SIRA Logo

Case study 16 - Major Depressive Episode

Overview

The Medical Assessor found a diagnosis of Major Depressive Episode does not meet the definition of a Minor Injury.

This case study examines whether the psychological injury sustained by the claimant in response to the motor accident is a minor in accordance with the Motor Accident Injuries Act 2017 (the Act).

Introduction

The 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. By this stage, the claimant was experiencing pain in the neck, with markedly decreased range of movement. In addition, there was persistent numbness in the lower back. The claimant was subsequently prescribed analgesic medication.

The claimant underwent physiotherapy for eight weeks, followed by hydrotherapy for a further four weeks.

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.

The assessment

There is a dispute about whether the injury is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act).

Clinical Examination

Pre-MVA

  • No history of psychiatric illness
  • Active social life
  • High level of self-care
  • Travelled without difficulties
  • No problems with memory or concentration
  • Performed household maintenance and improvements
  • Enjoyed playing sport and watching documentaries

Post MVA

  • Developed insomnia and early morning waking
  • Dysphoric mood
  • Social withdrawal
  • Anxious mood
  • Low self-esteem and poor confidence
  • Reduced ability to plan or think rationally
  • Poor memory and concentration
  • Less concerned with appearance and personal care
  • Weight gain due to increased eating
  • Clear themes of shame, guilt and hopelessness in thought content

Review of Documentation

No specific psychological or psychiatric reports were provided.

Letter from general practitioner refers only to physical injuries and the difficulties these injuries cause the claimant in dealing with daily living activities.

Diagnosis

  • Major Depressive Episode

In 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.

Minor Injury

Section 1.6(3) of the Act:

A minor psychological or psychiatric injury is a psychological or psychiatric injury that is not a recognised psychiatric illness.

Part 1 clause 4 (2) of the Motor Vehicle Injuries Regulation 2017:

2) Each of the following injuries is included as a minor psychological or psychiatric injury

a) acute stress disorder

b) adjustment disorder

3) In this clause, acute stress disorder and adjustment disorder have the same meanings as in the document entitled Diagnostic and Statistical manual of Mental Disorders (DSM-5).

The following injury is not a minor injury

  • Major Depressive Episode