An insurer's bid to overturn a psychological injury finding backfired when a review panel swapped the diagnosis but left the legal outcome untouched.
In a decision handed down on April 24, 2026, a Review Panel of the Personal Injury Commission of New South Wales revoked a medical certificate that had found a motor accident claimant suffered post-traumatic stress disorder. The panel replaced it with panic disorder - another recognised psychiatric condition that carries the same legal consequences for the insurer.
The case, Pok v Insurance Australia Limited t/as NRMA Insurance [2026] NSWPICMP 291, turned on whether Sona Pok's psychological injury qualified as a "threshold injury" under the Motor Accident Injuries Act 2017. Under that framework, claimants whose injuries are classified as threshold face tighter restrictions on the damages they can recover. Recognised psychiatric illnesses fall outside that classification - and open the door to broader claims.
Pok was sitting in her parked car on August 21, 2023, when another vehicle struck her from behind. She claimed statutory benefits and damages against NRMA Insurance. A medical assessor initially certified that her PTSD, caused by the accident, was not a threshold injury - meaning she could pursue a damages claim.
NRMA Insurance pushed back. The insurer applied for review, relying on its own psychiatric expert, Dr Berry, who had diagnosed adjustment disorder. Under the regulations, adjustment disorder is classified as a threshold injury. If that diagnosis held, Pok's claim would have been significantly curtailed.
The review panel conducted a fresh assessment under the Act, which allows panels to re-examine all matters from scratch rather than simply checking for errors. After re-examining Pok by video link, the panel agreed with the insurer that the PTSD diagnosis could not stand. The accident, it found, did not meet the DSM-5-TR standard for a qualifying traumatic event. Paramedics had not identified a life-threatening or severe injury, Pok was not transported to hospital, and she continued working after the accident.
But the panel did not land where the insurer hoped. Instead of adjustment disorder, it diagnosed panic disorder - pointing to recurrent panic attacks triggered by situations reminiscent of the accident, including the sight of red cars similar to the one that struck her. Pok met five of the 13 symptom criteria, where four is the minimum.
The insurer also argued that Pok's irregular use of prescribed medications - desvenlafaxine and propranolol - could account for her symptoms. The panel rejected that, finding medication withdrawal does not typically produce panic-level anxiety and that her attacks were clearly linked to accident-related triggers.
NRMA Insurance further pointed to Pok's pre-accident mental health history, including anxiety and depression documented in 2021 and 2022 during a marital separation. The panel found those earlier episodes were self-limiting and had resolved well before the accident.
The outcome: the original certificate was revoked and a new one issued, but the insurer's position did not improve. Panic disorder, like PTSD, is a recognised psychiatric illness and sits outside the threshold classification.
For claims professionals, the lesson is practical. Review mechanisms that permit fresh assessments carry built-in unpredictability. Winning on one diagnostic argument does not guarantee the final result shifts in your favour - and may simply hand the other side a stronger foundation for the same outcome.
