Peter Hunt
Principal
CTP Insurance, Insurance
Establishing Psychiatric Impairment
11 March, 2024
In Brief
- In order to demonstrate a psychiatric impairment, a Claimant must demonstrate they satisfy the diagnostic criterion in DSM-V.
- A Claimant’s reported functioning should be checked, in appropriate cases, against the objective facts.
Facts
On 8 March 2024, the Personal Injury Commission published its decision in AAI Limited t/as GIO v Adnan [2024] NSWPICMP 89.
The Claimant’s brother was killed in a tragic motor accident on 12 October 2016 when two cars collided head-on on the New England Highway.
The Claimant was 16 years old at the time of the accident and was living with her family in Pakistan. The Claimant subsequently moved to Australia and made a CTP claim under the Motor Accidents Compensation Act 1999.
A Medical Assessor diagnosed a persistent depressive disorder with persistent major depressive episode and assessed the Claimant’s psychiatric impairment at 13% WPI.
The Insurer successfully sought a referral to the Medical Review Panel on the grounds that there was reasonable cause to suspect error in the Medical Assessor’s Certificate.
The Review Panel’s Determination
The Medical Review Panel revoked the Medical Assessor’s Certificate for the following reasons:
- The Claimant was effectively working full-time hours with her university studies and paid work.
- The Claimant worked significantly longer hours during the COVID-19 pandemic when the work restrictions for overseas students were relaxed.
- The Claimant’s high school and university results demonstrated that she performed well and was able to concentrate, adapt and cope with her academic requirements.
- Whilst the Claimant told the Medical Assessor that she did not buy food and only ate what was in her refrigerator, this was inconsistent with her bank account statement which demonstrated payments at multiple fast-food outlets.
- The Claimant’s demonstrated level of functioning, ability to support herself and her ability to live independently were inconsistent with a psychiatric diagnosis.
- The Claimant’s symptoms did not meet the criterion for a DSM-V psychiatric diagnosis.
Key Learnings
Whilst this matter was determined under the Motor Accidents Compensation Act 1999, the same considerations apply to a claim under the Motor Accident Injuries Act 2017. Whilst the PIC decision was about the Claimant’s entitlement to damages for non-economic loss, a finding of no recognised psychiatric illness would prevent her from recovering any damages for her mental harm (see s 31 of the Civil Liability Act 2002).
The decision provides a good example of how a Claimant’s reported symptoms must be thoroughly investigated and compared with the objective facts underlying the claim.
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 Principal, Peter Hunt, today.
