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Case study 28 - psychological injury

Introduction

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’s vehicle was towed away from the scene and subsequently “written off”. 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 Psychological 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).

Pre-MVA

  • No history of psychiatric illness prior to the accident
  • Completed a Bachelor degree at University
  • Worked fulltime
  • Appropriate self-care and ate regular meals
  • Enjoyed an active social life and travelled without difficulties
  • No problems with memory or concentration

During Assessment

  • Described mood as poor and sad
  • Reduced interest in social life
  • No intrusive and recurrent memories of the accident or flashbacks
  • Continues to drive cautiously
  • Eats two good meals a day
  • Remains upset about the inability to work and earn money
  • Denies suicidal ideation
  • No plan to return to treating psychiatrist

The 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.

Review of Documentation

Medical certificates issued by the general practitioner state diagnosis of back pain after the motor accident and depression.

No specific psychological or psychiatric reports were provided.

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.

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).

As in the diagnosis and reasons above, the claimant only meets the criteria for an Adjustment Disorder and not for any specific psychiatric disorder. The Adjustment Disorder with anxiety DSM F43.22 is a minor injury.