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

1. The Review Panel revokes the determination of Medical Assessor Mukesh Kumar dated

12 July 2024. The Panel determines that the claimant suffers from: * Persistent Depressive Disorder with Alcohol Disorder,

which is a non-threshold injury for the purposes of the Act.

1. Grant Woodham (the claimant) is a 50-year-old man who was in close proximity to a severe motor vehicle accident which occurred on 11 May 2019.
2. Following the accident, the claimant sought a concession from the insurer that the psychological injuries he received ought to be considered non-threshold injuries. After an internal review, the insurer declined to make this concession and, thereafter, the claimant made an Application for Assessment of Threshold Injury.
3. The claimant was assessed by Medical Assessor Mukesh Kumar on 28 June 2024 and in a certificate dated 12 July 2024 he determined that the claimant suffered from post-traumatic stress disorder as a consequence of the motor vehicle accident and that this was not a threshold injury. He also, in the same certificate, determined that the alcohol use disorder was not caused by the motor accident.
4. The claimant sought a review of this determination and, in a certificate dated

20 August 2024, President's delegate Melinda Drew decided that there is a reasonable cause to suspect that the medical assessment was incorrect in a material respect. Consequently, the matter was then referred to this Medical Panel. 5. The Panel convened on 7 May 2025 to consider this matter. It was decided that it was appropriate for the claimant to be re-examined and, thereafter, a further conference occurred between the Panel members prior to issuing a certificate in this matter. 6. Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A "new decision maker" is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, the new review provisions apply. 7. The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Personal Injury Commission (Commission). 8. Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor. 9. Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application. 10. The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.

1. Section 57 of the MAC Act defines a "medical dispute" as a disagreement or issue to which Part 3.4 of the MAC Act applies.
2. Section 58 and s 60 of the MAC Act together with cls 1.5-1.7 of the Guidelines set out the procedures for referral to one or more Medical Assessors and the principles to be applied at such assessments.
3. The claimant was examined by Medical Assessor Gupta and Medical Assessor Verma on

22 May 2025 at 1.00pm by MS teams audiovisual conferencing.

1. Mr Grant Woodham (the claimant) was injured in a motor accident on 11 May 2019. On

28 June 2024, the claimant was examined by Medical Assessor Mukesh Kumar, who

subsequently issued a Medical Assessment Certificate (MAC) dated 12 July 2024. In his

assessment, Medical Assessor Kumar concluded that the claimant sustained post-

traumatic stress disorder as a result of the motor accident. NRMA Insurance (the insurer)

has since submitted an application requesting that the medical assessment be referred to a

Review Panel. The insurer contends that the original assessment was materially incorrect

and bases its request on the particulars and supporting evidence provided with the application.

1. Mr Woodham was raised by his biological parents and had a happy childhood. He denies suffering from any abuse or trauma. He is unaware of any history of mental illness in his family. He has an older brother who is doing well.
2. He is single at present but is trying to reconcile with his fiancée. He was in a four-year relationship and got engaged but that ended in November 2024. He has four children, all of whom have achieved adulthood. He has two grandchildren as well.
3. He denies any history of mental illness and says that he used to drink socially before the injury. He was charged with driving under the influence sixteen years ago but denies any other forensic history.
4. He was diagnosed with diabetes and sleep apnoea. He underwent gastric sleeve surgery eight years ago, and both these conditions subsided. He suffered a work-related injury in 1996 when he fell off the top of a scaffold and underwent treatment for four years. He denies any psychological impact from that injury.

1. Mr Woodham was driving a heavy haulage truck when he was injured on 11 May 2019. He was ferrying a machine that was 2.8m wide and weighed 53 tonnes. He was travelling straight when he felt a jolt. He looked in the rearview mirror and saw that a car had hit a pole behind him. He had not seen the incident but says that the car had "caught on to the truck" and was pushed into the telegraph pole. He stopped his truck and "ran up to the car". There was an unconscious lady driver, and there was blood everywhere. There were other people there who were helping the lady. He broke down, and other people had to comfort him. He stayed for several hours because the police asked him to. He was told that the lady might die. He is aware that she survived but suffered multiple injuries. He then drove off, under police escort, to drop off the machine.

1. Mr Woodham says that his mood is consistently low. He says that seeing his daughter and grandchildren can lift his mood. He says that he feels anxious all the time. He can experience chest pains with anxiety. He says that his sleep is impacted by nightmares, and he wakes up sweating. He has to have the TV on when he goes to sleep as he cannot manage to sleep in the dark. He says that he struggles to fall asleep after waking up. He says that he can stay in bed for days, either catching up on sleep or lying there. He says that he drinks daily and consumes more than eight high-strength beers. He smokes marijuana occasionally. He had started using speed but stopped that three years ago. He drinks in the evening on his own.
2. He says that he does not eat much, but that is long-standing. He has developed anger and irritability. He says that he has become scared of seeing the type of truck that he was in at the time of the injury. He says that he gets flashbacks whenever he sees one. He does not have any problem with smaller trucks and says that it is the heavy-haulage trucks that scare him. He is jumpy and hypervigilant while driving. He is uncertain about his future, but he wants to improve. He says that he was going to overdose two weeks ago, but he spoke to his ex-fiancée, who "talked him out of it". He denies current suicidal ideation.
3. Mr Woodham says that he started drinking in the aftermath of the accident, and his mental state started deteriorating with nightmares. He says that he did not know that he could get help and used alcohol to manage his distress. He says that he gave evidence in the matter two years later when he was advised that he could get help and started his treatment.

Mr Woodham is on antihypertensive medication and takes Diazepam 15mg to 20mg per day. He has just completed treatment with a psychologist. He is not seeing any psychiatrist. He has a case worker through a substance misuse service, WHOs (we help ourselves). He is doing courses on anger management and addiction through corrective services in addition.

1. Mr Woodham says that he had an injury to his shoulder when he tried to return to driving trucks. This occurred over two years ago. He says that he fell off the truck and "landed" on his right shoulder. He says that it is a lot better but still painful.

Mr Woodham presented as a casually dressed man who was helpful in his manner and was easy to build rapport with. He maintained good eye contact and did not display any psychomotor abnormality or psychic anxiety. He did not appear distressed while describing the incident. His mood appeared euthymic, and his affect was reactive. His speech was normal in rate, rhythm, tone and volume. His thought content revealed that he does not have a fear of driving trucks. He was not suffering from any perceptual abnormalities. He was able to maintain focus throughout the entire assessment. He appeared to be well-orientated to time, place and person. His insight and judgement were intact.

1. Mr Woodham says that he does not cook and relies on the food prepared by his friends. He can buy a cheeseburger occasionally. He says that he can go three to four days without the shower as he "forgets". He only has six teeth in is lower jaw and has lost the rest through diabetes. He does not wear dentures either and says that he has "learned to live without them". He does not use a mouthwash. He mows the lawns at his friend's place when he is lodging.

He keeps in contact with his brother and parents. He started a relationship four years ago (after the injury) and got engaged. His fiancée left him in November 24. He says that he was aggressive towards her, and she put an AVO against him. He was arrested and had to attend court in March 2025. He is now on a 12-month good behaviour bond. He is doing courses with corrective services on anger management and substance misuse. He says that he is in his second week, but it is "going well". He says that his concentration "depends on the day". He can understand the course content but forgets "most of it". He says that he has also become forgetful.

He was caught driving under the influence of alcohol in January but got it back at the beginning of this month. He says that he is still "working things out" with his fiancée and it is possible that they may get together. He is living between his daughter and a friend as he does not have the money to get a house of his own. He says that he has a five or six close friends. His friends invite him out; he has been out once but tends to "not turn up". His friends visit him and ring him up on occasion. He continues to drive and could visit new places following the GPS. He avoids driving long distances.

He tries to live off jobseeker allowance. He says that he can go to the shops but gets anxious. He travelled to Cairns with his finance last year, which he says was "good".

He returned to work as a truck driver after the injury two weeks later. He was injured on

11 May 2019 and continued working. He was sacked because he turned up drunk. He took up another job with an asphalt company as a labourer. He says that he continued to work for about a year. He took six months off from work as he was "breaking down". He then tried to return to work as a truck driver but fell off and hurt his right shoulder two weeks later. He returned to working in the asphalt sector again but was let go for turning up to work late and under the influence of alcohol. He has not worked since then. He says that he would still be working if he had not been drinking.

1. No inconsistencies were noted. He was asked about the pre-exiting anxiety mentioned in his case notes, but he says that that was related to the gastric sleeve surgery. He was asked about the alcohol intake, but he says that he used to drink over the weekends only and stopped after the gastric sleeve procedure.

1. The Panel noted the following pertinent information from the documentation provided:

(a) Treating general practitioner Dr Eric Lim referred Mr Woodham to a psychologist on 8 November 2022. He stated in the letter that Mr Woodham was suffering from post-traumatic stress disorder symptoms following a motor vehicle accident.

(b) Dr Lim also provided a functional capability certificate in which he advised that

Mr Woodham would be fit for modified work for eight hours per day, five days per week, from 8 November 2022 to 9 December 2022.

(c) Psychiatrist Dr Abdal Khan provided an independent medical examination report dated 12 February 2024. He noted that Mr Woodham had denied any pre-existing psychiatric condition or trauma. He further noted that following the injury, Mr Woodham's alcohol use had increased, and he was consuming 12 to 18 standard drinks daily. Dr Khan diagnosed the work-related injury as post-traumatic stress disorder, persistent depressive disorder, alcohol use disorder, and stimulant use disorder. He had noted the use of cocaine, but not in the recent past. He assessed Mr Woodham to have 24% whole person impairment.

(d) Psychiatrist Dr Abhishek Nagesh provided an independent medical examination report dated 27 September 2023. He advised that Mr Woodham had been drinking up to 18 bottles of beer since the motor vehicle accident. No drug use was described in this report. He advised that the diagnosis was post-traumatic stress disorder and alcohol use disorder. He assessed Mr Woodham to have 15% impairment of the whole person impairment.

(e)

Dr Nagesh provided a supplementary report dated 20 November 2023. This was based on new documentation. He noted that Mr Woodham had not reported any psychological symptoms, and there was no record of him having sought help from his general practitioner. He opined that that was not consistent with a diagnosis of post-traumatic stress disorder. He advised that Mr Woodham had not suffered any injury from the subject motor vehicle accident. He further noted that Mr Woodham had been working full-time until a workplace incident when he required time off. This incident was not described in the report. He advised that the alleged psychological injury was not caused by the motor vehicle accident but by a work-related incident.

Progress notes from the general practitioner, Dr Ben Dickson, were provided. Documentation starts on 27 October 2022, and the following pertinent information is documented:

(i) he was seen on 8 November 2022. It was noted that he was suffering from post-traumatic stress disorder and alcohol use disorder related to a work-related motor vehicle accident.

(ii) on 21 November 2022, it was noted that he was employed as an allocator for 'Pavement Solutions' and was working 40 hours per week.

(iii) low mood and broken sleep, along with nightmares and panic attacks, were noted on 23 November 2022, and

(iv) on 28 August 2023, it was noted that he had ongoing anxiety and psychological distress along with disturbed sleep. He was taking antidepressant medication.

(g)

Patient history from Scofield Medical Practice, printed on 19 October 2023, was provided. The following pertinent information is documented:

on 16 June 2015, it was noted that he had anxiety regarding weight, and

documentation continues until 21 December 2022. He continued to attend regularly at the surgery, but at no point did he report any psychiatric symptoms. He was not noted to have any psychiatric symptoms by the treating general practitioner either.

1. The panel considers that Mr Woodham's diagnosis is persistent depressive disorder with anxious distress.
2. Mr Woodham's presentation does not fulfil the diagnostic criteria for post-traumatic stress disorder under DSM-5 (Criterion A-H). Although he reports distressing flashbacks (Criterion B) and hypervigilance (Criterion E), he lacks the persistent avoidance of trauma-related stimuli (Criterion C), as he continues to drive and states that he could return to driving trucks had he not been drinking. The panel noted that Mr Woodham has a history of unstable employment, primarily due to alcohol use and related behavioural issues. He managed to return to work after his injury and held various roles, including truck driving and asphalt work, before being dismissed for turning up to work intoxicated or late. He attributes his job loss to alcohol misuse. He could work as a truck driver, if not for alcohol, but would not be able to drive heavy haulage trucks. His functional impairment is moderate but not to the degree typically seen in post-traumatic stress disorder, and his mental state examination showed euthymic mood and reactive affect without marked hyperarousal or intrusive distress, inconsistent with Criterion F (duration) and Criterion G (functional impairment) of post-traumatic stress disorder. In contrast, his symptoms align more closely with persistent depressive disorder (Dysthymia) (DSM-5 criteria 300.4), characterised by a depressed mood for most of the day, for more days than not, for at least two years (Criterion A), accompanied by at least two additional symptoms such as poor appetite, insomnia, low energy, low self-esteem, difficulty concentrating, or feelings of hopelessness (Criterion B). Mr Woodham demonstrates chronic low mood, sleep disturbance, irritability, concentration difficulties, and poor self-care, fulfilling these criteria. The anxious distress specifier (DSM-5, 300.4) applies given his constant feelings of anxiety, chest pains related to anxiety, and hypervigilance, fulfilling the criteria for this specifier, which requires at least two symptoms of anxiety during the depressive episode. His symptoms have persisted over several years with a degree of functional impairment, which supports a diagnosis of persistent depressive disorder with anxious distress rather than post-traumatic stress disorder.

Persistent depressive disorder is a milder form of depression and consistent with his level of functioning despite relative lack of treatment.

1. The Panel was not satisfied that the claimant had any relevant pre-existing mental illness at the time of the accident. He has not sustained any subsequent trauma, which can explain his symptoms either. Therefore, it can be reasonably stated that his persistent depressive disorder can be fully attributed to the motor vehicle accident.

1. The claimant suffers from persistent depressive disorder with anxious distress, which is a recognised psychiatric illness. This condition which is a non-threshold injury.