MOTOR ACCIDENTS - Motor Accident Injuries Act 2017; assessment of threshold psychological injury under section 1.6(3); claimant suffered injury as passenger in an accident; psychological condition existing since accident; Medical Assessor found the accident caused adjustment disorder; claimant sought review; Held - claimant had experienced psychological symptoms for more than six months; sustained persistent depressive disorder (dysthymia) from accident; certificate revoked; not a threshold injury.

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

1. The Review Panel revokes Medical Assessor Fukui's certificate dated 5 June 2024.
2. The accident caused the following injury:
   • persistent depressive disorder (dysthymia),

which is NOT a THRESHOLD INJURY for the purposes of the MAI Act.

1. The claimant was injured in motor accident on 28 April 2023 as the passenger of her then boyfriend's car when the insured motor bike collided with the car's rear.
2. A dispute arose about the claimant's entitlements to continuing statutory benefits and damages, because the insurer decided that the claimant's psychiatric injuries arising from the accident were threshold injuries as defined in s 1.6 of the Motor Accident Injuries Act 2017 (the MAI Act).
3. The insurer's original decision to deny liability beyond 52 weeks because it deemed the claimant's injuries to be threshold in nature was made on 14 August 2023, a decision that was affirmed upon internal review on 29 September 2023.
4. After obtaining further medical evidence in the form of a treating report from psychologist

Dr Jung Sook Kim dated 13 November 2023, the claimant requested a further review of the insurer's threshold injury decision in light of this new information pursuant to cl 4.43(c) of the Motor Accident Guidelines (Guidelines) on 12 December 2023. 5. The insurer maintained the decision on 1 February 2024, which lead to a request for a second internal review, in which the insurer again reaffirmed the decision to deem the claimant's injuries to be threshold in nature. 6. The claimant sought a determination from the Personal Injury Commission (Commission) on whether the injuries she sustained from the subject motor accident are threshold or not within the definition of s 1.6 of the MAI Act. The claimant submitted the claimant's psychological sequelae arising from the accident to be assessed and determined. 7. On 17 May 2024 Medical Assessor Fukui of the Commission assessed the claimant and issued a certificate dated 5 June 2024. The Medical Assessor found the accident caused an adjustment disorder with mixed anxiety and depressed mood. This was a threshold injury for the purposes of the MAI Act. 8. The claimant applied under s 7.26 of the MAI Act to refer this assessment to a review panel on the grounds that the medical assessment was incorrect in a material respect. The claimant provided reasons why it opposed that application. 9. The Presidential delegate accepted the claimant's application. 10. The Commission's President constituted this Review Panel (the Panel) to review the above medical assessment (the Review). 11. Following rule 128(1) of the Personal Injury Commission Rules 2021 (the PIC Rules) the Panel 'is to conduct and determine the proceedings in accordance with procedures determined by the panel'. 12. The Panel met on 27 May 2025 to discuss how this matter will proceed. 13. The Panel considered re-examination was required and Medical Assessors Canaris and Gupta arranged to conduct this examination on behalf of the Panel via MS Teams on

16 July 2025. 14. The claimant was also directed to provide up to date clinical notes from her general practitioner (GP) and treating psychiatrist.

1. Part 5 of the Personal Injury Commission Act 2020 (the 2020 Act) enables the Commission to make rules about the practice and procedure before the Commission including proceedings before a panel that will review a decision of a Merit Reviewer or a Medical Assessor.[1]
2. Rules 127 to 130 of the PIC Rules are made under Part 5 of the 2020 Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[2]
3. The term "threshold injury' is defined in s 1.6 of the MAI Act and includes a "threshold psychological or psychiatric injury". A threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness: s 1.6(3).
4. Section 1.6 provides the regulations may exclude or include a specified injury from being a soft tissue injury or a threshold psychological or psychiatric injury. Part 1, cl 4 of the Motor Accident Injuries Regulation 2017 (the Regulation) further define threshold psychological or psychiatric injury to include acute stress disorder and adjustment disorder.
5. Part 5 of the Guidelines are made pursuant to s 10.2 of the MAI Act. The Guidelines contain the procedure for assessing whether an injury caused by a motor accident is a threshold injury for the purposes of the MAI Act. Version 9.3 of the Guidelines commenced in October 2024 and applies to motor accidents occurring on or after 1 December 2017. In respect of assessing whether an injury is a threshold injury, the Guidelines provide:

"5.3 The assessment will determine whether the injury related to the claim is a soft tissue injury or a threshold psychological or psychiatric injury caused by the motor accident.

5.4 Diagnostic imaging is not considered necessary to assess threshold injury.

5.5 A diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer.

5.6 The assessment of whether an injury caused by the accident is a threshold injury for the purposes of the Act should be based on the evidence available and include all relevant findings derived from:

(a) a comprehensive accurate history, including pre-accident history and pre-existing conditions

(b) a review of all relevant records available at the assessment

(c) a comprehensive description of the injured person's current symptoms

(d) a careful and thorough physical and/or psychological examination

(e) diagnostic tests available at the assessment. Imaging findings that are used to support the assessment should correspond with symptoms and findings on examination."

1. Clauses 5.10, 5.11 and 5.12 of the Guidelines refer to the assessment of threshold psychological or psychiatric injury. These clauses provide:

"Threshold psychological or psychiatric injury assessment

5.10 In assessing whether an injury is a threshold psychological or psychiatric injury, an assessment of whether a psychiatric illness is present is essential.

5.11 The assessment of whether a psychiatric illness is present must be made using the Diagnostic & Statistical Manual of Mental Disorders (DSM-5), Fifth Edition, 2013, published by the American Psychiatric Association.

5.12 Where the symptoms associated with the injured person's psychological or psychiatric injury do not meet the assessment criteria for a recognised psychiatric illness, with the exception of acute stress disorder and adjustment disorder, the injury will be considered a threshold injury."

1. Causation of injury is addressed under Part 6 of the Guidelines dealing with permanent impairment:

"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. It is necessary for the Panel to consider whether the accident caused or contributed to the diagnosed psychiatric condition: Briggs v IAG Limited t/a NRMA Insurance [2022] NSWSC 372 at [75]. The motor accident does not have to be the sole cause as long as it is a contributing cause, which is more than negligible: Owen v Motor Accidents Authority of NSW [2012] NSWSC 650 at [50]. Further, the provisions of the Civil Liability Act 2002 apply, in particular s 5D and s 5E.

1. On 17 May 2024 Medical Assessor Fukui of the Commission assessed the claimant and issued a certificate dated 5 June 2024. The Medical Assessor found the accident caused an adjustment disorder with mixed anxiety and depressed mood and was a threshold injury for the purposes of the MAI Act.
2. The Medical Assessor accepted Ms Yun was involved in a minor motor vehicle accident whilst a passenger in a car. She reported suffering physical discomfort immediately after the accident which has become more painful over time.
3. She reported experiencing low mood, nightmares and anxiety related to the motor accident. There has been a decline in her ability to engage in activities of daily living since the motor accident because of her anxiety and depressive symptoms and impacted by her pain complaint.
4. Regarding causation the Medical Assessor was satisfied Ms Yun did not have a psychiatric history. She developed depressive and anxiety symptoms immediately following the subject motor accident which have mildly impacted on her level of functioning.
5. The timing of the onset of her symptoms and the characteristic nature of her symptoms was consistent with the subject motor accident being causally related to her psychological injury.
6. The Medical Assessor did not refer to the relevant DSM-5 criteria when assessing the condition as an adjustment disorder with mixed anxiety and depressed mood.

1. The police report classified the accident as a minor traffic crash.
2. The claimant's application for personal injury benefits related only to physical injuries.
3. The Initial Needs Assessment Report of ReCare Services dated 19 May 2023 noted that the claimant reported feeling increased "nervousness" and mood changes while documenting a request from her GP, Dr Lee, for approval by the insurer for psychological treatment.
4. An activity of daily living report dated 10 July 2023 noted that she was soon to start psychological treatment. A vocational assessment report dated 19 July 2023 noted her to be oriented in time and place, to have unremarkable thought and speech content, to have intact cognition concentration, and to be not attempting to solicit reassurance or reinforcement.
5. Medical Assessor Nelukshi Wijetunga dated 18 June 2024 determined that the claimant's physical injuries comprising a whiplash associated disorder to the cervical and thoracic spine and musculoligamentous sprain of the lumbar spine were threshold injuries for the purpose of the MAI Act.
6. Treating psychologist, Dr Jung Sook Kim's report dated 13 November 2023 diagnosed the claimant with major depressive disorder and generalised anxiety disorder with specific phobia. Dr Kim outlines DSM-5-TR diagnostic criteria. It also noted Dr Kim's clinical notes which documented feeling anxious in a car, nauseous in a car, loss of confidence and self-esteem is the worker, and lack of motivation, sleeping problems, tiredness, lack of energy, dizziness, poor appetite, irritability sensitivity over little things, agitation, difficulty coping, social withdrawal, avoidance behaviour, inability to relax because of intrusive thoughts, recurrent memories in relation to the accident, feelings of shame, confusion, memory difficulties and an "Unclear mind".
7. Dr Jung Sook Kim diagnosed depression and anxiety and in later consultations noted loss of libido, feelings of hopelessness and helplessness, low mood, lack of pleasure, insomnia, and weight loss.
8. Medical Assessor Atsumi Fukui dated 5 June 2024 determined that the claimant suffered from an adjustment disorder with mixed anxiety and depressed mood which was a threshold injury.
9. Neither party filed submissions addressing the additional documents despite having been given an opportunity to do so.[3]

1. The claimant provided up-to-date submissions to this Panel.
2. Following the accident, the claimant sought medical treatment from J Medical & Cosmetic Centre in Lidcombe NSW 2141, where she has remained under the care of treating GP

Dr Hajeong Lee to date for treatment and management of her physical and psychological injuries sustained from the accident. 3. The claimant had been mentally healthy before the accident. Since July 2023, the claimant received counselling for psychological injuries sustained in the accident. 4. Dr Jung Sook Kim diagnosed major depressive disorder and generalised anxiety disorder. This was broken down per the relevant DSM-5 criteria in Dr Kim's treating report dated

13 November 2023. 5. For example, the insurer mentioned in the second internal review outcome that the accident was self-reported to police on 5 May 2023 and that the police have deemed this as a minor traffic crash. 6. The claimant submits that referring to the police classification of the accident as minor to downplay the seriousness of the accident is misleading. The NSW Police Force's definition of a 'minor traffic crash' is in fact one that is reportable to NSW Police when all involved parties exchange their details, no drugs or alcohol was involved, vehicles required towing, and no persons required medical treatment within 24 hours after the crash. 7. It is not a measure of the seriousness of the accident, but instead a term used to triage accidents to determine whether it is reportable to police or not. 8. Relying on the police report is misleading and not applicable to whether the claimant's psychological symptoms give rise to a recognised psychiatric illness. 9. The insurer was informed on 28 February 2024, the claimant has had to cease working on

29 December 2023 due to her injuries, despite attempting to keep working after the accident. 10. The claimant continued to be significantly debilitated by her ongoing psychological sequelae and symptoms since the accident. She resorted to medication in the form of Effexor 150mg, Temazepam and Prazosin to manage her symptoms. 11. In respect to Medical Assessor Hong's diagnosis of adjustment disorder Criterion E of the DSM-5 criteria for adjustment disorder requires symptoms to not persist for more than six months after the specific disturbance that caused the claimant's psychological injury. 12. The claimant's accident was on 28 April 2023, almost 13 months before the assessment. 13. The Medical Assessor acknowledged the claimant had begun experiencing psychological symptoms within a month of the accident and had sought treatment with a psychologist around three months afterwards, which continued for several months. 14. At the time of assessment with the Medical Assessor, approximately a year after the claimant's psychological symptoms had commenced, the claimant had still been taking anti-depressants to manage her symptoms. 15. The claimant's symptoms have persisted for longer than six months. The claimant submits that she does not satisfy Criterion E for adjustment disorder. 16. The claimant also refers to cl 5.5 and 5.6 of the Guidelines. Clause 5.5 states that 'a diagnosis for the purpose of a threshold injury decision must be based on a clinical assessment by a medical practitioner or other suitably qualified person independent from the insurer'. 17. The claimant submits that Dr Kim's treating report contained all relevant findings as required under cl 5.6. 18. The claimant referred to Lynch v AAI Limited t/as AAMI [2022] NSWPICMP 6 (Lynch). As

Dr Kim was suitably qualified to diagnose the claimant's psychological condition, the claimant's injuries satisfy the conditions for non-threshold injury, even if her symptoms were in remission when she assessed later. 19. The claimant therefore submits that at the very least, her diagnosis at one point following the accident was that of recognised psychiatric illnesses and not acute stress disorder nor adjustment disorder and so should be considered to be beyond the definition of a threshold injury even if she is considered to be in remission at the time of an assessment by the Panel.

1. The insurer submitted the subject accident was relatively minor in nature and can be expected to have caused only minimal force. The claimant subsequently advised her rehabilitation provider Mr Alan Huynh at ReCare Services that she considered that the impact of the accident was "not severe".
2. The claimant did not attend hospital after the accident or any medical attention until

4 May 2023, almost one week after the subject accident, when she attended upon her GP. 3. Whilst the claimant denied any pre-existing conditions or injuries, Dr Jung Sook Kim treating records refer to an accident which occurred in the months before the subject accident, in January or February of 2023. The insurer reserved the right to rely on records pertaining to the earlier accident and the claimant's medical condition generally. 4. The claimant referred "psychological sequelae" for assessment relying upon Dr Kim's diagnosis of major depressive disorder and generalised anxiety disorder provided by Dr Kim in her treating report dated 13 November 2023. 5. The insurer accepts that both major depressive disorder and generalised anxiety disorder are non-threshold injuries however submits that the claimant has not produced sufficient clinical evidence to support her alleged symptomatology meeting the relevant criteria under the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision ('DSM-5-TR'). 6. In particular, the insurer submits that Dr Kim did not adequately justify her opinion that the relevant DSM-5-TR criteria has been met for the reasons contained in the Internal Review Certificate of Determination dated 22 February 2024 and summarised below. 7. As to the diagnosis of major depressive disorder, the insurer submits that Dr Kim has not provided sufficient justification to endorse criterion A of the DSM-5-TR criteria noting that:

(a) only four out of five required symptoms have been reported, being "hopelessness" (symptom 1), "lack of energy" (symptom 6), "concentration problems" (symptom 8) and "sleeping problems" (symptom 4). As previously indicated in the Certificate of Determination following the second Internal Review, the insurer notes that the symptoms of "loss of motivation" provided by Dr Kim in her report dated 13 November 2023 is not a symptom listed under Criterion A according to the DSM-5-TR;

(b) the DSM-5-TR requires that at least one of the symptoms of "depressed mood" or "loss of interest or pleasure" is satisfied, and

(c) Dr Kim has not confirmed if the abovementioned symptoms have been present within the same 2-week period as required for the diagnosis of major depressive disorder under the DSM-5-TR.

1. As to the diagnosis of generalised anxiety disorder, the insurer submits that Dr Kim has not provided sufficient justification to endorse Criterion A or B of the DSM-5-TR criteria, noting that:

(a) in relation to Criterion A, Dr Kim has not specified the events or activities causing anxiety, nor has she confirmed that the intensity, duration and frequency of the same is out of proportion to the actual likelihood or impact of the anticipated event as required under the DSM-5-TR, and

(b) in relation to Criterion B, Dr Kim has not provided any detail to distinguish the claimant's symptoms from non-pathological anxiety.

1. The insurer acknowledges that some of the claimant's reported psychological symptomatology accords with the diagnoses of major depressive disorder and generalised anxiety disorder, but it submitted that there is insufficient evidence to verify that all of the relevant DSM-5-TR criteria were present.
2. The insurer submits that Dr Kim did not differentiate the claimant's psychological condition from adjustment disorder, which is defined as a threshold injury at cl 4(2) of the Regulations.
3. In consideration of the available records, the insurer suggests that the claimant's psychological symptomatology more closely aligns with a diagnosis of adjustment disorder under the DSM-5-TR.
4. The claimant was able to sustain her full-time studies following the subject accident and completed a Diploma of Graphic Design at the Australian Pacific College in 2023.
5. The insurer submits that there is insufficient clinical evidence in support of the claimant's allegation that she has suffered a non-threshold psychological injury as a result of the subject accident.

1. This Panel's Medical Assessors Canaris and Gupta interviewed the claimant on Microsoft Teams on 22 July 2025. A certified professional Korean interpreter was present throughout the interview.
2. The claimant was at her workplace located in a Korean city. She assured us she had privacy. She presented as a woman of appearance consistent with her stated age who was well-groomed with neatly styled long hair.
3. She appeared well nourished . She appeared to have make-up although when specifically asked said that she wore only sunscreen which had "toner". She provided the history documented above. Her narrative was coherent and internally consistent. Her demeanour was depleted and her responses to questions were slowed.
4. However, she focused reasonably over the course of an interview lasting 1 hour and 25 minutes. No evidence of psychosis or cognitive impairment emerged.

Psychosocial history and pre-accident history

1. The claimant is a 38-year-old single English "teacher at an Academy" in Korea. The Panel asked about her need for an interpreter. She explained that she taught English grammar but was not so proficient in spoken language. She explained she was at private institute preparing middle school students in Korea for tests. She had been doing this job for about six months.
2. She denied any other history of psychiatric illness. she was specifically asked whether she had ever had an eating disorder as her BMI based on her reported weight and height would have been 17. However, she denied any concerns in relation to this.
3. She had been otherwise medically well.
4. She does not drink alcohol. She does not smoke. She does not use drugs. She does not gamble.
5. She denied any history of problems with the law. She had no other claims history.
6. She knew of no family history of psychiatric illness.
7. She has an older brother. Her father passed away about 10 years ago from a heart attack. He was a firefighter and "had other jobs as well". He later became a tailor and while working as a tailor was also a fisherman. Her mother is a care worker.
8. She "had a good childhood - it was happy - because I was the only daughter, my father looked after me well".
9. She graduated from university in Korea where she studied fashion design while she also studied graphic design in Australia. She came to Australia around 2019 or 2020.
10. She went back to Korea in September 2024. She studied full time at APC (Australia Pacific College). She thought she studied about two and a half years and had graduated in 2023 sometime after the accident. She worked as a waitress in Australia and continued working even after the accident. She worked "twice a week" and could not remember when she stopped working - she thought she continued for two or three months more and then stopped because she found it physically difficult what with her lower back problems.

1. On 28 April 2023, she was sitting in the front passenger seat on her way home with her boyfriend "and a motorbike hit me from behind". The accident was at night, and she did not see the motorbike and she assumed the bike went under the car as "it was downhill and slippery". Her vehicle stopped and her boyfriend exited the car and checked. He exchanged licence details with the driver.
2. Police and ambulance did not attend and the rider . The "rider would have been hurt or injured but it was very dark... we were not able to check if he had been injured...". The rider had a friend following "and I believe that his friend might have helped him". She went home - they were close to home. She does not know what happened afterwards with the rider.

History of symptoms and treatment following the motor accident

1. The Panel asked how this affected her. She responded, "It's something I do not wish to remember". She was asked to clarify this further. She said,

"I wanted to study in Australia - the money I set aside for the studies - that disappeared - the happy life we had together disappeared - we couldn't sleep together - we aren't together anymore - the happiness I had disappeared from the accident."

1. She was asked to tell us more about her depression. She replied, "How do I explain depression"?
2. When pushed further, she said she had "no motivation overall". She did not feel sad "but I remember the time that was good". She later admitted that she had been teary "sometimes" and she "would think about what I am doing".
3. She said, "Last year I was able to go to Korea, and I did a health check, and the depression was severe".
4. She "lost appetite" and she lost about 4 to 5 kg of weight - she now weighs 43 kg noting that she was 159 cm tall which would yield a BMI of 17 on the border of moderate thinness and being underweight. She still has her periods, but they are not always regular. She has no particular concern about her weight.
5. She would "sleep for about 5 hours per night" and she would "struggle to fall asleep" and then "wake up about twice" usually in response to a dream. She would have "various dreams - chasing - being chased". She finds it hard to get back to sleep but could not articulate what made it difficult.
6. Her energy levels are low, and she rated them as "3/10". She added, "On weekends, I don't go out of the house at all - not even one step... I don't want to, and I can't find a reason to go out of the house".
7. Her GP has told her that she had severe depression "but in Korea, people are not open minded about mental health - if I went to a hospital or clinic, I would pay between $100 to $150 and so I was not able to get treatment and I would have had to skip work".
8. She was asked how she felt currently. She responded, "Same as before".

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

1. She is not having treatment because of the lack of funding and the culture in her country.

1. She broke up with her boyfriend around August last year. They "weren't able to have a sexual relationship and I had depression - I wasn't able to sort out my depression".
2. We asked why the sexual relationship had ceased. She explained that the motor bike was "customised and did damage to our car and we were pushed forward initially I didn't have much pain, but my pain got worse, and we tried to have sex, and I felt tension and my body getting tightened". Her boyfriend may have sustained similar injuries.
3. She works 40 hours a week "but in Korea it's not full time like in Australia... in Korea they don't have part-time or full-time concept especially in a private institute".
4. She was asked how her work was going. She replied, "I just do it" and she does not know whether her employer is happy with her. We asked whether she thought she was working well. She replied, "I do my best". Her work involves giving students handouts with answers which the students would mark themselves.
5. She has a receptionist helping with such tasks. She tries to work hard "because otherwise it would cause disadvantage to students". She does not set up test papers as in Korea there are books with questions and answers, and she can get help with this from the Institute.
6. She spends her days when she is not working "at home" and would "lie on my bed" and "use my mobile phone". She has no visitors. Her family live in the same town but far away.
7. She does not read but does watch TV "but the maximum I would watch TV is about 2 hours per day - maybe not even that". She would watch episodes of dramas which ordinarily last about 50 minutes.
8. She has friends but does not see them "because I don't want to go out". She said she lives with her mother (her father has passed away) but she works as a care worker in hospital, and she sees little of her as she is not at home. Her relationship with her mother is "fine".
9. She added, "my mother knows my ex-boyfriend and she knows the situation and she is trying not to give me stress". It seems she and her boyfriend broke up "from both sides and we became distant, and we weren't having sexual relationships and so we became distant...". They broke up around August 2024. She is not in a relationship and is not dating.
10. She does not cook but she does clean. She does not use a vacuum because it is heavy, and she has a sore lower back. Her mother does the cooking. She does shower "because I have to go to work" and she changes her clothes daily ("It's summer here and if I don't change, I smell").
11. She brushes her teeth daily ("I have to do them because of children [students]"). She would go to the hairdresser "once every 4 months" and last went last April. She would get her nails done probably "every 3 weeks - I have someone come to my place and do my nails". She does not put on makeup and said she was not wearing makeup today. She said when asked that she had put on sunscreen which had a "toner".

1. The Panel noted her well-groomed appearance and her assertion that she was not wearing makeup despite appearances to the contrary. It accepted her assertions given the limitations inherent in videoconferencing.
2. The Panel noted her well-nourished appearance despite her reported weight loss but again noted the limitations inherent in videoconferencing assessments.

1. The Panel considered a diagnosis of posttraumatic stress disorder but determined that the accident as described did not comprise a Criterion A event as per the DSM-5-TR description of the diagnosis.
2. It noted Medical Assessor Fukui's diagnosis of an adjustment disorder but considered that the symptoms described coupled with her depleted demeanour and the duration of her symptoms were in excess of what one would anticipate from an adjustment disorder.
3. The Panel determined a diagnosis of persistent depressive disorder (dysthymia). In terms of DSM-5-TR criteria, it noted the presence of depressed mood for most of the day for more days than not present in excess of two years (Criterion A) with evidence of poor appetite, insomnia, low energy, and poor concentration (Criterion B).
4. She had never been free of these symptoms for any significant time (Criterion C). It was possible that she may have met criteria for major depressive disorder over this time, but this is not essential to the diagnosis (Criterion D). There had been no evidence of a manic, hypomanic, or cyclothymic presentation (Criterion E) and no evidence of a schizoaffective disorder, schizophrenia, delusional disorder, schizophrenia spectrum, or other psychotic disorder (Criterion F). Her symptoms were not attributable to the physiological effects of a substance or to another medical condition (Criterion G) and cause her clinically significant distress and psychosocial impairment as evidenced by her social withdrawal, lack of motivation, loss of libido, and a breakup of a relationship with her partner (Criterion H).
5. The Panel considered an eating disorder diagnosis because of her weight loss and low BMI but noted the absence of other symptoms to substantiate diagnosis as well as her well-nourished appearance.

1. She was free of symptoms before the accident. Her current raft of symptoms was specific to that event. There was no evidence of any other factors to account for her presentation.

1. The Panel met on 5 August 2025 and adopted the re-examination report as evidence in this case.
2. This was a dispute about whether the claimant suffered a non-threshold psychological injury in the motor accident; the claimant was re-examined by both Medical Assessors of the Panel who found that the diagnosis meets the DSM-5 criteria for persistent depressive disorder (dysthymia), which is not a threshold injury, based on the reasons above.
3. There is a plausible mechanism of injury from the circumstances of this accident and the development of these psychiatric injuries, and there is a temporal and thematic association with the psychiatric symptoms becoming prominent and the accident.
4. The Panel noted the insurer's submission that the accident was minor and should have not resulted in the accident causing the claimant to suffer a non-threshold injury.
5. The Panel gives more weight to the claimant's submission that the NSW Police Force's definition of a 'minor traffic crash' is actually a term used to triage accidents to determine whether it is reportable to police or not rather than an expert determination of whether an injury could occur. This is because it is only a classification and not the result of a thorough investigation which could adduce relevant evidence.
6. Further, the force of the collision is less relevant in the psychological context.
7. The Panel considered that the claimant's condition was active and not in remission. If it were in remission the Panel would consider whether the accident caused the claimant to have ever suffered from a psychological injury that would fall outside the definition of a threshold injury, which would satisfy DSM-5 criteria.
8. Dr Kim's report indicates that the claimant would have met the criteria for generalised anxiety disorder notwithstanding the insurer's submission.
9. The claimant would not have qualified for a strict DSM-5-TR diagnosis of major depressive disorder. This is not relevant as what the Panel assessed is the evolution of post-accident symptoms into persistent depressive disorder (dysthymia).

1. Persistent depressive disorder (dysthymia) is NOT a threshold injury for the purposes of the MAI Act.

1. The Review Panel's findings in relation to the threshold injury are different to the findings as stated in Medical Assessor Fukui's certificate dated 5 June 2024.
2. The Review Panel has determined this certificate is to be revoked and a replacement certificate is issued.
3. The accident caused the following injury:
   • persistent depressive disorder (dysthymia),

which is NOT a THRESHOLD INJURY for the purposes of the MAI Act.

[3] Review Panel Report and Directions dated 24 February 2025.