Background
Andrew Patsalis was injured when his vehicle was rear-ended while stopped in Sydney traffic in October 2021. A dispute arose under the Motor Accident Injuries Act 2017 (NSW) over the degree of permanent impairment caused by the accident, including psychiatric impairment and whether it exceeded the 10% threshold relevant to damages for non-economic loss.
A Personal Injury Commission Medical Assessor diagnosed accident-related post-traumatic stress disorder and major depressive disorder against a background of pre-existing schizophrenia. A delegate of the Commission President declined AAMI’s application to refer the assessment to a review panel. AAMI then sought judicial review of both decisions, alleging failures to address inconsistent medical histories, give adequate reasons, evaluate the evidence, provide procedural fairness, apply the DSM-5 criteria correctly, and use the proper statutory test for referral to a review panel.
The Court’s Holding
The Court dismissed AAMI’s summons. It held that the Medical Assessor had considered the insurer’s submissions and the differing medical evidence, explained her conclusions sufficiently, and was not required to discuss every asserted inconsistency. Her findings concerning PTSD, major depressive disorder, causation, and pre-existing schizophrenia were matters of clinical judgment supported by medical evidence. The alleged deficiencies did not establish jurisdictional error, legal error, constructive failure to exercise jurisdiction, or denial of procedural fairness.
The Court also rejected the challenges to the delegate’s decision. The delegate applied the statutory question under s 7.26—whether there was reasonable cause to suspect that the assessment was incorrect in a material respect—and did not exceed the gatekeeping role by independently resolving medical issues. In particular, the delegate did not personally construe or apply the DSM-5 but properly treated the PTSD diagnosis as a factual matter for the medically qualified assessor. AAMI was ordered to pay Patsalis’s costs.
Key Takeaways
- A medical assessor must provide reasons and evaluate the available evidence, but need not address every statement or asserted inconsistency in the record.
- A disagreement with a medical assessor’s clinical judgment, including a psychiatric diagnosis under the DSM-5, does not by itself establish reviewable legal error.
- A delegate considering referral to a review panel may examine the assessor’s reasoning while remaining within the statutory gatekeeping function.
Why It Matters
The decision underscores the limited scope of judicial review of medical assessments under New South Wales motor-accident legislation. Courts will examine whether the statutory process was lawfully followed, but will not reweigh medical evidence or subject an assessor’s reasons to overzealous scrutiny.
For insurers challenging psychiatric impairment assessments, identifying conflicting histories or opinions is not enough. The challenge must demonstrate a legally material failure in the assessor’s reasoning or procedure, or show that the review delegate did not lawfully apply the “reasonable cause to suspect” threshold.