DETERMINATION OF REVIEW PANEL	
	
CITATION:	CID v QBE Insurance (Australia) Limited [2025] NSWPICMP 170	
		
CLAIMANT:	[CID]	
		
INSURER:	QBE Insurance (Australia) Limited	
		
REVIEW Panel	 	
		
MEMBER:	Hugh Macken	
		
MEDICAL ASSESSOR:	Verma Surabhi	
		
MEDICAL ASSESSOR:	John Baker	
		
DATE OF DECISION:	17 March 2025	
		
CATCHWORDS:	MOTOR ACCIDENTS –  Review of medical assessment; threshold injury; psychosocial history; pre-accident family relationships; referral to pain management clinic; auto immune marker with scleroderma; post-accident commitment ceremony; post-accident employment circumstances; strained friendships and relationships post-accident; anxiety with near cars; diminished interest in socialisation; insomnia; fatigue with loss of energy; excessive guilt surrounding motor vehicle accident; depressive symptoms; anxiety symptoms including difficulty travelling; difficulty accessing psycho-social treatment; medical documentation and criteria for post-traumatic stress disorder; diagnosis of major depressive disorder of mild severity; non-threshold injury; Held – Medical Assessment Certificate revoked.
	
DETERMINATIONS MADE:  	CERTIFICATE OF DETERMINATION
Review Panel Assessment – Threshold Injury
Replacement Certificate issued under s 7.23(1) of the Motor Accident Injuries Act 2017
The Review Panel revokes the certificate of Medical Assessor Abhishek Nagesh dated 7 September 2023 and issues a new certificate determining that the major depressive disorder of mild severity is a threshold injury for the purposes of the Motor Accident Injuries Act.
The following injuries referred to the Panel for assessment had been assessed and determined to be not caused by the motor accident:
•	Post-traumatic stress disorder

	

STATEMENT OF REASONS
introduction
1.	[CID] (the claimant) is a 38-year-old woman who was injured in a motor vehicle accident on 28 May 2022. Following the accident an application for personal injury benefits was lodged. The claimant sought a concession from the insurer that her injuries ought to be considered a non-threshold injury. The insurer, after a review, declined to make this concession. Thereafter the claimant lodged an application for assessment of threshold injury with the Personal Injury Commission (Commission).
2.	On 14 June 2023 the claimant was examined by Medical Assessor Christopher Harrington who, in a Certificate dated 26 June 2023 determined that the injury to the cervical spine and thoracic spine is a threshold injury for the purposes of Motor Accident Injuries Act (MAIA Act).
3.	The claimant was seen by Medical Assessor Abhishek Nagesh on 8 June 2023 and, in a Certificate dated 7 September 2023, certified that the claimant had suffered an adjustment disorder which was a threshold injury for the purposes of the Act.  For completeness’s sake he certified that the injury referred to him for assessment, post-traumatic stress disorder, was not caused by the motor accident.
4.	The claimant sought a review of this determination which was referred to the President’s delegate, Catherine Freeman. In a Certificate dated 17 November 2023 she certified that she was satisfied there is a reasonable cause to suspect that the medical assessment, that being of Medical Assessor Nagesh, was incorrect in a material respect. This would seem to be on the basis that the Medical Assessor, having been presented with a diagnosis of post-traumatic stress disorder by her treating psychologist, ought to have specifically explained why he did not accept the diagnosis made by her treating psychologist. Further, there was confusion and irrelevant considerations when determining whether or not the claimant satisfied criteria A for a diagnosis of post-traumatic stress disorder.
5.	The matter was then referred to this Medical Appeal Panel.
6.	The Panel convened on 14 November 2024 and determined that the material before both Medical Assessor Nagesh and Medical Assessor Harrington ought to be provided to the Panel and that a re-examination of the claimant needs to take place.  
7.	Clause 14F of Schedule 1 of the Personal Injury Commission Act 2020 (the PIC Act) provides that the new review provisions apply in relation to a decision of a new decision-maker. A “new decision maker” is defined in cl 14A(1) of the Schedule 1 of the PIC Act. As the medical assessment, the subject of the review, was made on or after 1 March 2021, 
the new review provisions apply.
8.	The new review provision provide that a review panel consists of two Medical Assessors and a Member assigned by the Motor Accidents Division of the Commission.
9.	Part 5 of the PIC Act enables the Commission to make rules with respect to its practice and procedure including proceedings before a panel reviewing a decision of a Medical Assessor.
10.	Rules 127 to 130 of the Personal Injury Commission Rules 2021 (PIC Rules) are made pursuant to Part 5 of the PIC Act. A review panel determines how it conducts and determines the proceedings and may determine the matter solely based on the written application.
11.	The review of the medical assessment is by way of a new assessment of all the matters with which the medical assessment is concerned.
STATUTORY PROVISIONS/GUIDELINES
12.	Section 57 of the MAC Act defines a “medical dispute” as a disagreement or issue to which Part 3.4 of the MAC Act applies.
13.	Section 58 and s 60 of the MAC Act together with cls 1.5-1.7 of MAIA Act set out the procedures for referral to one or more medical assessors and the principles to be applied at such assessments.
Medical examination
14.	The claimant was examined by Senior Medical Assessor Baker and Medical Assessor Verma on 27 February 2025. Their report follows:
15.	[CID] was re-examined by Assessors Verma and Baker via telehealth on 
27 February 2025. She was unaccompanied and was assessed alone during the re-examination.
Psychosocial History
16.	[CID] is a 38-year-old female who lives with her husband aged 37 years and her 21-year-old daughter from [CID]’s first union. [CID] said that her daughter and herself had no contact with her daughter’s biological father.
17.	[CID] stated that she was born in South Korea. She was adopted by her identified mother and father at 3 months of age. She entered Australia at 3 months of age. She said she had never had any communication or contact with her biological parents. She stated that she had no desire to investigate her extended family history in South Korea.   
18.	[CID] said that her identified mother (mother) was of Dutch heritage. Her identified father (father) was of Australian heritage. Her mother separated from her father and formed a new union with [CID]’s stepfather. [CID] said she had little no contact with her mother and stepfather since the beginning of this union, many years prior to the motor accident. 
[CID] said she was in frequent contact and was close to her father who was 71 years old.
19.	[CID] said that she was not exposed to any childhood trauma, abuse or neglect. She said that she was not diagnoses as a child with any psychological condition or injuries. She said she was aware of emotional strain within the parental relationship prior to their separation. Whilst she had difficulties with frequent changes of school, she did not have any government support services in relation to the care of herself whilst a child. She said she had moved between schools depending on where her parents were living and working. The family bought small acreage, and [CID] had been raised in the equine discipline of Natural horsemanship and Western riding until she completed to Year 11 at Merville High School, NSW. [CID] was skilled in natural horse care, and she enjoyed pleasure riding of her horses. She was not involved in any horse sales, horse improvement or breeding.
20.	[CID] reported her relationship with her mother and stepfather as strained. She said by 14 year of age she had begun separating from them. She said as a teenager she had told her mother she had attempted to commit suicide and her mother’s response was to “laugh” at [CID].  [CID] said the relationship with her stepfather was also poor and she left this household after she was able to find employment.
21.	[CID] reported that she had surgery on each knee. She reported that her two synovectomy procedures had not resulted in any complications or psychological injuries. She said she had recurrent mild pain in relation to her knees however this pain had not prevented her from continuing to work or function in her social and employment roles. She said she had also had temporomandibular dental joint pain which was managed using botox injections which is a well-known procedure for management of this medical condition. She reported that she had not been referred to a pain management clinic prior to the motor accident. She had a mammoplasty augmentation procedure without complications many years prior to the motor accident.
22.	[CID] reported that she had “the gene” which is associated with a severe, flush reaction should she drink any alcohol. She said for this reason she does not drink alcohol as the biological reaction within her body is unpleasant until the alcohol had left her body. The flushing effect is well documented in the medical literature.
23.	[CID] reported that she had been identified with an autoimmune marker associated with Scleroderma. She does not have any of the physical symptoms of Scleroderma prior to, or subsequent to the motor accident. 
24.	[CID] reported that she had no complications during her pregnancy or birth of her daughter. She said her daughter was her only child. 
25.	[CID] said she was not allergic to any medication or substance. She said she does not smoke tobacco. She said she does not gamble. She said that she had no knowledge of her biological parents medical or family histories. 
26.	[CID] said that she was treated by her local medical practitioner on 29 September 2019 and diagnosed with an adjustment disorder with anxiety. She reported that her daughter was sexually assaulted by her father’s 40-year-old male friend whilst [CID] was on holidays in Hawaii, USA. The sexual assault occurred over two days. On [CID]’s return home she immediately reported the matter to the NSW Police Force. The perpetrator was prosecuted through the NSW Criminal Law courts and was jailed. [CID] reported that her daughter had part-time home schooling as well as help from her local community adolescent mental health team (CAMS). She said her daughter had suffered from depression with suicidal thoughts and self-harmed.
27.	[CID] reported that she had felt guilt for not having protected her daughter more. She said her condition was treated by a clinical psychologist. She did not receive much benefit from the treatment and this treatment ceased. [CID] reported that she was accepting of the court sentencing, however she remained having to provide care for her daughter who remains psychologically affected by the assault her daughter endured whilst [CID] was on vacation in Hawaii, USA.
28.	[CID] first commenced work at 17 years of age. She worked for a Christmas Bush exporting company to Japan. She worked in this role for about six months. she said that she married at 18 years of age. She gave birth to her daughter. She said she was a single mother for about nine years. She said she formed a second union with her current partner for about 10 years.
29.	[CID] reported that she had worked in various roles including administration for a pathology company, administration for a recruiting company and for Micheal Hil Jewellers. She said she had worked for Micheal Hill Jewellers for 13 years in this company’s Newcastle Shop. She said she was the Assistant Store Manager for two and a half years.
30.	[CID] then found employment working for [BNU]. She worked in this role for about three and a half years. She said she liked her work. She was a claims assessor prior to the motor accident. [CID] reported that as a claims assessor prior to the motor accident she was able to manage with the emotional and distressing images she would see whilst working in her role. She said she did not experience any work related psychological or physical injuries from her employment.
31.	[CID] reported that she had never lodged a Workcover related claim. She said she had never lodged any public liability claims. She said she had never lodged any claims related to her equestrian activities. She did state that whilst a “P-plate” driver she had a motor accident. She said she was not psychologically or physically injured by this event.
History of motor accident 
32.	[CID] was involved in a motor vehicle accident on 28 May 2022. She was the driver of the car that was involved in the motor accident. She had her best friend in the car who was sitting in the passenger seat. They both were wearing seatbelts. [CID] said that the activities for the day were to complete the necessary collections and arrangements for her Commitment Ceremony in Fiji which she had been planning. She said about 16 people were planning to travel and share this event with her. She said that her best friend was planning to help [CID] with the necessary arrangements in both Australia and Fiji.
33.	[CID] was driving from a dress fitting and then planned to collect the silk flowers she had ordered for the ceremony. She was driving in a the left lane.  The driver of the 4-wheel drive that caused the accident crashed into the side of [CID]’s smaller car. [CID] car side mirror, panels and windows were smashed in the incident.
34.	[CID] said she was initially in shock as she saw the 4-wheel drive move through the intersection. She pulled her car over to the side of the road out of the way from the flow of traffic. The driver of the other car came to check on [CID] and her friend. [CID]’s friend self-excited. The airbags of [CID]’s car failed to deploy. 
35.	[CID] was able to climb over the middle console of her car and exit through the passenger’s doorway. She said no ambulance or police attended the motor accident. She said she was unsure what to do. She said she called her partner, and he came to the accident scene. 
36.	[CID] saw that she was a short walk from a nearby police station. She walked to the police station and informed the police of the accident whilst making enquiries as to whether she was permitted to move her damaged car. She said she was informed she could move the car if it was safe to drive.
37.	[CID] then was asked what about what she did immediately after the motor accident. She said, “she and her best friend were late for collection of the silk flowers and there was no other day that this could occur.” She said her partner drove his 4-wheele drive to the accident scene. Both [CID] and her best friend took control of the 4-wheel drive and drove to complete the days planned events. [CID]’s partner, drove the damaged smaller car to the family home.
38.	[CID] was asked why she did not seek immediate medical attention for her and her best friend. She said that she was not going to miss her Commitment Ceremony and she prioritised this event. She said she had a short period of time allocated before she had to fly to Fiji and she was committed to meeting her scheduled deadlines.
History of symptoms and treatment following a motor accident 
39.	[CID] reported that she began to experience pain in her “neck and upper back”. She said as she worked as a claims assessor, she knew she was permitted two physiotherapy sessions through her insurance policy. She notified and booked her appointments with the physiotherapist the next day. Saturday was a day her general practitioner did not work so she organised to be assessed by her general practitioner for filling in of the necessary application forms, as soon as he was available and before her flying out to Fiji within the week. She attended her general practitioner “a couple of days” after the motor accident on her report at this re-examination.
40.	[CID] reported that she was treated for her anxiety with diazepam 5mg as required prior to her flying to Fiji. She said she had continued to need diazepam 5mg frequently in Fiji as she was irritable, agitated anxious whilst in Fiji.
41.	[CID], her best friend, and her partner along with other guest attended the Commitment Ceremony. She said she remained in Fiji at the resort for about 10 days which was the planned length of the vacation. She said that her partner suffered from severe gastroenteritis and was assessed and treated by a resort doctor for his acute condition.
42.	[CID] reported that she returned home and returned to work. She stated that she began to experience a depressed mood. She stated that her depressed mood initially improved without full resolution and then deteriorate. She stated as her condition did not improve, she tried to use the “Navigator Program” and seek rehabilitation assistance through her insurer. She reported that she was informed by her best friend that [CID]’s best friend required surgery. Her best friend then required further surgery for injuries her best friend had suffered in the motor accident whilst her friend was seated in the passenger seat. [CID] said she felt depressive feelings and had depressive ruminations involving excessive guilt for her best friend’s injuries caused in a motor accident where she was a driver. [CID] said that her best friend then began to distance herself from [CID]. She said that at the time of this re-examination the two were estranged. 
43.	[CID] reported that she had suffered other symptoms including the following because of the motor accident. She reported that within the first month after motor accident she began to be increasingly irritable and agitated, towards her partner when she was a passenger, and he was driving. She would shout “too fast or too close” to other drivers on the road. She said that she had lost interest in socialising with her friends and that she had stopped all celebrations within her home except for her daughter’s birthday. She said she was not interested in sharing time in socialising or watching movies with her partner. She said she spent time playing “simple games, like candy crush” and death scrolling on her mobile phone with no purpose other than avoiding talking to her partner or daughter. She said prior to the motor accident she would have attended the gym however since the onset of her psychological injury she had low energy with fatigue and lost interest in attending the gym.
44.	[CID] reported that her sleep was poor with her waking from sleep because of recurrent nightmares about the motor accident. She could not return to sleep after waking early from sleep due to this symptom. She stated she was low in her energy every morning and that she would delay rising from bed and greeting the day. She said every morning she had a depressive theme that ruminated in her head, “I wish I hadn’t woken up!.” She said that she had thoughts of dying and death without suicidal plans to harm herself or others. She said she had the frequent depressive rumination that she will die in another car crash.” She was tearful whist talking about her depression. She said she would remind herself about her role as mother to her daughter and this was reassuring for her.  
45.	[CID] reported that she had experienced pain in her back and neck. She was diagnosed with “whiplash” and was informed that she had a soft tissue injury to her neck and back. She reported that she would use over the counter analgesic medication for this pain. She reported she had not been referred to a pain clinic for her pain related to the motor accident. 
Current symptoms
46.	[CID] continued to report symptoms consistent with major depressive disorder of mild severity at the time of this assessment, these included the following: 
•	depressed mood most of the day, nearly every day, as evidenced by the 
[CID]’s feelings of hopelessness with her not wanting to wake up each morning;
•	markedly diminished interest with inability to remain interested in socialising with others outside of her daughter’s needs. Loss of interest attending the gym with loss of her gym friendship circle;
•	insomnia nearly every night with initial insomnia where she would ruminate about the motor accident and after falling asleep, she would wake from sleep due to nightmares which caused her difficulty returning to sleep;
•	fatigue with loss of energy nearly every day with her having low energy and having difficulty rising from bed each morning, and
•	feelings of excessive guilt that the motor accident where she was the driver had injured her best friend causing her best friend to need repeated surgery for her injuries. 
47.	[CID] reported that her depressive symptoms would become exacerbated by her having to frequently look at car crashes and manage car crash cases for her employer. She said she had requested that she be placed in a role that would enable her not to have access to the photographs, video and written reports.
48.	[CID] reported that her employer had recognised her ongoing difficulty receiving fully from the motor accident. She had been placed on a 12-month secondment. The claimant said she was unsure whether she would be permitted to continue in the role after one year. She said she had been informed that the secondment would not persist beyond one year. 
[CID] reported that she was unsure of her future as she could not return to daily viewing of motor accidents as part of her work. [CID] reported that as a consequence of the secondment her salary had been increased to a higher rate, as she was temporarily working in a higher role than as a case manager for motor accident claimants. 
49.	[CID] reported she had experienced anxiety symptom that had included difficulty travelling in a sedan, such that she now drives a large car with the expectation she will be less injured should she have an accident. [CID] stated that she also would have panic attacks whilst a passenger in the car when it was driven by her partner. She said that should he brake unexpectantly or not hard enough she would suffer from a panic attack and yell at him to be more careful.

Treatment  
50.	[CID] reported she had initial difficulty finding access to psychological treatment. She said she had to wait for availability of a clinical psychologist for treatment. She was referred to a clinical psychologist who had provided [CID] with evidenced-based psychological treatment. She said that she had stopped attending for psychological treatment. She said she was not prescribed antidepressant medication. She said she had not been referred for other treatment such as repetitive transcranial stimulation for depression. She had not been admitted to a psychiatric hospital for her condition. She was not expecting further treatment due to the time elapsed since motor accident.
Medical documentation
51.	The material included an Allied Health Recovery request from the claimant’s treating practitioner, Amanda Brown, dated 25 January 2023. This diagnosed post-traumatic stress disorder noting that the claimant met criterions A, B, C, D, E, F and G of DSM-5-TR F43.10. This recovery request stated that the claimant had exposure to actual or threatened death, serious injury as a consequence of the motor vehicle accident. The Panel, as has been outlined, did not agree that criteria A had been met and accordingly a diagnosis of post-traumatic stress disorder could not be made in respect to the claimant.
52.	The Panel also noted the report of Amanda Brown dated 13 January 2023 which again noted that the claimant presented with symptoms consistent with post-traumatic stress disorder consequent on the motor vehicle accident. This report referenced Amanda Brown’s Allied Health Recovery request dated 31 August 2022 which identified signs and symptoms including intrusive thoughts of the accident, flashbacks, avoidance and efforts to avoid reminder of the incident, impaired social occupational and other areas of functioning.
53.	As is outlined further the Panel did not consider that the criteria for post-traumatic stress disorder had been established either by the documentation or examination of the claimant.
Mental status examination
54.	[CID] was reviewed and assessed via MS Teams. She was unaccompanied throughout the re-examination.  She was casually dressed with her hair attended.  She reported her mood to be depressed and sad. Her effect was tearful, dysphoric and congruent to a depressed mood she described.  Her speech was spontaneous and normal in volume and tone.  Her thoughts involved depressive ruminations that the motor accident was not her fault. She reported loss of interest in attending her gym and loss of interest in her friendships. She stated that she had become estranged from her best friend as she felt excessive guilt for her best friend’s injury caused by the motor accident. She reported she lacked interest in social activities, and she had ongoing nightmares, and avoidance of driving small cars.  There was no evidence of any mania, psychotic symptoms or perceptual abnormalities.  She had insight into her condition and her judgment was intact. She reported recurrent depressive themes of death with her waking nearly every day with the thought, “I wish I hadn’t woken up.” She had no thoughts to harm herself and she had no plans to harm herself.
Diagnosis and Reasons
55.	[CID] was involved in a motor vehicle accident on 28 May 2022. Her immediate actions were to continue with her plan for the day. She did not demonstrate behaviour consistent with DSM-5-TR F43.10 post-traumatic stress disorder criterion A. Exposure to actual or threatened death, serious injury. The claimant reported that she had been assessed as experiencing soft tissue injuries by the Medical Assessor Harrington in his certificate in June 2023. [CID] continued on with her plan for the day without attending hospital or medical services as would be expected had she suffered a severe injury or threatened death because of the motor accident.  For these reasons [CID] does not meet DSM-5-TR F43.10 post-traumatic stress disorder criteria and by definition does not have this condition.
56.	The second most common clinical presentation in relation to trauma is major depressive disorder.
57.	[CID] meets DSM -5-TR F32.0 criteria of major depressive disorder of mild severity.  The following five symptoms have been present during the same two-week period and represent a change from previous functioning with the claimant experiencing a depressed mood and loss of interest in her prior activities as well as the following:
Criterion A.
•	depressed mood most of the day, nearly every day, as evidenced by [CID]’s feelings of hopelessness with her not wanting to wake up each morning;
•	markedly diminished interest with inability to remain interested in socialising with others outside of her daughter’s needs. Loss of interest attending the gym with loss of her gym friendship circle;
•	insomnia nearly every night with initial insomnia where she would ruminate about the motor accident and after falling asleep, she would wake from sleep due to nightmares which caused her difficulty returning to sleep; 
•	fatigue with loss of energy nearly every day with her having low energy and having difficulty rising from bed each morning, and
•	feelings of excessive guilt that the motor accident where she was the driver had injured her best friend causing her best friend to need repeated surgery for her injuries. 
B.	The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning:
This criterion is met by the [CID] not been able to return to reliably to work in her roles as a case manager due to constant reminders about her motor accident. She was transferred to a secondment role acting in a role that restricted her access to reports, video and injured claimants.
C.	The episode is not attributable to the physiological effects of a substance or to another medical condition:
[CID] does not have any history relating to substance misuse or other medical conditions that affect his depressed mood. 
D.	The occurrence of the major depressive episode is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified and unspecified schizophrenia spectrum and other psychotic disorders:
This criterion is met as [CID] does not have a history of any of these conditions.
E.	There has never been a manic episode or a hypomanic episode:
This criterion is met as [CID] does not have a history of any of these conditions.
58.	The Medical Assessors note that the claimant had reported anxiety in various phases of her condition. The panel notes that anxiety is a common clinical symptom associated with depression. Whilst [CID] had experienced anxiety related symptoms there were not sufficient symptoms to meet the minimum necessary criteria for the specifier “anxious distress” as defined by DSM-5-TR.
59.	[CID]’s psychological symptoms were more severe and more numerous than required for a diagnosis of adjustment disorder. Major depressive disorder is the second most common trauma related condition. [CID]’s major depressive disorder whilst mild in severity has not resolved since the motor accident to the date of the re-examination. 

60.	The contribution of pain to [CID]’s physical impairments were mild as these impairments were capable of been managed by conservative management and care. The physical impairments and pain from all causes were not included in the making of the diagnosed psychological injury in compliance with DSM-5-TR F32.0 Major depressive disorder – of mild severity. The Panel noted that the severity of the claimant’s major depressive disorder may have fluctuated from the time of onset to the date of this re-examination. The Panel notes that different clinicians and assessors may have focused on different aspects of [CID]’s psychological injury. Whilst prior to this re-examination [CID]’s may have had less severe psychological symptoms at the time of prior examinations as documented in the forwarded evidence with this referral, she was never in full remission or without major depressive disorder symptoms at any time from the date of the motor accident to the date of this 
re-examination. 
61.	For the above reasons the claimant meets all the criteria required to diagnose DSM-5-TR F32.0 Major depressive disorder of mild severity.
Current functioning
Self-Care and personal hygiene
62.	[CID]’s stated that she had low energy and was would rapidly fatigue. She reported that she had stopped cooking meals and had stopped sharing in the necessary chores such as cleaning, gardening and laundry. She said she paid for a cleaner and that she would rely on take-away food more since the motor accident. 
Social and recreational activities
63.	[CID]’s reported she had low energy, fatigue and loss of interest in attending her gym, that she would have attended frequently before the motor accident. She said she was less interest in social and recreational activities. She said she only celebrated her daughter’s birthday, and she did not celebrate any other cultural events or attend any social activities outside her home. She said she was less interested in socialising with her partner since the motor accident.
Travel
64.	[CID]’s reported she was able to travel by train and drove her partner’s 4-wheel drive should she need to attend medical and psychological appointments. She said she was familiar with her office’s head office in Sydney CBD and she was able to travel by train to this location.
Social functioning
65.	[CID]’s reported that she was less intimate with her partner since the motor accident. She reported they were like “good friends”. [CID] reported that she was now estranged from her best friend and had not been invited to her wedding.
66.	[CID] reported that she had sustained her relationship with her daughter who continued to live in the family home and was about 21 years of age at the time of this re-examination.
Concentration persistence and pace
67.	[CID] said that she would easily be distracted. She said she was slower in her pace. She reported that she had been granted a secondment so she would have fewer disruptive reminders whilst attending to complex tasks for her employer.
Adaptation
68.	[CID] reported that whilst she had been provided with an acting in a higher role, she was uncertain that she would be permitted to work beyond the 12-month duration of the secondment provided by her employer. [CID] said that she was too symptomatic to continue her work as a case manager where she would be frequently remaindered of her motor accident whilst working with other people who had been injured in their motor accidents. [CID] said she had no plan for the future beyond the secondment. 
Comments of consistency
69.	[CID]’s presentation was like prior reports and documented examinations prior to this 
re-examination. The claimant provided updated information regarding her changed employment role. The claimant’s presentation was consistent with her diagnosis psychological injury DSM-5-TR F32.0 Major depressive disorder of mild severity. 
Causation and reasons
70.	[CID] was independent in her lifestyle and capacity to perform her usual role as a case manager that was required to read reports, view photographs and video of car crashes in her daily work without impairment for a long term prior to the onset of this motor accident. 
[CID]’s was fit for her other roles such as supporting mother and carer of her daughter whilst her daughter’s sexual assault matter proceeded through the criminal courts to completion where the identified offender was jailed for his actions. 
71.	Prior to the onset of this motor accident, the claimant was diagnosed with an adjustment disorder with anxiety because of the change in her daughter’s behaviour and onset of a psychological injury suffered by her daughter due to the sexual assault that happed over two days.  On direct enquiry at the re-examination [CID] confirmed that the criminal court case was completed. [CID]’s reported that she and her daughter’s relationship remained intact. For these reasons [CID]’s adjustment disorder caused by the prior harm perpetrated against her daughter was resolved prior to this assessment. 
72.	[CID] was able to separate and explain that her psychological condition related to her daughter’s psychological had not prevented [CID] from continuing her role as mother, partner and worker in her defined role provided by her employer.
73.	[CID] was carefully re-examined regarding her behaviour since the motor accident. The motor accident contributed more than a negligible contribution to the claimant’s psychological injury. The injury was present and ongoing since the motor accident and had resulted in her requiring a change of role whilst she remained psychologically symptomatic due to the motor accident.  
74.	The claimant’s defined psychological injury was definable as DSM-5-TR F32.0 Major depressive disorder of mild severity. The psychological symptoms documented and reported by [CID]’s could be caused by the severity of the motor accident that she experienced. This diagnosis provides the best diagnosis to define all of the claimant’s symptoms. The anxiety related symptoms described by other authors is best understood as episodic agitation which is clinically common in people who suffer from Major depressive disorder. The Panel noted that whilst the claimant did report anxiety as a symptom there were insufficient criteria met for the specifier “anxious distress” to be used in compliance with DSM-5-TR criteria for this specifier. 
75.	In the opinion of the Medical Assessors on behalf of the Panel the subject motor accident on 28 May 2022 did cause the psychological injury defined as DSM-5-TR F32.0 Major depressive disorder of mild severity. 
Summary of injuries referred by the parties: 
76.	The following injuries WERE caused by the motor accident:
•	DSM-5-TR F32.0 Major depressive disorder of mild severity. 
77.	The following injuries WERE NOT caused by the motor accident:
•	DSM-5-TR F43.10 Posttraumatic stress disorder.
Threshold injury 
78.	Section 1.6(1) of the Act states that:
“For the purposes of this Act, a threshold injury is, subject to this section, one or more of the following—
(a)  	a soft tissue injury,
(b)  	a psychological or psychiatric injury that is not a recognised psychiatric illness.”
79.	Section 1.6(3) of the Act sates:
“A Threshold psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness.”
80.	Part 1 clause 4 (2) of the Regulation states:
“2) Each of the following injuries is included as a threshold psychological or psychiatric injury for the purposes of the Act:
a) 	acute stress disorder
b) 	adjustment disorder
3)	 In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)”
81.	[CID]’s psychological injury caused by the motor accident is DSM-5-TR F32.0 Major depressive disorder of mild severity this is not a threshold injury as defined by the Act.  The diagnosed psychological injury is definable using DSM-5-TR. 
82.	[CID]’s psychological symptoms and functional impairment were consistent with this diagnosis and exceeded the psychological symptoms that define an adjustment disorder as defined by DSM-5-TR. The duration of [CID]’s psychological symptoms exceeds the duration for the DSM-5-TR diagnosis for acute stress disorder and for these reasons, [CID]’s psychological injury caused by the motor accident is not a threshold injury as defined by the Act.  
83.	The assessment of whether the injury is a ‘threshold injury’ is not a direct measure of symptoms or disability. A finding that the injury is a ‘threshold injury’ indicates that there was an injury caused by the motor accident and that there may be continuing symptoms, however the injury satisfies the definition of a threshold injury under the Act and the Regulation.
Conclusion – Threshold Injury 
84.	The following injuries are not threshold injuries:
•	DSM-5-TR F32.0 Major depressive disorder of mild severity. 

85.	The following injuries referred to the Panel for assessment have been assessed and determined to be not caused by the motor accident:
•	DSM-5-TR F43.10 Post traumatic stress disorder.