MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; review of Medical Assessment Certificate (MAC) under section 7.26; permanent impairment dispute; Medical Assessor (MA) certified a permanent impairment of 7% which was not greater than 10%; claimant examined; claimant terminated examination before conclusion; Held - Review Panel diagnosed persistent depressive disorder and somatic symptom disorder; Review Panel satisfied claimant's psychological injuries were caused by the accident; degree of permanent impairment resulting from claimant's psychological injuries caused by the accident is 6% which is not greater than 10%; MA included specific percentage in certificate therefore MAC revoked.

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

1. revokes the certificate of Medical Assessor Christopher Canaris dated 9 February 2024, and
2. issues a new certificate determining that the injuries caused by the motor accident, being persistent depressive disorder and somatic symptom disorder, give rise to a permanent impairment of 6%.

1. On 28 September 2018, Andriuous Youekana (claimant) was involved in an accident on Campbelltown Road. A large truck merged into his lane, hitting the front of his vehicle and causing his vehicle to flip four times (accident).
2. AAI Limited t/as GIO (insurer) is the relevant insurer for the purposes of the Motor Accident Injuries Act 2017 (NSW) (MAI Act).
3. These proceedings involve a dispute between Mr Youekana and the insurer about Mr Youekana's degree of permanent impairment, for the purposes of the MAI Act, as a result of any psychological injury caused by the accident.
4. Medical Assessor Christopher Canaris assessed Mr Youekana and issued a certificate dated 9 February 2024. The Medical Assessor certified that Mr Youekana's psychological injury caused by the accident, being post-traumatic stress disorder in partial remission, persistent depressive disorder (dysthymia) with persisting major depressive episode, and somatic symptom disorder with predominant pain, has resulted in a permanent impairment of 7% being not greater than 10% for the purposes of the MAI Act.
5. Mr Youekana sought a review of Medical Assessor Canaris's assessment. On 11 June 2024, the President's delegate determined there was reasonable cause to suspect Medical Assessor Canaris's assessment was incorrect in a material respect, on the basis that the Medical Assessor did not disclose a clear path of reasoning regarding his assessment and determination.
6. On 6 March 2025 this review panel (Panel) was constituted to conduct a review of Medical Assessor Canaris's assessment (Review).

1. The present dispute involves whether Mr Youekana's "degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%". That is, whether it exceeds the "impairment threshold" for the purposes of the MAI Act.[1] This is relevant to his entitlement to damages for non-economic loss.[2]
2. Section 7.21 of the MAI Act provides that the degree of permanent impairment of an injured person is to be made in accordance with the Motor Accident Guidelines (the Guidelines). Relevantly, it states:

(1) The assessment of the degree of permanent impairment of an injured person for the purposes of this Act is to be made in accordance with the Motor Accident Guidelines. The assessed degree of permanent impairment is to be expressed as a percentage.

(2) Impairments that result from more than one injury arising out of the same motor accident are to be assessed together to assess the degree of permanent impairment of the injured person.

(3) In assessing the degree of permanent impairment, regard must not be had to any psychiatric or psychological injury, impairment or symptoms, unless the assessment of the degree of permanent impairment is made solely with respect to the result of a psychiatric or psychological injury.

(4) A medical assessor may decline to make an assessment of the degree of permanent impairment of an injured person until the assessor is satisfied that the impairment caused by the injury has become permanent."

1. The Guidelines are issued pursuant to s 10.2 of the MAI Act. Version 9.3 of the Guidelines is effective from 6 December 2024 and replaced version 9.2, except for claims arising from motor accidents before 1 April 2023.[3] For such accidents, such as the current accident, certain clauses do not apply, and specific clauses from version 9 of the Guidelines continue to apply.
2. Part 6 of the Guidelines is based on the American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition (AMA4 Guides). Part 6 of the Guidelines is definitive with regard to the matters it addresses but where it is silent on an issue, the AMA 4 Guides should be followed: cl 6.2 of the Guidelines.

1. Under the Guidelines, "impairment" is defined as "an alteration to a person's health status. It is a deviation from normality in a body part or organ system and its functioning. Hence, impairment is a medical issue and is assessed by medical means".[4]
2. The process by which impairment is evaluated is set out in cls 6.17 and 6.18 of the Guidelines. This provides a three-stage process which includes a review and evaluation of all available evidence, an interview and a clinical examination wherever possible, and preparation of a certificate using the methods specified in the Guidelines to determine the percentage of permanent impairment.
3. In respect of the third stage, the determination of psychiatric impairment is to be assessed in accordance with "Mental and behavioural disorders" found in cls 6.201 to 6.228 of the Guidelines: cl 6.35 of the Guidelines.
4. Any psychiatric or psychological impairment must be assessed separately from any impairment resulting from a physical injury: cls 6.36 to 6.37. Accordingly, in determining Mr Youekana's impairment resulting from his psychological or psychiatric injuries, the Panel must not take into account any impairment resulting from his physical injuries.

1. This is a medical dispute as defined in s 7.17 of the MAI Act and constitutes a medical assessment matter pursuant to Schedule 2, cl 2. It was referred to the Personal Injury Commission (Commission) for assessment under Division 7.5 of the MAI Act.
2. The Panel is to conduct the Review in accordance with s 7.26 of the MAI Act. Section 7.26(5A) of the MAI Act provides that the panel is to be constituted by two Medical Assessors being specialist medical practitioners and a Member assigned to the Motor Accidents Division of the Commission.
3. The Review is not limited to a review of only that aspect of the assessment that is alleged to be incorrect and is to be by way of a new assessment of all the matters with which the medical assessment is concerned: s 7.26(6) MAI Act.
4. The Panel is required to form its own opinion on the medical question in dispute by reflecting on the panel members' professional judgment and expertise; it is not to choose between competing opinions, nor to assess the correctness of such opinions.[5]

1. On 9 February 2024, Medical Assessor Christopher Canaris undertook a medical assessment of Mr Youekana and, in his certificate dated 9 February 2024, determined that Mr Youekana's psychological injuries give rise to a permanent impairment of 7%, being not greater than 10%.
2. Medical Assessor Canaris diagnosed Mr Youekana with post-traumatic stress disorder in partial remission, persistent depressive disorder (dysthymia) with persisting major depressive episode, and somatic symptom disorder with predominant pain (noted to be not assessable for whole person impairment).
3. Medical Assessor Canaris noted he had considered the documentation and the submissions of the parties.
4. An interpreter was present for the duration of the assessment.
5. Mr Youekana's pre-accident and psychosocial history was recorded. It was noted that he drank one or two beers most days. He is reported to have quit smoking prior to the accident but has resumed smoking 10 to 15 cigarettes a day. He denied any history of psychiatric illness and any family history of psychiatric illness.
6. The circumstances of the accident were noted. It was recorded that Mr Youekana was very frightened and subsequently shocked in the immediate aftermath of the accident. It was noted Mr Youekana was transported to hospital but left before seeing a doctor. He subsequently attended his general practitioner (GP) for treatment.
7. He was off work for approximately one year, then attempted to return to work for three days per week. He could not handle his job and has not worked since.
8. In addition to pain and attendant limitations, Mr Youekana has been anxious and depressed. He complains of flashbacks of the accident and is an anxious driver, especially around trucks or other large vehicles. He noted he had been "really suffering psychologically" and began to tear up and hyperventilate as he imparted his history. He noted sadness, crying, nightmares and difficulties getting to sleep. He admitted to feeling as though life is not worth living.
9. Mr Youekana is seeing a psychologist and has been prescribed mirtazapine 45mg at night. The Medical Assessor considered Mr Youekana was likely erratically compliant in terms of taking his medication.

1. The Medical Assessor interviewed Mr Youekana via Microsoft Teams. His affect was restricted.
2. In terms of functioning, it was noted that Mr Youekana no longer works due to his physical issues. He spends his day at home with his wife, whom he takes to her appointments and goes shopping for her.
3. He continues to drive and denied feeling anxious when driving, although when specifically asked, reported feeling "very worried" when he saw trucks. His trips are restricted to "30 to 40 minutes only" due to physical limitations.
4. He reports poor energy levels. His daughter helps with cooking and cleaning. He watches TV and struggles to follow programs. He does not go out socially and does not visit family. Visitors to his home are "very rare".
5. He denied any arguments with his wife or family and notes he "just keep[s] to myself". There is no intimacy with his wife because of how he feels.
6. He reported showering once or twice a week and changing his clothes two to three times a week.
7. The Medical Assessor referred to and evaluated the documents before him.

1. Medical Assessor Canaris noted Mr Youekana's previous diagnosis of post-traumatic stress disorder and persistent depressive disorder (dysthymia). The Medical Assessor noted that, while there is evidence of post-traumatic symptoms, they are now circumscribed suggesting that this is in partial remission.
2. Medical Assessor Canaris found Mr Youekana's symptoms met the DSM-5 criteria for persistent depressive disorder (dysthymia) with persisting major depressive episode. The Medical Assessor also noted that Mr Youekana's chronic pain warrants a diagnosis of somatic symptom disorder with predominant pain, reflecting the extent to which his pain has come to intrude upon and dominate his life, causing him distress and impairment.
3. Medical Assessor Canaris found that all three conditions were caused by the accident, and that Mr Youekana was free of any psychological symptoms before the accident.

1. Medical Assessor Canaris opined 7% whole person impairment, based on the following allocation in respect of each Psychiatric Impairment Rating Scale (PIRS) category:

(a) category 1: class 2. Medical Assessor Canaris referred to his erratic medication compliance, infrequent showering and changing of clothes, his normal appetite and commentary around not enjoying eating, and the fact his daughter does most of the shopping while his wife does most of the cooking. The Medical Assessor opined that, as best he can tell, Mr Youekana is fundamentally able to look after himself to a reasonable degree, notwithstanding his reliance on family.

(b) category 2: class 3. Mr Youekana does not go out socially and does not visit family. He reported feeling disgusted with life and cannot put up with being with people anymore. Visitors to Mr Youekana's home are "very rare".

(c) category 3: class 2. Mr Youekana continues to drive, denies feeling anxious driving but when specifically asked said he felt "very worried" when he saw trucks. He can only manage trips of 30 to 40 minutes due to physical restrictions.

(d) category 4: class 2. Mr Youekana denied arguments or quarrels with his family and keeps to himself as there is "nothing worth talking about". There is no intimacy with his wife due to how he feels.

(e) category 5: class 3. Mr Youekana's energy levels are poor. He watches TV but struggles to follow programs and does not recall what he watches.

(f) category 6: class 2. Mr Youekana no longer works due to pain. The Medical Assessor noted that Mr Youekana is not employable and, while he nominates his physical problems as the predominate reason for not working, the Medical Assessor opines that his psychological symptoms would also contribute to some impairment in this category. Medical Assessor Canaris also considers that Mr Youekana's limited English would be a factor preventing him from working in a less physically demanding job. The Medical Assessor noted that he was "able only to assign Class 2 in this category in keeping with the Guides".

1. The Medical Assessor made no apportionment for any pre-existing or subsequent impairment, and no adjustment for effects of treatment.

1. 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. The Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application: Rule 128 of the Personal Injury Commission Rules 2021 (PIC Rules).
2. On 6 March 2025, the Panel issued Directions to the parties requiring them each to file a bundle containing submissions and the documents they relied on for the purposes of the Review. On 18 June 2025, the Panel issued further Directions requiring the production of specific clinical records from Mr Youekana's treating medical practitioners.
3. If reference is not made to a document contained in the bundles, it should not be assumed that the Panel was unaware of that material or that the Panel failed to take the material into account.[6]

1. The insurer relies on its submissions to Medical Assessor Canaris dated 18 October 2021 and its submissions to the President's delegate dated 3 April 2024. Despite the Panel's directions to provide only one set of submissions, the Panel confirms that it has considered both sets of submissions. The Panel notes that neither sets of submissions are directed to the Panel's Review. It has considered the submissions in so far as they relate to the task of the Panel.
2. In respect of his psychological injuries, the insurer notes that Mr Youekana alleges post-traumatic stress disorder and a persistent major depressive disorder caused by the accident. The insurer disputes that these psychological injuries give rise to a permanent impairment greater than 10%.
3. The insurer's submissions dated 18 October 2021 largely focus on Mr Youekana's physical injuries said to be caused by the accident and are, in the most, not relevant to the Panel's Review. As recognised by the insurer, a Medical Assessor is only permitted to take into account psychological problems and not physical symptoms in assigning an appropriate class rating under the PIRS.
4. The insurer's submissions dated 3 April 2024 largely focus on Medical Assessor Canaris's assessment and the insurer's response to Mr Youekana's grounds of review. Relevantly, for the purposes of the Panel's Review, the insurer submits that the history obtained from Mr Youekana in relation to his capacity for work is entirely consistent with a class 2 rating.
5. The insurer notes that Medical Assessor Canaris accepted that Mr Youekana suffered from a number of recognised psychological illnesses and submits that, even if the Medical Assessor had determined that the post-traumatic stress disorder was not in partial remission, he would have proceeded precisely as he did. The insurer submits that the opinion the post-traumatic stress disorder was in partial remission had no bearing on the outcome of the medical assessment.
6. In respect of the Medical Assessor's assessment of Class 2 in respect of Adaption, the insurer submits that Mr Youekana's history regarding his capacity to work was entirely consistent with this rating. The insurer submits that the Medical Assessor's comment that he was only able to assign class 2 was due to him being only permitted to consider psychological and not physical symptoms in assigning the appropriate class rating.

1. Mr Youekana relies on submissions dated 24 September 2021 and 12 March 2024 regarding his application for review of the certificate of Medical Assessor Canaris. Despite the Panel's directions to provide only one set of submissions, the Panel confirms that it has considered both sets of submissions. The Panel notes that neither sets of submissions are directed to the Panel's Review. It has considered the submissions in so far as they relate to the task of the Panel.
2. Mr Youekana submits that he suffered post-traumatic stress disorder and persistent depressive disorder with persistent major depressive episode as a result of the accident, as well as physical injuries.
3. Mr Youekana contends that his psychological injuries are greater than 10% whole person impairment based on the medico-legal report of Dr Glen Smith. Mr Youekana was assessed by Dr Glen Smith, psychiatrist, on 9 July 2021. Dr Smith diagnosed him with post-traumatic stress disorder and persistent depressive disorder with persistent major depressive episode. Mr Youekana's submissions extract Mr Youekana's symptoms, as found by Dr Smith. Dr Smith assessed Mr Youekana's percentage of whole person impairment at 19%.
4. It is noted that Dr Sanki referred Mr Youekana to a psychologist, Dr Yasser Mohammad, who provided counselling and examined symptoms of nervousness and ongoing sleep disturbances. Mr Youekana was prescribed anti-depressants on 23 October 2019.
5. Mr Youekana notes that Dr Eric Lim, GP, examined Mr Youekana on 4 December 2018 and diagnosed him with acute stress disorder, as well as physical injuries.
6. In respect of the assessment by Medical Assessor Canaris, Mr Youekana submits that the PIRS was not applied correctly.
7. In respect of Travel, Mr Youekana refers to the Medical Assessor's statement that Mr Youekana "denied feeling anxious when driving" but reported feeling "very worried" when he encountered a truck while driving. Mr Youekana submits this is a translation error as he used the word "worried" in Arabic, which he believed meant anxiety. The interpreter's translation of "anxiety" to "very worried" does not accurately reflect Mr Youekana's continuing anxiety. Mr Youekana states that he continues to experience anxiety when driving, especially when near trucks. Mr Youekana further submits that this translation error has resulted in the Medical Assessor determining that Mr Youekana is in "partial remission" of his post-traumatic stress disorder.
8. In respect of Adaption, Mr Youekana notes the Medical Assessor applied class 2. He submits that the Medical Assessor did not state the reasons for only being able to assign a class 2. It is submitted that, notwithstanding his physical injuries, the evidence supports a conclusion that Mr Youekana would not be capable of working due to his psychological injuries and symptoms alone. Mr Youekana submits that, based on the evidence, a class 4 or 5 is warranted.
9. It is also submitted that, while Mr Youekana has reduced his alcohol consumption from five to six beers per day to one to two beers per day, he is still heavily reliant on alcohol. Mr Youekana submits that the Medical Assessor did not adequately consider the previously diagnosed alcohol use disorder and has not explained why he failed to diagnose same.

1. Mr Youekana's application for personal injury benefits dated 24 October 2018 has been considered by the Panel. There are no injuries listed in the application.
2. The accident is described as:

"I was on my way to work driving my Toyota Corolla (registration [redacted]) along Campbelltown Road (Freeway) before the exit when a big truck carrying 2 trailers merged into my lane and hit my vehicle. As a result, my car flipped four times."

1. Mr Youekana was conveyed to Liverpool Hospital via ambulance.
2. In response to whether he was suffering an illness or injury affecting the same or similar parts of his body at the time of the accident, Mr Youekana has ticked "No".
3. He reported that he was a self-employed painter but did not provide any details of his length of time off work due to the accident.

1. Mr Youekana's statements dated 24 September 2021 and 8 March 2024 have been considered by the Panel.
2. These statements outline his background. Mr Youekana notes he migrated to Australia in 1995 from Syria via Germany. He has limited English language skills and cannot read or write. He is also illiterate in the Arabic language. He does not have any formal qualifications or training. Upon migrating to Australia, he has worked as a labourer and then a painter. He says he enjoys working.
3. Mr Youekana sets out his recollection of the accident. He notes he was driving to work and a truck appeared alongside him in the right lane. As they were driving a similar speed, the vehicles drove alongside each other for approximately five minutes. Suddenly, with no warning, the truck entered Mr Youekana's lane and clipped the front right side of his vehicle. This caused his vehicle to flip three or four times and land on its roof. Mr Youekana was wearing his seatbelt and sitting upside down when the car stopped rolling.
4. Mr Youekana reports that after the accident he was in a state of shock. He became afraid and anxious.
5. He tried to get out of the vehicle but could not, and found he was trapped in his vehicle. A passerby opened his door and aided him out of the vehicle.
6. He reports that he initially did not want to go to hospital but was convinced by paramedics. He was conveyed to Liverpool Hospital via ambulance. He was assessed and then discharged after approximately four hours. An X-ray undertaken at the hospital revealed a fractured rib.
7. Mr Youekana reports that he was unable to drive for approximately five months following the accident due to his anxiety. He reports being scared and anxious in cars, especially when trucks pass by. Once he returned to driving, he would panic if he saw a truck and would need to stop the car to wait for the truck to pass.
8. Mr Youekana reports undergoing physiotherapy treatment for approximately one year after the accident. He notes it helped "a bit" but his pain would return.
9. Mr Youekana notes he was having difficulty sleeping and had recurrent nightmares about the accident. He states:

"I couldn't forget the memory of rolling in the vehicle and then being stuck, and the panic and fear that I experienced. I also experienced very low mood as I had always prided myself on working hard and providing for my family".

1. He reports seeing Mr Yaser Mohammad, psychologist, approximately two months after the accident. However, he ceased the sessions in mid-2020. Mr Youekana reports that he does not like talking about his problems, so was not keen to find another psychologist.
2. Mr Youekana was off work for approximately one year following the accident. He returned to light / restricted duties in February 2020 but ceased work in July 2020 as he found it was making his symptoms worse. Mr Youekana notes that he loves to work and feels "useless" when not working.
3. Mr Youekana reports that he "cannot do much at all" and relies on the support of his family. He does not want to engage or interact with people, which has a negative impact on his relationship with friends and family. He reports ongoing difficulties with memory and concentration. He feels "very hopeless" when he thinks about his future.
4. He lists "anxiety and depression; difficulty sleeping; and irritability" as ongoing symptoms. He finds it painful and uncomfortable getting up in the morning and spends most of his days lying in bed or on the couch.
5. He notes he was involved in a subsequent motor vehicle accident in late March 2020, where he was rear-ended by another vehicle. He did not make a claim in relation to that accident.
6. Mr Youekana's supplementary statement of 8 March 2024 notes that in Arabic there is no word that specifically translates to "anxious" or "anxiety". The closest word is "worry", which was the word used by Mr Youekana. Mr Youekana states he has been and remains very anxious while driving since the date of the accident, and especially near trucks.

1. The clinical records of Dr Gias Swid, GP, as at 26 July 2021 have been considered. These are handwritten notes with Mr Youekana's first attendance appearing to be on or around 24 October 2005. There is an entry that appears to come above this record but, due to the nature of the scan, it is not legible to the Panel.
2. On 31 January 2014, the notes record that Mr Youekana was recommended to undertake counselling and patches to assist him to cease smoking.
3. On 17 January 2019, it is recorded "...seeing Dr Sanki and his wife regarding MVA and about insomnia and psychologist, 2 choice and best for him, on third party, explained".
4. On 4 November 2019, it is recorded:

"seeing Dr A. Sanki & medical centre for a MVA happened on 29-9-18 & since then feeling down, depressed, sad, lack of sleep (insomnia), nervous at home, isolated, not mixing ... living at home with his wife & 3 children & currently not working & Dr Sanki advised him to see psychologist Yasef Mohammed under Medicare, arranged plan, TF & Kit Ten." [sic]

1. A GP Mental Health Plan dated 9 November 2019 notes that Mr Youekana had symptoms of "nervousness, depressed mood & sad; isolated, not missing with others; feeling down, apathy". This was reported to be post a motor vehicle accident on 28 September 2018. He was diagnosed with "PTSD, depressed mood, anxiety", and referred to Dr Yassem Mohammed for counselling sessions, relaxation, ventilation and CBT. Mr Youekana undertook a K10 test, with a score of 41/50.
2. On 9 November 2019, it is recorded that Mr Youekana was to "see Dr Y Mohammed for sessions kit (10) done, score 41/50".
3. The Panel was not able to identify any other references to psychological illnesses or injuries in the clinical notes of Dr Swid.

1. The clinical records of Fairfield District Medical Centre as at 23 March 2020, 30 December 2020, 27 June 2022 and 7 July 2025 have been considered. It is noted that there are numerous attendances that are not related to the accident or the issues in dispute.
2. On 4 October 2018, Mr Youekana attended upon Dr Soheir Sanki. It was recorded that he had a motor vehicle accident on 28 September 2018 and noted:

"Was hit from front of car. He was driving with 110 speed and next to him was a truck travelling at that speed and it hit him and car rolled 3 times. He got out of car and recalled accident. Now complaining lower back pain, rt shoulder and neck." [sic]

1. On 16 October 2018, Mr Youekana attended upon Dr S. Sanki. It was recorded that there was an argument between Mr Youekana and the doctor with respect to the doctor's completion of the relevant insurance form.
2. On 17 January 2019, Mr Youekana attended upon Dr Antione Sanki. It was recorded "Nervous. Psychological". A referral to Dr Mohammad Yaser was created.
3. On 6 February 2019, Mr Youekana attended upon Dr Mohammad Yaser. It was noted that he was involved in a motor vehicle accident on 28 September 2018 and was nervous with ongoing sleep disturbances. His ongoing pain was recorded to exacerbate his low mood.
4. On 24 April 2019, Mr Youekana attended upon Dr Yaser. It was noted that there was a family problem between his wife and parents which exacerbates his low mood.
5. On 12 September 2019, Mr Youekana attended upon Dr Sanki and was referred to a psychologist. Reference is made to a "W/C cert".
6. On 23 October 2019, Mr Youekana attended upon Dr Yaser. It was recorded that his pain affects his libido and exacerbates low mood. It was noted to liaise with Dr Sanki to commence Anafranil (anti-depressant).
7. On 27 November 2019, Mr Youekana attended upon Dr Yaser. It is noted that he reported he has ongoing insomnia and spends his time gardening and swimming in his pool. Counselling was provided. There is no reference to the accident. A referral was prepared to Imad Haloob and a letter to NSW WorkCover.
8. On 14 May 2020, Mr Youekana attended Dr Sanki. It is recorded "Had MVA recently from the back". There are no additional notes regarding this accident.
9. The letter dated 7 June 2020 from Dr Sanki to the insurer has been considered. Relevantly, this notes that on 17 January 2019, Mr Youekana was found to be quite nervous and very depressed, and was referred to see Mr Yaser Mohammad, psychologist, for his post-traumatic stress disorder. It was also noted that, on 6 December 2019, Mr Youekana was seen by psychologist Mr Yaser Mohammad, who described sleep disturbances and advised Mr Youekana to continue physiotherapy and do swimming exercises. References were also made to the provision of WorkCover certificates due to his physical and psychological injuries. Dr Sanki concludes that Mr Youekana is suffering from severe post-traumatic stress disorder as a result of the accident, along with physical injuries.
10. On 4 December 2020, Mr Youekana attended upon Dr Sanki. It is recorded "Surgery Consultation. Sore rt foot swollen midtarsal joints and ankle working 20hours /week for xray; celebrex panadeine forte. w/c certif light duties" [sic].
11. On 21 January 2021, Mr Youekana attended upon Dr Sanki. It is recorded "depressed cranky. Ins stopped".
12. On 29 January 2021, Mr Youekana attended upon Dr Sanki. It is noted this contact was due to Mr Youekana's "Cervical - disc disease; C5 lesion; right shoulder sabacrom bursitis; cervical radiculopathy". Mr Youekana was prescribed Endep 50mg.
13. The final entry is on 8 December 2021, with the exception of a visit to a nurse on 7 July 2025 that has no consultation notes. There are no other references to psychological injuries or symptoms.
14. The pathology reports and referral requests have been considered.

1. The clinical records of Fairfield Superscan as at 2 March 2020 have been considered. The Panel notes that these documents relate to imaging reports of Mr Youekana.

1. The clinical records of H K Medical as at 26 November 2021 have been considered.
2. Mr Youekana's first reported consultation was recorded by Dr Haythem Amir, GP, on 23 November 2020. It is noted that Mr Youekana's pain in the dorsum of the right foot and in the calcaneum is always disturbing him, including disturbing him in the night.
3. On 20 December 2020, the clamant attended upon Dr Amir. It was recorded that he was still complaining of pain in the lower legs and body joints, and suffering from neuropathic pains with the feeling of burning sensations in both feet.
4. On 24 December 2020, Mr Youekana attended upon Dr Amir. It was recorded that "there is multiple levels of lumbar disc prolapse with radiculopathy pain" [sic].
5. On 14 February 2021 and 7 March 2021, Mr Youekana attended on Dr Amir and it was noted that Mr Youekana had evidence of multiple lumbar disc prolapse with radiculopathy pain.
6. On 5 May 2021, Mr Youekana attended upon Dr Amir and reported generalised weakness and tiredness.
7. On 21 July 2021, Mr Youekana attended upon Dr Amir. He reported "severe lower backbends" on the left side of his back, radiating to the left legs. It is noted Mr Youekana has no history of falling down, and no history of lifting a heavy object. It was noted that there was a possibility of muscle spasm.
8. On 26 July 2021, Mr Youekana attended upon Dr Amir. It was noted that he has generalised weakness, tiredness and easy fatigability.
9. On 30 July 2021, Mr Youekana attended upon Dr Amir. It was noted that he is "having backbends; limitation of movement". It is recorded that "He is developing the back pain since his accident before 3 years".
10. On 13 August 2021, Mr Youekana attended upon Dr Amir. It is recorded:

"Still having lower backbends neck pain and right shoulder pain. He is generalise anxious. He had like the accident and he is developing the pain after the extent. Management: Reassure the patients' the patient is in generally having a lot of anxiety due to his and payment." [sic]

1. On 9 September 2021, Mr Youekana attended upon Dr Amir. He is reported to have generalised weakness, tiredness with easy fatiguability. He is noted to be recovering from a COVID-19 infection.
2. On 10 September 2021 and 1 November, Mr Youekana attended upon Dr Amir. The "comments" section of the certificates of fitness / certificates of capacity dated 10 September 2021 and 1 November 2021 is extracted. Relevantly, this notes that Mr Youekana has evidence of depression and anxiety, and "is also on need for the cognitive behaviour therapy relaxation technique".
3. It is noted that there are no other references to psychological or psychiatric symptoms or illnesses in the notes.

1. The clinical records of Dr Yaser Mohammad, psychologist, purportedly as at 7 July 2025, have been considered.
2. The referral letter dated 17 January 2019 from Dr Sanki to Dr Mohammad has been considered. This notes Mr Youekana was referred for back pain and insomnia after a motor vehicle accident, and also notes "PTSD".
3. The letter dated 16 December 2019 from Dr Mohammad to the insurer has been considered. This notes that Mr Youekana has had no change from his previous position, stated on 2 December 2019, and remains very depressed and anxious.
4. The letter dated 22 January 2020 from Dr Mohammad to Dr Gias has been considered. This notes that Mr Youekana is seeing Dr Mohammad for counselling following a referral from his GP. It states that Mr Youekana is suffering from "chronic PTSD" as a result of the accident, with his last DASS 21 results being depression: 30, anxiety: 31 and stress: 35. Mr Youekana reports experiencing long-standing symptoms of low mood in the context of ongoing psychosocial stressors, physical health related difficulties and chronic pain. It was noted that his main symptoms appear to be difficulty sleeping, poor concentration, low attention span and a fearful anxiousness.

1. The clinical notes of Dr Antoine Sanki, GP, purportedly as at 7 July 2025, have been considered.
2. The letter dated 7 November 2018 from Dr Antoine Sanki to Dr Sue Sanki has been considered. This only refers to Mr Youekana's physical injuries.
3. The letter dated 14 November 2018 from Dr Antoine Sanki to the insurer has been considered. This only refers to Mr Youekana's physical injuries.
4. The form completed on 14 February 2019 on the request of the insurer has been considered. The diagnosis only refers to physical injuries. It is noted that Mr Youekana has anxiety impacting participation in his pre-accident activities.

1. The clinical notes of Dr Mahmoud Abu-Arab, clinical psychologist, purportedly as at 8 July 2025, have been considered. The Panel notes that some of the clinical notes are handwritten and difficult to decipher due to the scan quality.
2. The referral letter from Dr Amir to Dr Abu-Arab dated 12 January 2022 has been considered. This notes that Mr Youekana is suffering from an increase in his anxiety and depression symptoms after an accident due to his chronic pain.
3. The handwritten clinical notes of Dr Abu-Arab have been considered. These date from 28 February 2022 to 13 September 2023. They refer to Mr Youekana's accident and his symptoms such as fatigue, insomnia, sleep issues, sexual disfunction, depression, forgetfulness and panic attacks. They also refer to Mr Youekana being frustrated with the claims process.
4. The letter of Dr Abu-Arab to Dr Amir dated 25 June 2022 and the letter dated 6 July 2022 have been considered.
5. These letters note that Mr Youekana attended six consultations, participating in a Cognitive Behavioural Program to help him overcome his psychological issues. It was noted that Mr Youekana reported the accident left him with significant injuries. The pain that Mr Youekana experiences is present every day for most of the day, and it causes significant distress and impairment in social, occupational and day-to-day areas of functioning.
6. Dr Abu-Arab noted that, as a result of Mr Youekana's pain, he finds it difficult to sleep and maintain good sleep. Mr Youekana described his mood as depressed every day for most of the day. He has lost interest in pleasant activities, feels helpless, hopeless, worthless, tired, lazy, unmotivated and has lost hope that things may improve.
7. He reported difficulty practicing his hobbies and household chores. Dr Abu-Arab noted his wife's cancer diagnosis and that she is undergoing chemotherapy.
8. Dr Abu-Arab diagnosed Mr Youekana with Major Depressive Disorder according to the DSM-5. In Dr Abu-Arab's opinion, Mr Youekana is unfit for work. Dr Abu-Arab noted Mr Youekana attempted returning to work after the accident but was unable to cope.

1. The report of Dr Alan Nazha, pain specialist, dated 31 January 2022 has been considered and evaluated. Dr Nazha reviewed Mr Youekana on 31 January 2022. Dr Nazha noted Mr Youekana's pain in his spine and limbs, including his legs and elbows.
2. Mr Youekana's psychometric scores were noted, including:

(a) DASS-21: extremely severe for depression, extremely severe for anxiety and severe for stress;

(b) pain self-efficacy questionnaire: above the average pain patient, and

(c) pain catastrophising scale: severe catastrophising present.

1. The examination notes and impressions of Dr Nazha have been considered, as well as the treatment plan.
2. The report of Dr Nazha dated 2 August 2022 has been considered and evaluated. This was a follow up appointment after Mr Youekana had undergone the nerve conduction study as referred by Dr Nazha. This was consistent with Mr Youekana's meralgia paresthetica.
3. Mr Youekana reported that his biggest pain complaint is his feet bilaterally, which was a complaint Dr Nazha was unaware of in his initial consult. Dr Nazha recommended Mr Youekana trial Duloxetine.

1. The clinical records of Dr Jayker Dave, orthopaedic surgeon, as at 1 October 2015 have been considered.

1. The clinical records of Dr Nestor Lalak, urologist, as at 20 October 2005 have been considered.

1. The independent medical report of Dr Graham Vickery, psychiatrist, dated 20 July 2022 has been considered and evaluated. Dr Vickery examined Mr Youekana via Telehealth on 5 July 2022. Mr Youekana was accompanied by an interpreter.
2. The report of Dr Vickery noted Mr Youekana was a painter for 30 years until the accident. Following the accident, he attempted to return to work in 2020, however had to cease after six months due to pain. He has no reported psychological or psychiatric history, and no family psychiatric history.
3. It is noted that Mr Youekana has pain in his neck radiating into his right shoulder and his arm, and pins and needles in his three outer fingers. He also has lower back pain radiating into his right leg. Mr Youekana sleeps for three or four hours and wakes at 5.00am. He has a disrupted sleep pattern with his pain.
4. Mr Youekana is reported to avoid socialising due to pain and he has not maintained friendships. He has lost interests as "all I am interested about now is my wife recovering from the cancer". It is noted that Mr Youekana has significant personal stressors associated with his wife having cancer, being hospitalised and undergoing "strong chemotherapy".
5. It is recorded that Mr Youekana undertook six sessions of psychological counselling with Mahmoud Abu-Arab in 2022. Mr Youekana reported that "he encouraged me a lot and gave me advice with the problems I am having".
6. It is noted that Mr Youekana has the ability to perform his general daily tasks. He reports his driving is good, but he does not drive for too long due to pain. He is no longer running due to his pain perception.
7. The circumstances of the accident were noted. It is noted that Mr Youekana is managed on a NASA antidepressant Mirtazepine.
8. Dr Vickery opined that the accident was minor in nature and would not have caused any permanent psychiatric impairment. He notes that there have been personal stressors causing "low mood". Dr Vickery also refers to the notes of Dr Mohammed on 24 April 2019 which record "there was a family problem between his wife and his parents which exacerbates his low mood".
9. Dr Vickery referred to the medicolegal report by Orthopaedic Surgeon Dr Anthony Smith dated 12 November 2020, the consultation notes of Dr Haythem Amir dated 11 November 2021, and the medicolegal report by Occupational Physician Dr Andrew Keller dated 1 April 2020. Dr Vickery opined that there was no acute trauma noted following the accident and that "he has recovered" from his injuries. There is no medical evidence for Mr Youekana's incapacitating pain and significantly restricted functionality being due to the accident. There is no relationship of Mr Youekana's complaints or disability being due to the accident. Dr Vickery noted there are inconsistencies in relation to the lack of any evidence for Mr Youekana's incapacitating pain and significantly restricted functionality being due to the accident.
10. Dr Vickery concluded that there is no recognised psychiatric illness as a result of the accident, and that there is no psychological incapacity related to any recognised psychiatric illness caused by the accident. Accordingly, Dr Vickery opined there was no whole person impairment due to the accident.

1. The medico-legal report of Dr Glen Smith dated 9 July 2021 has been considered and evaluated by the Panel. Dr Smith examined Mr Youekana via Telehealth on 9 July 2021 with an interpreter.
2. Dr Smith noted Mr Youekana's background and that he denied a history of significant anxiety and depressive symptoms prior to the accident.
3. Dr Smith noted the circumstances of the accident. He noted Mr Youekana stated he was "shocked, scared and terrified" and trapped inside his vehicle for around 10 minutes and unable to self-extricate.
4. Dr Smith noted that, from a psychological perspective, Mr Youekana stated he felt "depressed, angry, in pain" after the accident. He could not drive for five months and reported experiencing recurrent, intrusive distressing memories, flashbacks and nightmares of the accident. Mr Youekana reported that his nightmares had reduced in frequency but continued to experience them monthly.
5. Mr Youekana reported that he had commenced psychological therapy around two months after the accident and had weekly sessions until around mid-2020. He had not been prescribed any anti-depressant medication and had not been referred to a psychiatrist.
6. Dr Smith noted that Mr Youekana described his mood as sad and angry with no clear diurnal mood variation. Dr Smith reported that Mr Youekana reported a reduced interest and enjoyment of activities and low energy. He described ongoing pain in his neck, shoulders and legs. He reported sleep disturbance characterised by initial insomnia, and that he sleeps from around 10.00pm until 4.00am. He described difficulties with memory and concentration. He described a sense of hopelessness regarding the future. He avoids trucks when driving and remains hypervigilant on the road.
7. Dr Smith reported that Mr Youekana consumed alcohol only rarely and smokes 15 cigarettes per day.
8. Dr Smith noted Mr Youekana described his mood as depressed and angry and his affect was restricted to the depressed range with minimal appropriate reactivity. He reported feelings of worthlessness, but denied plans to act on those thoughts. Mr Youekana was reported to be alert and oriented. With respect to insight, Dr Smith noted Mr Youekana stated he felt depressed due to the pain and not being able to work, and that he felt anxious regarding driving.
9. Dr Smith made a provisional diagnosis of post-traumatic stress disorder and persistent depressive disorder with persistent major depressive episode based on the DSM-5. Dr Smith opined that Mr Youekana's condition may improve with the prescription of anti-depressant medication. However, given that Mr Youekana continued to present with significant symptoms for almost three years after the accident, his condition could be said to have stabilised.
10. Dr Smith opined that Mr Youekana suffered a whole person impairment of 19% based on the following:

(a) category 1: class 2. Mr Youekana showers daily but has low motivation for meal preparation and household duties. His wife is responsible for most cleaning and meal preparation duties;

(b) category 2: class 3. Mr Youekana described marked restriction in social and recreational activities. He sometimes swims at home during summer months;

(c) category 3: class 2. he drives alone but feels very anxious, particularly in the vicinity of trucks. He avoids travelling at high speed on motorways due to his anxiety of being involved in another serious motor accident;

(d) category 4: class 2. he described a strained in the relationship with his wife but no period of separation or violence;

(e) category 5: class 3: Mr Youekana reported difficulties with thinking and concentration likely attributable to his anxiety and depressive symptoms, and

(f) category 6: class 5. Mr Youekana has not worked since July 2020 and presented as completely unfit for employment due to his anxiety and depressive symptoms with associated difficulties with thinking and concentration.

1. There was no adjustment for the effects of treatment and no deduction for pre-existing impairment.

1. The Liverpool Hospital Emergency Department discharge referral dated 28 September 2018 has been considered. This refers to Mr Youekana having been in an accident with a truck while driving at "110kg/hour", which the Panel infers to be a reference to "110kmph". It was noted that he was able to get out of the car by himself and was feeling fine and mobilising with no issues. There are no references to psychological symptoms.

Certificates of capacity / certificates of fitness

1. The certificate of capacity / certificate of fitness which is undated but refers to capacity between 16 October 2018 to 14 November 2018 refers only to Mr Youekana's physical injuries and treatment.
2. The certificate of fitness / certificate of capacity dated 17 January 2019 diagnoses "depression anxiety insomnia lumbar radiculopathy, shoulder supraspinatus tendinitis [sic]". Treatment / medication is noted to be "Panadol osteo, counselling". Mr Youekana is certified to have some capacity for work
3. The certificate of fitness / certificate of capacity dated 12 September 2019 diagnoses "disc injury lumbar spine, depressive disorder". Treatment / medication is noted to be "anxiety depression and psychologist" with a referral to "Mohammed Yasser". Mr Youekana is certified to have no capacity for work.
4. The certificates of fitness / certificates of capacity dated 24 August 2018, 21 March 2019, 5 April 2019, 30 April 2019, 1 July 2019, 21 October 2019 and 1 November 2019 refer only to Mr Youekana's physical injuries and treatment. The certificates dated 5 April 2019 and 1 July 2019 also note, under referrals, "Yasser Mohammed" and "to see psychologist", respectively.
5. The certificate of fitness / certificate of capacity dated 2 December 2019 diagnoses "cervical spine disc lesion, depressive disorder, impotence, lumbar spine disc". Treatment / medication is noted to be "analgesics". Mr Youekana is certified to have no capacity for work.
6. The certificate of fitness / certificate of capacity dated 13 January 2020 diagnoses "back injury, L4/5 disc injury, cervical spine injury, depressive illness". Treatment / medication is noted to be "Panadol osteo, counselling". Mr Youekana is certified to have some capacity for work.
7. The certificates of capacity / certificates of fitness dated 3 February 2020, 2 March 2020 and 1 April 2020 diagnose "lumbar and cervical disc lesion, depressive state, insomnia". The certificate dated 2 February 2020 lists "lyrica" under treatment/medication, the 2 March 2020 lists "counselling" as treatment, while the 1 April 2020 certificate lists no treatment. Mr Youekana is certified to have no capacity for any employment.
8. The certificates of capacity / certificates of fitness dated 14 May 2020 and 15 June 2020 are mainly blank. They do not diagnose any injuries or list any management or treatment. The capacity for work section has not been completed.
9. The certificate of capacity / certificate of fitness dated 10 August 2020 diagnoses "spine disc injuries, depression" and lists no treatment. Mr Youekana is certified to have no capacity for any employment.
10. The certificate of capacity / certificate of fitness dated 9 October 2020 diagnoses "cervical and lumbar disc lesions, depressive disorder, RT shoulder injury" and lists treatment as "panadeine forte". Mr Youekana is certified to have no capacity for any employment.
11. The certificate of capacity / certificate of fitness dated 4 December 2020 diagnoses "severe injury cervical and lumbar spines, depressive disorder". No treatment is listed. Mr Youekana is certified to have capacity for "some type of work" but this capacity is not specified.
12. The certificate of capacity / certificate of fitness dated 29 January 2021 diagnoses "right shoulder suprasp, tendinitis, subacromial bursitis, c5/6 disc bulge + radiculopathy". It lists treatment as "analgesics, tryptanol, physio" and certifies that Mr Youekana has no capacity for any employment.
13. The certificate of capacity / certificate of fitness dated 4 March 2021 diagnoses "right lumbar radiculopathy, cervical radiculopathy, depression", with treatment as "lyrica, panadeine forte". It certifies that Mr Youekana has no capacity for any employment.
14. The certificates of capacity / certificates of fitness dated 20 May 2021 and 21 July 2021 have been considered. These diagnose "lumbar spine injury, radiculopathy" with treatment as "analgesia, exercise, counselling" and certify that Mr Youekana has no capacity for any employment.
15. The Panel notes that all the certificates of capacity / certificates of fitness dated between 15 June 2020 and 21 July 2021 are unsigned, with the exception of the certificate dated 20 May 2021.
16. The certificates of capacity / certificates of fitness dated 10 September 2021, 1 November 2021 and 29 November 2021 have left the "Diagnosis" section blank, but in "Comments" records:

"...He is in need for continuation with the pain killers medications which give him a lot of complications. He is having the evidence of depressions and anxiety. The patient is also on need for the cognitive behavioural therapy relaxation technique. He has a problem with his daily life activity." [sic]

1. "Treatment" is noted as "anti-inflammatory and painkiller". He is certified to have no capacity for work.
2. The certificates of capacity / certificates of fitness dated 11 February 2024, 10 March 2024, 7 April 2024, 5 May 2024, 30 June 2024, 25 August 2024, 29 September 2024, 24 November 2024, 22 December 2024 and 19 January 2025 have left the "Diagnosis" section blank, but in "Comments" record:

"...He is in need for continuation with the pain killers medications which give him a lot of complications. He is having the evidence of depressions and anxiety. The patient is also on need for the cognitive behavioural therapy relaxation technique. He has a problem with his daily life activity ... He is having an increase in the anxiety and depression symptoms. Currently there is no suicidal ideations however he is having insomnia suffering from the chronic pain...Arranging referral to the psychologist for further advice and check. Arranging for him to be continue with the psychologist for further assessment and consider to be review by the psychiatric if it is adequate... increasing the dose of the antidepressant because of the chronic pain." [sic]

1. "Treatment" is noted as "anti-inflammatory and painkiller". He is certified to have no capacity for work.
2. In addition to the above comments, the certificates of capacity / certificates of fitness dated 16 February 2025, 16 March 2025 and 13 April 2025 note:

"...start him with antidepressant to control over his anxiety and deression symptomes [sic] as a result of the chronic pain; having difficult [sic] to control over his anxiety and depression increase his cymbellta to be 120mg instead of 60 and keep avenza on 45mg".

1. The allied health recovery request dated 16 June 2013 is for a psychologist, referred by Dr Haythem Amir. The diagnosis is listed as "major depression, panic attacks". It is noted that Mr Youekana reports excessive anger, low frustration tolerance, pre-occupation with thoughts related to the changes in his ability and general health, worsening memory and concentration, and feeling tired most of the time.
2. He reported difficulty performing household chores and hobbies, panic attacks with difficulty breathing, increased heart rate and the feeling the worse may happen. He reported sexual dysfunction.

Permanent Impairment (Psychological) - Medical Assessor Aman Suman

1. On 13 October 2022, Medical Assessor Aman Suman assessed Mr Youekana and issued a certificate dated 26 October 2022 where he declined to make an assessment as he opined that the injury of post-traumatic stress disorder with depressed mood as per DSM-5 diagnostic criteria, and pain disorder and alcohol use disorder, were not yet permanent.
2. Medical Assessor Suman noted that the accident was a traumatic life-threatening event for Mr Youekana. It was noted that Mr Youekana felt stressed at home following discharge from hospital. He reported struggling with multiple physical injuries and pain related issues. He avoided driving for approximately three months following the accident and started driving again gradually. Mr Youekana reported experiencing severe anxiety as trucks reminded him of the accident.
3. He reported going back to work in 2020 but gave up after he tried light duties for seven months, stating "I could not cope due to my mental health issues". He reported seeing a psychologist on a few occasions but has not seen one since 2020. He reports being prescribed Zopiclone 7.5mg in 2021 and Mirtazapine 15mg in 2022, which was increased to 30mg. Mr Youekana reported feeling "slightly better on the medication".
4. Mr Youekana reported continuing to struggle with chronic pain symptoms and reports feeling sad all the time, "I don't enjoy anything". He started drinking an increasing amount of alcohol and reported consuming approximately six beers a day over the last six to eight months. Medical Assessor Suman noted that Mr Youekana's description indicates him using alcohol to manage his mental health issues and pain symptoms. Medical Assessor Suman considered his presentation satisfies the diagnosis of alcohol use disorder.
5. Mr Youekana rated his mood at 5/10 during the mental health examination. He was reported to present with a mix of dysphoric and anxious affect with restricted affective range and reactive. He was noted to continue to experience post-traumatic stress disorder symptoms, and depressive cognition including thoughts of helplessness and worthlessness. He denied self-harm ideation or thoughts of hurting others.
6. It was noted Mr Youekana sustained multiple physical injuries in the accident and continues to struggle with chronic pain disorder symptoms. The Medical Assessor opined that his mental health stressors have had an adverse effect on his social, occupational and general functioning over the years. The Medical Assessor opined that, while Mr Youekana's presentation / symptoms satisfy the criteria of post-traumatic stress disorder with depressed mood, and pain disorder and alcohol use disorder, his psychological condition has not reached maximum medical improvement considering the limited psychotropic treatment he has had since September 2018.
7. Accordingly, the Medical Assessor did not calculate Mr Youekana's whole person impairment related to his psychological injury.

1. Mr Youekana was assessed by Senior Medial Assessor Mason and Medical Assessor Verma via videoconference through MS Teams. An Arabic interpreter was present.

Psychosocial history and pre-accident history

1. Mr Youekana is a middle-aged gentleman who lives with his family in Fairfield. He reported sustaining both physical and psychological injuries in the accident.
2. Mr Youekana was born in Syria and grew up with his four brothers and four sisters. One of his siblings has now passed away. He was third in the family. His father worked as a labourer, and his mother was a stay-at-home mum.
3. He denied experiencing any traumatic incidents or adverse events. He witnessed war-like situations and lived in poverty, later moving to Lebanon where he saw the war breaking out. He said that he was impacted like "anyone else living in Lebanon but used to go and work like anyone living there." He denied experiencing any mental health symptoms at that time.
4. He immigrated to Australia in 1995 on a marriage visa. He got married here and has two sons and one daughter.
5. He currently lives with his wife and three children in a mortgaged house. His wife receives a disability support pension due to cancer in her limbs. Mr Youekana reported that the insurance paid him money for about two years and then asked him to look for work. He is not currently receiving any payments. He denied receiving any aged pension. His children have supported him since the insurance payments stopped.
6. He previously worked as a painter, mainly in 2020 for about seven months, before ceasing work. He explained he was on light duties and stopped working because he "could not continue working as he had pain in his leg, back, and a fracture in his shoulder and was on medication." He also reported numbness in his right leg, which affected his ability to work.
7. He denied any history of mental health issues, seeing a psychologist or psychiatrist, or being admitted to a mental health unit. He denied any physical health issues before the accident. He also denied any criminal convictions, incarceration, or family history of mental health issues.
8. He underwent knee surgery before the accident but was unsure of the exact type. He said he spent two hours in hospital and "came out walking on his legs."

1. Mr Youekana was involved in a motor vehicle accident on 28 September 2018. He reported that he was driving an old Toyota Corolla and was a belted driver, with no other passengers in the car. He was heading to work in Campbelltown, on the freeway, around 6.00am. He said that when he was trying to leave the freeway, "a truck which was driving beside his car came and hit his car."
2. He mentioned that the airbags did not deploy and the car landed on the driver's side. He was able to extricate himself from the car on his own, but someone helped him open the passenger door. He was in the car for about 15 minutes before he managed to get out, trying to understand what had happened and unfastening his seatbelt. He said that he got out of the passenger door with some assistance, and someone helped him.
3. He remembered feeling "worried and was shaky and was looking around." He denied losing consciousness at any stage. He stated that the truck involved in the accident stopped a few metres away, and the driver came to check on him. He recalls having "wounds on his hands, legs, and a tear in his shoulder."
4. He reported that ambulance and police attended the scene. However, he was not in a state to take photos or exchange contact details. Later, he found out that "there was something wrong with the driver and the driver denied being in Sydney at that time."
5. Mr Youekana was subsequently transported to Liverpool Hospital by ambulance and underwent an examination. He reported having difficulty passing urine and was advised to wait. Nonetheless, he was unable to wait and walked out of the hospital.

History of symptoms and treatment following the motor accident

1. Mr Youekana reported that he started experiencing both physical and psychological symptoms after the accident.
2. Pain symptoms: He added that he had "problems in his knees and had pain on the right leg and right side of his back". He would often rely on pain relief medications but eventually stopped because they were not very effective. He said that the "pain affected his sleep, which in turn affected him mentally." He was unable to work due to his ongoing pain, which he described as "quite devastating." He did not need to undergo any surgeries or interventions after the accident. He saw a specialist and was advised to have surgery, but he was hesitant when they explained how the surgery would be performed. He was also recommended a back surgery but declined it because he was scared about the procedure itself. He saw a physiotherapist and was referred to a pain specialist, Dr Nazha, and also consulted a neurologist for numbness in his right leg.
3. Mental Health: Mr Youekana reported feeling short-tempered and agitated. He said that once he felt uneasy, he would "start breaking everything." He gave an example of when he was at a clinic about three years ago and a patient came in front of him. This made him quite annoyed and irritable, so he walked out. A similar incident occurred at a mental health practice as well. His sleep was disturbed; he stayed up feeling anxious and sometimes got up early, feeling drowsy throughout the day. He went to bed late. His sleep was also disrupted because he had to go to the toilet two to three times, feeling a sense of urgency. He had some scans and was told there were kidney stones, and more recently, he was informed he has some prostate issues. He was at the doctor's clinic about two days ago and was assured that everything was okay, except that he would need to be on medication.
4. Mr Youekana also reported difficulty with driving. He felt tired and was unable to drive as frequently as before. There were no changes in his appetite. However, he gained 2-3 kg in the last year; he previously weighed 79 kg, and now his weight is 77 kg. He also experienced anxiety and "felt lost." He denied specific anxieties and said he worries about day-to-day things. He felt lost and, having lost his sense of purpose and no longer working, he started comparing his life before the accident, feeling unwell and unhappy afterwards. His energy levels and motivation were low. He felt "tired" performing simple tasks at home and often procrastinated, disregarding responsibilities. He reported working for seven months in 2020.
5. The Medical Assessors asked about the documents indicating he worked 20 hours per week. He explained that he saw his doctor because of knee pain and was diagnosed with osteoarthritis. He said the doctors did not explain much, just wrote prescriptions and asked him to leave.
6. When asked why he stopped working, he replied, "I don't understand what you mean by these questions." The Medical Assessors pointed out the fracture in his second metatarsal from the notes of Dr Amir on 16 June 2021. He responded, "I can tell you that I had pain in my leg, but I am hearing such things from you for the first time." He questioned, "Where did that come from?" and clarified, "I understand exactly, but I don't have any fracture in my right foot, as I used to stand for long periods, and I worked as a painter."
7. The Medical Assessors also asked about the precise duration and timings of his employment, and he said, "I'm not sure of the dates." The Medical Assessors then informed him that it was documented in the notes from Fairfield Medical Centre and HK Medical, to which he denied, then abruptly logged out of the meeting.

Details of any relevant injuries or conditions sustained since the motor accident

1. Mr Youekana was involved in another accident "probably three to four years ago". He said he was picking up his son when a car came from behind and rear-ended him. His car was stationary at the time, and the other car rear-ended his vehicle. He denied having any physical or psychological injuries. He mentioned that the accident did not affect him in any way. He said that the first accident was a "major incident" and his car was "flying in the air," while the second was a "slight accident."

1. Mr Youekana reported that he continues to experience similar symptoms as before. His pain is "the same and there has been no change". He has, however, stopped the pain relief medication and only takes "cholesterol and mental health tablets".
2. On a typical day, he wakes up around 6.00am, makes coffee with milk, and watches TV. He then smokes a cigarette, goes out, and comes back. He spends time "going to the backyard", "eating and sleeping", and that is how he "spends his time".
3. The Medical Assessors were unable to get more information about Mr Youekana's current symptoms, as he logged out abruptly before we finished our interview.

1. Mr Youekana is currently on the cholesterol-lowering medication Rosuvastatin 10 mg, the antidepressant Mirtazapine 45 milligrams, and Tamsulosin 400 mcg for prostate problems.
2. He continues to see a physiotherapist. He is not currently seeing a psychologist. He previously saw a psychologist about two years ago and had around "15 to 20 sessions.' He has not seen a psychiatrist for treatment purposes. He consults his GP regularly.

1. As noted above, the Medical Assessors reviewed Mr Youekana via video. He engaged well during the first half of the assessment; however, when the Medical Assessors' started highlighting inconsistencies and clarifying information, he started becoming irritable. Towards the end of the examination, he said, "I am tired, and I can't continue, and I don't want anything from insurance" and logged out abruptly.
2. He reported his mood to be low, and his affect was irritable. His thoughts were logical and goal-directed. His speech was coherent, relevant, and normal in volume and tone. He reported ongoing pain symptoms, anxiety and sleep disturbances since the accident. There was no evidence of any manic, psychotic or any perceptual abnormalities. He had insight into his condition, and his judgment was intact.

1. Self-care and personal hygiene: Mr Youekana reported that he showers once a week, but at times he doesn't feel like doing so. He has dentures and takes care of them. He changes clothes once every two to three days. He lacks patience and motivation to do these activities and has lost interest in grooming. He also reported experiencing pain in his back and leg, which does not affect his ability to do activities of daily living and personal hygiene. He said that he never did any household chores even before the accident and therefore he does not do any now.
2. Social and Recreational Activities: Mr Youekana used to enjoy walking, running, and swimming. He no longer takes part in these activities because he is "unable to do these activities because of the pain in his leg." He mentioned that, especially in the winter, the pain gets worse, which further limits his activity. He can sometimes swim in his backyard pool during summer and also enjoys gardening on occasion. He added that he had one close friend. However, a long time ago, before the accident, they had an argument and he hasn't spoken to him since. He explained that even before the accident he only had acquaintances whom he would say hello to and rarely saw. He said, "I was the person who liked to stay at home even before the accident." Currently, his brother visits him regularly, and they chat and watch TV together when he comes over. He has stopped attending weddings and church services. However, he is able to go out and take his wife to her appointments.
3. Travel: He drives himself to medical appointments and can drive for up to 45 to 60 minutes. He can also drive his wife to the hospital and will pick up and drop off his son, who works in Lidcombe, about a 45-minute drive away. He travelled to Melbourne two months ago to visit his mother. He enjoyed his trip and was happy to see her, although he felt mixed emotions since she was unwell and did not recognise him. He denied travelling overseas.
4. Social function. Mr Youekana reported that he has a good relationship with his wife. He said that she is unwell, but they still are able to joke at times. He said that her health has improved a little bit. He said that soon after the diagnosis, he was stressed but now denied being stressed about the cancer diagnosis. He has a positive relationship with his children. However, he does not like to join in birthday parties at restaurants due to his low mood.
5. Concentration, Persistence and Pace: Mr Youekana reported that his attention, concentration and ability to focus are poor. He struggles to focus when talking to someone and often has to ask them to repeat. He forgets the storyline and the characters of the TV programs that he watches. He does not play any video games. He did not read any books before the accident and has not done so since. The Medical Assessors inquired if he does any home maintenance, to which he said that "sometimes he can do it and sometimes he cannot."
6. Adaptation: Mr Youekana has the ability to work full-time, but in a different environment from that of his pre-injury job. He was able to return to work and work for around seven months in 2020 but then had to stop working because of the physical injuries.

1. The Medical Assessors tried to highlight the inconsistencies between the contemporaneous documents and the history given by Mr Youekana. However, they were not able to highlight all the inconsistencies as Mr Youekana abruptly terminated the assessment.
2. The Panel was also unable to ask Mr Youekana about his current alcohol use given his termination of the assessment. As the Guidelines require the Panel's assessment of Mr Youekana's impairment to be based on its evaluation at the time of the medical examination, it was unable to make a determination as to any reliance on alcohol.
3. The Panel notes that, based on Mr Youekana's comments when he terminated the assessment, the Panel determined that it was not appropriate to schedule a further assessment. Additionally, the Panel notes that Mr Youekana did not request a further assessment occur.

1. The Panel adopts the reasons and findings of the examination undertaken by the Medical Assessors of the Panel as set out above. The Panel confirms that its assessment of Mr Youekana's impairment is based on the evaluation at the time of the medical examination as required by the Guidelines. Reliance has been placed on the combined clinical expertise of the Medical Assessors on the Panel.

1. The Panel finds that Mr Youekana's presentation is consistent with a diagnosis of persistent depressive disorder. This is based on the Panel's findings in terms of the DSM-5-TR criteria, being:

(a) At the time of the assessment Mr Youekana reported feeling low for most of the days, low energy and fatigue levels, low self-esteem, insomnia and poor concentration. He has been experiencing these symptoms for more than two years and has never been without symptoms for more than two months at a time. This satisfies criterion A, B and C.

(b) There has never been a manic episode, a mixed episode, or a hypomanic episode, and the criteria for cyclothymia have never been met. This satisfies criterion E.

(c) A psychotic disorder does not better explain the symptoms and there has never been a schizoaffective disorder, schizophrenia, schizophrenia spectrum or other psychotic disorder. This satisfies criterion F.

(d) The disturbance is not due to direct physiological effect of any substance or any general medical condition. This satisfies criterion G.

(e) The symptoms cause clinically significant distress and impairment in important areas of functioning, like self-care and personal hygiene. This satisfies criterion H.

1. The Panel finds that Mr Youekana fulfils the DSM-5-TR diagnostic criteria for the diagnosis of persistent depressive disorder.

1. Panel noted the chronic pain symptoms that Mr Youekana has been experiencing. The Panel finds that his symptoms also fulfil the DSM-5-TR criterion for Somatic Symptom Disorder, as set out below:

(a) his somatic symptoms are distressing and result in significant disruption of daily life (criterion A);

(b) he has excessive thoughts, feelings and behaviours related to the somatic symptoms and associated health concerns, manifested by disproportionate and persistent thoughts about the seriousness of his symptoms, persistent high level of anxiety about health or symptoms, and excessive time and energy devoted to those symptoms and health concerns (criterion B);

(c) his state of being symptomatic is persistent and has presented for more than six months (criterion C), and

(d) his diagnosis is with predominant pain (previously pain disorder), as his somatic symptoms predominately involve pain.

1. The Panel considered whether Mr Youekana satisfied the DSM-5 criteria for post-traumatic stress disorder.
2. Mr Youekana did not report any significant intrusive symptoms associated with traumatic events. Therefore criterion B was not satisfied.
3. The Panel noted ongoing anxiety; however, it was not explicitly associated with the accident itself. He also did not report any persistent avoidance of stimuli, and Mr Youekana was able to talk about the accident without being obviously distressed. He did not report actively avoiding the site of the accident or driving itself. Therefore the Panel finds that criterion C was not satisfied.
4. The Panel noted his subjective problems with concentration, attention and irritability. However, there were no reports of any hypervigilance or exaggerated startled response.
5. The Panel finds that Mr Youekana does not meet the DSM-5-TR criteria for post-traumatic stress disorder, as he does not fulfil diagnostic criterion B and C.

1. Clause 6.5 of the Guidelines provides that a determination of whether the injured person's impairment is related to the accident is implied in all assessments. In addition to the relevant provisions of the AMA 4 Guides, the common law principles also apply in considering such issues. Accordingly, it is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychiatric condition.[7]
2. Clauses 6.6 to 6.7 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. In respect of the applicable common law principles, causation of injury is required to be established on the balance of probabilities. Mr Youekana is not required to establish causation to the level of medical certainty.[8]
2. The provisions of the Civil Liability Act 2002 (NSW) (CL Act) apply in determining causation.[9] It is therefore necessary to consider whether the accident caused or contributed to the diagnosed psychiatric condition. The accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible.[10]
3. As noted above, Mr Youekana's current presentation aligns with a diagnosis of persistent depressive disorder and somatic symptom disorder.
4. The Panel notes the accident involved a high level collision with a truck, which resulted in Mr Youekana's vehicle being flipped numerous times. Mr Youekana's vehicle landed on its roof. He was subsequently trapped in the vehicle for approximately 15 minutes. The Panel finds that the accident could have caused or contributed to the diagnosed psychiatric conditions.
5. The Panel finds that Mr Youekana does not have any predisposing factors such as a history of mental health issues, family history of mental health problems, or personality vulnerabilities that might have contributed to developing persistent depressive disorder.
6. The Panel finds that there is a clear causal and temporal link between the accident and the onset of depressive symptoms and chronic pain. The Panel finds that the accident was a substantial cause of Mr Youekana's persistent depressive disorder and somatic symptom disorder.
7. The Panel also notes the closely intertwined and bidirectional relationship between chronic pain and persistent depressive disorder, and it is the Panel's view that Mr Youekana's chronic pain continues to sustain his ongoing symptoms.
8. The Panel finds that Mr Youekana's diagnosed psychological injuries were caused by the accident.

1. The Panel finds that the following injuries were caused by the motor accident:

(a) persistent depressive disorder, and

(b) somatic symptom disorder with predominant pain.

1. The Panel finds that Mr Youekana does not fulfil the DSM-5-TR criteria for a diagnosis of post-traumatic stress disorder.

1. Permanent impairment is defined in the AMA4 Guides (p 315) as follows:

"Permanent impairment is impairment that has become static or well stabilised with or without medical treatment and is not likely to remit despite medical treatment.

A permanent impairment is considered to be unlikely to change substantially and by more than 3% in the next year with or without medical treatment."

1. Mr Youekana has received psychological treatment and has attended at least 15 to 20 psychology sessions since the accident.
2. He has also been regularly attending upon his GP. His GP initiated antidepressant treatment in around 2022. He has been on Mirtazapine since this time and is currently on 45mg.
3. The Panel finds that he has received evidence-based treatment for persistent depressive disorder in the form of psychological and biological treatment. The Panel finds Mr Youekana has reached maximum medical improvement.
4. This consistent treatment with the ongoing presence of psychological symptoms indicates that Mr Youekana's condition is now stable.
5. The Panel finds that it is unlikely that his mental health would change substantially or by more than 3% in the next year with or without medical treatment.

Degree of permanent impairment psychiatric impairment rating scale

1. The determination as to permanent impairment is made in accordance with the AMA4 Guides and Part 6 of the Guidelines.

Mr Youekana is currently on the antidepressant Mirtazapine 45mg.

He also received psychology treatment after the accident.

Mr Youekana reported that he showers once a week at times but at times doesn't feel like doing so. He has dentures and takes care of them once or twice a week. He changes clothes two to three times a week. He does not have patience or motivation to undertake activities of self-care and personal hygiene. He has lost interest in grooming activities.

He also reported experiencing pain in his back and in his leg, but it does not impact his ability to do activities of daily living and activities of self-care and hygiene.

He said that he never did any household chores even before the accident, and hence, he does not do any now.

The Panel assesses a moderate impairment in his self-care and hygiene based on the above findings.

Mr Youekana enjoyed walking, running and swimming before the accident. He said he is now "unable to do these activities because of the pain in his leg." He notes his pain increases in winter and his activity further decreases. During summer he is able to swim in his backyard pool and also enjoys gardening on occasion.

He had one friend with whom he had an argument before the accident. He has not talked to him since.

He elaborated that, even before the accident, he just had acquaintances to which he would say hello and did not see much. He said "I was the person who liked to stay at home even before the accident." He said that now his brother comes over to visit him. They chat and watch TV together. He has stopped attending weddings and church services. However, he is able to go out and take his wife for her appointments.

The Panel finds that the impairment in social and recreational activities is contributed to by both pain and psychological symptoms, and that his pain is the primary impairment factor. The Panel finds his impairment emanating from psychological symptoms is mild.

Mr Youekana drives to his medical appointments and is able to drive up to 45 to 60 minutes. He is able to drive his wife to the hospital and will pick up and drop his son who works in Lidcombe, which is about 45-minute drive.

Around two months ago, he flew to Melbourne to visit his mother. He enjoyed his time there and was happy seeing her, but had mixed feelings as she was unwell and could not recognise him. He denied traveling overseas.

The Panel finds no or minor deficit where Mr Youekana has demonstrated the capacity to travel independently interstate as well as the capacity to travel to areas in Sydney on his own. While Mr Youekana's submissions refer to him experiencing anxiety while driving, especially when near trucks, the Panel finds that this anxiety does not justify a different class of rating based on Table 6.13.

Mr Youekana reported that he has a good relationship with his wife. He said that she is unwell, but they still are able to joke at times. He said that her health has improved a little bit. He said that soon after her cancer diagnosis, he was stressed but now denied being stressed about it.

He has positive relationship with his children. He said that if they have a birthday party at the restaurant, then he does not like to be there because of his mood.

The Panel finds that he has mild impairment as he has maintained relationships with his family members, although his mood has impacted his participation in some interactions.

Mr Youekana commented that his attention concentration and ability to focus is poor. He cannot focus when talking to someone and has to ask them to repeat things. He forgets the storyline and the characters of the television programs that he watches. He does not play any video games. He does not read any books, and did not do so before the accident.

The panel enquired if he does any home maintenance, to which he said that sometimes "he is able to do it and sometimes he cannot", and that this is dependent on if he has pain or not. If he does not have pain, he can focus on the repairs. As such, the Panel concluded much of this difficulty was due to pain.

The Panel notes that he is able to undertake tasks requiring significant focus such as repairs around the house at times. While he can concentrate on watching television, he has difficulty remembering the stories and characters. This is consistent with mild impairment.

Mr Youekana has the ability to work full-time, but in a different environment from that of his pre-injury job. He was able to return to work and worked for around seven months in 2020. He subsequently had to stop working because of his physical injuries. The Panel finds that he has only mild impairment with regards to his psychological injuries.

Mr Youekana had ability to return to work after the accident but was unable to work because of physical impairment and pain symptoms. The Panel notes Mr Youekana's submissions that he would not be capable of working due to his psychological injuries and symptoms alone.

However, based on its review of the documentation and its clinical examination, the Panel finds that, from a psychiatric point, Mr Youekana only has mild impairment. The Panel finds that his adaptation has been largely impacted due to his pain rather than psychological injuries.

Psychiatric impairment rating scale - pre-existing/subsequent impairment

1. Mr Youekana denied having any pre-existing mental health issues or having any subsequent impairment. The Panel finds that Mr Youekana has no history of mental health issues and therefore makes no apportionment for pre-existing impairment.
2. The Panel noted that Mr Youekana was involved in a subsequent motor vehicle accident in 2020. Mr Youekana denied having any physical or psychological injuries. He mentioned that the 2020 accident did not affect him in any way. He said the first accident was "major" and his car was "flying in the air", while the second (2020) accident was a "slight accident".
3. Based on Mr Youekana's reporting and the treatment records, the Panel does not believe that the 2020 accident exacerbated or impacted his mental health and has made no apportionment.

Apportionment - pre-existing/subsequent impairment

1. The Panel has not made any apportionment for any pre-existing or subsequent impairment.

1. Mr Youekana reported experiencing the same symptoms and that there has been no improvement.
2. No apportionment has been made for the effects of treatment.

(a) The accident caused the following injuries:

(i) persistent depressive disorder, and

(i) somatic symptom disorder

(b) Mr Youekana's degree of permanent impairment resulting from the injuries caused by the accident is 6%, being not greater than 10%.

1. As Medical Assessor Christopher Canaris included a specific percentage (7%) in his certificate dated 9 February 2024, the Panel revokes the certificate of Medical Assessor Canaris and issues a new certificate.

[3] The current version of the Guidelines, v9.3, applies to policies that come into effect immediately after midnight 14 January 2025. For policies that come into effect from 15 January 2024 to 14 January 2025, Part 1 of the Motor Accident Guidelines v9.2 continues to apply: see clause 1.2. The Panel notes that version 10 of the Guidelines has been published but does not commence until 15 September 2025.

[5] Insurance Australia Group Ltd t/as NRMA Insurance v Keen [2021] NSWCA 287 and Insurance Australia Ltd v Marsh [2022] NSWCA 31.

[6] The Panel refers to Roger v De Gelder [2015] NSWCA 211 and Dunbar v Allianz Australia Insurance Ltd [2015] NSWSC 119.

[7] Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75].

[8] Briggs v IAG Ltd (t/as NRMA Insurance) (2024) 106 MVR 203; [2024] NSWSC 3 at [43]- [44].

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