DETERMINATION OF REVIEW PANEL	
	
CITATION:	Atoui-Dib v AAI Limited t/as GIO [2022] NSWPICMP 466	
		
CLAIMANT:	Rochelle Afaf Atoui-Dib	
		
INSURER:	AAI Limited trading as GIO	
		
REVIEW Panel	 	
		
MEMBER:	Susan McTegg	
		
MEDICAL ASSESSOR:	Gerald Chew	
		
MEDICAL ASSESSOR:	Matthew Jones	
		
DATE OF DECISION:	14 November 2022	
		
CATCHWORDS:	MOTOR ACCIDENTS – The claimant alleges she sustained injury in a motor vehicle accident on 8 April 2016; injury to neck and lower back; anxiety and depression; dispute as to whether treatment reasonable and necessary and whether causally related to psychological injury sustained in the accident; Medical Assessor had determined the claimant had not sustained a psychological injury related to the accident; claimant had long standing history of anxiety and depression; Held –  there is no current diagnosable psychiatric condition; any psychiatric condition not caused by the accident; no need for domestic assistance by reason of psychiatric injury; medication was reasonable and necessary but claimant did not take medication and even if she did it was not causally related to injury sustained in the accident; future medication not reasonable and necessary where no current psychiatric injury; future psychological treatment including counselling and future psychiatric treatment not reasonable and necessary where claimant no longer suffers from a psychiatric injury; Medical Assessment Certificate affirmed.	
DETERMINATIONS MADE:  	Medical Assessment – Treatment Dispute
Review Panel Certificate
issued under Part 3.4 of the Motor Accident Compensation Act, 1999
following a review under s 63 as to 
WHETHER TREATMENT PROVIDED OR TO BE PROVIDED TO THE CLAIMANT WAS OR IS REASONSABLE AND NECESSARY UNDER THE CIRCUMSTANCES AND WHETHER THAT TREATMENT RELATES TO THE INJURY CAUSED BY THE ACCIDENT
The Panel affirms the Certificate of Medical Assessor Atsumi Fukui dated 29 June 2021. 

		

REASONS FOR DECISION
BACKGROUND
1.	On 8 April 2016 Ms Rochelle Atoui-Dib (the claimant) was a passenger in a vehicle driving through a T intersection when a vehicle made a right hand turn from the side street colliding with the rear left hand of the vehicle in which she was a passenger (the accident). Ms Atoui-Dib states she hurt her neck and lower back and consulted her general practitioner (GP) several days later. She states she subsequently became depressed and anxious. 
2.	AAI Limited trading as GIO (the insurer) is the relevant insurer with liability to pay any damages to the claimant under the Motor Accident Compensation Act, 1999 (the MAC Act).
3.	This dispute is in relation to whether treatment provided or to be provided to the claimant was or is reasonable and necessary under the circumstances and whether that treatment relates to the injury caused by the accident.
4.	The dispute was referred to Medical Assessor Atsumi Fukui.
MEDICAL ASSESSMENT UNDER REVIEW
5.	Section 58 of the MAC Act states that the medical assessment procedures set out in Part 3.4 of the MAC Act, including review of a medical assessment by a review panel, applies to a disagreement between a claimant and an insurer about, inter alia, the following matters: 
(a)	whether the treatment provided or to be provided to the injured person was or is reasonable and necessary in the circumstances, and
(b)	whether any such treatment relates to the injury caused by the motor accident.
6.	The following treatment and care disputes were referred to Medical Assessor Fukui:
•	domestic assistance – reasonable and necessary – whether 0-10 hours per week of domestic assistance in relation to the psychological injuries from the date of the subject motor vehicle accident to the date of the MAS (Medical Assessment Service) assessment is reasonable and necessary in relation to the injury sustained in the subject accident;
•	domestic assistance – causation – whether the psychological injuries give rise to a need for domestic assistance from the date of the subject motor vehicle accident to the date of the MAS assessment is causally related to the injury sustained in the accident;
•	domestic assistance – reasonable and necessary – whether 0-5 hours per week of domestic assistance in relation to the psychological injuries from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is reasonable and necessary in relation to the injury sustained in the subject accident; 
•	domestic assistance – causation – whether the psychological injuries give rise to a need for domestic assistance from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is causally related to the injury sustained in the subject accident;
•	medication – prescription – whether any anti-depressant tablets per month in relation to the psychological injuries from the subject motor vehicle accident to the date of the MAS assessment is reasonable and necessary in relation to the injury sustained in the subject accident;
•	medication – prescription – whether any anti-depressant tables per month in relation to the psychological injuries from the subject motor vehicle accident to the date of the MAS assessment is causally related to the injury sustained in the subject accident;
•	medication – prescription – whether 0-30 anti-depressant tablets per month in relation to the psychological injuries from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is reasonable and necessary in relation to the injury sustained in the subject accident; 
•	medication – prescription – whether 0-30 anti-depressant tablets per month in relation to the psychological injuries from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is causally related to the injury sustained in the subject accident;
•	psychological treatment (including counselling) – whether 0-6 psychological consultations per year in relation to the psychological injuries from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is reasonable and necessary in relation to the injury sustained in the subject accident;
•	psychological treatment (including counselling) – whether 0-6 psychological consultations per year in relation to the psychological injuries from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is causally related to the injury sustained in the subject accident;
•	psychiatric treatment – whether 0-6 psychiatric consultations per year in relation to the psychological injuries from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is reasonable and necessary in relation to the injury sustained in the subject accident, and
•	psychiatric treatment – whether 0-6 psychiatric consultations per year in relation to the psychological injuries from the date of the MAS assessment and for the next 1 year, 2 years, 3 years, 4 years, 5 years, 10 years and/or ongoing for the remainder of the claimant’s life expectancy is causally related to the injury sustained in the subject accident. 
7.	In respect of causation Medical Assessor Fukui stated:
“Ms Atoui-Dib described a history of anxiety disorder and an eating disorder during her teens on a background of childhood trauma. She was managed by her GP and contact with psychologists but did not fully engage in treatment. She experienced exacerbation of her anxiety symptoms following the motor vehicle accident. Her current agoraphobic symptoms are NOT causally related to the accident. It is an aggravation of a pre-existing condition.”
8.	In her Certificate dated 29 June 2021 Medical Assessor Atsumi Fukui concluded the claimant had not sustained a psychological injury related to the accident. She concluded there was no treatment causally related to the accident because there was no psychological injury. 
REVIEW PROCEDURE
9.	The claimant applied for a review of the Medical Assessment Certificate of Medical Assessor Fukui dated 15 June 2021 pursuant to s 63 the MAC Act. 
10.	The Personal Injury Commission (Commission) commenced operation on 1 March 2021 and the Claims Assessment and Resolution Service was abolished by cl 3 of Part 2, Division 2, Schedule 1 to the Personal Injury Commission Act 2020 (the PIC Act).
11.	Under cl 14A(1)(a)(vii) Schedule 1 of the PIC Act pre-establishment proceedings include proceedings that before the establishment of the Commission were required or permitted to be dealt with by a review panel for a medical assessment constituted under the MAC Act. 	
12.	Clause 14F(2) of Schedule 1 of the PIC Act states that the new review provisions apply in relation to a decision of a new decision-maker in completed pre-establishment proceedings, including the medical assessment the subject of this review which was completed before 1 March 2021. 
13.	The new review provisions provide that a review panel consists of two medical assessors and a member assigned to the Motor Accidents Division of the Commission. 
14.	Clause 16.3.1 of the Medical Assessment Guidelines requires an application for review of an assessment by a single Medical Assessor in a treatment dispute to be lodged within 30 days after the date on which the certificate was sent to the parties. 
15.	An application for review of the medical assessment of Medical Assessor Fukui was lodged within the 30-day timeframe. 
16.	On 14 October 2021 the Delegate of the President 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).
17.	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.
18.	The review is by way of a new assessment of all matters with which the medical assessment is concerned.
MATERIAL BEFORE THE PANEL
19.	The Panel issued a Direction to the parties which required each party to file an indexed, paginated bundle of documents. 
20.	In response to this direction the solicitor for the claimant filed a bundle of documents paginated from pages 1 to 163 and filed in the portal as AD3, AD4 and AD5. The solicitor for the insurer filed a bundle of documents paginated from pages 1 to 306 and filed in the portal as AD6.	At the request of the Panel the report of Dr Teoh dated 15 December 2017, referred to by both parties in their submissions, was uploaded to the portal on 31 October 2022.
Statements
21.	The claimant was 21 years of age at the date of accident and is currently 28 years of age.
22.	The claimant provided a statement dated 9 May 2019. Ms Atoui-Dib stated she ceased school at the completion of year 10 in 2011. She subsequently qualified as a dental assistant but after four weeks work experience decided it was not for her. She then completed four months of a travel and tourism course at St George TAFE which she ceased because of personal issues. In February 2016 she commenced an online travel and tourism course through OTEN and says she had started making enquiries about the availability of work in the industry. 
23.	The claimant states prior to the accident she suffered from back pain due to scoliosis. She also suffered from depression and anxiety. She said she also had rebellious behaviour, anxiety attacks, sleep impairments and migraine headaches. 
24.	She states in October 2013 she was referred to a psychologist who she saw once. In June 2014 she had high levels of stress and in February 2015 she ended up in hospital. 
25.	The statement of 9 May 2019 otherwise focuses on the neck and lower back pain Ms Atoui-Dib experienced as a result of the accident and the impact on her activities of daily living. 
26.	Ms Atoui-Dib provided a further statement dated 21 July 2022. Ms Atoui-Dib states when it became clear to her following the accident that the pain in her back was not improving her depression got worse. She states at paragraph 27:
“Unfortunately, the depression that I was beginning to suffer from after the accident was such that I didn’t feel able to cope with it without medication and I therefore accepted the offer of Dr El Skafi to prescribe anti-depressant medication to me in July 2016. I took that medication because I didn’t think that I could deal with the post-accident depression in the same way that I had dealt with my anxiety problems in the past. I had tried to but it didn’t work”.
27.	At paragraph 42 of the statement dated 21 July 2022 Ms Atoui-Dib states she has stopped taking anti-depressant medication. 
28.	There is no suggestion in that statement that there is a need for domestic assistance arising out of the psychological injury. Any need for assistance is by reason of the claimant’s back condition. 
Photograph of the car
29.	 A photograph of the car shows some damage to the rear passenger door and around the wheel arch.
Medicare/PBS (Pharmaceutical Benefits Scheme) Records
30.	A report of prescriptions during the period 1 July 2010 to 1 July 2016 shows Venlafaxine prescribed on 13 March 2016 and supplied on 19 April 2016 and 15 June 2016.
31.	The Medical Certificate completed by Dr El Skafi on 19 April 2016 describes the injuries sustained by the claimant as whiplash injury and lower back pain. 
Uniting Medical Centre
32.	Ms Atoui-Dib consulted Dr El Skafi on 1 October 2012. She reported the claimant saw herself as fat, had low self-esteem, and was concerned with the way she looked. Dr El Skafi questioned whether she was anorexic and recommended she see a psychologist. 
33.	On 7 March 2013 Dr El Skafi reported anxiety symptoms, stress, possible panic attacks and diagnosed anxiety/depression. He provided a referral to Dr Mohammed Allam, psychiatrist and to Dr Fayza Al-Shamali psychologist for management of her depressive symptoms and completed a Mental Health Treatment Plan. 
34.	On 18 March 2013 Dr El Skafi saw the claimant in respect of anxiety and recommended she see a psychologist. He also discussed with the claimant reducing the dose and frequency of medication. 
35.	On 7 May 2013 Dr El Skafi diagnosed anxiety/depression and recommended the claimant continue psychological review. He referred the claimant to Dr Mohammed Allam for management of severe stress and anxiety with panic attacks. 
36.	On 25 September 2013 Dr El Skafi saw the claimant in respect of anorexia and on 1 October 2013 she reported the claimant was being bullied by a psychologically disturbed neighbour which was causing her stress.
37.	On 26 October 2013 Dr El Skafi noted the claimant had reduced appetite, stress, she was a nervous person and had anxiety issues. She noted there were compliance issues with following medical instructions and follow up with the psychologist.
38.	The claimant was counselled for stress, anxiety and depression on 4 December 2013 and again on 24 March 2014.
39.	On 4 February 2015, 9 February 2015 and 5 March 2015 Dr El Skafi saw the claimant for anxiety attacks and depression. She recommended the claimant see a psychologist. On 9 February 2015 Dr El Skafi placed Ms Atoui-Dib on a Mental Health Care Plan, noting she described her mood as very depressed, sad and unhappy. She was suffering from insomnia, lack of concentration, poor memory, low self-esteem, lack of confidence, lack of energy, fatigue, palpitation and difficulty with breathing. On the same day the claimant was referred to Josie Wakim at Psyc4life. 
40.	The claimant consulted Dr El Skafi for anxiety and depression re family and life related stressors on 21 January 2016.
41.	On 9 February 2016 Dr El Skafi reported the claimant had a panic/anxiety attack and ended up in the hospital. She noted the claimant had stress and anger issues which were difficult to control and needed psychological review and follow up. On 13 March 2016 Dr El Skafi saw the claimant for an adjustment disorder with depressed and anxious mood.
42.	The accident occurred on 4 April 2016. Ms Atoui-Dib saw Dr El Skafi on 19 April 2016 when she reported her involvement in the accident and reported pain in the lower back and neck. Dr El Skafi recorded her impression as whiplash injury and lower back pain.
43.	The first post-accident complaint of psychological symptoms is on 2 July 2016 when 
Dr El Skafi records neck and lower back pain and, anxiety/depression.
44.	On 9 March 2017 and on 8 May 2018 Ms Atoui-Dib saw Dr El Skafi for neck and lower back pain, anxiety and depression. 
Medico-legal reports
Dr McGroder, occupational health physician
45.	Dr McGroder assessed Ms Atoui-Dib at the request of her lawyers on 13 December 2017 and again on 27 June 2017. He reported she had a history of anxiety and depression. Dr McGroder concluded the claimant had sustained soft tissue injuries involving the neck and lower back aggravating a pre-existing mechanical lower back pain with a contribution from her underlying scoliosis.
Dr Ben Teoh, psychiatrist
46.	Dr Teoh assessed Ms Atoui-Dib at the request of her lawyers on 8 December 2017 and provided a report dated 15 December 2017. Dr Teoh reported Ms Atoui-Dib had a history of anxiety/depression when she was 16 years old. He reported she suffered from anorexia and was reluctant to take medication. 
47.	Dr Teoh reported Ms Atoui-Dib reported feeling depressed and anxious and had been worrying about her physical condition and future. He reported she lacked motivation, interest in her usual activities and had become socially withdrawn. He also reported a loss of confidence and difficulty sleeping. 
48.	Dr Teoh diagnosed a chronic adjustment disorder with mixed depressed and anxious mood. He recommended she would benefit from seeing a psychologist fortnightly to monthly for six months. He reported she did not require domestic assistance from a psychiatric perspective. 
Dr Graham George, psychiatrist
49.	Dr George assessed the claimant at the request of the insurer and provided a report dated 27 April 2018. 
50.	Dr George reported the following:
•	Ms Atoui-Dib left school at the beginning of year 10, having been suspended about five times; 
•	she had an “attitude problem” at school;
•	she was still troubled by nightmares of her father’s domestic violence against her mother; 
•	she had extreme anxiety catching buses prior to the accident; 
•	she had a troubled mood state from her teenage years;
•	she was anorexic at 17 and even now still continues with some degree of anorexia;
•	she had seen a psychologist on one occasion in the past;
•	depression had been associated with her anorexia and also with self-harm where she would cut her arms or wrists; 
•	she had experienced marked emotional numbing over the years; 
•	she does not trust anyone;
•	she has trouble controlling her anger;
•	she lashes out every few weeks, and
•	she was deeply troubled. 
51.	Dr George diagnosed a chronic post-traumatic stress disorder on a background of a mixed personality disorder. Ms Atoui-Dib did not relate her symptoms to the accident and Dr George concluded they were not related to the accident. He noted she had chronic mental health issues from a young age which have essentially gone unaddressed. 
Carolyn Grinter, occupational therapist 
52.	The clamant was assessed by Carolyn Grinter. She provided a report dated 28 December 2017. 
53.	Ms Grinter reported Ms Atoui-Dib become very depressed and anxious after the accident. She attended one session of counselling which she stated was not beneficial.
54.	In relation to her mood Ms Grinter reported the claimant suffered with mild depression before the accident but it has been worse since. She is easily irritated and is sometimes anxious when she is travelling in a car as a passenger depending on the driver. She reported the claimant was able to travel on public transport. 
55.	Ms Grinter found the claimant required domestic assistance of one hour a week to assist with vacuuming, sweeping and mopping. She concluded she would require additional assistance if she was living on her own in a unit, namely two hours a week for cleaning and changing bed linen, 30 minutes a week to have shopping delivered and 15 minutes a week for spring cleaning and window cleaning. However, the need for domestic assistance relates to the claimant’s physical limitations and not her psychological injury. 
SUBMISSIONS
Claimant’s submissions
56.	The claimant provided submissions which are undated.
57.	The claimant notes that Dr Teoh found the claimant suffered from a chronic adjustment disorder with mixed depressed and anxious mood. It is submitted the claimant has difficulty sleeping and is fearful of the possibility of being involved in other accidents. She lacks motivation and has become socially withdrawn. She is apprehensive about travelling and being on the road. 
58.	The claimant notes that Dr Teoh recommended she see a psychologist on a fortnightly basis for six months. 
59.	The claimant provided further submissions, also undated which address the question to be determined by the Delegate and which are not relevant to the dispute before the Panel. The claimant submitted the Medical Assessor concluded there had been an “exacerbation” of symptoms and an “aggravation of a pre-existing condition” without then also concluding that the exacerbation or aggravation of the claimant’s condition was causally related to the accident. 
Insurer’s submissions 
60.	The insurer provided comprehensive submissions dated 4 May 2020. In terms of this dispute the insurer submits there is no need for treatment or domestic assistance for any accident related psychological injury. The insurer notes the following:
•	the recommendations of Ms Grinter were made in the absence of any relevant pre or post-accident records;
•	the opinion of Dr Teoh was made in the absence of any relevant pre or post-accident records and he was unaware of the significance of the claimant’s pre-accident mental health issues; 
•	in his report dated 27 April 2018 Dr George recorded a comprehensive pre-accident history, specifically extreme anxiety in relation to catching buses and continuing nightmares of her father’s domestic violence against her mother up until she was 12 years of age;
•	Dr George noted a troubled mood state from her teenage years and a history of depression associated with anorexia, self-harming behaviours and marked emotional numbing over the years;
•	Dr George diagnosis a pre-existing chronic post-traumatic stress disorder on a background of a mixed personality disorder;
•	Dr George concluded the claimant’s psychiatric disorder was not caused by the accident;
•	the claimant was prescribed Efexor on 13 March 2016, one month prior to the accident, and
•	any need for treatment relates to the claimant’s longstanding anxiety and depression.
61.	The insurer provided further submissions dated 8 July 2020 in respect of past treatment expenses. The insurer referred to the records of Uniting Care Medical Centre and Medicare/PBS and noted that since the accident the claimant had been prescribed, inter alia, the following medication in respect of her psychological condition: 
•	2 July 2016 – Effexor capsule, and
•	2 July 2016 – Escitalopram tablet. 
62.	The insurer provided submissions dated 21 September 2021 addressing the question to be determined by the Delegate.
RELEVANT LEGAL AUTHORITY
63.	In AAI Limited v Phillips Davies J was asked to consider the question of causation in determining whether proposed surgical treatment was related to injury caused by one or more of three motor accidents. That case considered the words “whether any such treatment relates to the injury caused by the motor accident” where they appear in s 58(1) of the MAC Act.
64.	Davies J found the motor accident need only be a material contribution to the need for treatment and he further stated the Panel should have considered whether the proposed surgery would not have arisen but for the occurrence of one or more of the accidents being considered. 
EXAMINATION
65.	Ms Atoui-Dib was assessed by Medical Assessor Chew and Medical Assessor Jones at the medical rooms at the Commission on 24 October 2022. 
Psychosocial history and pre-accident history
66.	Ms Atoui-Dib is a 28-year-old single unemployed woman who lives in Riverwood independently with her 2-year -ld son. She has been living independently for around two years, prior to this she lived with family.
67.	Ms Atou-Dib was born in Australia and is of Lebanese cultural background. She was not aware of any issues with her mother’s pregnancy, her birth or early developmental milestones. Her early childhood was characterised by domestic violence perpetrated by her father. Her parents separated when she was around 11 or 12 years old. She recalls it being a difficult childhood with running away, apprehended violence orders and being “kidnapped” while overseas by her father. She recalled her father being physically aggressive, smashing objects etc. She does not recall being physically injured or requiring medical or hospital treatment.
68.	Ms Atoui-Dib said that she struggled at school, truanted often and struggled with “anger issues”. She reported that she left year 9 and completed an anger management program prior to completing her year 10 certificate. She completed training to be a dental assistant. She reported that she had “work experience” with a doctor for two weeks around the age of 16 or 17.
69.	She reported that she developed back pain around the age of 16 and was diagnosed with scoliosis. She has undergone various treatments including chiropractic treatment. She reported she would take Paracetamol and Ibuprofen for the pain.
70.	Ms Atoui-Dib admitted to psychological symptoms since the age of 15 or 16 including anxiety with attacks where she would hyperventilate for a few minutes. These could occur weekly or not at all for a few months. She reported she also suffered from low mood from this time. She reported symptoms of anorexia with reduced food intake and weight loss for a few years.
71.	She stated prior to the accident she had not driven a motor vehicle.
History of the accident
72.	She recalled being a rear seat passenger on the passenger side of the car on 8 April 2016. Her friend was driving, and her mother was also in the car. She was asleep at the time of the accident. She was woken up by the accident and said that it “took me a while to realise what had happened”. She said she felt “sick” at the time and was picked up from the scene and taken home.  
History of symptoms and treatment following the accident
73.	A few days later she experienced pain in her back, neck and knee. She said she thought the back pain was an aggravation of her scoliosis pain.
74.	Ms Atoui-Dib said after the accident she continued to experience anxiety symptoms which were similar to her pre-accident anxiety except for a heightened anxiety around cars. She felt more hesitant about getting into a car and would only get into a car when the driver was her mother or a sibling.
75.	She reported ongoing fluctuating periods of low mood. She denied any suicidality.
76.	Ms Atoui-Dib has seen her GP about her symptoms. She has seen a psychologist on one occasion but did not feel comfortable with this treatment. She was offered medication but declined this. She has not seen a psychiatrist.
Current symptoms
77.	Ms Atoui-Dib described ongoing back pain but reported the pain in her neck and knee had resolved.
78.	She reported ongoing anxiety and “anxiety attacks” although she said she had not had an attack for a few months.
79.	Ms Atoui-Dib said that her mood overall had been good, and she described great joy at being a mother and when talking about her son.
80.	She reported anxiety about getting into a car and would only get in a car if her mother or sibling was driving.
Current and proposed treatment
81.	Ms Atoui-Dib sees her GP approximately monthly.
82.	She is not taking any psychotropic medication.
83.	She does not see a psychologist or psychiatrist.
84.	Ms Atoui-Dib stated that she is open to seeing a psychologist and/ or psychiatrist and she is open to trialling psychotropic medication.
Mental state examination
85.	She appeared her stated age. She was neatly groomed in casual clothing. She was polite and engaging. She was co-operative and maintained good eye contact. She was euthymic in mood. Her affect was reactive and appropriate, lighting up noticeably when discussing her son. Her speech was of normal rate, rhythm, volume and prosody. There was no formal thought disorder. There were no delusions and no hallucinations. She was oriented to time, place and person and her cognition was grossly intact. She described no suicidal ideation or thoughts of self-harm.
Current functioning
86.	Ms Atoui-Dib is able to live independently and attend to activities of daily living for herself and her son. She says she gets pain when standing for periods greater than 25 minutes and is limited by this and needs a break. She said that her family attend daily for around an hour to help with daily tasks around the home and for social reasons. Her family live close by, “one street away”.
87.	She maintains a good relationship with her family. She has two good friends who she has maintained for years and who visit often.
88.	Ms Atoui-Dib has not worked for around four years, her last job was for a few months as a receptionist for her sister’s smash repair business.
89.	She is able to travel in a motor vehicle with her family and she has been able to travel overseas.
Comments on consistency
90.	There is no evidence of significant inconsistency.
Review of documentation
91.	Dr George report of April 2018 opines no psychiatric injury as a result of the accident.
92.	Dr Fukui certificate of 29 June 2021 opines no psychological injury as a result of the accident.
93.	Dr Teoh diagnosed a chronic adjustment disorder with mixed depressed and anxious mood, but the Panel notes he did not have a complete history of the claimant’s pre-accident psychological history, in particular, her attendances on her Dr El Skafi on 21 January 2016, 9 February 2016, and on 13 March 2016 when he diagnosed an adjustment disorder with depressed and anxious mood, and also prescribed Venlafaxine.
PANEL FINDINGS
94.	The Panel finds there is no current diagnosable psychiatric condition. Ms Atoui-Dib’s current symptoms do not meet the threshold for a psychiatric diagnosis.
95.	The evidence of Ms Atoui-Dib is that the anxiety she experienced following the accident was similar to her pre-accident anxiety except for a heightened anxiety around cars. 
96.	Having regard to the evidence of Ms Atoui-Dib and the available clinical records the Panel is not satisfied that any psychiatric condition, either the post-traumatic stress disorder diagnosed by Dr George or the chronic adjustment disorder with mixed depressed and anxious mood diagnosed by Dr Teoh, was caused by the accident. 
Domestic assistance
97.	The Panel notes there has been no suggestion by the claimant, her treating practitioners, the medico-legal specialists or even Ms Grinter, occupational therapist that there has been a need for domestic assistance by reason of psychiatric injury. Accordingly, the Panel finds no domestic assistance, either for the past of the future, was reasonable and necessary for psychiatric injury sustained in the accident where the Panel finds there was no psychiatric injury caused by the accident. 
Medication
98.	The Panel finds any recommendations by the claimant’s treating practitioners in respect of medication, namely anti-depressant tablets, from the date of the accident to the date of the assessment was reasonable and necessary. However, the Panel finds firstly, that the claimant stated she did not take medication and secondly, that even if she did take medication, it was not causally related to injury sustained in the accident, where the Panel finds the accident did not cause the claimant to sustain a psychiatric injury. 
99.	The Panel finds future medication, namely anti-depressant tables is not reasonable and necessary where the Panel finds the claimant no longer suffers from a psychiatric injury. 
Psychological treatment (including counselling)
100.	The Panel finds future psychological treatment including counselling is not reasonable and necessary where the Panel finds the claimant no longer suffers from a psychiatric injury.