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Case study 10 - Posttraumatic Stress Disorder non-minor injury

Introduction

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 stated they had not recovered from the PTSD. No other psychological history was reported. Returned to work 15 hours per week.

The claimant was a passenger and was rear ended by another vehicle. The claimant felt the impact and thought to themselves why was this happening again.

The claimant reported to their treating doctor that they felt more anxious and frightened when travelling as a passenger, experienced intrusive memories of the new MVA and flashbacks.  They felt they lost their temper more and avoided watching the news in case they saw other car accidents.  The treating doctor recommended psychological treatment in the form of cognitive behavioural therapy (CBT), which they have not undertaken and they had not been prescribed any antidepressant medication.

The Medical 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

The claimant was assessed approximately 9 months after the MVA. The claimant reported their mood was sometimes sad, but was still able to enjoy life. The claimant still thought of the previous MVA more often than the current MVA, but believed the recent accident had changed their life significantly. No thoughts of self-harm or suicidal thoughts, but they felt like a burden on their family, however they are very keen to recover from the psychiatric injuries. Sleep was often interrupted by nightmares or would wake up with shortness of breath and afraid.

Mental state examination

Well-groomed and dressed and showed no deficits of self-care. No evidence of self-harm or psychotic occurrences. Had good rapport and eye contact through the exam, demonstrated no evidence of psychomotor agitation or retardation, but was tearful at times during the assessment.

Their affect was anxious, there were mild themes of shame, guilt and hopelessness and reported symptoms of PTSD for both MVAs. They were uncertain whether their life was not worth living, but denied suicidal thoughts.

Current Functioning

  • Manages all self-care and eats regular meals
  • No longer goes out spontaneously to visit friends and no longer enjoys their company
  • Attends church regularly if driven by a family member
  • Finds it difficult to travel as a passenger and no longer drives,
  • manages to use public transport unaccompanied sometimes
  • able to watch TV, including the news
  • works only 1-2 hours per day
  • Interest in reading now minimal

Summary of Documentation

No psychological reports on file, all related to physical injuries.

Diagnosis

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.

Minor Injury

Section 1.6(3) of the Motor Accident Injuries Act 2017 (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 Accident Injuries Regulation 2017:

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

a) acute stress disorder

b) adjustment disorder

3) In this clause, acute stress disorder and adjustment disorder have the same meaning as in the document entitled Diagnostic and Statistical Manual of mental Disorders (DSM-5)

The following injury is not a minor injury as the claimant’s current psychiatric symptoms are consistent with a diagnosis of:

  • Post-Traumatic Stress Disorder