Certificate issued under Division 7.5 of the Motor Accident Injuries Act 2017

1. The Review Panel revokes the certificate of Medical Assessor Michael Hong dated

21 November 2024 and issues a new certificate as follows:

(a) the Review Panel certifies the following injury was caused by the motor accident:

(i) persistent depressive disorder with anxious distress, and

(b) the Review Panel finds that the above injury results in a whole person impairment of 15% which is greater than 10%.

1. Li-Chieh Wang (the claimant) was involved in a motor accident on 27 January 2022. He was the driver of a vehicle that was stationary at traffic lights when another vehicle re-ended him, pushing his vehicle into the vehicle in front.
2. He was taken to Liverpool Hospital complaining of chest and ribs pain. He says psychological symptoms developed soon after the motor accident.
3. The claimant made an Application for personal injury benefits with AAI Limited t/as GIO (insurer), the third-party insurer of the vehicle that he says caused the accident.
4. A medical dispute arose about whether the degree of the claimant's whole person impairment (WPI) is greater than 10% WPI. Where there is a dispute about the degree of a claimant's WPI, damages for non-economic loss[1] cannot be awarded and disputes must be referred to a Medical Assessor for determination.
5. On 21 November 2024, Medical Assessor Michael Hong found the claimant's psychological injury to be caused by the motor accident and assessed WPI at 13% which was greater than 10%.
6. The insurer lodged an application with the Personal Injury Commission (Commission) seeking a review of Medical Assessor Hong's decision. This was allowed by the President's delegate (Mr Kenneth Ho) and this Review Panel (Panel) was convened to conduct the review.

1. Medical Assessor Hong was referred the following injuries for medical assessment:
   • psychiatric condition - psychological injuries - chronic post-traumatic stress disorder and major depression.
2. The Medical Assessor noted that the claimant did not have any past psychiatric history. It was also noted that the subject motor accident caused physical injuries which were assessed by other Commission Medical Assessors at 5% WPI.
3. The Medical Assessor was satisfied the claimant developed psychological symptoms following the motor accident that were consistent with a persistent depressive disorder. As the claimant's appointments with his psychologist had stopped, his condition was considered entrenched. Impairment was assessed under the Psychiatric Impairment Scale (PIRS) at 13% WPI (1,2,2,3,3,3 - median 3, aggregate 14).

1. The insurer submits that the Medical Assessor failed to consider the histories recorded by other doctors, specialists and Medical Assessors that were relevant to the category "self-care and personal hygiene" in the assessment done under the PIRS. It is contended this was a breach of procedural fairness.
2. In its original submissions, the insurer relies on the medico-legal report of clinical psychologist Dr McMahon dated 3 August 2023 whose assessment under the PIRS was 1% WPI.

1. The claimant says the Medical Assessor properly exercised his clinical judgement and provided reasons that are without error. The claimant maintains its original submission that his accident-related psychological injuries amount to an impairment of greater than 10% WPI.

1. On 15 August 2025, the Panel issued a direction to the parties requesting indexed and paginated bundles of the information they relied upon. The Panel advised that unless documents are uploaded to the review file, the Panel would not be able to read and consider those documents. The insurer and the claimant complied with the direction lodging bundles comprising of pages 1-285 and 1-560 respectively.
2. The Panel has read the documentation relied upon by the parties.
3. At the preliminary conference on 5 November 2025, the Panel noted that central to the controversy identified in the parties' submissions was the different medical opinions in the assessment of the various categories under the PIRS.
4. While not being overly critical of the delegate's decision, the Panel's view is that it is not an error or inconsistency for Medical Assessor Hong or the Panel to arrive at a different conclusion to other doctors, psychologists or psychiatrists based on the history given by the claimant at the time of the assessment. The Panel notes that this approach is consistent with the direction in clause 6.21 of the Motor Accident Guidelines (Guidelines) which states that, "The evaluation should only consider the impairment as it is at the time of the assessment".
5. The Panel of course is aware of the other histories, particularly with Dr McMahon, who is a psychologist and has applied his documented history to an assessment under the PIRS. The Panel resolved that these histories comprised of the necessary background material that was reviewed prior to the Panel Medical Assessors' re-examination of the claimant.

1. As mentioned, at the preliminary conference on 5 November 2025, the Panel determined that the claimant be re-examined. The re-examination report of Medical Assessors Blom and Mason is below:

Mr Wang is a 51-year-old man who lives with his 51-year-old wife and 23-year-old daughter in rental accommodation in a Western Sydney suburb. He has not worked since the subject motor accident on 27 January 2022, now nearly 4 years ago, and is in receipt of payments from the CTP insurer. His wife works on a farm as a mushroom picker and his daughter works as a nurse.

Mr Wang was born in Taiwan and described a normal birth and development. His father is 82 years of age and his mother 80 years of age. In the past they managed their own food factory. He has 2 younger brothers. He described a normal happy childhood growing up in Taiwan and suffered no form of abuse. He completed his schooling to year 12 in Taiwan saying he completed his HSC with a below average result. After leaving school he had a few casual jobs in Taiwan before the family relocated to Australia in 1996. He spent 1 year at TAFE while in Sydney studying food science and then found a job in a toy store in Chinatown and worked there for a little over 1 year. He said he had always had an interest in radio controlled cars and planes and found work with a company manufacturing these devices in Taiwan, where he remained for 16 years. He said he worked his way up from a junior to managing the organisation. The company closed down in 2016 and he found work with a company in Guangzhou China where he was managing the supply chain.

He married in 2000 and his daughter was born in 2002. They lived as a family until 2019 when his daughter came to Australia to study. Mr Wang said he came to visit his wife and daughter in 2020 but was unable to return to China because of the COVID pandemic; he remained in Australia and eventually found work with Coles as a trolley collector and cleaner.

Leisure activities prior to the motor accident consisted of making and repairing radio controlled cars and planes. He also enjoyed reading novels and martial arts publications. In addition he enjoyed watching videos on YouTube.

When asked about past motor vehicle accidents he initially said there were none. He was reminded of a rear end accident while in China which he acknowledged but said it did not result in any injury. He said there were no further traumatic events. Again when reminded he acknowledged he had been the subject of a home invasion in which the family were threatened with a weapon. He said at the time he was living with relatives and the home invasion was related to other people who were living in the household. He moved out with his wife and child soon afterwards. He said he was stressed and upset by the event but it did not have any ongoing impact on him. He denied any history of problems with the law.

When asked about his medical history he said he was diagnosed with diabetes in 2007 or 2008 and was insulin-dependent. He had a heart attack in Taiwan in 2017 which he said did not require bypass surgery. He acknowledged difficulties with hypertension and high cholesterol. He reported allergies to alcohol and antibiotics. He said he had not undergone surgery. He did not appear to be aware of the significance of his ongoing medical conditions although acknowledged he did have anxiety about his health and was worried about his weight. He said he was 174 cm tall and weighed 126 kg; his BMI was calculated 41.6 kg/m².

Mr Wang was unable to provide details of his current medication. The medical records from 2022 indicate he was using bisoprolol 5 mg, clopidogrel 75 mg, gliclazide 60 mg, Jardiamet 12.5/1000 mg twice daily perindopril 5 mg, ezetimibe/simvastatin 10/20 mg, and Toujeo Solostar 300 IU/mL insulin.

Mr Wang denied past psychiatric illness. However he said he did experience stress arising from work related pressure. He said he was inclined to become irritated and angry when under pressure. He denied any family history of psychiatric illness.

He denied the use of cigarettes and alcohol and said he does not use any recreational drugs. He does not drink excessive coffee; he said he prefers tea.

On 27 January 2022 at approximately 6 AM he was taking his Coles uniform to the laundry to be cleaned. He was stationary at a red light when his vehicle was rear ended and pushed into the car in front. Seatbelt was worn but airbags did not deploy. He described damage to the front and rear bumpers and lights and said the car was written off.

Mr Wang said he had a blackout episode and believes he was unconscious for 1 or 2 minutes. When he came to the seatbelt was tight. He said there was heavy traffic going by close to his vehicle and he carefully self-extricated through the driver's door. He said he immediately felt dizzy and the drivers of the other vehicles got out and came to check on him. He asked the driver of the vehicle in front to call police and ambulance but he did not speak English. He said he then called the police himself. He said at some point a tow truck appeared and an ambulance also attended.

Mr Wang was transported by ambulance to Liverpool Hospital where he remained for 2 or 3 hours. There were problems at the hospital because of COVID and people being on strike. He said an ultrasound examination was conducted and he left after 2 or 3 hours. He had presented with chest pain and he was told to take painkillers and go to an emergency department if it worsened. The ED discharge summary indicated lower chest wall and abdominal pain with bruising secondary to a low-speed motor vehicle accident.

He said the chest pain worsened and he attended a local Medical Centre; further scans were ordered. He said this was the same as with the hospital and he was provided with mild analgesics. He spoke with a friend who recommended he see a lawyer and the lawyer recommended he attend GP Dr Eugene Khoo. Further investigations revealed 4 left-sided rib fracture and thoracic spine fractures. Commission Medical Assessor Alan Home noted things had resolved and diagnosed a left shoulder injury and soft tissue injury of the lumbar spine.

Mr Wang stated the condition was painful and he found it unbearable while breathing in and out. Paracetamol was not helpful and Dr Khoo prescribed stronger pain tablets. The pain resulted in immediate increased irritability. He said currently the pain is not as severe and it is only exacerbated by sharp, strong movements. However he noted he was unable to work because of the pain because physical exertion causes it to return. He was unable to provide the name of the current analgesia.

With regard to psychiatric symptoms he said the motor vehicle had a 'huge impact'. He said when he regained consciousness he did not realise he had been rear ended. He believes his head must have hit something in the car and his chest impacted the steering wheel. He said he could not work out if he was in the car, outside the car, or already dead. He said he returned to reality after a minute or two.

When asked about his symptoms he said he has constant nightmares and is totally withdrawn socially. He said he does not want to be with anybody. The nightmares commenced a few weeks after the motor accident and consisted of him being hit, being chased or falling from a height. They did not involve motor vehicle accidents.

When asked to elaborate on the social withdrawal he said he does not want to talk to anybody. He said he stays at home and largely lies in bed. He has no desire to see friends or relatives. He said he does have relatives in Australia but does not want to be with them. He does not believe he has made many friends in Australia. He referred to the people he worked with as acquaintances and said he has not maintained contact with them. His only contact with his friends from China is to send them a message at Chinese New Year. Following the accident the family moved from Liverpool to St Marys and he does not have any friends in the area.

He said he became fearful of driving following the motor accident. He said he found it difficult to resume driving and was always afraid when another vehicle was behind. He was pressured to resume driving by his family and was eventually able to resume driving in the local area. He said he can drive for 4 or 5 minutes.

Mr Wang became depressed following the motor accident. He described his mood as frustrated and sad. He said the depression partly arose from the pain he was experiencing and partly from the fact that he was unable to work. He said at times he did feel life was not worth living and it would be better if he died but he did not have any active intent to take his own life.

Associated with the depression and pain was a sense of anger and irritability. He said he was snapping at his wife and daughter. He described an episode in which he was having a meal with extended family and he became angry, stood up and tipped up the table causing all the contents to fall on the floor. He said everybody was shocked. He noted this was uncharacteristic behaviour.

Mr Wang described a disturbed eating pattern. He said his weight fluctuates between 120 and 140 kg. There were periods of time when he does not want to eat at all and other periods of time when he eats to excess, consuming anything he can get his hands on. He said his wife is concerned about his eating and weight and she tries to implement healthier routines but he becomes angry when she does. She tries to get him out of the bedroom or out of the house but he resists this.

He was asked if he has intrusive thoughts about the motor accident. He said he does have memories of it but when they occur he pushes them out of his mind because he does not want to go through it again.

When asked how he spends his time during the day he said he watches all sorts of short video clips on YouTube. He also reads some Japanese novels or martial arts material and some fiction on his phone. He noted his ability to read had substantially reduced and he said he can persist only for 5 minutes. He also said his ability to watch video clips was similarly reduced.

Treatment consisted of the prescription of a sleeping tablet by Dr Khoo. Mr Wang could not remember the name of the medication. The documentation indicates this was melatonin 2 mg at night. He went on to say he does not use this medication regularly and he often forgets to take it. There was no other prescription of psychotropic medication.

Dr Khoo referred him to psychologist Ms Lois li and he attended at least 10 telehealth sessions over 1 year. He believes the last attendance was approximately 2 years ago.

Injuries or Conditions since the Motor Accident

Mr Wang said the main problems since the motor accident have been cockroaches and mice that infest his rental property. He also complained about noisy neighbours working on cars and noisy dogs.

These are largely as described above. Pain continues although has improved to some degree. He stated he is unable to work because of pain. Sleep continues to be disturbed. He is chronically depressed and withdrawn from social interaction. He spends much of his time in bed. He is irritable and excessively angry. He continues to experience constant nightmares. He said his condition tends to fluctuate and he has good and bad days. He becomes angry if he sees mice or cockroaches.

Mr Wang is a 51-year-old right-hand dominant man whose appearance is consistent with his stated age. He was located alone in a room in his home in Western Sydney. He was lying face down on his bed throughout the interview. He was identified from his photograph on his NSW driver license. He was interviewed using the Microsoft Teams application with a good Internet connection.

Interpreter Ms Sandy Shi, NAATI No CPN 3MH13B, was present for the duration of the interview and the entire interview was conducted through the interpreter. The interview commenced at 2 PM and concluded at 3:40 PM on 19 January 2026.

Mr Wang had longish messy hair, a straggly beard and he appeared to be missing a right front upper incisor tooth. No pain behaviour was evident throughout the interview. He was depressed in appearance and his range of affective expression was significantly reduced. He referred to thoughts of passive suicidal ideation but indicated there was no active intent. He described significant social withdrawal and excessive anger and irritability. He also described a fear of driving, particularly in relation to being rear ended again. He described nightmares which were not directly related to the subject motor accident.

Mr Wang was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology. He made no reference to pseudo hallucinatory phenomena.

There was no evidence of inconsistency of presentation apart from the need for him to be reminded of a previous motor accident and a previous home invasion to which he responded appropriately.

The Panel noted the significant difference in PIRS category scores between those provided by psychologist Dr John McMahon and the assessment of Assessor Hong. Mr Wang was carefully questioned in this regard because of this difference. While there were differences, particularly in the class ratings found by Dr McMahon in August 2023, the Panel relies on its expertise in the questions asked of the claimant and the answers provided which were then applied to the relevant PIRS category."

1. Section 7.21 of the Motor Accident Injuries Act 2017 **(**MAI Act) provides that the degree of permanent impairment of an injured person is to be assessed in accordance with the Guidelines.
2. Version 10.1 of the Guidelines, effective from 12 December 2025, applies to the review.
3. The Guidelines were issued pursuant to Division 10.2 of the MAI Act and adopt the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.
4. Permanent impairment is assessed in accordance with Chapter 6 of the Guidelines. Specifically, the assessment of psychiatric impairment draws from the chapter "Mental and behavioural disorders" which commence at cl 6.201 of the Guidelines.

1. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychological or psychiatric condition.
2. Causation is dealt with at cls 6.5-6.7 of the Guidelines. An abridged form of the requirements is contained in cl 6.7 which states:

"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. Further, the provisions of the Civil Liability Act 2002 apply, in particular ss 5D and 5E.

1. The review of the medical assessment is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned.[2]
2. The evaluation should only consider the impairment as it is at the time of the assessment.[3]
3. The Panel may confirm the certificate of assessment or revoke that certificate and issue a new certificate as to the matters concerned.[4]
4. The Panel refers to the above re-examination report of Medical Assessors Blom and Mason. The Panel reconvened on 4 February 2026 and discussed the re-examination report findings before collectively making the below determinations.

1. Mr Wang has no previous psychiatric history. He was involved in a frightening although not life-threatening motor vehicle accident which was capable of resulting in a psychiatric condition. He saw his general practitioner (GP) Dr Khoo soon after the accident who referred him to psychologist Ms Lois Li for which he attended at least 10 telehealth sessions over one year. He currently presents to the Panel with a continuation of his depressive symptoms. The Panel was satisfied that the claimant sustained a psychiatric injury as a result of the motor accident.

1. Mr Wang was involved in a frightening motor accident which resulted in not insignificant physical injuries. However, it is the opinion of the Panel this was not a life-threatening motor accident and does not satisfy Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) Criterion A for post-traumatic stress disorder. The Panel notes the presence of some trauma related symptoms such as nightmares, avoidance and intrusion symptoms, but complete criteria were not satisfied. However, there is an ongoing anxiety related component associated with driving.
2. Subsequent to the motor accident, Mr Wang developed a mood disorder which at the time of interview is best characterised as a persistent depressive disorder. It is likely there were episodes of major depressive disorder throughout the four years since the subject motor accident. Because of the above anxiety related component, the most satisfactory diagnosis is persistent depressive disorder with anxious distress.
3. Mr Wang meets DSM-5-TR criteria for persistent depressive disorder with anxious distress as follows:

Criterion A. Mr Wang has experienced depressed mood most of the day for more days than not for at least two years.

Criterion B. Mr Wang described the presence, while depressed, of both poor appetite and overeating, insomnia, low energy and fatigue, low self-esteem, poor concentration, and feelings of hopelessness.

Criterion C. The above symptoms have never been absent for more than two months at a time.

Criterion D. It is likely there had been symptoms of major depressive disorder throughout the course of his illness.

Criterion E. There has never been a manic or hypomanic episode.

Criterion F. The condition is not better explained by another major psychiatric disorder.

Criterion G. The condition is not due to a substance or another medical condition.

Criterion H. The condition has caused clinically significant distress and impairment in both social and occupational functioning.

The descriptor "with anxious distress" captures his symptoms of anxiety while driving. The Panel notes he does not meet full criteria for a specific driving phobia because he is able to do so in the local area.

1. Persistent depressive disorder with anxious distress

Mr Wang showers every two days and changes his clothes every two or three days at the insistence of his wife. He said he does not leave the house often so there is no requirement to shower or change. He said he has his hair cut and beard trimmed every six months but noted in the past he preferred to wear long hair. He last had it done in December 2025 because his wife forced him to do so. His appetite varies between non-existent and over eating. He no longer does any cooking. His wife nags him to eat properly. He is not capable of living independently. He is moderately impaired.

Mr Wang said he does not go out to see or visit anybody. Sometimes his wife or daughter insist he goes to the shops with them but he does not participate in any other social activity. He said the preacher from a church visits on a monthly basis and he pretends not to be home. He said no friends visit his home and he does not visit any friends. He does not go out to hotels, clubs or entertainment venues. He does not attend or play sport. He is moderately impaired.

Mr Wang said he can drive in the local area for four or five minutes but this is with some significant anxiety. When asked if he can use public transport he said he has travelled by bus. He has not been overseas. He is mildly impaired.

His relationship with his wife and daughter is intact despite his anger and irritability. He does not see any friends. He sends messages to his Chinese friends only at Chinese New Year. He is mildly impaired.

Mr Wang said this is much worse. While acknowledging his response, the Panel noted that Mr Wang can watch a TikTok video for five or six minutes and then changes to a different video, as is the usual manner of operation on this app. His reading of martial art material online is restricted to 5 or 10 minutes. He said he is not working on any remote-control vintage cars or aircraft but this was not due to psychiatric reasons. He no longer manages the family money and leaves this to his wife.

His concentration during the one hour, 40-minute interview was satisfactory, with adequate pace. There were gaps in his recollection of the names of his medication however this was not considered a significant factor with respect to impairment.

He had been asked to provide ID at the beginning of the interview but said his driving licence was elsewhere in the house. At the end of the interview, he reminded the Panel Medical Assessors he needed to get his driving licence and went to do so indicating reasonable memory and concentration.

Mr Wang reported being unable to work because of pain. The Panel carefully discussed this aspect, as a blanket acceptance of this self-report would mean an assessment of Class 1. If pain was put aside, the Panel considered the claimant's depressed mood to be the greater (above 50%) contributor to Mr Wang's inability to work. The Panel noted that Mr Wang's pre-accident occupation was trolley collecting which would not require much interaction with customers. However, the Panel accepts that Mr Wang does not leave his home often because of his depressed mood state. If required, the Panel felt Mr Wang could perform his previous role of trolley collecting at a reduced pace and work one or two non-consecutive days.

With regard to functioning at home, he does very little other than bringing in the laundry and put putting the garbage bins out.

1. There is no clinical evidence of pre-existing or subsequent impairment. There is no requirement for apportionment.

1. There is no evidence that treatment has been effective. No treatment allowance effect is made.

Degree of permanent impairment caused by the motor accident

1. Persistent depressive disorder with anxious distress results in WPI of 15%.

1. The Panel concludes that the claimant's injury caused by the motor accident results in a WPI of 15% which is greater than 10%. While the Panel's diagnosis is similar to the medical assessment under review, the total impairment finding is different to that found by Medical Assessor Hong.
2. The certificate issued by Medical Assessor Hong dated 21 November 2024 is therefore revoked. A new certificate is issued at the front of this determination.