SIRA Logo

Case study 11 - PTSD and depression not minor-injury

The Assessor diagnosed the claimant with Posttraumatic Stress Disorder and Major Depression which, either on their own would be a non-minor injury.

Introduction

The claimant was stopped in traffic waiting to turn and was rear ended. The claimant did not lose consciousness, but felt shocked and dazed and wasn’t sure what was happening.

Emergency services were called to the scene; however, the claimant was taken home by a relative, then attended a family function later that evening.

The claimant reported no prior psychological problems.

Over the following weeks the claimant had variable pain in the neck, leg and buttocks.  The claimant saw a treating doctor approximately 19 days after the motor vehicle accident (MVA), as their symptoms were not getting any better. The main issue were their psychological symptoms. The claimant was referred to a psychologist.

The Medical Assessment

The claimant was assessed approximately 8 months after the MVA. The claimant reported their mood was low, felt withdrawn and fatigued, had reduced motivation and negative thoughts about themselves. The claimant also reported nightmares causing nocturnal panics, avoided driving and other social situations. The claimant had a normal appetite, but had reduced sleep. Work role was adjusted to avoid travelling, however performance at work was not affected.

Clinical examination

Mental state examination

Well groomed, showed no deficits of self-care. The claimant’s speech was slow and restrained. The claimant found it destressing to discussed the contents of the nightmares and avoided recalling the accident as it was unpleasant.  The claimant’s mood was low and body language would change on relating the accident itself.  Described both basic features of depression with low mood and reduced interest. No evidence of self-harm or psychotic occurrences.

Cognitive function was intact, the claimant continues to function at a high level at work and their performance and focus has not been affected.

Current Functioning

  • Manages all self-care
  • Visits friends less often, but when prompted would go out and socialise
  • Able to travel locally if they must, prefers family members to drive, can use public transport
  • Lives with family, well supported however withdrawn from them
  • Work role has been modified due to dislike of travelling

Summary of documentation

The treating psychologist report confirmed the same history as taking at the time of medical assessment.

Diagnosis

Post-Traumatic Stress Disorder and Major Depression. The claimant appeared to be dissociated at the time of the MVA, as well as reporting considerable fear, meeting criterion A of the DSM IV. The claimant also displayed features of the other five diagnostic criteria, including re-experiencing, avoidance, arousal, mood and cognition.

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:

  • Post-Traumatic -Stress Disorder
  • Major Depression