DETERMINATION OF REVIEW PANEL	
	
CITATION:	Boom v AAI Limited t/as GIO [2023] NSWPICMP 29	
		
CLAIMANT:	Craig Boom	
		
INSURER:	AAI Limited t/as GIO	
		
REVIEW Panel	 	
		
MEMBER:	Ray Plibersek	
		
MEDICAL ASSESSOR:	Doron Samuell	
		
MEDICAL ASSESSOR:	Wayne Mason	
		
DATE OF DECISION:	31 January 2023	
		
CATCHWORDS:	MOTOR ACCIDENTS – Motor Accidents Compensation Act 1999; claimant was a passenger and trainee driver in a bus which stopped suddenly; injuries reported; shoulders and psychological injury; Held – original Medical Assessment Certificate affirmed; claimant did not sustain any psychological injury as a result of or caused by the motor accident; Review Panel found no exacerbation of his pre-existing disorder due to the bus accident; no whole person permanent impairment psychological injury attributable to the bus accident; claimant had a past history of chronic psychological conditions prior to the bus accident; after the bus accident the claimant completed a technical and further education (TAFE) course, commenced work and had no record of psychological difficulty for some months following the accident. 	
DETERMINATIONS MADE:  	CERTIFICATE OF DETERMINATION
Issued under Part 3.4 of the Motor Accidents Compensation Act 1999
The Review Panel:
1.	Affirms the certificate of Medical Assessor Christopher Rikard-Bell dated 22 October 2021.
2.	Finds that the claimant did not sustain any psychological injury as a result of or caused by the motor accident on 21 November 2017.

STATEMENT OF REASONS
INTRODUCTION
1.	On 21 November 2017 Mr Craig Boom (the claimant) was standing up and traveling in a bus being taught to drive the bus. He was working in training position for the State Transit Authority (STA). Mr Boom said the bus stopped suddenly and without warning. The sudden stop resulted in his right shoulder hitting a pole in the bus which caused him to strain his left shoulder. Mr Boom reported injuries to his left and right shoulders and also psychological injuries.
2.	The owner and driver of the bus was insured by AAI Ltd t/as GIO (the insurer) who had liability to pay to the claimant any damages and/or statutory compensation entitlements under the Motor Accidents Compensation Act 1999 (the MAC Act).
3.	There is a dispute about whether the degree of permanent impairment sustained by the claimant as a result of psychological injury caused by an accident is greater than 10%. This constitutes a medical dispute within the meaning of the MAC Act. The degree of permanent impairment is referred to in sub-section 58(1)(d) of the MAC Act.
4.	The current dispute is about a determination made by Medical Assessor Christopher Rikard-Bell assessment dated 22 October 2021. The certificate states that the date of assessment was 28 October 2021. In its written submissions the solicitors for the claimant note that the certificate and reasons were not provided to the parties until 8 November 2021. 
5.	Medical Assessor Rikard-Bell certificate concluded that there is no diagnosable psychiatric injury attributable to the motor vehicle accident.
6.	A delegate of the President of the Personal Injury Commission (the Commission) determined there was reasonable cause to suspect an error in the certificate of Medical Assessor Rikard-Bell dated 22 October 2021.  The President has now convened this Panel to review that certificate.
The review procedure  
7.	In this application for review the claimant Mr Boom is the applicant.
8.	The present application is a review of a medical assessment under s 63 of the MAC Act. The relevant medical assessment was conducted by Medical Assessor Rikard-Bell and is dated 22 October 2021.                      
9.	The review is by way of a new assessment of all matters with which the medical assessment is concerned.
10.	The Panel considered it appropriate for the assessment to review all matters with which the assessment of Medical Assessor Rikard-Bell was concerned. Because the review involved the assessment of permanent impairment the Panel decided to medically examine Mr Boom. 
11.	The Panel issued an initial direction to the parties requiring the provision of respective bundles of documents to be considered. The parties were subsequently advised that the claimant would be examined by the Medical Assessors on the Panel. 
12.	Mr Boom was examined by Medical Assessor Samuell and Medical Assessor Mason in MS Teams on behalf of the Panel. The Medical Assessors prepared a report about that examination which is contained later in these reasons.
Statutory provisions and Guidelines
13.	Under sub-section 63(3A) of the MAC Act, a review of a medical assessment is not limited to a review of only what is alleged to be incorrect, it is a new assessment of all the matters with which the medical assessment is concerned. A review should also generally involve a re-examination of the claimant. 
14.	The Motor Accident Permanent Impairment Guidelines 2018 (the Guidelines) were issued under s 44(1)(c) for the assessment of permanent impairment. The Guidelines are based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 4th edition (AMA 4 Guides). The Guidelines are definitive with regard to the matters they address but where they are silent on an issue, the AMA 4 Guides are followed.
15.	The Guidelines set out the procedure to be followed when assessing the degree of permanent impairment.:
“1.18 An assessment of the degree of permanent impairment involves three stages: 
1.18.1 a review and evaluation of all the available evidence including: 
○ medical evidence (doctors’, hospitals’ and other health practitioners’ notes, records and reports) 
○ medico-legal reports 
○ diagnostic findings 
○ other relevant evidence.”
16.	In regard to issues of pre-existing impairment and subsequent injuries, the Guidelines provide as follows:
“1.31 The evaluation of the permanent impairment may be complicated by the presence of an impairment in the same region that existed before the relevant motor accident. If there is objective evidence of a pre-existing symptomatic permanent impairment in the same region at the time of the accident, then its value must be calculated and subtracted from the current WPI value. If there is no objective evidence of the pre-existing symptomatic permanent impairment, then its possible presence should be ignored.
1.34 The evaluation of permanent impairment may be complicated by the presence of an impairment in the same region that has occurred subsequent to the relevant motor accident. If there is objective evidence of a subsequent and unrelated injury or condition resulting in permanent impairment in the same region, its value should be calculated. The permanent impairment resulting from the relevant motor accident must be calculated. If there is no objective evidence of the subsequent impairment, its possible presence should be ignored.”
17.	In regard to the issue of causation of injury, the Guidelines provide as follows: 
“1.5 An assessment of the degree of permanent impairment is a medical assessment matter under Section 58 (1)(d) of the Act. The assessment must determine the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident. A determination as to whether the injured person’s impairment is related to the accident in question is therefore implied in all such assessments. Medical assessors must be aware of the relevant provisions of the AMA4 Guides, as well as the common law principles that would be applied by a court (or claims assessor) in considering such issues. 
1.6 Causation is defined in the Glossary at page 316 of the AMA4 Guides as follows: ‘Causation means that a physical, chemical or biologic factor contributed to the occurrence of a medical condition. To decide that a factor alleged to have caused or contributed to the occurrence or worsening of a medical condition has, in fact, done so, it is necessary to verify both of the following: 
1. The alleged factor could have caused or contributed to worsening of the impairment, which is a medical determination. 
2. The alleged factor did cause or contribute to worsening of the impairment, which is a non-medical determination.’ This, therefore, involves a medical decision and a non-medical informed judgement. 
1.7 There is no simple common test of causation that is applicable to all cases, but the accepted approach involves determining whether the injury (and the associated impairment) was caused or materially contributed to by the motor accident. The motor accident does not have to be a sole cause as long as it is a contributing cause, which is more than negligible. Considering the question ‘Would this injury (or impairment) have occurred if not for the accident?’ may be useful in some cases, although this is not a definitive test and may be inapplicable in circumstances where there are multiple contributing causes.”
18.	The Panel will now consider the Medical Assessment Certificate of Medical Assessor Rikard-Bell.
Assessment under review
19.	The certificate by Medical Assessor Rikard-Bell was dated 22 October 2021. The Medical Assessor had the following injuries referred to him by the Commission for assessment: psychiatric condition - depression, anxiety, adjustment disorder, post-traumatic stress disorder and traffic phobia.
20.	Medical Assessor Rikard-Bell found that prior to the accident Mr Boom was struggling with caring for himself. Mr Boom reported that he was depressed and not coping. He sought help through his general practitioner and the psychologist. His relationship with his siblings was poor. Mr Boom did not have a clear working role at that time.
21.	In their written submissions the claimant’s solicitors dispute the above findings of Medical Assessor Rikard-Bell.
22.	Medical Assessor Rikard-Bell noted that the general practitioner wrote a mental healthcare plan on 9 July 2017 in relation to depression and on 26 October 2017 it was noted there was a history of depression which had become worse over the previous seven months.
23.	Medical Assessor Rikard-Bell concluded with his assessment that Mr Boom’s psychological symptoms were pre-existing and the persistent depressive disorder is unrelated to the subject motor vehicle accident. Therefore, there is no diagnosable psychological injury attributable to the motor vehicle accident.
Claimant’s submissions 
24.	In written submissions dated 22 November 2021, the claimant’s solicitors submit that Medical Assessor Rikard-Bell inaccurately described the claimant’s psychiatric condition. Their submissions acknowledge that the claimant had sought treatment for depression in the seven months prior to the subject accident. At the time of the accident the claimant had a job which was a trainee bus driver. The claimant’s situation that existed at the time of the accident was considerably different to that which existed prior to the accident in 
November 2017.
25.	The claimant submits that, as stated in Nguyen v Motor Accidents Authority & Anor [2011] NSWSC 351, it is the impairment that has to be assessed, not the injury.
26.	The claimant’s solicitors submit that there is no doubt that the claimant has a recognised psychiatric condition. The issue is to what extent has the subject accident caused a psychiatric impairment, if any.
27.	Following the accident, the claimant became incapable of working and that he has become more depressed than he has ever previously been and he has developed a chronic pain syndrome. 
28.	The claimant’s solicitors submit that there is clear and unequivocal evidence that the claimant’s ratings under each category of the psychiatric impairment rating scale (PIRS) have significantly deteriorated since the accident.
29.	The Medical Assessor failed to use the correct methodology to assess the impairment of the claimant. The Medical Assessor was required to undertake an assessment of the current level of permanent impairment using the PIRS. He then had to undertake an assessment of pre-accident permanent impairment, which would have been deducted from the current impairment: see cl 6.218. 
30.	Medical Assessor Rikard-Bell was in his reasons relied upon a copy of the report of Assessor Wijetunga, without being informed that it had been determined by the Commission that such assessment was suspected of being incorrect.
Insurer’s submissions 
31.	In written submissions dated 20 December 2021 the insurer’s solicitors submit that a Medical Assessor's reasons are not to be subject to unduly technical or overly zealous critique; Medical Assessor Rikard-Bell's assessment was correct; and the claimant has failed to identify a material error.
32.	The insurer notes the claimant’s argument that Medical Assessor Rikard-Bell adopted a pre-existing impairment assessment conducted by Mr McIntosh in September 2017, and did not, in the claimant's view, provide reasoning for rejecting alternative evidence. The insurer notes that once the totality of the Medical Assessor reasons are read, that sufficient reasons have been given by Medical Assessor Rikard-Bell with respect to the determination of a pre-existing permanent impairment.
33.	The insurer submits that the claimant’s submissions do not suggest that there was any error by Medical Assessor Rikard-Bell in the calculation of whole person impairment either for pre-existing and post- accident or for the percentage assessed. The claimant’s solicitors have only challenged the rationale behind the pre-existing deduction.
34.	The insurer also submits that whilst a reference was made to the Certificate of Medical Assessor Wijetunga, Medical Assessor Rikard-Bell did not use or rely upon the certificate in his reasonings or determination.
35.	In its submissions the insurer is critical of the claimant’s arguments. Merely submitting that there is an error with the assessment of pre-existing impairment does not support the claimant’s submission that the certificate of Medical Assessor Rikard-Bell was incorrect.
36.	In earlier written submissions dated 3 December 2020 the insurer’s solicitors submit that clinical records from treating doctors show that the claimant continued to receive treatment for his pre-existing psychological condition. The claimant consulted Dr Macintosh, psychologist, and Achieve Psychology to treat his condition. The insurer submits that there is no evidence held to suggest that the claimant's psychological condition had been impacted by the subject accident.

37.	The insurer submits that any psychiatric impairment based upon any purported aggravation resulting from the subject accident, was less than negligible in causing an aggravation of his pre-existing symptoms. As a consequence, the insurer submits that the claimant's psychiatric injuries were not caused by or related to the subject accident. In the alternative, the insurer submits that the claimant's psychiatric impairment is not greater than 10%.

MATERIAL BEFORE THE REVIEW PANEL
38.	Both parties filed bundle of documents in accordance with the initial Direction dated 
2 August 2022. In response to this direction the solicitor for the claimant filed a bundle of indexed documents paginated from pages 1 to 158 and filed in the portal as AD 5. The solicitor for the insurer filed a bundle of indexed documents paginated from pages 1 to 262 and filed in the portal as AD6. 
39.	The Panel notes that there are extensive and voluminous medical records, reports and clinical notes describing the claimant’s psychological and physical injuries. The Panel has read, discussed and carefully considered all of these medical records reports and notes before it. The Panel has not referenced or summarised the records relating to Mr Boom’s physical injuries or symptoms unless they are relevant or have some bearing on the consideration of his psychiatric injuries which are the subject matter of the Panel’s reassessment process. For example the claimant has filed a number of reports from the claimant’s treating orthopaedic surgeons, Dr David Cossetto and Dr Stuart Jensen about his shoulder injuries. Unless there is something of relevance in those reports that may be relevant to assessing the claimant’s psychiatric impairment, such reports will not be referenced.   
40.	The Panel has not referenced or summarised all of the records relating to Mr Boom’s psychiatric symptoms or injuries. If some of those medical records and reports are not referred to in the Panel’s review, it should not be assumed that the Panel was unaware of that medical material or that the Panel failed to take the material into account. In its review the Panel is endeavouring to carry out its statutory function and promote the objects of the legislation it operates under including the legislator’s guiding principle that proceedings in the Commission be just, quick and cost-effective resolution of the real issues in the proceedings. Consistent with this guiding principle, the Panel has not referred to every item of medical evidence but has done its best to refer to them sufficiently but briefly.
Claim form and claim documents
41.	In the Personal Injury Claim Form dated 11 May 2018, the claimant stated that he sustained the following injuries as a result of the subject accident: right and left shoulder, can’t sleep properly most nights and have issues with muscles in arms. The form did not claim that the accident resulted in any psychological injury or impairment.
Treating medical records and reports
42.	Dr James Macintosh, psychologist, provided a report dated 19 September 2017. 
Dr Macintosh wrote that Mr Boom’s diagnosis is challenging. He is not actively manic or presenting with hallucinations. There are some atypical statements that should be monitored.
43.	Dr Macintosh provided another report dated 26 June 2018 . Dr Macintosh wrote that 
Mr Boom’s self-report of depression had worsened. Dr Macintosh recommended that 
Mr Boom receive ongoing psychological support. Dr Macintosh states that Mr Boom is managing his depressive disorder but further investigation is warranted.
44.	Dr Macintosh provided another report dated 10 July 2019. The report provided is one page only, is unsigned and appears to have one page missing. Dr Macintosh wrote that Mr Boom’s psychological state has deteriorated. 
45.	Contained in the claimant’s and the insurer’s bundle of documents are a number of medical certificates including those headed Centrelink medical certificate. These certificates appear to be completed by Dr T D Mahon or Dr Delboni from the Centre Health Complex, 
Mr Boom’s treating general practitioners. The doctors certify that Mr Boom is unfit for work due to depression and/ or his injured shoulders and appear to date from 26 October 2017 to May 2020.
Medico-legal reports
46.	Report of Dr Matthew Jones psychiatrist dated 6 December 2020. Dr Jones noted that 
Mr Boom reported that since August 2019 he has been working part-time as a disability support worker between 16 and 25 hours per week. Dr Jones asked Mr Boom about whether he had any particular mental health impact from the accident. Mr Boom said he felt very fatigued and tired. He also said he was in constant pain. 

47.	Dr Jones then provided the following summary of his examination of Mr Boom: 
“Mr Boom reported a narrative, and presented at assessment, as consistent with having no ongoing, active psychiatric disorder. He reported ongoing physical problems including pain and fatigue that limited his day-to-day functioning. There was little in the way of specific psychological or psychiatric symptoms related to the motor vehicle accident. He has had infrequent contact with a psychologist and received no other specific psychiatric or psychological treatment. He has returned to reasonable functioning in his day-to-day activities including self-care, his relationship with his family, and a return to meaningful employment. In summary, there is no ongoing psychiatric disorder and no permanent psychiatric impairment caused by the motor vehicle accident.”  
48.	Dr Andrew Keller, occupational physician, provided a report dated 8 December 2020. The report mostly concerned the diagnosis and measurement of Mr Boom’s shoulder injuries. However, Dr Keller wrote: 
“… in my opinion it is possible that he suffered some brief soft tissue injuries to the shoulders that would be expected to have fully recovered within 1– 3 months following the incident. There is no evidence that the subject incident caused any psychological injury .”

RE-EXAMINATION AND DIAGNOSSTIC FINDINGS
49.	The Panel determined that the claimant be re-examined by both Medical Assessors given the factual issues in dispute. The claimant was re-examined by both Medical Assessors Samuell and Mason on 24 October 2022. 
50.	The re-examination report by Medical Assessor Samuell and Medical Assessor Mason is as follows.
51.	At the time of the assessment, Mr Boom was aged 53 and working on a casual basis as a support worker employed by a disability support company. He is presently working for 10 to 20 hours per week. He said that he works overnight shifts that are eight hours in duration. Daytime shifts may be between two and four hours. He advised the panel members that he was working at his capacity. He said that he has been in his current position for “a couple of years” and told the Panel that the work was “not too bad”. In his capacity as a support worker, he takes clients out for coffee and attends medical appointments. He said that his clients are disabled.
52.	Panel members asked Mr Boom about any medical limitations to his employment, and he stated that it was all he could cope with. He said that, mentally, he did not feel as though he was “up to it anymore”. He said that he often does not want to get out of bed, feels tired and is not in the right frame of mind. He said that he may miss shifts once a fortnight or more frequently. Over time, he said that his hours have remained the same. During the pandemic, he had hours cut, sometimes at short notice.
53.	He is under the care of his general practitioner, Dr Powell, whom he sees on a monthly basis. He was not seeing a psychiatrist or a psychologist in relation to the subject accident. He advised the Panel, though, that there was a “bad incident” at work where a client did not want to take this medication and advised us that there was a break-in at a residence during a sleepover shift. He said that his general practitioner had referred him to a psychologist in relation to that workplace event and he had undertaken two sessions in relation to that matter. He said that he has made a claim for workers’ compensation in relation to the break-in that he said occurred three to four months before the assessment. He said that he was diagnosed by his general practitioner as suffering from a post-traumatic stress disorder.
54.	Mr Boom told the Panel that he had no psychological treatment in the two years before the assessment, based on the insurer’s denial to fund treatment. He said that he had been on a waiting list to see a psychologist for 8 to 12 months. He complained that he had been having problems with sleep and diarrhoea, however, stressed that those symptoms post-dated the workplace break-in. He told the Panel that his depression was “very different than before”. He said it was previously related to “grieving”. He said that he had not progressed and reiterated that he was denied treatment.
55.	The Panel asked Mr Boom about his current symptoms. He said that he had ongoing shoulder and neck pain from the subject accident and complained of pins and needles in his fingers. He said the pain affected his sleep. He said that, as a result of his physical symptoms, he “couldn’t do anything too physical”. He said that his wife undertakes the majority of activities at home due to his physical limitations. He said that his wife helps him shower and dress. Over time, he says that his physical symptoms have worsened, and he said that he has been told that he will not get better without operative intervention.

Medication
56.	At the time of the assessment, he was taking no medications, other than Gastro‑Stop.
Psychiatric history
57.	The Panel found it difficult to establish a clear chronology of Mr Boom’s psychological difficulties. He said that he experienced depression in 2009 during the global financial crisis. He told the Panel that he did not have psychological difficulty until he lost his mother some four years ago, approximately one year after the subject accident. He denied having psychological difficulty immediately prior to the subject accident. He acknowledged that he had difficulty recalling the extent of his mental health difficulties at the time of his alleged injury. Despite this, the Panel concluded there was documentary evidence to support a diagnosis of persistent depressive disorder prior to the motor accident.
58.	He denied any family psychiatric history.
Medical history
59.	He said that he lost 55 kg due to diet and exercise over a two-year period after being diagnosed with diabetes. He denied any other significant personal or family medical history pre-dating the subject accident.
Physiological symptoms
Sleep
60.	The Panel asked Mr Boom about some specific symptoms. He said that he was sleeping for four to six hours per night following the subject accident. He said that, before the subject accident, his sleep was “not too bad”. At present, he said that he had difficulty getting to sleep as he was “thinking about things”.
Appetite
61.	He told the Panel members that his appetite was “pretty good”, however, at times he did not feel like eating. He told the Panel members that his weight was stable.
Mood
62.	When I asked about his mood, Mr Boom told the Panel that it was “not great most of the time”. He said that thinking about things gets him down. At the same time, he acknowledged that his disability support work was purposeful and that he was making a difference in the lives of his clients. He equivocated about whether he was enjoying any activities. 
Diurnal mood variation
63.	He reported no diurnal mood variation.
Concentration
64.	His concentration appeared normal to Panel members, although he reported that it was “not great”. He said that pain interfered with his concentration. The Panel members noted that it was difficult to obtain a precise answer from Mr Boom.
Suicidal ideation
65.	Mr Boom said that he was last suicidal three to four weeks before the assessment as he was “not in a good space”. He said he was suicidal “quite a bit” after the bus accident.
Social history
66.	Mr Boom lives with his wife and youngest child. He had been living with his wife for 22 years. He said that his wife looks after their two dogs and “does everything at home”. He said that he was not capable of participating in domestic activities due to physical and mental limitations. He said that his relationship with his wife was “pretty good”. There have been no separations. He and his wife were planning to travel overseas for a holiday in the year or two following the Panel interview. He said that he used to enjoy going camping, but had not done that for two years. He and his wife will sometimes go shopping together and drive together.
67.	He has three children in total, with the youngest, aged 18, living with them. He said that his older two children live independently. He provides some financial support for his second eldest. He says that he has a “pretty good” relationship with his children and enjoys contact with them once or twice per week.
68.	Mr Boom says that his wife looks after the shopping, finance and bills as he gets frustrated. He said that his wife has done that since the subject accident. He says that he and his wife have a joint bank account in which he deposits between $800 and $1,000 per week from his work.
69.	The Panel enquired about Mr Boom’s social functioning. He said that he has lost a lot of friends due to a reduction in his physical abilities. He said that he cannot swim or play because of his shoulders. He said that he had contact with his friends every six months or so. He denied having any hobbies at the time that we assessed him. He told us that he spent his time watching movies and keeping to himself. He does not gamble and is not engaged in any other legal processes.
70.	He is able to drive, and does so three or four times per week, and can drive unaccompanied. He said that his driving is limited by shoulder pain. He said that he cannot cook or clean due to physical reasons. His wife does the grocery shopping as he cannot carry. His wife assists him with dressing because of his shoulders. He is able to toilet himself without assistance. He showers with assistance and said that he showers only once per week as he “can’t be bothered”. He said that his physical complaints are a factor in limiting his showering. He said he was previously showering three to four times per week before the subject accident.
Toxicology
Alcohol
71.	He said that he does not drink alcohol.
Cigarettes
72.	He does not smoke.
Illicit
73.	He takes no illicit substances.
History
74.	The Panel sought to better understand the subject accident in November 2017. The Panel members found it difficult to establish the precise nature of his employment at the time of the subject accident. Mr Boom advised the Panel that he was employed to work on a full-time basis, however, he was participating in an evaluation when the subject accident occurred. He said that the evaluation was undertaken in order to obtain employment. He said that the employment ceased after the subject accident. He said that he made no workers’ compensation claim in relation to that matter. The mechanism of the subject accident was claimed to be the sudden application of brakes by the bus driver, leading Mr Boom to hit his shoulder into a pole.
75.	Mr Boom first sought medical assistance one to two weeks after the subject accident. He said that he was delayed in seeking assistance as he thought the physical problems would go away. He said that he took Panadol and treated his shoulder injury as a sprained ankle. He said that he was told that he could not return to work without a medical clearance.
76.	Around one to two weeks later, Mr Boom said that the subject accident impacted him mentally. He said that he was concerned about what was going to happen. He was angry that the bus driver “didn’t sing out or scream out”. He did not engage in any psychological assistance following the subject accident. He advised the Panel that he told his general practitioner that the accident affected him mentally in the first or second appointment after the subject accident. The Panel members noted that there was no reference to depression in the general practice notes for many months after the subject accident.
77.	The Panel members note that there were no recorded complaints of psychological difficulty until 19 September 2018.
Mental state examination 
78.	Mr Boom is a 53-year-old man whose appearance is consistent with his stated age. He was located alone in a room in his lawyers’ office in Nowra. The interview commenced at 2:35 pm and concluded at 4:35 pm. The interview was conducted via the Microsoft Teams application with a good internet connection.
79.	There were administrative difficulties at the beginning of the interview. Mr Boom expected the interview to start at 2 pm. Dr Samuell and the claimant joined at 2:15 pm. Dr Mason had difficulty accessing the interview because of administrative difficulties and did not join until 2:20 pm. When the claimant was told the doctors required 10 minutes to speak together before the beginning of the assessment, he became quite angry and said he had been informed the interview would commence at 2 pm. He indicated he had another appointment after the interview and had allocated only one hour for the interview as indicated on the Microsoft Teams invitation he had received. When informed the interview was likely to take 1.5 hours, he became even more angry, pointed out the incompetence of the Commission, and made it clear he would submit a complaint about the matter. He eventually agreed to leave the interview for 10 minutes. He had calmed down somewhat when he re-joined the interview at 2:35 pm.
80.	He appeared to be neatly casually dressed. He had a beard and rather unkempt hair. There was some pain behaviour evident in that he stood up on two or three occasions indicating he was in pain. There was further anger throughout the interview when he was asked for details such as when he attended his doctor after the subject accident and when he first informed his doctor of psychological problems. He became somewhat aggressive and insisted on asking the Medical Assessors if they could remember what happened four years ago or even at this time last week.
81.	Throughout much of the interview his responses were very vague and he often said, "I cannot remember". However, he demonstrated that he did not have any cognitive difficulties of clinical significance, explaining how he was able to work as a disability support person, read books and watch movies without difficulty. Apart from the anger there was no evidence of anxiety or depression throughout the interview. He was not tearful. His affective expression was limited to the angry range. He described recent passive suicidal ideation without intent. He did not report any trauma-related symptoms arising from the motor accident. His thought content was preoccupied with anger and disdain for the insurer and the Commission.
82.	Mr Boom was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology.
Personal history
83.	Mr Boom was born in Wollongong and grew up there. He said that life growing up was “normal”. He has two older siblings and said that his relationship with them is “not too bad”. He said that his father used to run purchasing supplies for the Wollongong Hospital. His mother was engaged in domestic duties. He denied any adverse early life events or difficulty. He was schooled through to Year 12. He completed a degree of a Masters in Chemistry and Science at Sydney University in the late 1980s/early 1990s. He said that he then worked in his own coating business for 30 years where he made his own formulations. He said the business failed during the global financial crisis. He said that he then made a decision not to go back to that. He said that, during that business, he was working long and hard hours.
84.	Following the collapse of his business, he said that he worked in traffic control for 10 years where he said that he was in charge of 200 to 300 people as a team leader. He said that he ceased that activity as he was working with drug addicts and he described an incident that crystallised his dislike for that work and decided that he “wasn’t going to put up with that”. He subsequently studied a disability course in 2018 and completed the course in the same year, attending TAFE three to four days per week. He obtained a Certificate III in disabilities.
Document review
85.	The claim form was noted in which the claimant describes the mechanism of injury that occurred when he was a trainee with STA and he states that the driver suddenly applied brakes and his right shoulder “banged into [a] pole”.
86.	The psychology date of assessment is 19 September 2017, two months prior to the subject accident. There was reference to some “possible distorted cognitions”, with Mr Boom saying that he had a curse placed on him a decade earlier. It was noted that he had been seeing a psychic to resolve that matter. The author, psychologist, James McIntosh, found Mr Boom’s diagnosis to be “challenging”, noting there were some “atypical statements”. In correspondence by James McIntosh, dated 26 June 2018, it was noted that Mr Boom’s presentation “continues to be complex”, and it was noted that his presentation had deteriorated. It was further noted that there were psychosocial stressors, with the definitive diagnosis remaining challenging.
87.	The Patient Summary, dated 22 June 2020, was noted. It was uninformative from a psychological perspective.
88.	The record of the Centre Health Complex, between 15 August 2018 and 27 July 2020, was noted. An entry, dated 20 May 2020, described Mr Boom as, inter alia, having low mood, being depressed, anxious, having a lack of energy, a lack of concentration and memory and sleep disturbance. It was noted that there was a family history of depression. At the time, 
Mr Boom was prescribed analgesics and Diazepam. The Centrelink Certificate, dated 
31 August 2018, noted a long-standing history of depression with anhedonia and other symptoms, with an exacerbation of the depression in the seven months preceding the Certificate. The date of onset of the condition was listed as 2009. The mental health care plan, dated 9 July 2009, was noted, with the diagnosis of depression. The accompanying referral stated that the claimant suffered from depression and was “battling with a work related injury and well-known to you from past”.
89.	The Department of Human Services Disability Benefit Payment record was noted. It was noted that there were Certificates issued in the relevant period. Dr Delboni certified the claimant unfit to work due to depression between 26 October 2017 and 26 December 2017, noting the accident occurred on 21 November 2017.
90.	The report of psychiatrist, Dr Matthew Jones, dated 6 December 2020, was noted. It was noted by Dr Jones that the claimant had only been prescribed Diazepam and had not been treated by a psychiatrist, and had seen a psychologist, James, on around six occasions in the preceding two years. It was Dr Jones’ view that Mr Boom presented with no ongoing, active psychiatric disorder and, as such, no permanent impairment. 
91.	The assessment by Medical Assessor Rikard-Bell, with date of Certificate 22 October 2021, concluded that Mr Boom suffered a pre-existing persistent depressive disorder. It was Medical Assessor Rikard‑Bell’s conclusion that the subject motor vehicle accident was relatively minor and symptoms should have resolved within a few months without treatment and that there was continuing depression and development of a chronic pain syndrome after the subject accident. It was Medical Assessor Rikard-Bell’s view that there was no diagnosable psychological injury attributable to the subject accident.
92.	The complete record of the Centre Health Complex was provided, as at 14 August 2018. The entry, dated 26 October 2017, was noted and recorded that there was a long-standing history of depression with anhedonia, adynamia, low/flat mood and that there had been an exacerbation of depression for the preceding seven months. It was noted that the claimant was seeking a Centrelink Certificate and was being treated by a psychologist and was refusing the antidepressant medication. He requested a letter stating that he was diagnosed with depression and suffering from type II diabetes.
93.	The Panel notes the correspondence from Dr Mahon, dated 10 July 2019, that describes 
Mr Boom as appearing drawn and unkempt, and it was stated that he was “heavily impacted by his current circumstances”. It was noted that he had difficulty finding work due to his shoulder injury and that there were ongoing domestic stressors. Dr Mahon noted that 
Mr Boom continued to attend church. It was also noted that there was a “series of tragedies and suicides by those close to the family”, in addition to financial distress.
94.	The surveillance, dated 25 May 2021, was reviewed. It was noted, inter alia, that the claimant was observed lifting a toolbox from a vehicle.
95.	The permanent impairment assessment by Medical Assessor Wijetunga on Certificate, dated 30 March 2021, was noted. Medical Assessor Wijetunga attributed a 4% permanent impairment for whiplash-associated disorder of the right shoulder, cervical spine and left shoulder.
Opinion
96.	Mr Boom was a trainee bus driver who says that he was physically and psychologically injured as a result of his trainer/driver suddenly applying the brakes, causing him to injure his shoulder on a pole in the bus. He claims to have developed a psychological injury following that incident.
97.	The Panel members noted that Mr Boom was able to complete a TAFE course following the subject accident and that there was no record of psychological difficulty for some months following the subject accident. The Panel members further noted that Mr Boom had not engaged in psychological health-seeking behaviour in relation to the subject accident. The Panel members concluded that Mr Boom was not psychologically injured as a result of the subject accident. Specifically, there was no exacerbation of his pre-existing disorder due to the subject motor accident.  At the time of the Panel’s assessment, there was no whole person permanent impairment attributable to the subject accident, from a psychological perspective.
Conclusion
98.	The Panel concludes that the claimant was not psychologically injured as a result of the motor accident. The Panel finds there was no psychological impairment and no whole person permanent impairment attributable to the motor accident. The replacement certificate is set out at the commencement of these Reasons.