DETERMINATION OF REVIEW PANEL	
	
CITATION:	AAI Limited t/as GIO v Ahmed [2024] NSWPICMP 476	
		
CLAIMANT:	Affan Ahmed	
		
INSURER:	AAI Limited trading as GIO	
		
REVIEW Panel	 	
		
MEMBER:	Susan McTegg	
		
MEDICAL ASSESSOR:	Michael Hong	
		
MEDICAL ASSESSOR:	Christopher Canaris	
		
DATE OF DECISION:	16 July 2024	
		
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accident Injuries Act 2017; section 1.6(3); threshold injury; specific phobia (driving); Medical Assessor found claimant sustained a specific phobia for driving cars, which was not a threshold injury; insurer sought review; Held – the claimant satisfied DSM-5 criteria for specific phobia for driving caused by the accident; non-threshold injury; Medical Assessment Certificate confirmed.  

DETERMINATIONS MADE:  	CERTIFICATE OF DETERMINATION
Assessment of Threshold Injury
Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017
1.	The Review Panel affirms the certificate of Medical Assessor Gerald Chew dated 6 February 2023.	

STATEMENT OF REASONS
introduction
1.	On 12 October 2019 Mr Affan Ahmed (the claimant) was a backseat passenger in a vehicle struck on the left side by another vehicle (the accident). 
2.	Mr Ahmed is 24 years of age and was 19 years of age at the date of the accident. 
3.	On 24 March 2020 Mr Ahmed lodged an Application for personal injury benefits.
4.	AAI Limited trading as GIO (the insurer) is the relevant insurer with liability to pay any damages to Mr Ahmed under the Motor Accident Injuries Act 2017 (the MAI Act).
5.	Mr Ahmed’s claim is governed by the provisions of the MAI Act. At the time of the accident statutory benefits for treatment and care under the MAI Act ceased after 26 weeks if the person’s only injuries resulting from the motor accident were threshold injuries.
6.	On 5 June 2020 the insurer issued a liability notice declining liability for benefits beyond 26 weeks on the basis the injuries sustained by the claimant were minor (threshold) injuries for the purposes of the MAI Act. 
7.	On 9 March 2022 the claimant requested an internal review pertaining to the threshold injury decision. 
8.	The insurer issued a Certificate of Determination dated 18 March 2022 affirming the original decision. 
9.	The claimant filed an application with the Personal Injury Commission (Commission) seeking a medical assessment to resolve the minor (threshold) injury dispute between the parties. 
10.	Pursuant to Schedule 2, cl 2 of the MAI Act, various matters are declared to be a medical assessment matter, including “whether the injury caused by the motor accident is a threshold injury for the purposes of the Act”. 
11.	A medical assessment matter is determined in accordance with Division 7.5 of the MAI Act by a Medical Assessor.
12.	The dispute as to threshold injury was referred to the Commission and the psychological injury was referred to Medical Assessor Gerald Chew. He issued a issued a certificate dated 6 February 2023 in which he certified that the psychological injury sustained by Mr Ahmed caused by the accident was not a minor (threshold) injury. 
13.	The insurer has sought a review of the certificate of Medical Assessor Chew. 
EVIDENCE BEFORE THE REVIEW PANEL 
14.	The Review Panel (the Panel) issued a Direction to the parties on 28 November 2023 requiring each party to file an indexed, paginated bundle of documents. In response to this Direction the solicitor for the insurer uploaded to the portal documents marked insurer’s bundle paginated from pages 1 to 144. On 14 June 2024 the solicitor for the claimant uploaded to the portal documents marked claimant’s bundle paginated from pages 1 to 8 (incorporating submissions only).
15.	On 26 March 2024 the Panel agreed an examination was required. 
THRESHOLD INJURY – STATUTORY PROVISIONS
16.	The Motor Accident Injuries Amendment Act 2022 (the MAI Amendment Act) was assented on 28 November 2022 with various amendments commencing on 1 April 2023. From 1 April 2023 the MAI Amendment Act provides that a “minor injury” is known as a “threshold injury” and “minor injuries” are known as “threshold injuries”. 
17.	The definition of what constitutes a minor injury has not been amended and continues to apply to a threshold injury.
18.	Any reference in these reasons to “minor injury” is a reference to a “threshold injury” and any reference to the word “minor” referring to the injury alleged to have occurred in the accident is a reference to “threshold”. 
19.	A threshold injury is defined in s 1.6 of the MAI Act. Section 1.6(1)(a) of the MAI Act defines a “threshold psychological injury” as:
“A psychological or psychiatric injury that is not a recognised psychiatric illness.” 
20.	Section 1.6 provides that regulations may be made to exclude or include a specified injury from being a threshold psychological or psychiatric injury. 
21.	Part 1, cl 4(2) of the Motor Accident Injuries Regulation 2017 (the MAI Regulation) provides the following:
“Each of the following injuries is included as a threshold injury for the purposes of the Act:
(a)	acute stress disorder,
(b)	adjustment disorder.” 
22.	Part 5 of the Motor Accidents Guidelines (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 the motor accident is a threshold injury for the purposes of the MAI Act. Version 9.1 of the Guidelines commenced on 1 April 2023 and applies to motor accidents occurring on or after 1 December 2017. In respect of the medical assessment of whether an injury is a threshold injury, the Guidelines relevantly 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	Insurers should not require injured persons to undergo diagnostic imaging for the purpose of the insurer determining whether the injury related to the claim is a threshold injury. 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.”
23.	In respect of threshold psychological or psychiatric injury the Guidelines also provide:
“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, Fifth Edition, Text Revision (DSM-5-TR), 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.” 
OTHER MEDICAL ASSESSMENT CERTIFICATES
Certificate of Medical Assessor Geoffrey (Paul Curtin)
24.	In a certificate dated 8 August 2022 Medical Assessor Curtin assessed the facial scaring and determined it was a minor (threshold) injury for the purposes of the MAI Act.
25.	Medical Assessor Curtin noted Mr Ahmed has sustained permanent and noticeable scarring of his face. 
Certificate of Medical Assessor Clive Kenna 
26.	In a certificate dated 8 August 2022 Medical Assessor Kenna assessed the left shoulder as a soft tissue injury and determined it was a minor (threshold) injury for the purposes of the MAI Act.
CERTIFICATE UNDER REVIEW
27.	In a certificate dated 6 February 2023 Medical Assessor Gerald Chew certified the following injury caused by the accident was not a minor (threshold) injury for the purposes of the MAI Act: 
•	specific phobia - driving cars.
28.	The injury referred for assessment was “psychological injury”.
29.	Medical Assessor Chew reported the claimant lived with his parents and two younger sisters. He was studying Civil Engineering and Business at the University of Technology Sydney (UTS) and working approximately 12 hours a week in retail. He had no past medical history. 
30.	Medical Assessor Chew reported following the accident on 12 October 2019 Mr Ahmed said he was in shock and unable to leave the vehicle. He described profuse bleeding from his face. He was taken to hospital for observation. Since the accident he has had some physical treatments including physiotherapy. He had not had any mental health treatment. 
31.	Mr Ahmed reported since the accident he avoids being in cars. He can drive if necessary but is extremely anxious and worries about another accident. He was able to be a passenger but had similar worries and anxiety preferring to use public transport such as trains.
32.	Medical Assessor Chew reported the claimant functioned at a high level except with respect to his ability to drive or travel in a car. 
33.	He concluded Mr Ahmed met the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for specific phobia-driving cars. This was a non-minor (threshold) injury. 
REVIEW PROCEDURE
34.	The insurer lodged an application for review of the medical assessment of Medical Assessor Chew within 28 days of the date on which his certificate was made available to the parties.
35.	On 12 April 2023 the delegate of the President being satisfied there was reasonable cause to suspect that the medical assessment was incorrect in a material respect referred the medical assessment to the Panel.
36.	Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the Personal Injury Commission Act 2020 (PIC Act). A review panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.
37.	The review is by way of a new assessment of all matters with which the medical assessment is concerned. 
THE EVIDENCE 
Photographs
38.	A photograph of the vehicle in which the claimant was travelling shows significant damage to the left hand side of the small vehicle. The rear passenger door which has been stowed in and intrudes into the cabin.
39.	Another photograph depicts the claimant at the hospital with lacerations to the left hand side of his face. 
Application for personal injury benefits
40.	On 24 March 2020 Mr Ahmed lodged an Application for personal injury benefits in respect of the following injuries: 
•	four to five stitches on forehead;
•	glass shards in face;
•	badly bruised left trap and left quadricep;
•	shoulder pain, and
•	long period of a state of shock. 
Treating medical records
Ambulance report
41.	The ambulance report states:
“CT MVA, assessing 1 passenger of car. Car going approx. 50 kph and got T-boned by another car. Intrusion to cabin to rear door. Pt 19yo male, O/A pt alert, orientated, well perfused, sitting in backseat of car. O/E…Pt has ~6cm deep lac to L forehead w multiple small lacerations to forehead and eyelid w minimal bleeding. Pt C/O L trapezius pain worsened on palpation, nil radiation, nil shoulder pain, normal ROM of shoulder, nil obvious deformity to shoulder/clavicle. Pt C/O pain to L lateral thigh … Pt denies headache, dizziness or LOC, able to recall event, denies C-spine tenderness,… . Pt states was wearing seatbelt, nil seatbelt trauma evident. Pt mobile. C-spine collar applied….”
St George Hospital
42.	St George Hospital reported the claimant was involved in a collision in which another car 
T-boned the car he was travelling in as a middle rear set restrained passenger. He did not lose consciousness, was able to self-extricate and mobilise. Mr Ahmed had lacerations to the forehead and eyelid on the left and a bruise to his left thigh. Shards of glass were removed from his face and sutures inserted. 
Dr Albert Nguyen, general practitioner (GP)
43.	Mr Ahmed consulted Dr Nguyen on 14 October 2019 when he provided a history of the accident. Mr Ahmed complained of pain in the shoulders, neck, left face and left knee and bruises on the left side of the face. 
44.	Having regard to the head injury sustained by Mr Ahmed Dr Nguyen reviewed him on 15 October 2019 and on 19 October 2019. On 23 October 2019 Dr Nguyen noted the scar on the claimant’s face which affected him psychologically. He reported “Anxiety +++ Not depressed.”
45.	On 28 January 2020 Dr Nguyen noted recurrent shoulder pain since the accident. He issued a Certificate of capacity/certificate of fitness dated 28 January 2020 with the diagnosis of “left shoulder injury/left facial abrasion”.
46.	On 11 March 2020, Mr Ahmed is noted to have returned from a tour of Bangladesh and to be exhausted with insomnia and tiredness with a diagnosis of jetlag.
47.	On 17 May 2022 Dr Nguyen reported Mr Ahmed was anxious, with intermittent panic attacks. 
“anxious
Intermittent panic attacks
Not depressed
Still enjoys enjoyable activities
Normal libido
Intermittent sleep disturbance and nightmares
Apprehension/fearful anticipation
Irritable intermittently. Impatience
Exaggerated startle response. Sensitive to noise
Poor concentration
Tenison headache intermittently
Intermittent trembling/shaky/twitching
Easily tired/fatigue
Tense fist
Intermittent palpitations/Globus hystericus/SOB/Dizziness
Excessive perspiration
Dizzi
Normal appetite/energy
No psychotic/suicidal features
No PHx of mania/BPD
Functioning reasonably OK adequate social support …”
48.	On 2 July 2022 Dr Nguyen reported the scar on the claimant’s face had affected him psychologically and his anxiety and irritability had increased. 
49.	There are no other notes referencing psychological issues, no prescriptions for psychotropic medication, and no referrals to other clinicians such as psychologists.
Insurer’s submissions
50.	The insurer provided submissions dated 6 March 2023.
51.	The insurer notes specific phobias are dealt with at pages 197 to 202 of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). The diagnostic criteria are set out at page 197 as follows:
“(A)	Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
(B)	The phobic object or situation almost always provokes immediate fear or  anxiety.
(C)	The phobic object or situation is actively avoided or endured with intense fear or anxiety.
(D)	The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.
(E)	The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.
(F)	The fear, anxiety, or avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
(G) 	The disturbance is not better explained by the symptoms of another mental disorder, including fear, anxiety, and avoidance of situations associated with panic-like symptoms or other incapacitating symptoms (as in agoraphobia); objects or situations related to obsessions (as in obsessive-compulsive disorder) reminders of traumatic events (as in post-traumatic stress disorder); separation from home or attachment figures (as in separation anxiety disorder); or social situations (as in social anxiety disorder).”
52.	The insurer notes the diagnostic features are elaborated at pages 198 and 199:
“… To meet the criteria for a diagnosis, the fear or anxiety must be intense or severe (i.e., ‘marked’) (Criterion A). The amount of fear experienced may vary with proximity to the feared object or situation and may occur in anticipation of or in the actual presence of the object or situation. Also, the fear or anxiety may take the form of a full or limited symptom panic attack (i.e., expected panic attack). Another characteristic of specific phobias is that fear or anxiety is evoked nearly every time the individual comes into contact with the phobic stimulus (Criterion B). Thus, an individual who becomes anxious only occasionally upon being confronted with the situation or object (e.g., becomes anxious when flying only on one out of every five airplane flights) would not be diagnosed with specific phobia. …
The individual actively avoids the situation, or if he or she either is unable or decides not to avoid it, the situation or object evokes intense fear or anxiety (Criterion C). Active avoidance means the individual intentionally behaves in ways that are designed to prevent or minimize contact with phobic objects or situations (e.g., takes tunnels instead of bridges on daily commute to work for fear of heights; avoids entering a dark room for fear of spiders; avoids accepting a job in a locale where a phobic stimulus is more common). Avoidance behaviors are often obvious (e.g., an individual who fears blood refusing to go to the doctor) but are sometimes less obvious (e.g., an individual who fears snakes refusing to look at pictures that resemble the form or shape of snakes). Many individuals with specific phobias have suffered over many years and have changed their living circumstances in ways designed to avoid the phobic object or situation as much as possible (e.g., an individual diagnosed with specific phobia, animal, who moves to reside in an area devoid of the particular feared animal). …
… The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more (Criterion E), which helps distinguish the disorder from transient fears that are common in the population, particularly among children. …”
53.	And at page 201 of DSM-5 it states:
“Individuals with specific phobia show similar patterns of impairment in psychosocial functioning and decreased quality of life as individuals with other anxiety disorders and alcohol and substance use disorders, including impairments in occupational and interpersonal functioning.”
54.	The insurer submits to meet the diagnostic criteria there must be immediate marked (that is, intense or severe) fear or anxiety on almost every occasion there is exposure, car travel must be either actively avoided or endured with intense fear or anxiety and, finally, those symptoms must be present for 6 months or more.
55.	The insurer submits Medical Assessor Chew did not address the diagnostic criteria or how it was met by the claimant and notes the lack of documentary evidence to support the diagnosis.
56.	The insurer provided submissions dated 24 May 2022 in respect of the threshold injury dispute. The claim made was for post-traumatic stress disorder. 
57.	The insurer notes the claimant reported being in a state of shock following the accident but note there was no formal diagnosis by any treating provider. The insurer notes the claimant has not submitted any evidence in support of the application and there is no DSM-5 diagnosis. 
Claimant’s submissions
58.	The claimant provided submissions dated 28 March 2023. The submissions address whether there is reasonable cause to suspect the assessment of Medical Assessor Chew is incorrect in a material respect. 
59.	The claimant submits he meets the diagnostic criteria of Specific Phobia under DSM-5. 
60.	In respect of Criterion A the claimant notes Medical Assessor Chew reported “He is able to drive if necessary. He however is extremely anxious and worries about another accident. He is able to be a passenger however has similar worries and anxiety.” It is submitted this indicates the claimant experiences marked anxiety when exposed to the phobic stimulus, whether he is the driver or passenger of a motor vehicle. 
61.	It is submitted the history recorded by Medical Assessor Chew above also satisfied Criterion B in that the claimant experiences anxiety when he is a passenger or driver of a motor vehicle. 
62.	Medical Assessor Chew reported “since the accident he avoids being in cars” and he is extremely anxious and worries about another accident. Mr Ahmed also reported he prefers public transport such as trains. The claimant submits this satisfies Criterion C in that Mr Ahmed actively avoids the phobic stimulus. 
63.	The claimant submits he satisfied Criterion D where his marked anxiety relating to motor vehicles is out of proportion to the actual danger posed. 
64.	The claimant submits he satisfies Criterion E in that his marked anxiety and avoidance behaviour has persisted since the date of accident, a period of at least three years. 
65.	The claimant submits criterion F is satisfied where the impairment has a negative impact on his occupational and interpersonal functioning, including his engineering career, specifically his eligibility for jobs where he is required to be comfortable operating or riding in a motor vehicle. The claimant argues his inability drive or travel in a car has also impacted his socialisation. 
66.	The claimant submits the specific phobia was caused directly by the accident where there are no other plausible explanations in accordance with Criterion G.
THE MEDICAL EXAMINATION
67.	The claimant was assessed by Medical Assessor Canaris and Medical Assessor Hong on 2 July 2024 by videoconference through MS Teams.
Psychosocial and pre-accident history
68.	Mr Ahmed is a 24-year-old single retail worker casually employed in a clothing shop. 
69.	At the time of the accident, he had started his university studies in civil engineering and business. 
70.	Mr Ahmed identified “stress” as having been a part of his life but not anxiety. By stress, he meant meeting strangers or public speaking saying that the feeling with cars was definitely more intense. 
71.	He had been otherwise well psychologically and physically. 
72.	He does not drink alcohol. He does not smoke. He does not use drugs. He does not gamble.
73.	He denied any history of problems with the law. He had no other claims history. 
74.	Mr Ahmed knew of no family history of psychiatric illness. 
75.	He is Australian to Bangladeshi parents. He has two younger sisters. His father is a taxi driver. His mother looks after the family home. 
76.	He described his childhood as fun saying, “I got to play my soccer… a bunch of sports… I got to play rugby – cricket”.
77.	Mr Ahmed completed year 12 and went to UTS and is enrolled in a business/engineering degree. He is not sure what he will do and “might even branch out into another field”.
The accident
78.	On 12 October 2019, Mr Ahmed was in the back of a friend’s car in the middle seat. He had a friend in the front passenger seat. He had bent down to do up his shoelaces. He heard his friend in the front passenger seat scream “and the jeep just collided”.
79.	He “couldn’t move – I didn’t know why – I was winded – I saw the liquid on my fingers – I touched it – I saw it was blood – my friends saw me and started screaming… they said to call the police”. 
80.	Police cut his shirt and jumper and helped him out of the car and into an ambulance which took him to St George Hospital where he was “still in a stretcher thing… they placed me on another bed… the doctor put me in a gown… he started stitching my forehead and taking the glass shards out…”.
81.	Mr Ahmed was “three or four hours” in hospital after which he went home – his friend’s parents picked him up.
82.	He said he was okay initially because of the adrenaline rush but in the morning found it hard to get up because of an injury to his left shoulder and thigh.
83.	His shoulder is now okay, but he finds it hard to sleep on his left side. 
84.	The Panel asked Mr Ahmed how he had fared psychologically. In 2019 he had his licence. He recalled, “The first time I got driven in a car – I remember we came to a traffic light – there was a car coming from the left… I felt he would hit me… from then on, it’s in that situation, it’s always the same… definitely anxious… it’s 24-24 – I can only trust a small number of people to drive me”. He does drive “but never very far”. He can manage a 20-to-30-minute drive on his own limited by his anxiety. 
85.	He stopped driving for “more than half a year”, although later, he was more specific saying it was eight months. He does not own a car – he drives his father’s. He said, “I didn’t plan to drive – I just didn’t like driving… the main thing was I didn’t trust people around me on the road”. 
86.	Apart from his difficulty in cars, he is “alright”. He has not felt depressed. That said, 
“anxiety and stress is pretty common for me – I guess it’s study or certain situations”. He illustrated this by saying, “I recently found out my grandmother got sick – I felt I couldn’t do anything about it – there’s the standard uni stress”. He feels that he might be very much set back if he had another accident. 
87.	He has had “two dreams” relating to accidents. He saw himself in a different country and involved in a plane crash. The second dream was a car crash, but he could not recall the details which would have been about a year ago.
88.	He sometimes notices the scar on his forehead, and this distresses him. This does not bother him except when he might be brushing his hair or trimming his beard and he finds himself thinking how lucky he was to survive particularly if he had been sitting in the left-hand seat. He characterises a scar as “an unwanted addition to my face… but it is what it is”. 
89.	He might find himself thinking about the accident “if I’m speaking to the friends that were involved but otherwise not really”.
90.	He has not sought assistance saying, “It’s never something that’s been encouraged” within his cultural background “and for me personally as well, I guess I’m a bit naïve to it”.

Mental state examination
91.	Mr Ahmed was interviewed by Microsoft Teams. He was sitting in his car. He presented as a dark-complexioned man with a long bushy beard who provided the history documented above. His narrative was coherent and consistent. 
92.	His affect was warm and reactive. 
93.	There was no evidence of psychosis or of cognitive impairment. 
Current functioning
94.	Mr Ahmed is in the final year of his engineering/business studies which are going very well. He has just obtained his results and has done well – he has one semester to go. He has managed a credit average. 
95.	He is doing well in his casual job although it is “a bit monotonous”.
96.	Mr Ahmed recalls that he did not sleep well in the first year after his accident because of physical discomfort. He has trained himself to sleep on his back though he sometimes wakes if he rolls over onto his left shoulder. 
97.	His energy levels are “pretty good”, and his concentration is “good”. If he has an assignment he “can never sit for more than half an hour” needing to take a break, although this may have always been the case. 
98.	Mr Ahmed has always had a good appetite though of late he has been “very comfortable eating a meal a day” and he can easily lose weight although he can regain the weight if he prioritises gym. 
99.	He plays soccer every week. He visits friends or have them come over which might happen once a week.
100.	Mr Ahmed lives with his family. They are “very tight – very close”. He denied any tensions. He has no girlfriend or partner which relates more to not having come across the right person. He sees certain people less, mainly because he does not want them to drive him. 
101.	He showers and changes his clothes daily. 
102.	Overall, he feels well “except when it comes to driving – otherwise I’m pretty normal”. 
Comments on consistency
103.	There was no evidence of any inconsistency. The Panel noted Mr Ahmed was sitting in a car at the time of the interview. However, this was not considered evidence of inconsistency as the claimant’s anxiety had receded in intensity and his anxiety related to driving and travelling as a passenger in a car rather than the mere fact of being in a car. Moreover, the Panel noted that his reported avoidance had diminished significantly.
DIAGNOSIS 
104.	The Panel determined that Mr Ahmed’s presentation was very much consistent with a specific phobia (driving). In terms of DSM-5-TR criteria, it noted the presence of marked fear and anxiety about a specific situation (Criterion A) which almost always provokes immediate fear or anxiety (Criterion B). The phobic situation was actively avoided or endured with intense fear of anxiety particularly over the eight months after the accident during which time the claimant could not drive at all (Criterion C). His anxiety was out of proportion to the actual danger posed by the specific situation and in the social cultural context (Criterion D) and driving had been actively avoided since the accident although as noted above he did resumed driving after eight months but even now is very cautious as to whose vehicle he will enter (Criterion E). It caused him clinically significant distress and impairment in that he did not drive at all for a considerable time and there was evidence of ongoing albeit attenuated avoidance (Criterion F). His disturbance was not better explained by the symptoms of another mental disorder (Criterion G).
105.	Given that his levels of fear had attenuated over time, his specific phobia could be said now to be in partial remission.
106.	The Panel noted Mr Ahmed had not sought treatment but also accepted his explanation that seeking psychological help was out of kilter with his sociocultural background.
CAUSATION 
107.	Mr Ahmed’s specific phobia arises entirely because of the accident which as described and as evident from the documentation on hand was an event carrying an inherent probability of precipitating a condition of this nature. There was no evidence of any other situation contributing to its emergence. Some degree of pre-existing anxiety was apparent, but this does not appear to have had the requisite severity or pervasiveness to warrant a diagnosis though it may have contributed to an element of vulnerability.
THRESHOLD INJURY
108.	Specific phobia (driving) in partial remission is a recognised psychiatric condition as per the DSM-5-TR and is hence by definition a non-threshold injury.
109.	The Panel affirms the certificate of Medical Assessor Gerald Chew dated 6 February 2023.