnosed with post-traumatic stress disorder as a result of the accident.
15. Mr Teghlian says he commenced treatment with Diane Sibilant, psychologist, in or around September 2024 and has attended approximately ten sessions with her.
16. At the time of the accident, Mr Teghlian says he was working approximately 15 hours per week as a self-employed diamond stone maker / jeweller. He states that, while his doctor says he does have capacity to work, he "do[es] not feel [he] can handle working anymore" due to his physical and psychological injuries.

1. The Panel has viewed and considered the photographs of the accident contained in Mr Teghlian's bundle. The Panel refers to Blacktown City Council v Hocking [2008] NSWCA 144 and is cognisant of the need to use caution when considering photographic evidence, particularly in the absence of expert evidence addressing the photographs.

1. The Panel has considered the medicolegal report prepared by Dr Richa Rastogi dated 9 April 2024.
2. Dr Rastogi examined Mr Teghlian on 9 April 2024 in person. Dr Rastogi noted that Mr Teghlian was cooperative, polite and well-groomed. His mood was anxious and his affect was restricted. He reported being triggered and Dr Rastogi opined he had residual symptoms of anxiety and fears, amplified when he is a passenger, and ongoing sleep problems. He denied any current suicidal ideation or any psychotic features.
3. Dr Rastogi diagnosed post-traumatic stress disorder in recovery. Dr Rastogi opined that Mr Teghlian presented with symptoms of post-traumatic stress disorder given that immediately post-accident he was fearful of his safety and reported flashbacks, nightmares, startled responses, hypervigilance and arousal. He is triggered being a passenger and displays safety and avoidance behaviours. He still gets triggered by trucks coming close and is more wary on the road. There is mild fear and avoidance with triggers affecting him.
4. Dr Rastogi opined that he had responded to treatment and demonstrated some improvement in his functioning, although remains vulnerable. Dr Rastogi further opined that his avoidance has improved; he is more insightful and adopting mindfulness techniques; his motivation has improved; he is involved in different forms of meditation and enjoying that, and he has continued to work in his pre-accident job doing the same hours, but is slower and less agile due to pain. Dr Rastogi opined he has a fair prognosis with ongoing treatment.
5. Dr Rastogi opined that Mr Teghlian qualified for a DSM-5 diagnosis of post-traumatic stress disorder characterised by:

(a) criterion A: accident where he felt his life was in danger;

(b) criterion B: recurrent intrusive dreams, flashbacks, dreams of the accident and psychological reactivity;

(c) criterion C: persistent avoidance of driving, avoiding accident site, inability to recall certain aspects of the accident, decreased interest in activities, restricted range of affect;

(d) criterion D: insomnia, irritability, difficulty with concentration, startled;

(e) criterion E: lasting for more than a month, and

(f) criterion F: causing significant distress.

1. A letter in response to Mr Teghlian's GP, Workers Doctors, prepared by Carl Nielsen, psychologist, dated 13 November 2023 has been considered.
2. Mr Nielsen notes he has examined Mr Teghlian on ten occasions since 20 June 2023. Mr Nielsen diagnosed Mr Teghlian with post-traumatic stress disorder based on his symptoms of low mood, avoidance, fluctuations in arousal, irritability, sleep disturbance, fatigue, poor concentration. In terms of functioning, it is stated that he has been unable to return to pre-injury hours and duties, is socially withdrawn, unable to use a treadmill, unable to do gardening, and has reduced capacity to exercise. Mr Nielsen addressed the DSM-5 criteria.
3. The referral letter from Dr Eric Lim dated 26 July 2023 has also been considered. This states the referral is for "psychological therapy due to eduring [sic] PTSD symptoms following a MVA".

1. The clinical notes of Workers Doctors have been considered.
2. Mr Teghlian's first appointment with Workers Doctors was on 20 June 2023 with Carl Neilsen, psychologist. This was via telehealth. The clinical notes reference the accident and diagnose Mr Teghlian with post-traumatic stress disorder. A PCL 5 result is 57/80. It is noted that he was in a motor vehicle accident and sustained serious injuries (criterion A); reported repeating disturbing and unwanted memories pertaining to the accident, specifically regarding the truck about to collide with the car he was a passenger in (criterion B); avoidant behaviour by only going into cars when necessary, avoiding the scene of the accident and avoiding speaking of the accident (criterion C); anxious and depressive cognitions regarding his capacity to recover from the injuries and return to pre-accident functioning (criterion D); fluctuations in arousal ranging from hypervigilance to low mood (criterion E); symptoms lasting for over one month in duration (criterion F); considerable distress evidenced by avoiding going out, reducing his exercise and becoming socially withdrawn (criterion G); and denied any illicit substance or alcohol abuse (criterion H).
3. Mr Teghlian also attended a physiotherapist, Matt Meoli, on 20 June 2023. The clinical notes of this appointment reference a physical examination of Mr Teghlian. There is no reference to psychological symptoms or injuries, nor a reference to the accident.
4. Mr Teghlian also attended upon Dr Morgan Mo. The Panel notes that the date on these clinical notes reads 20 June 2023 but the notes record that Mr Teghlian initially presented for consultation on 4 July 2023. The notes record that Mr Teghlian has reduced hours and activities due to pain, and records his injuries as "L) Elbow / Back / Psych", and in respect of the psychological illness diagnoses "PTSD". It is recorded that hospital attendance was not required. His relevant symptoms include reduced social activities and travel capacity, low concentration and experiencing nightmares, sleep disturbance (recorded to be due to lower back pain), low motivation, stressed, distressed, and overthinking. He is recorded to shower every second day. It was recommended he attend a psychologist to manage his psychological distress.
5. On 21 June 2023, Mr Teghlian attended Connor Waterhouse, psychologist, for a telehealth assessment. Mr Teghlian's diagnosis is recorded as "PTSD" with symptoms including anxiety, poor sleep, anxious cognitions, ruminations, ongoing pain and stress. It is noted he has delays with domestic duties and delays with self-care. It is recorded he is in the early stages of recovery. It was recorded "past psychological history - aggravating factors".
6. On 26 July 2023, Mr Teghlian attended a telehealth consultation with Dr Eric Lim. The clinical notes record Mr Teghlian has trouble sleeping due to nightmares, has been taking longer to do his work and struggles to focus. It also records physical symptoms.
7. On 31 July 2023, Mr Teghlian attended a telehealth consultation with Paul Dekkers, psychologist. This records that Mr Teghlian is pushing through pain, cannot do much at home, his life feels upside down, he is feeling lazy and lacking in motivation, he is scared to be in the car and is very anxious as a passenger, and is having nightmares. His concentration is said to be a problem impacting his work.
8. On 9 August 2023, Mr Teghlian attended Dr Ben Dickson for a telehealth consultation. This primarily related to his physical symptoms, but it was noted "conts [sic] to have nightmares about the accident; sleep difficult, pain and anxiety".
9. On 14 August 2023, Mr Teghlian attended Michael Simpson, psychologist, for a telehealth consultation. This noted Mr Teghlian had poor sleep, "limited BA - 'becoming lazy'", and that it feels like his personality is changing. Mindfulness of breath was practiced, and Mr Teghlian was encouraged to do this twice daily.
10. On 21 August 2023, Mr Teghlian attended Mr Waterhouse for a telehealth consultation. It was noted that Mr Teghlian's sleep is "really bad" and that he has been practicing breath and mindfulness at work, which is helping. He is struggling due to distractions. It was recorded "past psychological history - aggravating factors". Mr Teghlian reported symptoms of low mood, low motivation, poor sleep, stress, anxious cognitions and depressive cognitions. He was told to discuss sleep hygiene and melatonin with his GP.
11. On 23 August 2023, Mr Teghlian attended a telehealth consultation with Dr Ben Dickson. Mr Teghlian asked about management of post-traumatic stress disorder. Psychoeducation regarding post-traumatic stress disorder was provided and treatment avenues were discussed, including medication, psychological therapy and exposure therapy.
12. On 31 August 2023, Mr Teghlian attended a consultation with Dr Dickson. It was recorded that he has persistent anxiety, trauma symptoms, difficulties sleeping, is "on edge during the day", and has "racing thoughts". He was prescribed a trial course of Fluoxetine 20mg.
13. On 4 September 2023, Mr Teghlian attended a telehealth consultation with Mr Waterhouse. It is reported that Mr Teghlian takes Fluoxetine and had been practicing breathwork and meditation daily. Mr Teghlian reported low mood, low motivation, poor sleep, stress, anxious cognitions and depressive cognitions.
14. On 20 September 2023, Mr Teghlian attended a telehealth consultation with Mr Waterhouse. Mr Teghlian noted he was using a mindfulness app and listening to relaxing music to help sleep. Mr Teghlian reported his mood as four or five out of ten, and reported the same symptoms as on 4 September 2023.
15. On 5 October 2023, Mr Teghlian attended a telehealth consultation with Mr Waterhouse. Mr Teghlian's mood was reported to have dropped down to a "1 or 2". He reported having nightmares about the accident and a bad experience in a taxi on his way to an MRI.
16. On 19 October 2023, Mr Teghlian attended a telehealth consultation with Connor Waterhouse. It is recorded that Mr Teghlian has anxiety while driving, is socially isolated and withdrawn, and has lesser participation in recreation.
17. Also on 19 October 2023, Mr Teghlian attended a telehealth consultation with Dr Paul Tawadros in respect of his physical and psychological injuries said to be caused by the accident. It was recorded that Mr Teghlian has ongoing sleep issues, nightmares, prolonged sleep latency, "does not drive, never driven; anxious ++ in car; longest in car is 30 mins". He was prescribed Fluoxetine 20mg and Melatonin MR 2mg.
18. On 2 November 2023, Mr Teghlian attended a telehealth consultation with Mr Waterhouse. It was noted that Mr Teghlian nearly set fire to his house due to poor concentration and accidently put the iron on in a closet. He reported not feeling comfortable in a car and requested a referral to a phobia centre. An exposure plan was provided, involving Mr Teghlian sitting in the car with no one driving, and slowly increasing to short drives around the neighbourhood to longer drives around known roads.
19. On 9 November 2023, Mr Teghlian attended a telehealth appointment with Dr Calvache-R. The clinical records note "PTSD" and states that these symptoms persist. They otherwise focus on Mr Teghlian's alleged physical injuries.
20. On 16 November 2023, Mr Teghlian attended a telehealth appointment with Mr Waterhouse. Mr Teghlian noted he tried sitting in the car and found there was no issue or stress, however when he went on a 10 minute drive his anxiety jumped. He noted "sitting in the car is not a problem, it is when it turns on and we hit the road". Mr Teghlian was encouraged to continue with stage 2 of the exposure plan.
21. On 1 December 2023, Mr Teghlian attended a telehealth appointment with Mr Waterhouse. It is recorded that Mr Teghlian continued with stage 2 of the exposure plan. It is recorded that he "struggled because some of the streets are really narrow ... the wider street was ok. Sudden cars coming from the side streets is also stressful. Stress level 70/100 when in the car. At the beginning I was closing my eyes but now I can open my eyes". Mr Teghlian was encouraged to continue with the exposure therapy.
22. A telehealth video consultation on 7 December 2023 records "nightmares intermittently, finding benefit from psychology". Fluoxetine 20mg and Melatonin 2mg 1 nocte prn was prescribed.
23. A telehealth consultation on 15 December 2023 records Mr Teghlian is "feeling ok I guess - things are up and down", "I am having sleeping problems", "I took more melatonin but I can't see any difference", "Because of the lack of sleep I am having concentration issues". It is recorded that treatment including "sleep hygiene, psychoeducation on caffeine, anxiety when driving management" was provided.
24. A telehealth consultation on 12 January 2024 records that Mr Teghlian has cut down on caffeine and has otherwise been unwell due to an unrelated issue. Under "Psych Treatment Benefits" the same notes appear as 15 December 2023, with the addition of "Poor sleep, Fatigue" as a symptom. Mr Teghlian's "mood" is noted as "low".

1. The clinical notes of Diane Sibilant at North Kellyville Medical Centre have been considered. These reference six sessions between 24 September 2024 to 23 December 2024 and record correspondence including exposure worksheets and "DASS 42 assessment".
2. The records include a copy of a GP Mental Health Plan prepared by Dr P Castleman dated 3 September 2024 which notes "PTSD post MVA June 2023" under "Patient history". A K10 administered by Dr Castleman dated 3 September 2024 records Mr Teghlian's result as 38 out of 50, with the maximum score of 50 indicating severe distress and the minimum score of 10 indicating no distress.
3. A DASS 42 dated 24 September 2024 is titled "initial" and records a score of 24 for depression (severe), 21 for anxiety (extremely severe) and 29 for stress (severe).
4. Notes of the consultation on 24 September 2024 record Mr Teghlian's reason for presentation as "treatment of PTSD post MVA in June 2023" and provides that he has no prior history of "M/H". It is recorded that his life at home is "very good" and he has a supportive wife and son. It was noted that he has issues with sleep and frequent nightmares. He has lost interest in work and hobbies such as fishing since the accident due to the physical and psychological impact of the accident. Under "clinical impression / formulation" it is noted "adjustment disorder, PTSD?".
5. A letter from Ms Sibilant to Dr Castleman dated 24 September 2024 regards her initial consultation with Mr Teghlian and notes:

"Mr Teghlian reported the following symptoms and behaviours; feeling depressed and/or anxious at least 3 days per week, difficulty coping since MVA in May 2023, very poor sleep regime including initial insomnia and frequent waking, frequent nightmares at least one day per week pertaining to MVA, loss of motivation/morale impacting his employment as well as domestic duties and hobbies, socially withdrawn/decreased interest in most things, mind racing, difficulty relaxing, decreased cognitive functioning (attention, concentration) impacting his day to day life including work, irritability and frustration with some anger outbursts and an overall feeling of worry about the future."

1. On 29 October 2024, it was noted that Mr Teghlian reports ongoing stress and anxiety since his accident last year. It was noted he had insomnia and was falling asleep around 4.00am. He reported nightmares of car accidents, causing him a lot of distress and resulting in him avoiding going to bed until he is very tired. He reported hypervigilance while in the car and being "triggered with seeing trucks - flashbacks".
2. On 12 November 2024, it was noted Mr Teghlian reported he was not good, tired, and had sleepless nights. He reported his mind is always occupied. It was noted that the exposure record for car trips recorded patterns of fluctuating anxiety, with higher anxiety reported before and during longer car trips of less than 25 minutes.
3. An "Exposure Activity" chart dated 12 November 2024 records trips taken between 29 October 2024 to 9 November 2024 and appears to have been completed by Mr Teghlian.
4. On 26 November 2024, Mr Teghlian was reported to have said "it's been better" and that he had spent the past five days doing a lot of work outside, including painting the fence. He had been out with friends twice in the past two weeks, including to the RSL for dinner and to a christening. He had been continuing his exposure therapy in the car with his wife and reported "it's getting better during the trip". It was noted there was an evident pattern of decreased anxiety during car trips, and that Mr Teghlian was able to travel "far to Liverpool". He reported having two nightmares involving a car in the past week. It was recorded "evidence of PTSD dreams".
5. An "Exposure Activity" chart dated 26 November 2024 records trips taken between 12 November 2024 to 24 November 2024 and appears to have been completed by Mr Teghlian.
6. A DASS-42 completed on 26 November 2024 is titled "Re-Assessment" and records a score of 9 for Depression (normal), 10 for Anxiety (moderate) and 18 for Stress (mild).
7. On 10 December 2024, it is noted that Mr Teghlian reported an overall exacerbation in his anxiety in the past week, with bad concentration, "really bad" sleep, and increased anxiety in the car. Recent triggers and stressors were denied. It was noted that Mr Teghlian reported everything was going well with his family, that he had been going out and connecting with friends, and doing work outside putting up Christmas lights. It was noted that the heat / humidity may have been a possible trigger, as he does not like the heat.
8. An "Exposure Activity" chart dated 24 December 2024 records trips taken between 26 November 2024 and 7 December 2024 and appears to have been completed by Mr Teghlian.
9. The "Thought Record Sheet" which appears to have been completed by Mr Teghlian has been considered.
10. A DASS-42 completed on 23 December 2024 is titled "Re-Assessment" and records a score of 3 for Depression (normal), 11 for Anxiety (moderate) and 14 for Stress (normal).
11. On 23 December 2024, it is noted that Mr Teghlian reported he was "better", and while he had experienced "ups and downs", "but downs were light". It was noted that he reported an overall improvement in travelling in the car with his wife.
12. A letter from Ms Sibilant to Dr Castleman dated 23 December 2024 reports that Mr Teghlian had shown an overall improvement in his symptoms and is implementing strategies to manage his "anxiety and PTSD symptoms".

1. The referral letter to Dr M O'Shea from D Varatharajan dated 29 July 2025 for "? PTSD" has been considered.

1. The Allied Health Recovery Requests dated 21 June 2023, 19 October 2023 and 6 March 2024 have been considered by the Panel.
2. These diagnose post-traumatic stress disorder, noting Mr Teghlian was "involved in an MVA and sustained serious injuries". In the request dated 21 June 2023, it is recorded "PCL 5 = 57 / 80". In the request dated 19 October 2023, it is recorded "PCL 5 = 51 / 80 administered on 19/10/2023". In the request dated 6 March 2024, it is recorded "PCL 5 = 43 / 80 administered on 06/03/2024".

Certificate of Capacity / Certificate of Fitness

1. The certificates of capacity / certificates of fitness dated 26 July 2023, 9 August 2023 and 23 August 2023 have been considered. These were prepared by Dr Eric Lim and Dr Ben Dickson and relevantly refer to "PTSD" and physical injuries under "diagnosis". Under "Management" it is noted "Modified work/activities", and a referral to a psychologist is noted. Mr Teghlian is certified to have capacity for some type of work for normal hours per day, on normal days per week. The Panel notes that these certificates are unsigned.
2. The certificates of capacity / certificates of fitness dated 7 September 2023, 5 October 2023, 19 October 2023, 9 November 2023 and 7 December 2023, have been considered. These were prepared by Dr Morgan Mo, Dr S Calvache-R and Dr Paul Tawadros and refer to "PTSD" and physical injuries under "diagnosis". Under "Management" it is noted "Modified work/activities". "Medications" are listed to include Fluoxetine, and a referral to a psychologist is noted. Mr Teghlian is certified to have capacity for some type of work for normal hours per day, on normal days per week. The Panel notes that these certificates are unsigned.
3. The certificates of capacity / certificates of fitness dated 18 January 2024, 15 February 2024, 14 March 2024, 11 April 2024, 9 May 2024 and 14 May 2024 have been considered. These were prepared by Dr Morgan Mo, Dr Taslima Sultana and Dr Paul Tawadros and refer to "PTSD" and physical injuries under "diagnosis". Under "Management" it is noted "Modified work/activities", "Medications" are listed to include Fluoxetine and Melatonin, and a referral to a psychologist is noted. Mr Teghlian is certified to have capacity for some type of work for normal hours per day, on normal days per week. The Panel notes that these certificates are unsigned.

1. Medical Assessor Rapaport assessed Mr Teghlian on 2 April 2024 in person and issued a certificate dated 4 April 2024.
2. Medical Assessor Rapaport certified that Mr Teghlian's injuries caused by the accident, being abrasions to the left elbow, soft tissue injury to the lumbar spine with aggravation of pre-existing chronic degenerative disease, and soft tissue injury to the cervical spine, are threshold injuries for the purposes of the MAI Act. He also found that the injuries of bilaterial shoulder tears were not caused by the accident.
3. Medical Assessor Rapaport also certified that the referral by Dr Morgan to Dr Bhisham Singh, spinal surgeon, does not relate to injury caused by the accident and is not reasonable and necessary in the circumstances, and that it will not improve the recovery of Mr Teghlian.
4. It was noted that Mr Teghlian's psychological symptoms of flashbacks, insomnia, poor concentration on his work and a lack of motivation were Mr Teghlian's primary concerns. It was noted he takes medication to counteract depression and insomnia.

1. Medical Assessor Steiner assessed Mr Teghlian on 8 April 2024 and issued a certificate dated 10 April 2024. Medical Assessor Steiner certified that Mr Teghlian's injury to left eye due to shattered glass entering after accident is a threshold injury for the purposes of the MAI Act.
2. Medical Assessor Steiner noted Mr Teghlian has mild dry eyes, worse on the left. Despite noting there was no evidence that there was ever a glass foreign body within the eye, gave Mr Teghlian the benefit of the doubt that there was a foreign body in the left eye which was removed spontaneously and is no longer present.

1. On 12 September 2025, Mr Teghlian attended a medical examination before Senior Medical Assessor Mason and Medical Assessor Yeates.

1. Mr Teghlian is a 61-year-old man who lives with his wife and 30-year-old stepson in their own home in a Western Sydney suburb. He is working from home approximately two hours per week as a diamond setter. He is in receipt of a carer's payment for providing care to his wife who was injured in an accident 10 years ago.

1. Mr Teghlian was born in Beirut, Lebanon, and described a normal birth and development. His father died at 88 years of age in 2015 and his mother died at 90 years of age in 2022. He is the youngest of six children and has a nonidentical twin brother. The oldest child is 80 years of age. His twin and another brother live in Canada while two of his brothers and his sister remain in Lebanon. He maintains contact with his siblings. He is of Armenian Orthodox Christian background.
2. Mr Teghlian described a happy early childhood and denied exposure to trauma associated with civil unrest. He said the family moved into a special Armenian area in 1970 which was removed from the war. He said he was aware of the sound of bombs but was never personally impacted. He denied any form of abuse throughout childhood.
3. Mr Teghlian attended a private Christian school and completed year five of primary school when he was 13 years of age. He said he scored in the top 20% of his class. He had friends at school and denied getting into trouble. He denied learning problems but said he did not like attending school and went to work at 13 years of age. He spent one year in a factory making hand bags, two years in a shoe making business and one year in a sock factory. With the assistance of a brother-in-law he found work as a diamond setter at age 16 and worked full-time in that trade for almost 20 years. He said he was working in the Eastern area of Beirut and again was not impacted by the civil unrest.
4. In 1989 Mr Teghlian migrated to Canada under a family migration scheme; he was sponsored by an aunt. He continued to work full-time as a diamond setter although had brief periods of unemployment not extending longer than two months. He initially worked for other businesses and then established his own diamond setting business.
5. Mr Teghlian said he had not been involved in any long-term relationships because he had preferred his independence. He met his wife during one of her visits to Canada. She was visiting from Australia and he said they got along well together. He noted he had known her since early childhood. He came to Australia on a tourist visa in August 2005. They married in 2006 and he had to wait until he obtained permanent residency before commencing work as a diamond setter in the Sydney CBD. Prior to the accident he said he was working 15 to 20 hours per week but had moved his business to his home during COVID-19.
6. Leisure activities prior to the accident consisted of having outings with his wife to the city and going for walks. He said they would go out for meals. They got together with different friends every two or three weeks. He said he had completed the walk across the arch of the Harbor bridge with his stepson. He also enjoyed gardening and looking after the home.
7. Mr Teghlian denied any previous motor accidents or worker's compensation claims. He noted he has not held a driver's licence for many years and does not drive motor vehicles. He relies on his wife to do the driving. He denied any history of problems with the law.
8. Medical history consists of the development of both hypertension and hypercholesterolaemia approximately 20 years ago. Mr Teghlian denied having asthma but said he does need to use a Ventolin puffer. Prior to the motor accident in 2023 he underwent sinus surgery and the insertion of grommets in his left ear which resulted in improved hearing.
9. Past psychiatric history consists of approximately 10 family counselling sessions soon after moving in with his wife because his stepson was initially resentful of his presence. He said the issues were resolved satisfactorily and he now has a very good relationship with his stepson. He denied he struggled with anxiety or depression at that time. He also denied a family history of psychiatric illness.
10. Current medications consist of Sevikar HCT (olmesartan 20 mg, amlodipine 5 mg and hydrochlorothiazide 12.5 mg) for hypertension and rosuvastatin 10 mg for hypercholesterolaemia. He uses Panadol Osteo two tablets three times daily for pain which he supplements with ibuprofen and Panamax as needed. He is not currently using the antidepressant fluoxetine 20 mg; this ceased in May 2025 on the advice of his psychologist. He reported he had used medicinal cannabis (both oil and flowers) for pain for approximately six months but he found it to be of no benefit and ceased in mid-2024.
11. Mr Teghlian smokes 15 cigarettes per day (roll-your-own). Alcohol consumption consists of one beer per month. He denied the use of recreational drugs. He does not gamble. He has five plus cups of strong coffee per day. He does not use high caffeine energy drinks.

1. Mr Teghlian was a restrained front-seat passenger in a Honda vehicle driven by his wife. He said they were travelling through an industrial area in Auburn on their way to do some shopping. He estimates the speed at 40 to 45 kmph. He said a truck with a flat top tray reversed out into the road in front of his wife. She applied the brakes and attempted to avoid the truck, but the right rear corner of the tray struck the front of the car. It impacted the bonnet, the A pillar and the passenger side of the windscreen.
2. Mr Teghlian said the corner of the tray of the truck was directly in front of his face. He said airbags did not deploy but he was showered with dust and shattered glass. He said he sat there in shock for a few moments and then he undid the seatbelt and self-extricated. He said his hands were shaking and he sat down on the corner and had a cigarette. Both police and ambulance attended.

1. Mr Teghlian did not strike his head or lose consciousness. Mr Teghlian said he was bleeding from the elbow. Paramedics washed powdered glass from his eyes and ears. He said he called a friend to organise a tow truck and the friend took him to his shop. The insurer then arranged for a replacement vehicle. He said the whole process took from midday until 4.00pm. He said his wife then drove home, but they got lost on the way.
2. He described the development of pain from his neck down to his shoulder and lower back. After one week the pain became stronger, especially in his left elbow. He said he was unable to sleep because of pain and he went to see his usual GP after about two weeks. Then, after discussions with a friend, he consulted Workers Doctors at Parramatta because they provided everything in-house. He said he was checked out, sent for MRIs and referred to specialists. He said the insurer covered him for one year. He had an injection to the left side of his neck in early 2024 organised by Dr Bhisham Singh which helped for about six to eight months but the neck pain has now returned. He said he was referred to a different doctor for his right shoulder who arranged an injection; this also helped but then the pain came back.
3. Currently, he experiences pain in his left shoulder at the level of 6/10 on an analogue scale. Right shoulder pain is now 2/10. He said he is unable to do gardening, home repair projects, or painting. His work as a diamond setter is also impacted. He said the pain in the lower back has been made worse. Due to pain in both shoulders and the lower back, his sleep is affected. He said he experiences referred pain from the lower back down his left leg.
4. Mr Teghlian was asked to describe his psychiatric symptoms. He said he has difficulty initiating sleep and is unable to get to sleep until 3.00am or 4.00am. He then has four hours of sleep at most. He said he usually has a nap in the afternoon although that can also be impacted by difficulty getting to sleep.
5. Mr Teghlian described nightmares, 95% of which involve cars. In some nightmares he is driving and he is hitting people. In other nightmares, other people are driving, but they also involve hitting people. He said his wife is aware he is making noises and wakes him up. He then gets out of bed and sits for a while. He said the nightmares have been constant and now occur between one to three nights per week. The other 5% of the nightmares involve someone choking him; it is not clear if there is a contribution from obstructive sleep apnoea.
6. Mr Teghlian described difficulty with concentration and memory. He said he misplaces things such as keys, wallet and phone. He forgets why he has come into a room. He said he sits in his garden and suddenly starts to cry because he feels worthless. At this point in the interview he burst into tears. He said sometimes while he is travelling in a car as a passenger he gets upset and starts shaking.
7. Mr Teghlian describes some degree of social withdrawal and he tries to avoid friends. He said they ask him out but he does not go. In the past he would see friends every two or three weeks, but now it is every three months.
8. Mr Teghlian said he does not feel like the same person he was prior to the accident. He said because of his poor concentration he has some difficulty at work. He has broken stones and then cannot charge for the work and must pay for the broken stone. He said he has made mistakes in his work such as setting stones upside down. Added together, he said these things make him feel as if he is worthless.
9. Mr Teghlian was asked about treatment. He said he attended one year of psychological treatments with Mr Connor Waterhouse of Workers Doctors. He said he was taught meditation, sleep hygiene and techniques to distract himself if he is anxious. He believes he did have a consultation with a psychiatrist who prescribed fluoxetine 20 mg but he could not remember his name. He said sometimes the treatments he received were helpful, but his symptoms continue.
10. The insurer ceased funding the treatments after one year and he was referred by his regular GP to psychologist Ms Diane Sibilant under a GP mental health care plan. He said he pays a little bit in addition to the Medicare refund. He had six sessions with her until December 2024 and he stopped it because he thought he was doing okay. However in May 2025 he returned to see her and she said she could not help him and he should see a psychiatrist.

1. Mr Teghlian said he continues to have difficulty with insomnia, and he experiences the nightmares described above on three nights per week. He said his concentration remains poor and he continues to be socially avoidant. He also described the experience of pressure in his abdomen. He summarised by saying he feels like a different person and he feels worthless.

1. There is no current treatment. Mr Teghlian ceased the use of the antidepressant medication fluoxetine 20 mg when his psychologist told him she could not help him in May 2025. He said he has an appointment to see psychiatrist Dr Shivdev Sandhu at Ramsay Clinic Wentworthville next week.

1. Mr Teghlian is a 61-year-old right-hand-dominant man whose appearance is consistent with his stated age. He was identified from his photograph on his NSW photo card. He was located alone in a room in the office of his lawyer in Parramatta. He was interviewed using the MS Teams application with a good internet connection. The interview commenced at 9.00am and concluded at 10.30am.
2. He was cooperative with the interview and provided information willingly and without prompting. He presented as a cheerful, open, and friendly person who related warmly and without difficulty. His range of affective expression was full and appropriate to the material under discussion. There was no evidence of anxiety or depression throughout the interview. He did become tearful briefly as he described memory difficulties and avoidance of friends. He described nightmares related to motor accidents and some anxiety while travelling in a motor vehicle. He described feeling worthless because he was unable to work due to a combination of pain and poor concentration. He did not describe suicidal ideation or intent.
3. Mr Teghlian was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.

1. Self-care and personal hygiene: Mr Teghlian showers five days per week. He wears clean clothing. He has put on some weight since the accident, stating his weight has increased from 114kg to 130kg. He said he has difficulty putting on socks and doing up his shoes and must rely on his wife for help; this is due to back, neck and arm pain.
2. Social and recreational activities: Mr Teghlian has mostly stopped seeing friends. He said they get together with a friend perhaps every three months, whereas in the past it was every three weeks. He does go out shopping with his wife and they sometimes eat at the shopping mall. He does not go out to hotels, clubs or entertainment venues.
3. Travel: Mr Teghlian was unable to drive prior to the accident. He is able to use public transport and believes he could travel by air.
4. Social functioning: Mr Teghlian said he and his wife have a very good relationship and he gets along well with his stepson. His friendship circle has been reduced.
5. Concentration, persistence and pace: Mr Teghlian said he enjoys watching comedy and scientific programs on YouTube. He and his wife share management of the household money. He said he has difficulty reading and is restricted to about one paragraph. He described difficulty with short-term memory such as forgetting where he placed items. There was no evidence of memory or concentration difficulty throughout the interview.
6. Adaptation: Mr Teghlian said his work as a diamond setter has been reduced from 15 hours per week to two hours per week. Part of this reduction is due to physical problems and part due to psychological difficulty. He continues to receive the carer payment for looking after his wife. He is less able to do household maintenance and gardening tasks because of his physical injuries.

1. Mr Teghlian's presentation was internally consistent, consistent with the documentation provided and consistent with the diagnosis made.

1. A medical review panel is a new assessment of all matters with which the medical assessment is concerned. The Panel is not required to choose between competing medical opinions and is required to form its own opinion.[4]
2. Mr Teghlian bears the onus of establishing that any injury is not a threshold injury for the purposes of the MAI Act.[5]
3. The injury referred for assessment was psychological injury, including but not limited to post-traumatic stress disorder.
4. Relying on the expertise of the psychiatrist members of the Panel, the Panel finds that Mr Teghlian does not meet the full DSM-5-TR diagnostic criteria for post-traumatic stress disorder. The reasons for this conclusion are as follows:

(a) Criterion A. Mr Teghlian was involved in a motor in which he was exposed to threatened serious injury. In the clinical judgement of the psychiatrist members of the Panel, this criterion is met. While the accident was low speed, it involved a collision to the passenger side of the vehicle which broke the windscreen above Mr Teghlian's head and caused him to be showered in glass. The corner of the truck was directly in front of Mr Teghlian's face, and he could have suffered serious injuries had his wife not taken evasive action. Police and ambulance attended.

(b) Criterion B. Mr Teghlian described recurrent distressing dreams in which the content was related to the motor accident. This criterion is met.

(c) Criterion C. Mr Teghlian did not avoid memories, thoughts or feelings about the motor accident or external reminders about the motor accident. This criterion is not met.

(d) Criterion D. Mr Teghlian did not describe negative alterations in cognitions and mood associated with the accident. This criterion is not met

(e) Criterion E. Mr Teghlian did describe alterations in arousal and reactivity associated with the motor accident consisting of problems with concentration and sleep disturbance. This criterion is met.

(f) Criterion F. Duration has been greater than one month. This criterion is met.

(g) Criterion G. Significant distress or impairment in social and occupational functioning. This criterion is met.

(h) Criterion H. The condition is not attributable to a substance or another medical condition. This criterion is met.

1. The Panel is cognisant of the decisions in David v Allianz Australia Insurance Limited [2021] NSWPICMP 227 and Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6. However, on balance and based on the material before it, the Panel is not satisfied that Mr Teghlian satisfied the DSM-5-TR criteria for post-traumatic stress disorder at any stage post-accident.
2. The claimant's submissions failed to point to any evidence or identify any references in the medical evidence that indicates satisfaction of criterion D at any time since the accident. As set out above, the Panel has considered and evaluated the evidence before it. There is no evidence to suggest Mr Teghlian at any stage following the accident suffered from symptoms sufficient to satisfy criterion D of post-traumatic stress disorder.
3. The Panel notes the previous diagnoses made by Carl Neilsen and Dr Rastogi. The Panel respectfully disagrees with these diagnoses because criterion C and D of the DSM-5-TR are not met.
4. Relevantly, Dr Rastogi refers to "insomnia, irritability, difficulty with concentration, startled" in respect of criterion D. The Panel notes that the description provided by Dr Rastogi does not align with the DSM-5-TR and there is no evidence that two or more of the sub-criteria are met. Similarly, the diagnosis by Carl Neilsen fails to adequately address criterion D of the DSM-5-TR.
5. Based on his presentation at the medical examination, the symptoms he described, and a review of the medical evidence before the Panel, Mr Teghlian does not meet DSM-5-TR diagnostic criteria for a major mood disorder (major depressive disorder or persistent depressive disorder) or a major anxiety disorder (generalised anxiety disorder or specific phobia).
6. Mr Teghlian did describe the development of nightmares, insomnia, intermittent episodes of emotional distress, a sense of worthlessness because he is less able to work or help at home, and a sense that he is "not the same person".
7. The psychiatric members of the Panel consider these symptoms are consistent with a persistent adjustment disorder with anxiety. He meets DSM-5-TR criteria for this diagnosis as follows:

(a) Criterion A. He developed emotional and behavioural symptoms within 3 months of the motor accident.

(b) Criterion B. The symptoms he described are clinically significant. His distress is out of proportion to the severity of the stressor and it resulted in some impairment in social and occupational functioning.

(c) Criterion C. Criteria for another mental disorder were not met and the condition is not an exacerbation of a pre-existing disorder.

(d) Criterion D. The symptoms do not represent normal bereavement.

(e) Criterion E. The condition is present in persistent form because it has not resolved within 6 months.

1. Accordingly, relying on the clinical judgment and specialist expertise of the Medical Assessors on the Panel, the Panel finds that Mr Teghlian meets the diagnosis of adjustment disorder with anxiety.

1. Causation is not specifically addressed in Part 5 of the Guidelines. However, it is generally accepted that it is appropriate to apply the test for causation as set out in cls 6.5 to 6.7 in a threshold injury assessment.[6] These clauses of the Guidelines provide:

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. The Panel considers it is appropriate to apply the test of causation as defined in Briggs in respect of a threshold injury determination.
2. In Raiana v CIC Allianz Insurance Ltd, Campbell J noted:[7]

"One may accept that a review panel is engaged in a process of dispute resolution by expert assessment of medical issues arising under the Act. However, the questions arise in a legal context and it is incumbent upon the panel, medical practitioners they may be, to correctly apply the law including the law of causation in the exercise of their powers. This includes the provisions of Division 3 of Part 1A of the Civil Liability Act 2002 (NSW), ss5D and 5E: see s 3B(2)(a) of that Act. Although it may be expected that questions about the appropriate scope of liability will arise but rarely."

1. The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining the issues of negligence and causation.[8] It is therefore necessary for the Panel to consider whether the accident caused or contributed to the injuries. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[9] As observed by Spigelman CJ (Davies AJA agreeing) in Seltsam Pty Ltd v McGuiness (2000) 49 NSWLR 262; [2000] NSWCA 29 at [143]:[10]

"An inference of causation for purposes of the tort of negligence may well be drawn when a scientist, including an epidemiologist, would not draw such an inference."

1. Mr Teghlian was involved in a frightening and unexpected motor accident. It had the capacity to inflict significant physical damage if his wife had not been able to stop the car when she did. The subject motor accident was capable of giving rise to a psychiatric condition. The Panel has diagnosed an adjustment disorder with anxiety caused by the motor accident.
2. The Panel is satisfied that the accident could have caused adjustment disorder with anxiety and that, but for the accident, Mr Teghlian would not have this diagnosis.

1. Adjustment disorder with anxiety is a threshold injury for the purposes of the MAI Act.
2. The Panel confirms the certificate of Medical Assessor Verma.

[3] Wingfoot Australia Partners Pty Ltd v Kocak (2013) 252 CLR 480; [2013] HCA 43 at [47].

[4] Insurance Australia Group Ltd t/as NRMA Insurance v Keen (2021) 399 ALR 765; [2021] NSWCA 287; Insurance Australia Ltd v Marsh (2022) 99 MVR 1; [2022] NSWCA 31.

[5] Lynch v AAI Limited t/as AAMI [2002] NSWPICMP 6.

[6] Briggs v IAG Ltd (t/as NRMA Insurance) [2022] NSWSC 372 (Briggs) at [35]. See also the discussion of Stern JA (Mitchelmore and Ball JJA agreeing) in Insurance Australia Limited t/as NRMA Insurance v Le [2025] NSWCA 121.

[7] [2021] NSWSC 13 at [65].

[9] Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50].

[10] Cited with approval by White JA (Macfarlan and Payne JJA agreeing) in Metro North Hospital and Health Service v Pierce [2018] NSWCA 11 at [138].