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Case study 35 - non-minor injury

Overview

This case study explores a dispute about whether a psychological injury is a minor injury under Schedule 2 section 2(e) of the Motor Accident Injuries Act 2017 (the Act). The Assessor provided a diagnosis of Posttraumatic Stress Disorder, which does not meet the definition of a Minor Injury in accordance with the Act.

Introduction

The 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.

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

Prior to the MVA

The claimant was noted to be:

  • Living with their parents
  • Completing occasional casual work when offered by friends
  • Enjoying surfing, camping and socialising with friends
  • Driving independently

The 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.

Post MVA

  • 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 task
  • Nightmares about the MVA and recurring dreams about dying in the crash
  • Flashbacks about the crash and increased arousal with irritability
  • Poor sleep due to nightmares and an exaggerated startle response especially when in a vehicle
  • Loss of contact with some friends, concentration problems and memory deficiency

Review of Documentation

A psychologist’s report completed months prior to the accident, identified a diagnosis of paranoid psychosis. Based on the presentation at the interview for assessment it is likely the claimant had a pre-existing paranoid psychotic disorder. This is confirmed with symptoms such as guarded history and concerns about “disagreements with people”.  The psychologist identified no overtly psychotic symptoms such as delusions or hallucinations, however the report notes that the claimant is on anti-psychotic medication.

The Medical Assessor determined that the current presentation is more consistent with Posttraumatic Stress Disorder than a Paranoid Psychosis.

Diagnosis

  • Posttraumatic Stress Disorder

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).

Posttraumatic Stress Disorder 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.

The following injury is not a minor injury

  • Posttraumatic Stress Disorder