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Case study 9 - changing diagnosis

The Assessor agreed that the Claimant was suffering from acute stress disorder/adjustment disorder however by the time the Assessor conducted the examination, this had manifested as Post traumatic Stress Disorder, which is a non-minor injury.

Introduction

The 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.

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 documented history of psychiatric illness
  • Able to drive independently
  • Ate meals regularly and attended to housework

During Assessment

  • 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 anxiety

The claimant denied thinking life was not worth living or experiencing thoughts of self-harm or suicidal ideation. Cognitive function was intact.

Review of Documentation

Psychologist report proffered an initial diagnosis of Adjustment Disorder with mixed anxiety and depressed mood.

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.

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).

Post traumatic Stress Disorder is not considered a minor injury. The claimant’s psychiatric diagnosis began as an Acute Stress Reaction, which by definition occurs immediately after a traumatic event, and has a time limit of one month. Since the condition has extended beyond the one month time frame, it is considered Post traumatic Stress Disorder.