DETERMINATION OF REVIEW PANEL	
	
CITATION:	Hassim v QBE Insurance (Australia) Limited [2024] NSWPICMP 386	
		
CLAIMANT:	Chanelle Hassim	
		
INSURER:	QBE Insurance (Australia) Limited	
		
REVIEW Panel	 	
		
MEMBER:	Member Susan McTegg	
		
MEDICAL ASSESSOR:	Wayne Mason	
		
MEDICAL ASSESSOR:	Samson Roberts	
		
DATE OF DECISION:	17 June 2024	
		
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; medical review panel; psychological injury; panic disorder; agoraphobia; anxiety; whole person impairment (WPI); permanent impairment; self-care and personal hygiene; social and recreational activities; travel; social functioning; concentration, persistence and pace; adaption; pre-existing condition; on 13 October 2022 Medical Assessor (MA) Sidorov certified a major depressive disorder with anxious distress was not caused by the accident; Held – pre-existing predisposition to anxiety and depression but not at level of diagnosable condition at the time of the accident; diagnosis of panic disorder and agoraphobia; WPI assessed at 17% caused by accident; certificate of MA Sidorov revoked; new certificate issued.

DETERMINATIONS MADE:  	MOTOR ACCIDENTS COMPENSATION ACT 1999
WHETHER THE DEGREE OF PERMANENT IMPAIRMENT OF THE INJURED PERSON AS A RESULT OF THE INJURY CAUSED BY THE MOTOR ACCIDENT IS GREATER THAN 10%
1.	The Review Panel revokes the certificate of Medical Assessor Sidorov dated 13 October 2022 and issues a new certificate determining that the following injuries were caused by the motor accident and give rise to a whole person impairment which, in total, is greater than 10% and is 17%
(a)	panic disorder, and
(b)	agoraphobia. 

	

REASONS FOR DECISION
INTRODUCTION
1.	On 1 August 2017 Ms Chanelle Hassim (the claimant) was the front seat passenger in a vehicle driven by her partner when the insured vehicle travelling in the opposite direction attempted to make a right hand turn and collided with the front of the vehicle in which the claimant was travelling (the accident). Ambulance and police attended the scene. After speaking to paramedics, the claimant and her partner walked home. 
2.	Ms Hassim asserts as a result of the accident she sustained injury to her neck, back, both shoulders, ribs and shock. She also asserts she sustained a psychiatric injury. 
3.	QBE Insurance (Australia) Limited (the insurer) is the relevant insurer with liability to pay any damages to Ms Hassim under the Motor Accident Compensation Act 1999 (the MAC Act).
4.	This dispute is in relation to whether the degree of permanent impairment sustained by Ms Hassim as a result of psychological injury caused by the accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act.
5.	The dispute was referred to Medical Assessor Sidorov who issued a certificate dated 13 October 2022. 
REVIEW PROCEDURE
6.	On 11 November 2022 the claimant lodged an application for review of the medical assessment of Medical Assessor Sidorov pursuant to s 63 of the MAC Act.
7.	On 15 December 2022 the delegate of the President of the Personal Injury Commission (Commission) being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application referred the medical assessment to the Review Panel (the Panel).
8.	The Motor Accident Permanent Impairment Guidelines (the Guidelines) were issued pursuant to s 44(1)(c) for the assessment of permanent impairment. The Guidelines are based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides should be followed.
9.	Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.
10.	The review is by way of a new assessment of all matters with which the medical assessment is concerned.
11.	On 13 December 2023 the Panel decided a medical examination was required.
MATERIAL BEFORE THE REVIEW PANEL
12.	The Panel issued a Direction to the parties on 11 August 2023 which required each party to upload an indexed, paginated bundle of documents. 
13.	In response to this Direction the solicitor for the claimant uploaded to the portal a bundle of documents paginated from pages 1 to 444 and marked claimant’s documents. The solicitor for the insurer uploaded to the portal a bundle of documents paginated from pages 1 to 92 and marked as insurer’s documents. 
14.	In a report and direction dated 13 December 2023 the Panel directed the claimant to upload to the portal by 13 March 2024 the following additional records:
(a)	Medicare records pertaining to the claimant from 1 January 2014 to date; 
(b)	Centrelink records pertaining to the claimant from 1 January 2014 to date; 
(c)	updated clinical records from NAS Advanced Medical Care from 16 February 2023 to date; 
(d)	updated clinical records from Park Road Medical Centre from 16 March 2023 to date, and
(e)	 updated clinical records from Medkare Medical Centre from 24 February 2023 to date.
15.	On 8 March 2024 the claimant uploaded to the portal the clinical records of Wellbe Counselling & Psychology Practice (Wellbe documents).
16.	On 18 March 2024 the claimant uploaded to the portal the following:
(a)	updated clinical records of Medkare Medical Centre (Medkare documents), and
(b)	Centrelink documents.
17.	On 22 March 2024 the insurer uploaded a Medicare Patient History Report relating to the claimant as of 18 February 2022.
RELEVANT LEGAL AUTHORITY
18.	Causation of injury is addressed in the Guidelines:
“1.5	An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person’s impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues. 
1.6	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.
1.7	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.”
MEDICAL ASSESSMENT UNDER REVIEW
19.	In his certificate dated 13 October 2022 Medical Assessor Alexey Sidorov found all the injuries referred to him for assessment were not caused by the accident. Therefore, an assessment of the degree of permanent impairment of those injuries was not required. 
20.	The following injuries were referred to Medical Assessor Sidorov for assessment: 
•	psychological injury – post-traumatic stress disorder, major depression – anxious distress. Major depressive disorder.
21.	Medical Assessor Sidorov concluded Ms Hassim met the diagnostic criteria for a major depressive disorder with anxious distress as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
22.	In relation to causation Medical Assessor Sidorov noted Ms Hassim had experienced significant anxiety symptoms since primary school and more recently had developed depressive symptoms. He found there was no evidence apart from her subjective account that the symptoms of depression and anxiety were caused or worsened by the accident. He found there was evidence to suggest her depressive symptoms had developed more than a year later in 2018 due to factors unrelated to the accident. He also questioned the veracity of the claimant’s account given the multiple inconsistencies in her account.
23.	Medical Assessor Sidorov concluded the major depressive disorder with anxious distress was not caused by the accident. 
THE EVIDENCE
Personal injury claim form
24.	In the claim form dated 30 November 2017 Ms Hassim listed her injuries as “psychological, neck, back, ribcage”. In the accompanying medical certificate dated 7 December 2017 Dr Mohmand provided the following diagnosis:
“Pain rt side of the neck
Low thoracic spine
Anxiety disorder.”
Statement of the claimant
25.	The claimant provided a statement dated 8 July 2020. She is currently 35 years old. At the time of the accident, she was 28 years of age. 
26.	She states since 2011 she worked on a part time basis for various periods as an assistant strata manager with Bonded Strata Manager. She was also a published author and states she otherwise focused on writing and self-publishing her books/journals. 
27.	Ms Hassim states she was involved in an accident in or about 2012 although she did not suffer injury. 
28.	On 6 July 2016 she was the victim of an assault in a nightclub. She suffered an injury to her nose and experienced some anxiety following the assault. Ms Hassim states she was in good health at the time of the accident. 
29.	Ms Hassim states she has suffered from significantly increased anxiety levels since the accident. 
Centrelink 
30.	Centrelink records demonstrate that the claimant received Jobseeker payment from 2 May 2022 until 22 December 2023.
31.	Medical certificate information documents certificates in respect of anxiety and depression since 7 November 2022 with the addition of post-traumatic stress disorder from 11 February 2023.
32.	An assessment was undertaken by a psychologist Jennifer on 30 June 2022. She noted a medical certificate of Dr East dated 12 February 2019 reported a diagnosis of anxiety and depression with the date of onset being 2018. Symptoms reported included “panic attacks, social isolation, inability to drive, poor sleep, daily feelings of anxiety, flat mood, decreased energy, social isolation”. 
33.	Jennifer stated Ms Hassim reported she had experienced symptoms of anxiety for many years with the onset during primary school. She reported panic attacks, and constant feelings of fear. She noted poor memory, poor concentration, difficulty interacting with people and coping in new environments. She reported symptoms of depression since leaving her last job in October 2018, difficulty sleeping and low mood. Jennifer reported Ms Hassim had been referred to a psychologist. She also reported the condition prevented Ms Hassim using public transport without substantial assistance. 
Treating medical records 
Blue Cross Medical Centre – clinical notes
34.	On 20 April 2010 Dr Karalasingham reported neck and occipital pain for a few days, no trauma but noted the claimant was an “anxious person”.
35.	The first relevant record after the accident was on 5 February 2019. Dr East reported flat mood, low motivation, guilt/regret, anhedonia, social anxiety and occasional suicidal thoughts. Dr East reported a new mental health care plan was in place. The entry otherwise reads:
“Suffering from anxiety and depression
Anxiety longstanding - bullied at school with counselling at the time
Managed anxiety ok until recently when it has started to affect her ADLs/ability to work
Depression has been present for the past 8 months
Anxiety
Panic attacks – sweaty palms, SOB, palpitations
Cant drive along due to anxiety
Situations travel the panic
Lives with anxiety every day
Commuting on trains brings on anxiety
Rumination at night, tension in shoulders [sic]”.
36.	On 12 February 2019 Dr East wrote to Centrelink stating the current exacerbation of the claimant’s long standing anxiety with the addition of depression meant she had been unable to work since October 2018. On 15 February 2019 Dr East referred the claimant to Wellbe Counselling and Psychology Clinic. 
 Medkare Medical Centre clinical notes 
37.	On 20 April 2009 Dr Wagdy Latif recorded “anxiety and depression”.
38.	On 11 January 2011 Dr Morgan reported neck spasm and “stressed”. On 28 November 2011 she reported:
“Stressed, TAFE, unable to continue taking care of her father
110/70
Educ re stress mx, counselling
Refuses med. X’s f/u [sic].”
39.	On 26 July 2014 Dr Latif reported Ms Hassim was stressed re “STI” and provided counselling. 
40.	On 15 December 2014 Dr Morgan reported “lost best friend, in w mother, Reactive depression, counselling”. He prescribed Avanza and created a GP Mental Health Treatment Plan which reported the diagnosis was depression, adjustment disorder and mental disorder not otherwise specified. 
41.	On 19 September 2022 Dr Morgan saw the claimant in relation to an unrelated condition but reported “counselling re anxiety mx”.
42.	The updated records of Medkare Medical Centre as of 2 January 2024 show the claimant did not return to that practice after 19 September 2022.
Park Road Medical Centre (Dr Chow) clinical notes
43.	On 26 July 2016 Dr Chow saw Ms Hassim following an assault on 24 July 2016. 
44.	Whilst clinical notes dated 10 September 2016, 12 November 2016, 14 July 2018, 10 May 2019, 25 August 2020, 27 August 2020 and 23 October 2020 do not refer to psychological symptoms, a Referral form for Allied Health Services under Medicare dated 6 November 2020 indicates Dr Chow referred Ms Hassim to Dr Catherine Devetzis, psychologist for psychological assessment and therapy for anxiety and depression. 
45.	On 14 November 2020 Dr Chow records the accident on 1 August 2017. He refers to neck pain, anxiety and notes Ms Hassim is too scared to drive. 
46.	On 11 February 2021 Dr Chow referred the claimant to Wellbe Psychologists.
NAS Advanced Medical Care clinical notes
47.	Ms Hassim attended the surgery on 18 July 2017, and on further occasions for unrelated complaints. 
48.	On 13 June 2019 Dr Mohiuddin reported the claimant was a “very anxious patient” and advised her to see a psychologist. It seems Ms Hassim only agreed to do so after a lengthy discussion. 
49.	On 19 November 2020 Dr Kassam reported waiting on X-ray of the neck. The X-ray undergone on 16 November 2020 was reported to be normal with no significant degenerative change identified. 
50.	On 27 January 2022 Dr Mohiuddin reported mild restriction of right and left rotational movement. 
51.	On 7 November 2022 Dr Jahan reported Ms Hassim had a history of depression/anxiety for years and used to see a psychologist before the COVID pandemic. Dr Jahan reported Ms Hassim wanted referral to a psychologist. He also reported she cannot look for a job due to her anxiety and was anxious to drive. He noted her hand was shaking and she had sweaty hands. He prescribed Lexapro. On 14 November 2022 Dr Jahan reported Ms Hassim refused to start the medication and wanted referral to another psychologist as the previous psychologist did not do face to face consultations. Ms Hassim was referred to Ms Toofan Hamidi. 
52.	On 11 February 2023 Dr Jahan reported Ms Hassim was under a lot of stress, “anxiety flairs dad sick in hospital”. She reported severe anxiety and an inability to sleep the whole night.
Priority Medical Centre clinical notes
53.	On 17 August 2018 Ms Aminda Huynh, (physiotherapist ?) referred to the accident in August 2017 stating Ms Hassim had reopened the case six months ago but had had no treatment since. She reported rib pain and whiplash. Her sleeping pattern was said to depend on Panadol. She did not report any psychological symptoms.
54.	On 31 August 2018 Ms Huynh reported discussing psychological treatment. 
Wellbe Counselling and Psychology Practice clinical notes 
55.	On 12 February 2021 Wellbe Counselling and Psychology Practice reported Ms Hassim was booked in for an appointment with Glessia Matar on 4 March 2021. On 4 March 2021 Ms Hassim apparently attended the appointment but ran away after experiencing a panic attack. It was reported the claimant had been “freaked out” by the old building, long and dim hallway, no reception-waiting area, no receptionist so she felt unsafe, trapped and ran away. 
56.	Client notes record a telehealth consult on 22 March 2021. Ms Hassim described the accident and recalled feeling extreme fear and “truly believed” that she and Dennis were going to die. After getting out of the car she recalled being in extreme “shock” and very shaken. Post accident she reported feeling numb for a few days, preferred to stay home and cried most of the time. 
57.	On 28 April 2021 it was reported Ms Hassim relived the trauma, experienced flashbacks, intrusive thoughts/images, nightmares and intense distress, she had disturbed sleep, panicked when reminded of the trauma, difficulties concentrating, became startled, irritable and easily upset, had a sense of overwhelming fear, fear of leaving the house, presenting with shortness of breath, and experienced a feeling of discomfort and choking. 
58.	On 12 May 2021 it was reported Ms Hassim was dealing with grief over the psychological and lifestyle changes she experienced as a result of the accident. She described disruption in relationships, withdrawal, family conflict and loss of interest in physical relations, and family conflict. 
59.	Glessia Matar provided a report dated 6 June 2021. She reported she first met Ms Hassim on 4 March 2021, but the consultation was prematurely terminated as Ms Hasim “ran away in panic”. Subsequently Ms Hassim had attended five consultations. Treatment included Trauma Focused – Cognitive Behavioural Therapy (TF-CBT). She reported Ms Hassim had demonstrated a poor response to treatment. 
60.	On mental state examination Ms Matar reported Ms Hassim was anxious and apprehensive during consultations. She diagnosed post-traumatic stress disorder, agoraphobia disorder, panic disorder, major depressive disorder and generalised anxiety disorder. She stated:
“Ms Hassim described her mood as being anxious and depressed. Her affect was dysphoric at times and mood congruent. She reported depressive and anxious cognitions, excessive fear of driving, being in inescapable situations, being troubled by anxiety and nervousness. She was debilitated by anxiety and catastrophic thoughts. She reported fixed image of the accident and had high arousal and vigilance. She denied any suicidal ideation or psychotic symptoms. Her insight and judgment are intact.”
61.	On 14 July 2021 Ms Hassim reported having images of the accident go through her mind over and over. She had excessive fear and worry about leaving the house, perceiving being in a car or a crowded place as dangerous and unsafe. On 28 July 2021 Ms Hassim reported feelings of hopelessness, helplessness and shame. 
62.	The next attendance for counselling was not until 3 December 2021 when Ms Hassim reported her mood was unchanged, she only felt safe at home and feared being in a car or crowded/public places. Ms Hassim attended again on 22 March 2022, 8 April 2022 with the next session not taking place until 22 March 2023. She continued to describe her struggle to cope with daily living, to leave the house and described feeling frustrated, and upset and unable to concentrate. On 30 May 2023 Ms Hassim reported being irritable and distressed. 
63.	The next session was not until 14 February 2024 when in addition to her difficulty in being around others Ms Hassim reported a sense of loss of control over her life, difficulty engaging socially with friends, concentration difficulties, panic and feeling disconnected. 
Medico-legal reports 
Dr Peter Conrad, general surgeon 
64.	Dr Conrad assessed the claimant and provided a report dated 12 September 2018. He concluded she had sustained a whiplash injury of the neck. Dr Conrad assessed a 5% whole person impairment. 
Dr Graham George, psychiatrist 
65.	Dr George assessed the claimant and provided a report dated 4 December 2020.
66.	Following the accident, the claimant reported high anxiety levels and volunteered that she suffered nightmares for three and a half years, but now they only occurred every few weeks. Ms Hassim described her mood as flat. She enjoys reading and walking including bushwalking. Ms Hassim has not driven alone since the accident and was anxious as a passenger. 
67.	Ms Hassim reported no prior psychiatric conditions. 
68.	Dr George reported Ms Hassim alleged symptoms suggestive of post-traumatic stress disorder in that she has nightmares and can relive the accident. He reported she described a high level of anxiety, a degree of apprehension and a preference to be accompanied when driving. Dr George felt there were contradictions in the history provided in that Ms Hassim did not volunteer information about the assault in 2016 and did not volunteer any symptoms related to a past psychiatric disorder. Dr George did not provide a diagnosis. He concluded because he had some concerns about her presentation and the history provided, she should be subjected to psychometric evaluation to obtain objective evidence with respect to her presentation of alleged psychopathology. 
Dr Glen Smith, psychiatrist
69.	Dr Smith assessed the claimant and provided a report dated 23 September 2020.
70.	He reported she was somewhat anxious after being assaulted in 2016 but did not receive treatment prior to the accident. Dr Smith reported she denied a history of previous episodes of depression, hypomania or mania. She denied pre-existing panic attacks and obsessions. She had not accessed psychiatric or psychological treatment. 
71.	Dr Smith reported some bullying in years five and six. Dr Smith reported during her teenage and early adulthood years Ms Hassim had been “confident, friendly, bubbly” and “not particularly shy or anxious”.
72.	Dr Smith reported after the accident Ms Hassim experienced pain in her neck. Psychologically she was not the same and was riddled with anxiety and depression. He reported she felt anxious when driving and could no longer drive alone due to fear of being in an accident. She also reported being more socially withdrawn, and her motivation and interest in activities was reduced. She found it difficult to sleep due to pain and experienced fatigue and low energy. He reported she felt depressed. She reported intrusive memories of the accident and hypervigilance when travelling on the road. 
73.	Dr Smith diagnosed an adjustment disorder with mixed anxiety and depressed mood in the context of post-traumatic anxiety, persistent pain and limitation in functioning and subsyndromal symptoms of post-traumatic stress disorder. He did not assess permanent impairment where she had not received any psychological therapy. 
74.	Dr Smith reviewed the claimant by telehealth and provided a report dated 18 June 2021. 
75.	Dr Smith reported Ms Hassim had mild anxiety but did not receive treatment following the assault in 2016 by the ex-girlfriend of her partner. He reported following the accident Ms Hassim had experienced marked anxiety and had not driven alone.
76.	Dr Smith reported Ms Hassim had commenced psychological therapy but with no improvement in her symptoms, but on the contrary a deterioration. She reported anxiety and avoidance of social and family events and reduced interest and enjoyment of activities. He reported panic attacks when she leaves the house and particularly when travelling in a motor vehicle. She reported sleep disturbance and nightmares. She described poor concentration and focus and had thoughts that life was not worth living. However, she denied recurrent, intrusive distressing flashbacks of the accident. 
77.	Dr Smith concluded Ms Hassim’s condition had worsened and now satisfied the DSM-5 criteria for the diagnosis of major depressive disorder with anxious distress. He also reported she presented with marked anxiety regarding driving consistent with subsyndromal symptoms of post-traumatic stress disorder. 
78.	In a supplementary report dated 18 June 2021 Dr Smith provided an assessment of 22% whole person impairment calculated as follows:
Category	Class	Reason for Decision	
Self-care & Personal Hygiene	2	Ms Hassim stated that she showers daily but her partner or her mother usually prepare meals due to her low motivation. She stated that she sometimes prepares meals and helps clean the property.	
Social & Recreational Activities	3	Ms Hassim described marked restriction in social and recreational activities due to reduced motivation and anxiety when leaving the house. She stated that she avoids going out if possible but sometimes goes with her partner for walks or to the local café. She avoids large crowds and unfamiliar places due to her anxiety. She is not a member of any clubs or associations.	
Travel 
	3	Ms Hassim stated that she does not drive alone and she avoids travelling as a passenger in a motor vehicle if possible due to her marked anxiety and panic symptoms.	
Social Function
	2	Ms Hassim stated that her partner has been supportive but he has been upset with the changes in her, “he says, ‘you’re a completely different person’”. This had caused strain in the relationship but there had been no episodes of separation or violence.	
Concentration, Persistence & Pace	3	Ms Hassim stated that she takes longer to read books due to poor focus and concentration and she finds it difficult to persist with tasks due to low motivation. She performed poorly on simple tests of memory and concentration.	
Adaptation	5	Ms Hassim stated that she had not worked or engaged in any study since my assessment in September 2020. In my opinion, she presented as unfit for employment due to her anxiety and depressive symptoms with anxiety with panic symptoms whenever leaving the house, suicidal ideation and cognitive impairments.	
List classes in ascending order: 2,2,3,3,3,5	
Median Class Value: 3	
Aggregate Score: 18 	
% Whole person impairment: 22%	
79.	Dr Smith found although Ms Hassim reported mild anxiety in relation to the assault in 2016 there was no evidence of impairment at the time of the accident. He also found there was no significant effect of treatment justifying an adjustment. 
Dr Brian Stephenson, orthopaedic surgeon
80.	Dr Stephenson assessed the claimant at the request of the insurer and provided a report dated 29 October 2019. He reported since the accident Ms Hassim suffered from an anxiety state. He diagnosed a whiplash associated disorder to the cervicothoracic spine with some asymmetric loss of range of motion at the neck. He stated the complaint as to anxiety was beyond his expertise. 
81.	Dr Stephenson reviewed the claimant and provided a report dated 12 February 2021. The history reported by Dr Stephenson included the following: 
“Said she has anxiety and nightmares and has a referral to see a psychologist. She said she has not driven since the accident and has lost her independence. She said she is on edge if Dennis or her mother-in-law is driving the car. She perspires and gets anxious.
Her partner, Dennis Pahos, is concerned that Chanelle is not the person she was prior to the accident. She exhibits anxiety and for example when attending a birthday party, she spent a lot of time in the bathroom avoiding people. Last week at a restaurant, on Saturday evening, Chanelle spent a lot of time in the bathroom and other people do not understand.”
82.	Dr Stephenson’s opinion as to diagnosis was unchanged although he concluded any incapacity for employment appeared to be related to psychological issues with anxiety. He thought Ms Hassim may need psychological counselling or opinion from a psychiatrist. 
Dr Evan Dryson, occupational physician
83.	Dr Dryson assessed the claimant and provided a report dated 8 September 2020. He reported Ms Hassim was not working at the time of the accident but reported she had worked on and off since 2011 for Bonded Strata Management. He reported following the accident she was able to continue working intermittently at Bonded Strata Management. She was able to continue her work as a writer. Dr Dryson reported Ms Hassim did have anxiety prior to the accident which was aggravated by the accident. Dr Dryson diagnosed a whiplash associated disorder. 
SUBMISSIONS
Claimant’s submissions
84.	The claimant provided undated submissions in support of the application for review. 
85.	The claimant submits Medical Assessor Sidorov failed to adequately address causation, applied the wrong test and engaged in ‘speculative’ analysis in identifying non accident related reasons for the claimant’s diagnosis and impairment. 
86.	Further Medical Assessor Sidorov failed to identify and quantify any symptomatic pre-accident impairment as required by clauses 1.31 to 1.34 of the Guidelines noting he made a diagnosis of major depressive disorder with anxious distress. 
Insurer’s submissions 
87.	The insurer provided submissions dated 28 November 2022 in response to the claimant’s application for review. 
88.	The insurer submits the accident has not resulted in any recognisable psychiatric injury.
89.	The insurer relies upon the following:
(a)	the entry in the clinical notes of NOAS Advanced Medical Centre of 5 September 2017 (approximately five weeks after the accident) does not reference the accident and was with respect to an unrelated health complaint. Whilst the claimant was not seen again until 6 June 2019, she was thereafter seen on five separate occasions in the context of unrelated health complaints. The insurer notes the reference on 13 June 2019 to being a “very anxious patient” and finally agreeing to seeing a psychologist was in the context of no mention being made of the accident. 
(b)	The first record of attendance on a medical practitioner for treatment of injuries arising from the accident was when she saw Dr Mohmand on 30 November 2017.
(c)	The claimant attended Priority Medical Centre on 17 August 2018, 24 August 2018 and 31 August 2018 in relation to physical complaints arising out of the accident but no psychiatric type complaint was made. 
(d)	Clinical records of Blue Cross Medical Centre dated back to 10 June 2010 but no mention was made of the accident on 5 February 2019 (18 months post-accident) albeit the record states:
“…Suffering from anxiety and depression. Anxiety longstanding – bullied at school with counselling at the time. Managed anxiety okay until recently when it has started to affect her ADLs/ability to work. Depression has been present for the past eight months. Anxiety; panic attacks – sweaty palms, SOB, palpitations. Can’t drive alone due to anxiety…Lives with anxiety every day…”.
(e)	On 12 February 2019 Dr East in correspondence to Centrelink referred to depression having been present for eight months, which suggests the symptoms post-dated the accident by a significant period (more than 12 months) and are unrelated to the accident. 
(f)	The claimant presented on 26 July 2016 with a history of being assaulted and correspondence from the Victims Compensation Tribunal suggests the claimant made a claim for victim’s compensation. The Panel has not been provided with any records from the Victims Compensation Tribunal.
(g)	Despite being treated at the Park Road Medical Centre on 14 July 2019, 6 November 2018, 10 May 2019, 25 April 2020, 27 August 2020 and 23 August 2020 no mention was made of the accident until 14 November 2020, more than three years after the accident. 
(h)	Dr Dryson, occupational physician recorded a “past medical history of anxiety prior to the motor vehicle accident of 1 August 2017. This has been aggravated by the accident.”
(i)	The claimant concedes that she was not engaged in paid employment at the time of the accident. 
(j)	Neither Dr Smith nor Ms Matar have provided an opinion that takes into account the lack of contemporaneous complaint together with the delay in complaint of symptoms until some 18 months post-accident. Further both Dr Smith and Ms Matar appears to have been operating under the erroneous history that the claimant was engaged in employment at the time of the accident. 
90.	Whilst the insurer does not concede the claimant presents with any recognisable psychiatric injury it refers to the history recorded by Dr George as to her presentation with respect of the assessment of permanent impairment as follows: 
“Activities of daily living were canvassed with Ms Hassim. She said that when she wakes in the morning, she would have a shower and then, get dressed. She would make breakfast and after she has had breakfast, she would attempt to do some writing. She would answer emails and she would be involved in marketing. She did not appear to have any particular problems with self-care.
In terms of social functioning, she said that she would still go out and have a coffee with girlfriends. She said that she enjoyed bushwalking and coastal walking. She enjoys writing and reading. She did not appear to have any significant impairment in terms of social and recreational activities.
In terms of travel, she indicated that, if she drove her car, she would prefer to be accompanied. She said that she was a very anxious traveller, and also, anxious driving a car. She did appear to have a mild impairment but she could still drive a vehicle.
In terms of social functioning, she said that she gets on well with her partner and she gets on well with her parents and also, sibling. She did not describe strain in relationships as such.
As far as concentration, persistence and pace were concerned, she said that she could read fiction and non-fiction and journal articles. The only factor which would tend to interrupt her level of concentration, would be pain, according to her description, but not any psychological symptoms. There was no impairment from a psychiatric viewpoint in terms of her ability to attend, concentrate and complete tasks.
As far as her work was concerned, she said that she had cut back on work with her employer but, of course, this has been influenced by COVID-19 virus. She said that currently she was working and she said that she was also engaged in her writing”.
91.	The insurer provided additional submissions dated 25 September 2023.
92.	The insurer notes that clinical notes produced by MedKare Medical Centre detail that the claimant was seen on approximately five occasions with respect to mental health issues over the period 20 April 2009 to 15 December 2014 (approximately 2.5 years prior to the accident).
93.	The insurer notes the following: 
(a)	on 11 January 2011 the history of an earlier accident, neck spasms and the claimant having felt stressed; 
(b)	on 28 November 2011 the claimant being “…stressed [about] TAFE, unable to continue taking care of her father…”; 
(c)	on 15 December 2014 suffering from reactive depression following the loss of her best friend, and
(d)	Dr Morgan completed a GP Mental Health Treatment Plan on 15 December 2014 and recorded a K10 (Kessler Psychological Distress Scale) score of 22 and diagnosed depression, adjustment disorder and a “mental disorder not otherwise specified”.
MEDICAL ASSESSMENT
Brief personal details
94.	Ms Hassim is a 35-year-old woman who lives with her parents in their home on four days a week and with her partner Dennis in his home on three days a week. She is not working and is in receipt of the Centrelink Jobseeker allowance. She has an exemption from job seeking on the basis of a medical certificate for post-traumatic stress disorder provided by Dr Jahan of the Auburn Medical Centre. Ms Hassim said she has not worked since the accident in August 2017, although the records disclose that whilst the claimant was not working at the time of the accident she did attempt to return to part time work with Bonded Strata Management following the accident, although it appears to have been short lived. Certainly, the records suggest the claimant has not worked in regular employment since 2018. 
Psychosocial history
95.	Ms Hassim was born at St Margaret's Hospital in Sydney and described a normal birth and development. Her father is 69 years of age and her mother 71 years of age. They retired 10 years ago after running a clothing manufacturing business together. She is the youngest of three children with a 44-year-old brother and a 42-year-old sister. Ms Hassim described a good early upbringing during which she felt safe and well cared for. She denied any form of abuse at home. She attended Clemton Park Primary School where she said she was bullied by a bunch of boys in year 6 which she found very distressing. She then attended St Ursula’s Catholic High School in Kingsgrove where she completed year 12 in either 2003 or 2006 with an average result. Ms Hassim said she enjoyed high school, was a member of the popular group, was not bullied and did not suffer anxiety.
96.	When she left school Ms Hassim completed a six-month Certificate III in Tourism at Ultimo TAFE and then travelled to the United Kingdom and South of France where she visited family members.
97.	On return to Australia, Ms Hassim worked in a clothing store, Shona Joy at Bondi Beach, for one year as a retail manager. She described a few months of work in call centres such as for MS Australia and then commenced work “on and off” for Bonded Strata Management in 2011 as a clerical assistant. Ms Hassim noted she had been working privately as a writer since 2016 and had self-published two short works on self-love and affirmations. 
98.	The panel noted a significant gap in her employment history before she commenced work with Bonded Strata Management which she was not able to adequately explain. Only later in the interview did Ms Hassim confirm she most likely completed the HSC in 2003, which left even more years unaccounted for in terms of her employment history.
99.	With regard to relationships, Ms Hassim reported she was with a man called Greg for four years but said she was too young at the time and brought the relationship to an end. Following that she was single for four years from 2011 and then met her current partner Dennis in 2015. She acknowledged she was assaulted by his ex-partner in a nightclub in 2016. She said his ex-partner was very intoxicated, pulled her hair from behind and pushed her into a wall and then kicked her in the stomach. She said she had a significant nose injury from the assault, but she did not attend a general practitioner and denied any psychological problems arising from the assault. 
100.	Ms Hassim said her current relationship with Dennis is solid and they are not in danger of separation, but she believes he finds her taxing. She went on to explain she has a hypothyroid condition, has gained a significant amount of weight, and has no interest in their intimate relationship. She said there are multiple health issues which means she cannot have a child until she recovers but asserts the relationship is okay. Ms Hassim said she gets along very well with her parents and her brother who are supportive of her. Her sister lives in the United Kingdom and is also supportive.
101.	When asked about leisure activities prior to the accident Ms Hassim said she was doing much more reading. She enjoyed going to night clubs with her partner and to cafes and shops with her friends. She said at that time she was able to take a girlfriend out for lunch. She also enjoyed creative writing. Ms Hassim denied any past insurance claims and said there had been no history of problems with the law.
102.	With regard to medical history, Ms Hassim said she has raised cholesterol and described a very concerning level of 10 but said she was not using a statin medication because of her concern about side-effects. She described preferring to deal with it via natural methods. She also stated she has thyroid antibodies. Her weight has increased to 77 kg since the accident. Previously she was 60 kg. At a height of 160 cm her BMI is currently 30.1 kg/m² which is inside the obese category. She is not using thyroid hormone supplementation. Ms Hassim was unable to clarify if she had undergone a thyroid ultrasound or had her thyroid hormone levels determined. She said her blood pressure is normal and she has not undergone any surgery. 
103.	Ms Hassim was questioned about illness anxiety in the past and it was pointed out she had attended multiple general practitioner surgeries with multiple concerns about her health. She acknowledged this was the case but said she takes very good care of her health in a natural way and prefers not to use medications prescribed by doctors. Ms Hassim prefers herbal medicines and supplements.
104.	When asked about her past psychiatric history Ms Hassim said she had not attended counselling. She acknowledged she was referred for counselling two years prior to the accident but she did not attend any actual sessions. When the panel pressed for further information about this she said she was not sure why. Ms Hassim was questioned about her level of anxiety prior to the accident. She denied this was ever an issue. She also denied any family history of psychiatric illness. In general terms Ms Hassim was reluctant to acknowledge past difficulties. The medical assessors concluded she did have a pre-existing predisposition to anxiety and depression but accepted that it was not at the level of a diagnosable condition at the time of the accident.
105.	Ms Hassim said she does not use cigarettes or recreational drugs and does not gamble. When asked about alcohol she said she does drink red wine on the weekends such as on Friday and Saturday nights when she has two glasses with Dennis. She said she would also sometimes drink when she goes out with friends but never too much.
History of the accident
106.	Ms Hassim said she was a restrained front seat passenger in her own Toyota Echo driven by her partner Dennis. They were travelling along a straight road at approximately 50kmph. She said an oncoming vehicle turned right across their path and they were unable to avoid a head-on collision. She said she had been looking down at her phone and when she looked up she could see what was going to happen. She said it seemed to her everything was in slow motion. The airbags did not deploy because of a fault in the vehicle. She said she was shocked and had pain in her ribs from the "G-force". She said during the accident her partner tried to protect her. She denied head strike or loss of consciousness. She was able to self-extricate and sat on the side of the street while her partner Dennis liaised with the other driver. They were checked out by the paramedics and then walked to her partner's home nearby.
History of symptoms and treatment following the accident
107.	Following the accident Ms Hassim said she was frightened but eventually settled. She developed neck and shoulder pain which she described as whiplash. She attended a general practitioner approximately one week later at the Priority Medical Centre in Auburn and was referred for physiotherapy. She attended five or six sessions which she said did not really help. She was not prescribed any analgesic medication and used over-the-counter paracetamol. She suffered occasional niggles of pain which were not major, and she was sleeping okay.
108.	From a psychological point of view Ms Hassim said she was unable to be in a car and lost her independence to drive a car. She said she was too frightened to drive and that continues to be the case. She developed panic attacks which occur if she goes out in public. She described her symptoms as intense anxiety, difficulty breathing, hands becoming sweaty and a need to run away. She said if she is in a restaurant or café she immediately has to get out. When asked when the panic attacks started she said they commenced immediately after the accident.
109.	Ms Hassim also described intense repetitive nightmares such as being stuck in an elevator or a wave coming over her and she is running to get away. She also dreams of driving a car and being unable to stop. Ms Hassim said these commenced within one year of the accident and still continue two or three times per week. She said after seven years she is still unable to do anything. She said she cannot even have a child because she has no independence. She said she cannot travel alone, even by train. She cannot drive alone but could do so if accompanied for perhaps a few suburbs. She cannot drive on a main road and can drive for only 20 or 30 minutes in the local area.
110.	Ms Hassim was asked about mood. She said she feels disabled because she has lost a lot of her independence. She said if ever she does go out she has to pump herself up and she gets really anxious. She avoids friends because of the stigma of her condition; she hates being asked about herself and hates having to explain her situation. When asked if she enjoys any activities she said she enjoys being with her partner and her parents. She also enjoys reading fiction and non-fiction and especially spiritual material; she said she was unable to do any writing. When questioned Ms Hassim acknowledged publishing a journal in 2016 and in 2020 she published a book of affirmations.
111.	Treatment consisted of consultations with psychologist Ms Glessia Matar. These commenced in March 2021. Ms Hassim estimates she has seen her on approximately 10 occasions since then with the last appointment in February 2024. She said the sessions were helpful to some extent, but she has not been able to drive again, and the fear is still very strong. She acknowledged running out of the first appointment with Ms Matar because of fear (a panic attack) and said the subsequent attendances have been online which she has been able to manage.
112.	She denied taking any psychotropic medications because she prefers naturopathy. She had not consulted a psychiatrist and had not participated in eye movement desensitisation response treatment (EMDR).
Injuries or conditions since the accident
113.	Ms Hassim denied any injuries or conditions since the accident.
Current symptoms
114.	Ms Hassim continues to experience extreme fear which prevents her from driving and prevents her from leaving the house alone. She acknowledged being extremely dependent on her parents and partner. She continues to experience panic attacks which often require her to flee public situations. There is also inhibition of most of her activities due to the fear of initiating a panic attack. The nightmares she described are consistent with her intense anxiety states and are not indicative of post-traumatic stress disorder.
Current and proposed treatment
115.	There is no current or proposed psychological treatment and no proposed treatment with psychotropic medication.
Mental state examination
116.	Ms Hassim is a 35-year-old right-hand-dominant woman whose appearance is somewhat younger than her stated age. She was identified from her photograph on her NSW driver licence. She was located alone in a room in her partner's home; he was present elsewhere in the house. She was interviewed using the Microsoft Teams application with a good internet connection. The interview with Medical Assessors Mason and Roberts commenced at 3.20pm and concluded at 5.10pm.
117.	Ms Hassim was cooperative with the interview and provided information willingly and without prompting. She was not depressed in appearance and did not appear anxious until describing her anxiety symptoms. She was significantly distressed on one or two occasions during the interview. She described experiencing occasional suicidal thoughts in the past but was clear she had no intention of acting on them. Her memory for events subsequent to the accident was poor and she frequently responded with "I do not know" or "I cannot remember".
118.	Ms Hassim provided a clear history of significantly disabling panic attacks which have restricted her activities and movements to the point of being agoraphobic. She did not describe reexperiencing symptoms consistent with post-traumatic stress disorder. She also did not describe symptoms consistent with a primary mood disorder.
119.	Ms Hassim was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.
Current functioning
120.	With regard to a daily routine Ms Hassim said she retires at about 10.00pm, wakes up at 3.00am and lies there with her "brain wired". She is sometimes woken by nightmares. She gets back to sleep after two hours and then wakes at 7.30am. She has breakfast and showers and then moves around the home or reads a little bit. She tries to write but said she has poor motivation and energy. She does not contribute much to the cooking, relying on her mother or her partner. She said she does cook occasionally when she has the energy and attributed this difficulty to her thyroid condition.
121.	Self-care and personal hygiene: Ms Hassim said she has a regular shower and always wears clean clothing. She sometimes does the laundry but again mostly relies on her partner or mother. She said she has put on weight due to the impact of the accident and her thyroid condition. She is unimpaired.
122.	Social and recreational activities: Ms Hassim said she normally hangs out with her partner and her parents. She has some friends, but she has hardly seen them since the accident. She said she tries to get out with them every few months. She goes out for a walk in the park, and she enjoys reading. She said it is too painful for her to see her friends because they have babies. The panel believe she is significantly restricted by anxiety. She is moderately impaired.
123.	Travel: Ms Hassim is able to drive in the local area for up to 30 minutes if accompanied. She cannot use main roads. She can use public transport but only if accompanied. She has not travelled by air since the accident. She is unable to travel away from her residence without a support person. She is moderately impaired.
124.	Social functioning: Ms Hassim said she gets along well with her partner and her parents. She said her brother in Australia is supportive and she has a good relationship with her sister in the United Kingdom. She sees much less of her friends because of anxiety. She is mildly impaired.
125.	Concentration, persistence and pace: Ms Hassim said she does not like to watch television and does not look at YouTube. She said she prefers to read and write. She can manage her own money. She has been able to publish a book on Affirmations since the accident. There was some difficulty with memory. She did not have difficulty with concentration throughout the interview. She is mildly impaired.
126.	Adaptation: Ms Hassim is unable to work because of anxiety. She said she is unable to travel to the workplace. She said she has lost confidence in her abilities and is fearful of panic attacks when she is expected to perform under pressure. The panel accept that she is seriously impaired by anxiety. She is totally impaired. 
Consistency of presentation
127.	There were a number of inconsistencies throughout the interview which were brought to Ms Hassim's attention. Ms Hassim denied past psychiatric problems. It was pointed out that the records indicate in 2009 she was unable to work; she said this was because a friend had died. The Panel notes Dr Wagdy Latif diagnosed major anxiety and depression at that time. Ms Hassim said the condition resolved naturally. 
128.	It was also pointed out that in 2011 she was involved in a motor accident. She said her then partner Greg was driving and he merged into the left lane and scratched the door of his car. She believes she may have suffered a neck injury and was very stressed but then added she could not remember. 
129.	Ms Hassim was informed the medical records indicate she was referred for counselling in 2014 by Dr Amany Morgan and commenced on the antidepressant Mirtazepine. She acknowledged this was because a friend had died but said she did not go to counselling and did not use the medication. It was further pointed out to her that between December 2014 and March 2015 she was depressed to the point of being unable to leave home. She again indicated this resolved naturally and was not an issue. 
130.	In general terms Ms Hassim was reluctant to acknowledge past psychological difficulties. The medical assessors concluded she did have a pre-existing predisposition to anxiety and depression but accept that it was not at the level of a diagnosable condition at the time of the accident.

PANEL DELIBERATIONS
131.	Ms Hassim is a 35-year-old woman who was involved in the accident on 1 August 2017 when she was 28 years of age. She was a front seat passenger in a small car driven by her partner which was involved in a head-on collision. The Panel accepts this was a frightening motor accident which resulted in a significant exacerbation of pre-existing asymptomatic underlying anxiety. Ms Hassim went on to develop panic attacks which were not present prior to the accident. As a consequence of the panic attacks, she restricted her activities to the point where she has become agoraphobic. This has resulted in a very restricted lifestyle in which she is unable to leave the home alone and is dependent on her parents and her partner for her general level of functioning.
Diagnosis
132.	Ms Hassim described symptoms consistent with both panic disorder and agoraphobia. She meets DSM-5 criteria for these conditions as follows.
“Panic Disorder
A. 	Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches peak within minutes, and during which time four (or more) of the following symptoms occur:
1. 	Palpitations, pounding heart or accelerated heart rate.
2. 	Sweating.
3. 	Trembling or shaking.
4. 	Sensations of shortness of breath or smothering.
5. 	Feelings of choking.
8. 	Feeling dizzy, unsteady, lightheaded or faint.
11. 	Derealisation (feelings of unreality) for depersonalisation (being detached from oneself).
12. 	Fear of losing control or ‘going crazy’.
13. 	Fear of dying.
B. 	At least one of the attacks has been followed by 1 month (or more) of 1 or both of the following
1. 	Persistent concern or worry about additional panic attacks or the consequences.
2. 	A significant maladaptive change in behaviour related to the attacks (e.g., behaviours designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C. 	The disturbance is not attributable to the physiological effects of the substance or another medical condition.
D. 	The disturbance is not better explained by another mental disorder.
Agoraphobia
A. 	Marked fear or anxiety about 2 (or more) of the following 5 situations:
1.	Using public transportation.
2.	Being in open spaces.
3.	Being in enclosed spaces.
4.	Standing in line or being in a crowd.
5.	Being outside of the home alone.
B. 	The individual fears or avoids these situations because of thoughts that escape might be difficult or help not might be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms (e.g., fear of falling or fear of incontinence).
C. 	The agoraphobic situations almost always provoke fear or anxiety.
D. 	The agoraphobic situations are actively avoided, require the presence of a companion, or are endured with intense fear or anxiety.
E. 	The fear or anxiety is out of proportion to the actual danger posed by the agoraphobic situations and to the sociocultural context.
F. 	The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
G. 	The fear, anxiety or avoidance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
H. 	If another medical condition is present, the fear, anxiety or avoidance is clearly excessive.
I. 	The fear, anxiety, or avoidance is not better explained by the symptoms of another mental disorder.”

Causation
133.	The insurer has raised the lack of contemporaneous complaint made by Ms Hassim following the accident. 
134.	In Norrington v QBE Insurance (Australia) Ltd Brereton J addressed the presence or absence of a contemporaneous record of complaint in the determination of causation stating at [31]:
“In the context of medical assessment under MACA, there is now a substantial body of authority that a panel which decides the question of causation solely on the basis of the existence or otherwise of contemporaneous evidence of complaint of injury fails properly to address the questions posed by s 58(1), and that this is jurisdictional error.” 
135.	In Norrington Brereton J followed the decision of the Court of Appeal in AAI Limited v McGiffen where the Court stated at [64]:
“The question that the review panel was required to address was not simply whether there was any contemporaneous evidence of complaint about an injury to the lumbar thoracic spine. It included whether Mr McGiffen’s lumbar thoracic spinal injury was causally related to the ‘gait derangement’, itself caused by the accident. That is, was the accident a contributing cause of a lumbar thoracic spinal injury by reason of the gait derangement caused by the accident.”
136.	In Kinchela v Insurance Australia Group Ltd t/as NRMA Insurance Justice Walton set aside the decision of a Medical Review Panel. In considering the question of causation in relation to an amputated toe Justice Walton concluded that the question was not whether there was any contemporaneous evidence or corroborative evidence to support the injury but whether the motor vehicle accident materially contributed to that injury. 
137.	The Panel notes the Personal Injury Claim Form dated 7 December 2017 included “Anxiety Disorder” although there is no apparent complaint to medical practitioners of psychological symptoms until 2019. Indeed, the first attendance on a medical practitioner for injuries arising from the accident was not until 30 November 2017 and whilst Ms Hassim attended Priority Medical Centre on 17 August 2019, 24 August 2018 and 31 August 2018 in respect of physical injury arising out of the accident she did not report any psychological symptoms. 
138.	On 12 February 2019 Dr East referred to depression being present for eight months and on 13 June 2019 Dr Mohiuddin reported the claimant was a “very anxious patient” and advised her to see a psychologist. 
139.	In the experience of both medical assessors a person with severe agoraphobia is likely to be reluctant to approach a medical practitioner to discuss her internal feelings. The Panel notes on various occasions before the accident hypochondriacal anxiety was identified by medical practitioners having regard to the claimant’s presentation rather than her articulation of psychological symptoms. Similarly, the Panel finds it likely the claimant was reluctant to discuss or undergo treatment for her developing sense of panic and agoraphobia. This is evident from the lengthy discussion Dr Mohiuddin engaged in with the claimant on 13 June 2019 before he was able to persuade her to see a psychologist. 
140.	Ms Hassim was involved in a frightening motor accident which was sudden, unexpected and dangerous. It was capable of giving rise to symptoms of psychological distress which reach the threshold of a diagnosable psychiatric condition. The Panel notes Ms Hassim was a vulnerable individual with a past history of anxiety and depression but was not actively symptomatic at the time of the motor accident. The Panel regards the motor accident as being more than a minor contributing factor to Ms Hassim's current psychiatric condition.
Whole person impairment
Psychiatric diagnoses	1. Panic Disorder	2. Agoraphobia	
Psychiatric treatment description	Psychological counselling	

Category	Class	Reason for Decision	
1. 	Self Care and Personal Hygiene	1	Ms Hassim said she has a regular shower and always wears clean clothing. She sometimes does the laundry but again relies on her partner or mother. She said she has put on weight due to the impact of the accident and her thyroid condition. She is unimpaired.	
2. 	Social and Recreational Activities	3	Ms Hassim said she normally hangs out with her partner and her parents. She has some friends but she has hardly seen them since the accident. She said she does try to get out with them every few months. She goes out for a walk in the park and enjoys reading. She said it is too painful for her to see her friends because they have babies. The panel believe she is significantly restricted by anxiety. She is moderately impaired.	
3. 	Travel
	3	Ms Hassim is able to drive in the local area for up to 30 minutes if accompanied. She cannot use main roads. She can use public transport only if accompanied. She has not travelled by air since the motor accident. She is unable to travel away from her residence without a support person. She is moderately impaired.	
4. 	Social Functioning
	2	Ms Hassim said she gets along well with her partner and her parents. She said her brother in Australia is supportive and she has a good relationship with her sister in the United Kingdom. She sees much less of her friends because of anxiety. She is mildly impaired.	
5.	Concentration, Persistence and Pace	2	Ms Hassim said she does not like to watch television and does not look at YouTube. She said she prefers to read and write. She can manage her own money. She has been able to publish a book on Affirmations since the accident. There was some difficulty with memory. She did not have difficulty with concentration throughout the interview. She is mildly impaired.	
6. Adaptation
	5	Ms Hassim is unable to work because of anxiety. She said she is unable to travel to the workplace. She said she has lost confidence in her abilities and is fearful of panic attacks when she is expected to perform under pressure. She is totally impaired.	
List classes in ascending order: 1 2 2 3 3 5	
Median Class Value: 3 	
Aggregate Score: 16	
% Whole Person Impairment: 17%	
*%WPI = Percentage Whole Person Impairment
Apportionment – pre-existing/subsequent impairment
141.	While there were indications of psychological difficulty in 2009 and in 2014 Ms Hassim was not psychologically ill at the time of the accident. She denied any subsequent accidents and conditions. There is no requirement for apportionment.
Effects of treatment
142.	There is no evidence that there has been adequate treatment or any treatment response. The panel makes no treatment effect allowance.
Conclusion
143.	The panel has diagnosed both panic disorder and agoraphobia using DSM-5 criteria giving rise to 17% whole person impairment.