Helen Huang
Special Counsel
CTP Insurance, Insurance
Adjustment Disorder or Persistent Depression?
18 December, 2023
In Brief
- A threshold injury is defined under section 1.6 of the Motor Accidents Injuries Act 2017 (MAIA).
- If a Claimant’s injuries are only threshold injuries, they are not entitled to claim either statutory benefits beyond 52 weeks, or common law damages.
Facts
On 15 December 2023, the Personal Injury Commission (PIC) released its decision in Dokoza v AAI Limited t/as GIO [2023] NSWPICMP 626. The Claimant was involved in a motor vehicle accident on 2 September 2020.
The Claimant alleges sustaining a psychological injury as a result of the accident. The Insurer alleges the Claimant had only sustained a threshold injury. The matter proceeded to the Commission for determination of whether the Claimant sustained a threshold psychological injury.
A Medical Assessor determined the Claimant developed an adjustment disorder, which is a threshold injury under MAIA. The matter was referred to the Review Panel for assessment.
Review Panel’s Reasons
The Claimant was re-assessed by two Medical Assessors and the Review Panel accepted the accident caused significant pain and tremor which led to the development of Persistent Depressive Disorder, which is a non-threshold injury.
The Review Panel arrived at this diagnosis because the Claimant did not have any prior psychological history, there was no other explanation for the psychological symptoms except for the Claimant’s involvement in the accident and relied on the Claimant’s presentation and her history of the symptoms at their assessment of the Claimant.
Key Learnings
The decision in Dokoza v GIO reminds us:
- The Claimant bears the onus of proof in establishing that any injury is not a threshold injury for the purposes of the MAIA; Lynch v AAI Ltd 2022] NSWPICMP 6 at [44]– [62].
- A Claimant may discharge the onus of proving causation where there is no prior psychological history and no other explanation for the psychological symptoms reported by the Claimant’s treating doctors.
If you have a query relating to any of the information in this case note, or would like to discuss a similar matter of your own, please don’t hesitate to get in touch with CTP Insurance Special Counsel Helen Huang today.
