An insurer pointed to a driver's second injury claim to challenge his crash payout. The court was not persuaded.
In a decision dated August 7, 2026, the Supreme Court of New South Wales dismissed AAMI's attempt to overturn a medical assessment linking a driver's PTSD and major depression to a 2021 rear-end crash, and ordered the insurer to pay the driver's costs.
The driver was stopped in traffic in Sydney in October 2021 when another vehicle hit him from behind. He said the crash left him with post-traumatic stress disorder and major depressive disorder, on top of a schizophrenia diagnosis that predated the accident by more than a decade.
The complication was a second claim. The same man was pursuing a workers compensation claim over alleged bullying at a warehouse employer in 2012, which he said had aggravated his schizophrenia. AAMI argued the two claims did not fit together. In the workers compensation file, a psychiatrist assessed 21% whole person impairment from the workplace injury. In the motor accident file, the same psychiatrist assessed 22% from the crash, with no deduction for a pre-existing condition. The insurer said a claimant could not credibly attribute his impairment to a 2012 work injury in one claim and to a 2021 crash in another.
AAMI had conceded early that the driver cleared the scheme's 10% impairment threshold, relying on a report assessing 18%. It later obtained the workers compensation material, revoked the concession, and in June 2024 issued a decision declining to concede the threshold at all.
The Personal Injury Commission's medical assessor examined the driver in October 2024 and certified 23% whole person impairment caused by the crash, applying a 5% deduction for the pre-existing condition. A delegate of the Commission's president later refused to send the assessment to a review panel. The insurer took the matter to court on ten grounds.
The threshold drives the money. Under the Motor Accident Injuries Act 2017 (NSW), the court noted, "No damages for non-economic loss may be awarded in respect of injury unless the degree of permanent impairment of the injured person as a result of the injury caused by a motor accident is greater than 10%."
AAMI's main argument was that the assessor never grappled with the inconsistencies and simply accepted the driver's account. She had written that his account was "generally consistent with those reported during other psychiatric assessments," and that she "did not find any major inconsistencies in his reporting."
The court did not accept that this was a failure to carry out her task. An assessor's job, the court explained, is to form her own opinion on the medical question using her own expertise - not to choose between competing reports or rule on which doctor is correct. She acknowledged the inconsistencies the insurer raised, weighed them against the other psychiatric evidence, and was entitled to conclude they were not significant enough to change her view.
There was also a dispute over the PTSD diagnosis itself. A diagnostic criterion under the DSM-5, the standard psychiatric manual, requires exposure to actual or threatened death or serious injury. Pointing to minimal damage to the car, the insurer said the crash was too minor to qualify. The assessor found the driver's towbar had taken the brunt of the impact and that he "felt that he was quite shocked and disoriented and felt that it was potentially a life-threatening accident. Therefore, his perception of the accident fulfils Criterion A for a DSM-5 diagnosis of PTSD."
Whether an event is traumatic enough to cause PTSD, the court held, is a clinical question of fact reserved for the qualified assessor - not something a court or a non-medical delegate should decide in her place.
The court also found the delegate had applied the correct test - whether there was "reasonable cause to suspect that the medical assessment was incorrect in a material respect" - and had not crossed into deciding the medical question himself.
All ten grounds failed. The summons was dismissed and AAMI was ordered to pay the driver's costs.
For CTP and claims teams, the decision marks the limits of the inconsistency argument. Documented conflicts between a claimant's reporting across two claims did not, on their own, require the assessor to reconcile them point by point or reject the claim. Where an assessor acknowledges the conflicting material and forms her own view, courts are slow to step in - and here, the finding that the driver's perception of the crash was enough to support a PTSD diagnosis survived the challenge.
