Barry.Nilsson. Lawyers . Lawyers



MAIA – Minor Injury Case Study SummaryPHYSICAL INJURYDate & Case Study No.DecisionInjury/DiagnosisFindings/CommentsJanuary 2018No.1Minor InjurySoft tissue cervical spine.Referred symptoms to upper thoracic and right shoulder were not causally related to accident. Principles in “Singh” are not applicable.MRI cervical spine showed evidence of multilevel degenerative changes.Claimant had full range of motion in cervical spine upon examination.January 2018No. 2Minor InjuryWhiplash injury to cervical and thoracic spine with referred symptoms to shouldersRadiology investigations reported no abnormality.Upon examination, the claimant had 75% of normal range of motion in cervical spine and upper extremity. January 2018No. 4Minor InjuryWhiplash injury to cervical and thoracic spineClaimant reported referred symptoms into both shoulders with 75% of normal range of movement in cervical spine.MRI of cervical spine showed no abnormality.January 2018No. 5Minor InjurySoft tissue injury to cervical and lumbar spine, left knee and left shoulderUpon examination, the claimant demonstrated 60-70% of normal range of movement in cervical, thoracic and lumbar spine and full range of movement in upper and lower extremities.MRI of cervical and lumbar spine reported no showing significant abnormality.January 2018No. 6Minor InjurySoft tissue injuries to cervical spine, right shoulder, lower back, left chest and right kneeClaimant’s GP diagnosed that the claimant sustained an exacerbation of pre-existing osteoarthritis of neck, lower back and knees.Upon examination, the claimant had moderately and symmetrically reduced range of motion in cervical and lumbar spine with full range of motion in all joints.There was no available radiology investigationsJanuary 2018No. 7Minor InjurySoft tissue injury to cervical spine with referred pain to right shoulderClaimant had 50% of normal range of movement of cervical spine.There was no available radiology investigations. January 2018No. 12Minor InjuryAggravation of pre-existing back condition and soft tissue injury to neckClaimant had a motor vehicle accident 3 years prior and injured back but was asymptomatic at the time of accident. MRI lumbar spine 3 years prior showed disc desiccation and prolapse with similar changes in latest MRI following accident.Assessor found that the claimant’s right leg pain was not of a radicular patter and not consistent with radiculopathy.January 2018No. 13Minor InjurySoft tissue cervical spineMRI Cervical Spine reported compression of right C6 by degenerative changes.Claimant had reduced range of motion upon examination.Assessor found that the claimant did not have significant symptoms to confirm radiculopathy even though right sided neurological symptoms were noted.January 2018No. 17Minor InjurySoft tissue injuries to neck, chest and lumbar spineInitial CT cervical spine showed no evidence of traumatic injury. There was no subsequent radiology investigations.Upon examination, the claimant demonstrated moderate and symmetrical restrictions in cervical, thoracic and lumbar spine with full range of motion in upper extremities.January 2018No. 18Non-Minor InjuryL5/S1 central disc protrusion with right sciatica and right sided low back pain and right S1 radiculopathyCT scan conducted day after accident reported no fracture and noted presence of small posterior disc bulge at L4/5.Upon examination, claimant 1/3 to 2/3 of normal range of movement in lumbar spine. Wasting was noted on right calf 2cm and 1cm at thigh with a slight but definite diminution of right ankle reflex.Whilst no muscle weakness was noted, 3 clinical signs of lumbar radiculopathy were found to be consistent with a right S1 nerve root compression.January 2018No. 25Minor InjurySoft tissue injuries to cervical and lumbar spineClinical notes 1 month post-accident recorded persistent neck and lumbar pain with radiculopathy.Upon examination, the claimant demonstrated full range of movement in neck and lumbar spine. The Assessor found no evidence of radiculopathy.January 2018No. 26Minor InjurySoft tissue injury to cervical spine with attendant chronic symptomatic aggravation of underlying degenerative change.Claimant had ? to ? of normal neck range of movement.CT cervical spine refers to severe pan-cervical spondylosis with multilevel hyperostosis associated with interbody bony bridging and advanced long-standing degenerative changes at various levels.December 2018No. 32Minor InjurySoft tissue injury to cervical spine (whiplash associated disorder grade II)Soft tissue injury to lumbar spine including aggravation of longstanding and symptomatic degenerative changeSoft tissue injury to left shoulderUpon examination, the claimant demonstrated 2/3 to 1/2 of normal range of motion with forward protrusion of head and neck described as “poke neck”.Claimant had 1/3 of normal range of movement in lumbar spine which was consistent with findings by treating specialist 2 years prior to accident.Claimant also had impingement signs in the left shoulder.January 2018No. 37Minor InjuryMild strain to cervical, thoracic and lumbar spine7 years prior to accident the claimant injured lower back and underwent lumbar spine surgery 3 years later. Following accident, claimant’s treating doctor noted lower back, thoracic spine and neck pain with radiculopathy.MRI cervical spine reported disc herniation at C5/6. MRI lumbar spine noted L4/5 moderate bilateral facet arthropathy narrowing inferior aspect of neural foremen resulting mild bilateral formal stenosis without impingement.Assessor found no significant physical signs, no radiculopathy or neurological deficit.January 2018No. 38Minor InjurySoft tissue injury to cervical and thoracic spineClaimant’s MRI cervical spine reported C3-4 and C5-6 disc herniation with cord contact with minor 5% compression of cord.Assessor found that the abnormalities shown on MRI are likely to be secondary to constitutional and age related degenerative factors. There was no clinical signs of radiculopathy. All reflexes, muscle bulk and power assessed as normal.January 2018No. 39Minor InjurySmall styloid fracture to right wristX-ray conducted month post-accident reported “slight fracture”. There was no recorded complaint of wrist pain immediately following accident.Assessor found the imaging not convincing for a fracture and note that a facture, even if as small and displaced as this one is reported to be would be painful at the time of accident. Assessor concluded that this injury is medically implausible and concluded that there has not been a fracture or a significant cartilage injury.January 2018No. 40Minor InjurySoft tissue lumbar spineClaimant was involved in 2 prior accidents and sustained suspected spine and upper extremity injuries.MRI lumbar spine conducted 6 months post-accident showed disc protrusions at L4/5 and L5/S1. However, MRI lumbar spine conducted 7 years prior indicated no changes from MRI lumbar conducted 6 months post-accident.January 2018No. 42Minor InjuryMusculoligamentous strain to cervical spineSoft tissue strain to right shoulderMusculoligamentous injury to lumbar spineClaimant was involved in a subsequent accident and further aggravated his back pain.MRI lumbar spine showed disc disease with an annular fissure at L3/4 and a transitional L5 vertebrae and possible compression of the transiting left L4 nerve root. Assessor found annular fissure is not a rupture.Ultrasound and MRI right shoulder reported mild bursitis.January 2018No. 43Minor InjurySoft tissue cervical spine.MRI cervical and thoracic spine showed signal change involving T2 and T3 segments but treating specialist found the changes unrelated to accident.Claimant had reduced range of motion by ?.January 2018No. 44Minor InjurySoft tissue cervical spine.Aggravation of pre-existing lumbar spine degenerative changesX-ray cervical spine reported loss of cervical lordosis and multilevel narrowing of disc spaces.MRI lumbar spine reported disc bulge at L2/3., annular fissure of L5/S1 and disc protrusion at S1/S2. Treating specialist found objective signs of radiculopathy. Assessor found the claimant not qualify for disc injury with radiculopathy.January 2018No. 45Non-Minor InjuryLumbar spine – disc protrusion with L5 radiculopathyMRI lumbar spine showed L4/5 posterior central, right central and right subarticular annular fissure associated with a mild broad-based posterior annular disc bulge, asymmetrical to the right. There is also right subarticular stenosis resulting in possible impingement of right L5 nerve root. There is L5/S1 focal left central and subarticular disc protrusion with abutment and potential impingement of left S1 nerve root. Mild to moderate L5/S1 and to a lessor extent L4/5 facet joint arthrosis.Assessor found that the investigations are consistent with clinical findings of right L5 radiculopathy from disc protrusion with severe symptoms consistent with right sided lower limb neuropathic pain.January 2018No.47Minor InjurySoft tissue cervical spine.Claimant demonstrated reduced range of motion by ? and reduced range of motion in upper limbs by ?.December 2018No. 33Minor InjurySoft tissue injury to cervical spineClaimant had a subsequent fall due to dizziness 5 months after accident and sustained a fractured right wrist.Early medical records contained no reference to dizziness or head injury but ongoing headaches following accident.Assessor found no evidence that the claimant’s dizziness was related to neck.December 2018No. 34Non-Minor InjurySoft tissue injury to cervical spineDisc rupture in lumbosacral spineClaimant reported occasional “electric” feelings in right thigh in addition to lower back pain. Upon examination, claimant demonstrated 70% of normal range of motion in thoracic and lumbar spine.Treating specialist report identifies a disc prolapse rather than a disc bulge. MRI lumbar spine showed a L5/S1 disc injury. Assessor found that the disc showed evidence of rupture. Given the claimant’s relatively young age, Assessor found that it was unlikely to be present prior to accident.December 2018No. 36Minor InjurySoft tissue injury to cervical and lumbar spineBone scan 2 weeks post-accident confirmed facet joint arthritis in lumbar spine at L2/3 and L3/4 with early mild degeneration in hands, wrists, shoulders, hips and knees.Claimant demonstrated reduced range of motion in cervical and lumbar spine.December 2018No. 46Minor InjurySoft tissue injury to cervical and lumbar spine, right elbow and right ankleMRI of lumbosacral spine reported lumbar canal stenosis with suspected impingement of L4 and L5 nerve roots. MRI of cervical spine reported small to moderate size C5/6 disc protrusion with canal stenosis.Claimant demonstrated 70% of normal range of motion in whole spine.Assessor commented that an acute injury does not cause degenerative spondylosis and annular tears are common in asymptomatic people of the claimant’s age. There was no convincing medical evidence that annular tear could have been caused by accident.April 2019No. 48Non-Minor InjurySoft tissue injury to cervical spine with symptom radiation to right scapulaL4-5 disc lesion consisting of partial rupture of fibrocartilage of lumbar spineCT lumbar spine showed degenerative change with disc space narrowing and osteophytes predominately at L4-5 level. CT cervical spine showed degenerative changes at C5-6 and C6-7, similar to scans taken prior to accident.Whilst there were references of “radiculopathy confirmed” in radiology reports, the Review Panel noted that radiculopathy is a clinical diagnosis, rather than one made based on imaging.The Review Panel referred the CT lumbar spine to a Medical Assessor specialising in diagnostic radiology to clarify whether the L4-5 disc herniation meant that the claimant had incurred a “cartilage rupture” from the accident.The radiologist noted narrow disc consistent with chronic disc degeneration at L4-5 and advised that it was not possible to determine the age of right L4-5 protrusion, whether it was acute or chronic. The radiologist concluded that there had been a partial rupture of fibrocartilage.PSYCHOLOGICAL INJURYDate & Case Study No.DecisionInjury/DiagnosisFindings/CommentsJanuary 2018No. 3Minor InjuryAdjustment DisorderThe claimant was driving in moderately paced traffic and was rear ended by another vehicle, with the claimant’s car being shunted into the vehicle in front. The claimant did not lose consciousness. The claimant’s vehicle was drivable but subsequently reported to be “written off”. The claimant noted no awareness of physical or psychological symptoms at the time of the motor vehicle accident (MVA) and drove home “slowly”. The claimant attended a Psychologist once as part of treatment, but was not provided with any exercises or benefit and so ceased treatment. The claimant noted having “family problems” commencing late 2017 and continuing into early 2018.The claimant has a number of educational qualifications and is currently completing a University level qualification. Time has been taken off for reasons a physical illness not related to the MVA which resulted in a hospital admission. As such, the claimant had fallen behind in the educational course work by three weeks.Upon assessment, the claimant reported:Does not drive despite having been bought a car by the family, uses Ubers, taxis, and friends to transport and has plans to start driving in the future but has not commencedDespite preferring not to think about the accident, noted no change in affect when recounting the MVASpent time away from friends/social groups however has commenced re-engagement with friendsReported hospitalisation at the end of the first quarter of 2018, unrelated to MVA, however was discharged after 3-4 days on antibiotics. This resulted in non-attendance at university study for 3 weeks, but has caught up in university study since that timeSleep disturbed, waking once or twice during the night, however clinically does not meet the criteria for middle insomniaSelf-reported “depression” clinically noted to last between minutes to hours and is able to distract themselves from depressive symptoms easily andHas not returned to work in the hospitality setting, reportedly due to physical components of the MVA in addition to the higher demands of university study during the year.Claimant was assessed with Adjustment Disorder with Anxiety. Anxiety is present and disproportionate to the intensity of the stressor (MVA with physical injuries). The claimant does not have the cardinal feature required for a Major Depressive Disorder diagnosis or the duration or severity of symptoms required for a dysthymia (persistent mild depression).The claimant does not have symptoms for Generalised Anxiety Disorder nor panics required for this diagnosis.The claimant has clinical severity of cluster C symptoms (persistent avoidance) for Posttraumatic Stress Disorder (PTSD), but no other domains. As such they do not meet the diagnostic criteria for PTSD.January 2018No. 8 & 21Non-Minor Injury PTSD and Major Depressive Disorder The claimant was driving with their pregnant partner as a passenger. They were travelling at approximately 80km per hour along a main road when two vehicles in front of them suddenly collided. This caused the claimant to brake suddenly. The rear of the claimant’s vehicle was impacted by another car. Airbags did not deploy. The claimant’s vehicle was badly dented but drivable.The claimant became concerned for their partner and unborn child. They drove to hospital from the scene of the accident.The claimant was not assessed at hospital, however his partner was assessed and monitored in the maternity ward.Upon returning home, the claimant was unable to sleep. Overnight, severe pain developed in the lower back, neck, pelvis and ankle. The following day the claimant attended a general practitioner. The claimant was prescribed analgesic medication and referred to a physiotherapist for treatment.The claimant experienced symptoms of acute psychological distress involving fear of serious injury to their partner and baby at the time of the accident and persisting thereafter. There has been no referral to a psychiatrist and no suggestion of treatment with medication. Upon assessment, the claimant reported:Intrusive distressing memories of the traumatic event both in dreams and whilst awakeHeightened arousal with irritability and escalation to anger as an indication of physiological reaction to the subject accidentAvoidant behaviour including limited enthusiasm for driving and heightened fear whilst on the road in trafficEmotional numbing and detachment from those who are close, especially within the family settingDifficulty with concentrationDisturbed appetiteInsomniaFeelings of guilt and self-blame associated for the role as driver in the accidentDeteriorated performance at work regarding thinking, organising and completing tasksRecurrent thoughts of death and suicidal ideation in the absence of a specific plan or intentDepressed mood that is persistent for most of the daySignificant diminished interest in virtually all activitiesThe claimant has significant psychiatric illness and symptoms consistent with a diagnosis of Posttraumatic Stress Disorder as per DSM 5 criteria. Additionally, the claimant’s mood disturbance is in excess of the disturbed mood identified with Posttraumatic Stress Disorder. The extent of his mood disturbance warranted a diagnosis of Major Depressive Disorder consistent with the diagnostic criteria of DSM 5. This diagnosis was outside the scope of a minor injury. As such, the injuries assessed did not meet the description of a minor psychological or psychiatric injury.January 2018No. 9Non-Minor InjuryAcute stress disorder and adjustment disorderPTSDThe claimant was driving with multiple family members as passengers. As the claimant slowed down and indicated left to turn off the main road, a vehicle collided with the rear of their car. The claimant lost control of the car and it spun around to face the other vehicle involved in the accident. The other vehicle landed on the bonnet of the claimant’s car. At this point the claimant momentarily lost consciousness.Upon regaining consciousness, the claimant was still sitting in the car. The claimant was concerned with the welfare of their family members and immediately checked that they were unharmed. The other car was upside down and the claimant thought there may be children inside as it was a “family vehicle”. The claimant feared that somebody may have died.The claimant and their family members were transported to hospital by ambulance. The claimant underwent x-rays and a CT scan of the head and was discharged the same day.The claimant subsequently consulted with a general practitioner, with complaints of a stiff neck, pain, headaches and insomnia. The claimant was referred to a physiotherapist and treated with analgesic medication. The symptoms did not improve.Since the date of the accident, the claimant has attended four sessions of psychological counselling and is scheduled to see a psychiatrist in the near future.Upon Assessment, the claimant reported the following:?Intrusive and recurrent memories of the accident, experienced daily?Flashbacks?Disturbed sleep with occasional nightmares?Irritability and elevated startle response?Persistent thoughts of self-blame and guilt?Fluctuating appetite?Poor energy and lack of motivation?Unable to drive due to increased anxietyThe claimant denied thinking life was not worth living or experiencing thoughts of self-harm or suicidal ideation. Cognitive function was intact.Diagnosis: Immediately after the accident the claimant experienced the onset of an Acute Stress Reaction (ASR). The symptoms of the ASR lasted longer than one month, and therefore came to fulfil diagnostic criteria for Post traumatic Stress Disorder.The claimant’s psychiatric symptoms remain consistent with a DSM-5 diagnosis of Post traumatic Stress Disorder.January 2018No. 10Non-Minor InjuryPTSD (subsequent episode)The claimant was involved in a previous motor vehicle accident (MVA), 3 years prior to the current MVA. The claimant was referred to a treating counsellor who provided approximately 10 sessions of counselling and was diagnosed Post-Traumatic Stress Disorder (PTSD). No antidepressants were prescribed. The claimant had not recovered from the PTSD. No other psychological history was reported. Returned to work 15 hours per week. Despite a prior diagnosis, the claimant reported:Manages all self-care and eats regular mealsNo longer goes out spontaneously to visit friends and no longer enjoys their companyAttends church regularly if driven by a family memberFinds it difficult to travel as a passenger and no longer drives,manages to use public transport unaccompanied sometimesable to watch TV, including the newsworks only 1-2 hours per dayInterest in reading now minimalDiagnosed with Post-Traumatic Stress Disorder. The previous unresolved symptoms of PTSD immediately worsened after the current MVA. In addition to pre-existing symptoms of intrusive memories and flashbacks of the previous accident, the claimant began to experience additional intrusive memories and flashbacks related to the current MVA and therefore has developed a new episode of PTSD.January 2018No. 11Non-Minor InjuryPTSD and major depressionRear end collision. Emergency vehicles were called to the scene, however claimant was transported home by relatives. Over the following weeks the claimant had variable pain in the neck, leg and buttocks. The claimant saw a treating doctor approximately 19 days after the motor vehicle accident (MVA), as their symptoms were not getting any better. The main issue were their psychological symptoms. The claimant was referred to a psychologist. Upon assessment, described both basic features of depression with low mood and reduced interest. Current reported functioningManages all self-careVisits friends less often, but when prompted would go out and socialiseAble to travel locally if they must, prefers family members to drive, can use public transportLives with family, well supported however withdrawn from themWork role has been modified due to dislike of travellingDiagnosed with Post-Traumatic Stress Disorder and Major Depression. The claimant appeared to be dissociated at the time of the MVA, as well as reporting considerable fear, meeting criterion A of the DSM IV. The claimant also displayed features of the other five diagnostic criteria, including re-experiencing, avoidance, arousal, mood and cognition.The claimant has significant psychiatric illness and symptoms consistent with a diagnosis of Posttraumatic Stress Disorder as per DSM 5 criteria.In addition, the claimant’s mood disturbance is in excess of the disturbed mood identified with Posttraumatic Stress Disorder. The extent of his mood disturbance warranted a diagnosis of Major Depressive Disorder consistent with the diagnostic criteria of DSM 5.January 2018No. 15Non-Minor InjuryMajor Depressive Disorder and Acute Stress Disorder/Adjustment DisorderThe claimant was examined 9 months post motor accident, was driving in traffic and a passenger when the vehicle was hit on the driver’s side. The claimant did not lose consciousness, the airbags were deployed, and the claimant reported feeling that “they might die”. They were taken to Hospital for imaging and assessment. The claimant was subsequently discharged with soft tissue injuries and recommended to have physiotherapy and psychological counselling. With regards to functioning, the claimant reported:Noted having attempted to return to work 2 days per week, however ceased due to a combination of pain and psychological motivation;Sleeping 9 hours or more per day, noted to be normal sleep duration although broken with onset insomnia;Able to drive for short periods, however becomes anxious when driving for long periods;Avoids the site of the motor accident;No reported re-experiencing, nor hyperarousal or hypervigilance;Poor historian regarding prior information;Low, dysphoric mood with anhedonia and reduced energy;Reduced movement, motivation, and social withdrawal;No psychotic symptoms and no cognitive testing was completed.The claimant was assessed with cardinal features of depression; pervasive low mood and anhedonia. In addition to clinical sleep disturbance, which was not only related to pain, they reported reduced motivation and negative cognitions. January 2018No. 16Not-Minor InjuryMajor depressive episodeThe claimant was a front seat passenger in a motor vehicle involved in a rear-end impact from another car. Several of the claimant’s family members were in the motor vehicle at the time, some of whom were adolescents. The claimant’s initial reaction was to fear for the safety of their family members, especially the children. The claimant was relieved when they found that nobody appeared to be hurt. Shortly thereafter, the claimant began to notice some numbness in their back. No police or ambulance attended the scene. The following day the claimant attended a general practitioner. In the presence of persistent pain, with little improvement over time, the claimant developed insomnia. The claimant was unable to pursue many of the activities they previously enjoyed prior to the accident and began to experience dysphoric mood. Upon assessment, the claimant reported:Developed insomnia and early morning wakingDysphoric moodSocial withdrawalAnxious moodLow self-esteem and poor confidenceReduced ability to plan or think rationallyPoor memory and concentrationLess concerned with appearance and personal careWeight gain due to increased eatingClear themes of shame, guilt and hopelessness in thought contentIn the presence of chronic pain and decreased ability to engage with daily activities, the claimant began to experience symptoms of dysphoric mood, including anxiety and depression. These symptoms became progressively worse over time. The Medical Assessor found that the symptoms described above are more consistent with a Major Depressive Episode than with the diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood.January 2018No. 19Non-Minor InjuryMajor Depressive disorderThe claimant was stopped in traffic waiting to turn and was rear ended. The claimant did not lose consciousness, but felt shocked and dazed and wasn’t sure what was happening. Emergency services were called to the scene; however, the claimant was taken home by a relative, then attended a family function later that evening. Over the following weeks the claimant had variable pain in the neck, leg and buttocks. The claimant saw a treating doctor approximately 19 days after the motor vehicle accident (MVA), as their symptoms were not getting any better. The main issue were their psychological symptoms. The claimant was referred to a psychologist.The claimant reported the following:Manages all self-careVisits friends less often, but when prompted would go out and socialiseAble to travel locally if they must, prefers family members to drive, can use public transportLives with family, well supported however withdrawn from themWork role has been modified due to dislike of travellingWas assessed with Post-Traumatic Stress Disorder and Major Depression. The claimant appeared to be dissociated at the time of the MVA, as well as reporting considerable fear, meeting criterion A of the DSM IV. The claimant also displayed features of the other five diagnostic criteria, including re-experiencing, avoidance, arousal, mood and cognition.January 2018No. 20Non-Minor InjuryAcute Stress Reaction and Posttraumatic Stress DisorderThe claimant was driving with multiple family members as passengers. As the claimant slowed down and indicated left to turn off the main road, a vehicle collided with the rear of their car. The claimant lost control of the car and it spun around to face the other vehicle involved in the accident. The other vehicle landed on the bonnet of the claimant’s car. At this point the claimant momentarily lost consciousness.Upon regaining consciousness, the claimant was still sitting in the car. The claimant was concerned with the welfare of their family members and immediately checked that they were unharmed. The other car was upside down and the claimant thought there may be children inside as it was a “family vehicle”. The claimant feared that somebody may have died. Since the date of the accident, the claimant has attended four sessions of psychological counselling and is scheduled to see a psychiatrist in the near future.Upon assessment, the claimant reported:Intrusive and recurrent memories of the accident, experienced dailyFlashbacksDisturbed sleep with occasional nightmaresIrritability and elevated startle responsePersistent thoughts of self-blame and guiltFluctuating appetitePoor energy and lack of motivationUnable to drive due to increased anxietyImmediately after the accident the claimant experienced the onset of an Acute Stress Reaction (ASR). The symptoms of the ASR lasted longer than one month, and therefore came to fulfil diagnostic criteria for Posttraumatic Stress Disorder.January 2018No. 23Non-Minor InjuryPost-Traumatic -Stress DisorderMajor DepressionThe claimant was stopped in traffic waiting to turn and was rear ended. The claimant did not lose consciousness, but felt shocked and dazed and wasn’t sure what was happening.Emergency services were called to the scene; however, the claimant was taken home by a relative, then attended a family function later that evening.Over the following weeks the claimant had variable pain in the neck, leg and buttocks. The claimant saw a treating doctor approximately 19 days after the motor vehicle accident (MVA), as their symptoms were not getting any better. The main issue were their psychological symptoms. The claimant was referred to a psychologist.The claimant reported no prior psychological problems. Was assessed 8 months post accident. The claimant’s presentation was well groomed, showed no deficits of self-care. The claimant’s speech was slow and restrained. The claimant found it destressing to discussed the contents of the nightmares and avoided recalling the accident as it was unpleasant. The claimant’s mood was low and body language would change on relating the accident itself. Described both basic features of depression with low mood and reduced interest. No evidence of self-harm or psychotic occurrences.Cognitive function was intact, the claimant continues to function at a high level at work and their performance and focus has not been affected.Upon assessment, the claimant reported the following:Manages all self-careVisits friends less often, but when prompted would go out and socialiseAble to travel locally if they must, prefers family members to drive, can use public transportLives with family, well supported however withdrawn from themWork role has been modified due to dislike of travellingThe claimant was found to have Post-Traumatic Stress Disorder and Major Depression. The claimant appeared to be dissociated at the time of the MVA, as well as reporting considerable fear, meeting criterion A of the DSM IV. The claimant also displayed features of the other five diagnostic criteria, including re-experiencing, avoidance, arousal, mood and cognition.January 2018No. 24Minor InjuryAdjustment Disorder with depressed moodThe claimant was involved in a rear end motor vehicle accident (MVA) resulting in neck and lower back pain. A GP review resulted in prescription of analgesic medication and physiotherapy treatment. The claimant did not return to work due to pain which caused financial problems. This caused anxiety and arguments with the claimant’s partner. The claimant had one consult by a psychiatrist for symptoms of stress, depression and sleeping issues and was prescribed medication.Upon assessment, he reported:Shower and dress – not dailyEnjoys food and eats regularlyVisited friends less often and enjoyed their company lessDrives locallyLive with partner but argues moreWatches less TV and has lost interest in sportsHas not returned to work due to chronic painAssessed with Adjustment Disorder with depressed mood, on the background of chronic pain. The claimant’s symptoms do not support a diagnosis of Major Depressive Episode.January 2018No. 27Minor InjuryNon-Minor InjuryAdjustment Disorder with Mixed Anxiety and Depressed Mood Specific Phobia – situational (of driving a motor vehicle) The claimant was driving with family member as passengers. While waiting to turn their car was rear ended and then hit two cars into ongoing traffic.The claimant reported neck, right shoulder pain and anxiety with driving. They also reported being withdrawn, more tearful, stopped going out with friends and driving.The claimant had nine sessions psychology counselling, which helped, however they remain very anxious when driving. They can now drive around the local area, but due to anxiety and panic symptoms they have reduced activity and attendance at social events.Upon assessment, the claimant had the following presentation:Well groomedSpeech normal rate and flowNo impairment on cognitive testingReduced social interaction with friends and familyLimited driving due to anxiety and panic symptomsRelationships with family are strainedLow mood and tearfulnessClaimant has the following psychiatric conditions according to DSM-5 criteria:Adjustment Disorder with Mixed Anxiety and Depressed MoodSpecific Phobia – situational (of driving a motor vehicle)The severity of the claimant’s phobic symptoms of driving a car are such that they cannot be subsumed under the diagnosis of Adjustment Disorder with Mixed Anxiety and Depressed Mood and require a separate psychiatric diagnosis according to DSM-5 criteria.January 2018No. 35Non-Minor InjuryPTSDThe claimant reported being hit from the driver’s side of their motor vehicle at significant speed causing their vehicle to flip twice, landing roof-side down. An ambulance attended the motor vehicle accident (MVA), however the claimant declined to be transported to hospital. The claimant noted during the interview that this was an error of judgement as they were not “in the right mind”. They later underwent surgery to remove glass from their arm.The claimant was noted to be a poor historian, guarded when questioned about a disability pension and events prior to the MVA. They refused to answer ongoing questions about their history.Prior to the accident, the claimant was noted to be:Living with their parentsCompleting occasional casual work when offered by friendsEnjoying surfing, camping and socialising with friendsDriving independentlyThe claimant had a history of taking Zyprexa (anti-psychotic medication), was in receipt of a disability pension and was guarded about identifying why they were receiving this.Following the accident, the claimant reported the following symptoms:Increased anxiety and fear about being in cars as a passenger/driver, the claimant was advised to sit in a stationary vehicle by their psychologist however was unable to complete this taskNightmares about the MVA and recurring dreams about dying in the crashFlashbacks about the crash and increased arousal with irritabilityPoor sleep due to nightmares and an exaggerated startle response especially when in a vehicleLoss of contact with some friends, concentration problems and memory deficiencyThe claimant was found to have Posttraumatic Stress Disorder which is a recognised psychiatric illness. The claimant did not have symptoms of the disorder prior to the MVA and the noted pre-existing paranoid symptoms have not been exacerbated by the MVA.January 2018No. 41Minor InjuryStressThe claimant was in a stationary vehicle that was impacted to the front when a car ran a red light at speed. Police and ambulance attended the accident. The claimant was taken to hospital for observation and later discharged with no significant injuries. The claimant report heightened mental arousal at the time of the accident. Following the accident, the claimant attended their general practitioner and has been conservatively managed since. At the time of assessment, the claimant was not undergoing active psychiatric treatment. Upon examination, the claimant reported:The claimant reported “some anxiety” when travelling as a passenger in a vehicle. Specifically, reporting thoughts of “what could have happened”.A heightened startle reflex and responds excessively to stimuli or triggers.The claimant noted difficulty sleeping following the accident lost employment as a result of the injuries suffered in the accident. (however video gaming appears to have attributed to this)The clinical examination confirmed no cognitive abnormalities. The claimant has been able to successfully secure employment Has a stable intimate relationship since the accident.The daily functioning of the claimant has remained unchanged or possibly increased since the accident. The claimant appears not to have a psychiatric disorder. The diagnosis of the treating psychologist indicates residual stress, which accurately describes the claimant’s symptoms.November 2018No. 28Minor InjuryAdjustment Disorder with depressed mood.The claimant’s vehicle was stationary at a traffic intersection when it was rear ended by another vehicle, pushing the claimant’s vehicle into the rear of the vehicle ahead of it. The claimant described a brief period of disorientation directly following the collision, however managed to alight unassisted from the vehicle within two or three minutes. An ambulance arrived and conveyed the claimant to hospital. The claimant recalled experiencing pain on the left side of the neck and in the lower back on the way to the hospital.The claimant was kept overnight in hospital for observation. The claimant underwent a physical examination and x-rays were taken.The claimant subsequently consulted with a general practitioner due to ongoing significant pain. The claimant was treated with analgesic medication and referred for eight sessions of physiotherapy.The claimant did not return to fulltime work after the accident due to persistent pain. Consequently, the claimant began to experience financial difficulty and worried about being unable to meet financial commitments. This led to increased anxiety. The claimant reported stress, depression and an impeded ability to sleep.The claimant was then referred to a psychiatrist by a general practitioner. The psychiatrist prescribed psychotropic medication, which the claimant used for a period of one month, however experienced no beneficial clinical effects.The claimant had no history of psychiatric illness prior to the accidentUpon Assessment, the claimant reported the following:Described mood as poor and sadReduced interest in social lifeNo intrusive and recurrent memories of the accident or flashbacksContinues to drive cautiouslyEats two good meals a dayRemains upset about the inability to work and earn moneyDenies suicidal ideationNo plan to return to treating psychiatristThe claimant demonstrated no evidence of delusions, hallucinations or disorder of thought form. Cognitive function was intact, while insight and judgement were fair. There were no themes of guilt in thought context, however spoke of some feelings of hopelessness.The claimant did not report symptoms consistent with posttraumatic stress disorder.Diagnosis: The claimant described symptomatology most consistent with a diagnosis of Adjustment Disorder with depressed mood. The number and severity of the mood symptoms is not supportive of a diagnosis of Major Depressive Episode.November 2018No. 29Minor InjuryAdjustment Disorder with Mixed Anxiety and Depressed Mood The claimant was a passenger in the front seat of a vehicle that was hit by another vehicle on the right front side in a “T-bone” fashion. The claimant did not experience a loss of consciousness, however felt immediate pain in the chest and back. An ambulance transported the claimant to hospital from the scene of the accident. The claimant became immediately afraid of driving or being in a car. The persistent symptoms of pain led to poor sleep and irritability. The claimant reported:Low moodLoss of employmentReported suicidal ideationSleep interrupted frequently by symptoms of painLoss of motivation and libidoRemains anxious about driving, however will travel as a passenger if necessaryReduced social interaction with friendsFinds it hard to focus and is easily distractedSometimes will not shower and will wear the same clothes for consecutive daysIncreased food intake, leading to weight gainDiagnosed with an Adjustment Disorder with Mixed Anxiety and Depressed Mood.November 2018No. 30Non-Minor InjuryPTSDThe claimant was involved in a motor vehicle accident (MVA) where their car was hit perpendicular (T-bone) on the passenger’s side. Immediately following the accident, the claimant reported being fearful for the welfare and safety of their child. The claimant noted following the accident that the other vehicle involved was significantly damaged and they were worried the other driver had been killed. Since the accident, the claimant reported:Has been attending physiotherapy and approximately 3-5 sessions with a psychologist. Commenced attending psychologist 6 months post-MVA.Observed and reported low mood and anxiety, fatigue, and phobia of driving.Sleep interrupted, specifically noted very limited sleep. This was noted to be due to dreams of recurring accidents and increased arousal due to cognitive ruminations.Hypervigilant when in a vehicle, currently driving as part of psychological therapy however is aware of being slower, taking more time and having significant anxiety while driving.Sense that their “life has shortened” and awareness of being hypervigilant about anyone in cars and particularly their children and partner.Panic attacks commenced one week post-MVA and have continued to date. Highly distractible and has difficulty concentrating. Noted that they have ceased completing administrative tasks at work and subsequently ceased working.Noted and observed loss of interest in personal care.Relies on takeaway food or misses meals frequently.Reduced socialising and specifically only goes out when able to leave easily and resting is available.Significant reduction in appetite, subsequently lost 6 kilograms.The claimant’s symptoms had been present for longer than one month and therefore does not have Acute Stress Disorder and the extent and nature of the symptoms exclude a diagnosis of an adjustment disorder. The claimant has not reported a melancholic mood which would relate to a symptom of Major Depressive illness. ................
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