PTSD claims are rising, but Courts are not always buying them: Lessons for Insurers from Finn v Gerritsen [2025] WADC 93

The recent decision of the WA District Court in Finn v Gerritsen [2025] WADC 93 highlights a critical issue for insurers managing psychiatric injury claims: a Post-Traumatic Stress Disorder (PTSD) diagnosis will not be accepted unless the underlying factual basis is proven. 

Where a claimant’s history is found to be unreliable, inconsistent, or embellished, the Courts may prefer alternative diagnoses, such as somatic symptom disorder, and, consequently, may significantly limit any award of damages. 

For insurers, Finn v Gerritsen provides essential guidance on how to scrutinise psychiatric claims early and effectively.

Credibility and the accuracy of the history provided

Psychiatric injuries, including PTSD, are increasingly claimed in motor vehicle and workers’ compensation claims. 

However, Finn v Gerritsen serves as a reminder that a claimant’s credibility is central to any allegation of psychiatric injury. The Court’s analysis demonstrates that even where a psychiatrist diagnoses PTSD, the Court will not accept that diagnosis unless the factual foundations objectively exist and are reliably proven.

The plaintiff alleged she developed PTSD following a motor vehicle collision in January 2020. Dr Jackson, a consultant psychiatrist, briefed by the plaintiff diagnosed her with PTSD (and a somatic symptom disorder with persistent, predominant pain), relying heavily on the plaintiff’s self‑reported symptoms of nightmares, panic attacks, hypervigilance, daily distress, and functional restrictions.  In response, Dr Edwards-Smith, psychiatrist, was briefed by the defendant. Dr Edwards-Smith found the plaintiff presented with ‘complex psychiatric issues’ and diagnosed the plaintiff with generalised anxiety disorder and panic disorder which were longstanding, remained of the view that the plaintiff did not suffer from PTSD, but said there was evidence for somatic symptom disorder. 

The Court highlighted that medical practitioners in coming to their diagnoses (whether it be physical or psychological), are primarily reliant on a claimant giving to them an accurate history of the presenting complaint. 

To that end, the Court:

• was satisfied that the plaintiff tended to exaggerate and embellish matters and subsequently treated her complaints and evidence with caution. Additionally, it said that there was no other objective evidence to support her claims of substantive and ongoing injury and disability, and in some instances, her claims were inconsistent with the objective findings on assessment by medical practitioners. 
• despite Dr Jackson’s diagnosis, ultimately rejected a finding that the plaintiff had suffered PTSD. Instead, it found the plaintiff suffered a somatic symptom disorder (pain sensitisation) and an exacerbation of pre‑existing anxiety, but not PTSD. 

Why the Court rejected the PTSD diagnosis

The Court was not satisfied that the factual basis for the plaintiff’s diagnosis of PTSD was established to the requisite standard. 

It said that several evidentiary factors were decisive in it making that finding:

Inconsistent and embellished reporting of symptoms

The Court identified a clear pattern of exaggeration by the plaintiff, including:

• long‑term swelling and bruising of the plaintiff’s arm claimed to have lasted 6 months, which was unsupported by any objective medical evidence (only mild bruising was noted by her GP).
• claims of daily nightmares and panic attacks, inconsistent with her early medical records, which did not document such symptoms despite her multiple attendances.
• descriptions of being unable to drive more than 20 minutes, contrasted with evidence of a driving holiday from Esperance to Adelaide (an inherently long trip).

Non‑disclosure of relevant medical history

The plaintiff failed to disclose:

• severe lower‑back pain caused by a spinal anaesthetic during assessments in 2024; and
• previous episodes of anxiety and panic attacks, which were significant and longstanding.

This selective disclosure led the Court to question the reliability of the history she had provided to psychiatric experts.

Behavioural inconsistency in the witness box

The Court remarked that the plaintiff’s demeanour changed dramatically between examination‑in‑chief and cross‑examination:

• in examination in chief: emotional, vague, distressed, “going blank”, and 
• during cross-examination: focused, articulate, not distressed.

The Court considered this inconsistency in the plaintiff’s presentation to be troubling and suggestive of exaggeration when discussing her accident‑related symptoms.

Conflict between experts

Crucially, Dr Edwards‑Smith, who had the benefit of the plaintiff’s full psychological history (including panic attacks, longstanding anxiety, developmental trauma), maintained that the plaintiff did not suffer PTSD.  She opined that the plaintiff’s symptoms were more consistent with:

• generalised anxiety disorder;
• panic disorder; and
• somatic symptom disorder.

The Court found Dr Edwards-Smith’s analysis more consistent with the objective evidence and preferred her diagnosis. 

What this means for insurers: practical lessons

This case offers several key insights for insurers and claims managers managing psychiatric injury claims.

Given that diagnoses of psychiatric injury are increasingly common, and often rely overwhelmingly on a claimant’s self-reported narrative, when considering the merits of such claims, take care to:

Test the reliability of a claimant’s symptom history early

• Compare early medical records with later reports.
• Identify inconsistencies in symptom onset, persistence, and severity.
• Look for contradictions in daily functioning (e.g., driving, employment, parenting responsibilities).
• Question dramatic or prolonged symptoms unsupported by clinical finding

Strengthen briefing of any medico‑legal experts 

A well‑framed brief enables experts to form reliable, defensible opinions. Consider:

• Providing experts with complete medical records, including pre‑accident anxiety or depression.
• Highlighting functional inconsistencies (e.g., long road trips vs. alleged driving anxiety).
• Asking experts to comment specifically on credibility issues and the effect of inconsistent reporting on diagnosis.
• Identifying any non‑disclosures or psychological stressors unrelated to the accident.

Know when to challenge a PTSD diagnosis

A PTSD diagnosis should be challenged where:

• the diagnosis relies solely on self‑reporting;
• symptoms commenced significantly later with no explanation;
• the claimant’s behaviour is inconsistent with PTSD symptoms;
• objective evidence contradicts subjective reports;
• there is a strong pre‑existing psychological history;
• there is poor specificity about DSM‑5 criteria.

Where these red flags appear, requesting clarification from the diagnosing expert is appropriate.

Seek an additional expert opinion when needed

A second psychiatric opinion is justified where:

• the initial expert was not given full medical history;
• credibility issues arise;
• there is evidence of exaggeration or somatic focus;
• there had been no meaningful exploration of alternative diagnoses (e.g., anxiety disorder, somatic symptom disorder).

In Finn v Gerritsen, this proved decisive. Dr Edwards‑Smith’s opinion aligned with objective evidence and was ultimately preferred by the Court. 

Conclusion

Finn v Gerritsen demonstrates that a psychiatric diagnosis, especially PTSD, will not be accepted by the Court at face value. Courts will exercise scrutiny to closely examine the accuracy and consistency of the claimant’s underlying history, and where a claimant exaggerates, omits, or embellishes facts, the diagnosis may be rejected entirely.

For insurers, the message is clear:

Early scrutiny, comprehensive briefing, and careful evaluation of psychiatric evidence are essential to managing risk and achieving fair outcomes.

Please contact our team, should you have any questions or wish to discuss this topic further 

This article was written by Kirsh Audit, Associate Insurance.