ACC8536 Specialist Cover Assessment - Adult

**ACC8536** **Specialist Cover Assessment - adult** This report should be completed for a Specialist Cover Assessment or Function Assessment by the Named Assessment Provider. Please refer to the Sensitive Claims Service operational guidelines and report guidelines available on our website: www.acc.co.nz/resources. Return the completed report to sensitiveclaimsreports@acc.co.nz. **Part A: Kiritaki information** 1. Kiritaki details Kiritaki name: Sarah Bellingham Date of birth: 17/08/1985 Claim number: 10026841 Contact details/safe contact where appropriate: Safe contact via the kiritaki's mobile 027 384 1972, voice call only, weekdays between 09:00 and 15:00. SMS is acceptable for appointment confirmations only. **Part B: Specialist Cover Assessment** **2. Sources of information** a. Dates and duration of consultations: Three face-to-face clinical interviews were conducted at the assessor's Christchurch clinic on 28/04/2026 (120 minutes), 05/05/2026 (90 minutes), and 12/05/2026 (90 minutes). A collateral information session was held with the kiritaki's husband, Tom Bellingham, on 15/05/2026 (60 minutes) with the kiritaki's written consent. b. Sources of information collected, received, and considered (include dates and authors): ACC referral pack dated 04/04/2026 from ACC Sensitive Claims Service. Early Supports Plan ACC8530 dated 12/03/2025, authored by Maeve Connelly, Registered Clinical Psychologist (Lead Service Provider, Whaiora Community Psychology). Cover and Wellbeing Plan ACC8534 dated 24/09/2025, authored by Maeve Connelly. Progress reports dated 18/12/2025 and 14/03/2026, authored by Maeve Connelly. GP records dated 2018 to present from Dr Amelia Roy, Hagley Medical Centre, received 18/04/2026. Christchurch Hospital ED discharge summaries dated 14/06/2022 and 03/11/2023, received 19/04/2026. Workplace correspondence from the kiritaki's school principal, Mr David Tahuhu, dated 22/04/2026, regarding extended sick leave and modified duties. Psychometric measures completed during the assessment period (see section 6). Self-completed timeline of mental health history dated 30/04/2026, provided by the kiritaki. **Only complete the rest of Part B if you are providing information for cover determination.** **3. About the Schedule 3 events** The kiritaki has disclosed events of non-consensual sexual contact occurring during her childhood. The events occurred over a date range of approximately 1991 to 1995, when the kiritaki was aged six to ten years, with a reported frequency of weekly to fortnightly over that period. The perpetrator is a maternal uncle who lived in the family home for part of that period. The kiritaki first disclosed the events to her husband in 2022 and to her GP in 2024. A police complaint was lodged in late 2024, with the investigation now closed without charges due to the death of the perpetrator in 2023. **4. Background kiritaki information** a. Summary of relevant background information: The kiritaki is a 41-year-old NZ European woman, born in Christchurch and ordinarily resident in Aotearoa New Zealand throughout her life. Medical history is notable for migraines from her early twenties, irritable bowel syndrome diagnosed in 2018, and two presentations to Christchurch Hospital ED (June 2022 and November 2023) following episodes of acute panic and dissociation. No prior hospitalisations. Cultural and spiritual background: identifies as NZ European with no formal religious affiliation; however, she draws meaningful support from a small group of close friends and from outdoor activities including tramping and gardening. Family and personal history: parents separated when she was 14; mother is alive and lives in Nelson, contact is intermittent and described as ambivalent; father is deceased (2008); one older brother in Auckland with whom she has limited contact. The kiritaki has been married to Tom Bellingham for 14 years and they have two children, aged 12 and 9. Developmental history: full-term birth, milestones met in normal range, no early developmental concerns reported. Education: completed Year 13 at Burnside High School, Bachelor of Teaching and Learning from University of Canterbury (2007), registered as a primary school teacher with the Teaching Council of Aotearoa New Zealand. Employment: continuous employment as a primary school teacher from 2008 to 2025, including the past nine years at Riccarton Primary School. Currently on extended sick leave since November 2025. Alcohol and drug history: prior heavy alcohol use between 2018 and 2023, with intake reaching 30+ standard drinks per week at peak; abstinent since November 2023 following the second hospital presentation. No illicit drug use reported. Forensic history: no contact with the criminal justice system other than the police complaint described in section 3. b. Summary of current circumstances and presenting difficulties: Current circumstances: The kiritaki lives at home in Christchurch with her husband and two children. She has been on extended sick leave from her teaching role since November 2025 and is currently in receipt of Weekly Compensation. Her husband works full-time as an engineer and the family is financially stable in the short term, although the kiritaki expresses significant concern about long-term financial sustainability without her income. Her children are aware she is unwell but have not been told the nature of the underlying difficulties. Presenting difficulties: The kiritaki reports intrusive memories of the Schedule 3 events, occurring multiple times daily; nightmares at least five nights per week, with content directly related to the events; hyperarousal symptoms including exaggerated startle, hypervigilance, and persistent sleep disturbance; avoidance of locations, individuals, and conversational topics associated with the events; emotional numbing and reduced capacity to experience positive emotions; persistent shame and self-blame; dissociative episodes occurring approximately weekly, lasting up to 30 minutes, typically triggered by sensory reminders; depressed mood with anhedonia, fatigue, and reduced appetite; passive suicidal ideation occurring intermittently over the past six months without active intent or plan; and significant occupational impairment manifesting in inability to manage classroom triggers, panic attacks at school, and an inability to sustain attention or emotional regulation in the work environment. c. Mental health history and treatment delivered: Mental health history: First presentation to her GP with low mood and anxiety in 2015, following the birth of her second child. Diagnosed with postnatal depression at that time and commenced sertraline, with reported partial response. Re-presentation in 2018 with worsening anxiety and increased alcohol intake; referred to an EAP-funded counsellor for six sessions, with limited benefit. Acute presentation to Christchurch Hospital ED in June 2022 following a dissociative episode at work; assessed and discharged with community mental health follow-up but did not attend. Second ED presentation in November 2023 following an episode of acute panic and intoxication; safety planning completed, abstinence from alcohol commenced, and a community mental health referral made. First disclosure of the Schedule 3 events to her GP in early 2024 led to referral to the ACC Sensitive Claims Service. Treatment delivered: Sertraline 50 mg from 2015 to 2018 (partial response); EAP counselling six sessions in 2018; psychoeducation and motivational interviewing during 2022 ED presentation; safety planning and brief alcohol-focused intervention in 2023 following second ED presentation. Following ACC referral in 2024, the kiritaki commenced trauma-informed psychological therapy with Maeve Connelly (Registered Clinical Psychologist) under the Sensitive Claims Service in March 2025. Therapy initially focused on stabilisation, safety, and emotion regulation, with limited progress to trauma processing. Her Lead Service Provider has recommended Specialist Cover Assessment in view of the complexity of presentation and the need to consider further packages of support. d. Health providers who have delivered treatment for this condition: Contact name: Maeve Connelly, Registered Clinical Psychologist Contact email or phone: maeve.connelly@whaiorapsych.co.nz Contact name: Dr Amelia Roy, General Practitioner Contact email or phone: 03 366 1827; areception@hagleymed.co.nz e. Current medications and dosages: Sertraline 100 mg daily, prescribed by Dr Amelia Roy, in place since February 2024. Quetiapine 25 mg at night, prescribed by Dr Amelia Roy, in place since June 2024 for sleep and acute anxiety. Propranolol 10 mg as required for situational anxiety, prescribed by Dr Amelia Roy, in place since June 2024. **5. Strengths and vulnerabilities** a. Personality assessment: The kiritaki presents as conscientious, achievement-oriented, and self-critical, with a long-standing pattern of high personal standards and reluctance to seek help. Premorbid functioning is described by collateral history as well-organised, socially engaged, and emotionally resilient. The current presentation includes patterns consistent with the personality traits of high conscientiousness with self-criticism and an avoidant interpersonal style under stress, neither reaching the clinical threshold for a personality disorder. These patterns are relevant to engagement and treatment planning; in particular, her tendency to mask distress and to under-report symptoms requires careful attention from the treating team. b. Kiritaki strengths and protective factors: The kiritaki has multiple significant protective factors, including a stable and supportive marriage of 14 years, two children to whom she is deeply attached, a stable home environment, a small but reliable social network including two close friends from her teacher training, demonstrated motivation to engage in therapy, a clear cultural and recreational identity linked to outdoor activities and gardening, and continuing identification with her vocational identity as a teacher despite her current incapacity to work. She is currently abstinent from alcohol with strong personal motivation to remain so. c. Areas of vulnerability: Vulnerabilities affecting engagement and treatment include ongoing dissociative episodes that limit her capacity to engage with trauma-focused work; intermittent passive suicidal ideation requiring ongoing monitoring; the chronic and complex nature of the presenting difficulties, with multiple comorbid diagnoses; limited family support, with ambivalent relationships with both her mother and brother; financial vulnerability associated with extended absence from paid work; and a history of underreporting distress, which has historically delayed access to appropriate care. d. Risk assessment: Are there any risks identified? [x] Yes [ ] No The kiritaki reports intermittent passive suicidal ideation occurring approximately weekly over the past six months, without active intent, plan, or means. No risk to others identified. Risk of harm from others is considered low; the perpetrator of the Schedule 3 events is deceased. Duty of care actions taken: collaborative safety plan completed with the kiritaki and her husband, including identification of trusted contacts (her husband and her GP), removal of stockpiled medication from the home, and agreement to contact 1737 or attend Christchurch Hospital ED if ideation escalates. Her GP and Lead Service Provider have been notified with consent. e. Other agencies involved: [x] Yes [ ] No Whaiora Community Psychology (Maeve Connelly): ongoing therapy under the Sensitive Claims Service. Hagley Medical Centre (Dr Amelia Roy): primary care and medication management. Riccarton Primary School pastoral and HR teams: workplace liaison regarding extended sick leave and any future graduated return. **6. Psychometrics** a. Results of psychometric testing and symptom validity measures: | Name of measure | Date administered | Respondents | Rating | |---|---|---|---| | PTSD Checklist for DSM-5-TR (PCL-5) | 28/04/2026 | Kiritaki self-report | 58 | | Depression Anxiety Stress Scales-21 (DASS-21) | 28/04/2026 | Kiritaki self-report | Depression 28 (severe), Anxiety 22 (severe), Stress 30 (severe) | | International Trauma Questionnaire (ITQ) | 05/05/2026 | Kiritaki self-report | PTSD criteria met; disturbances in self-organisation criteria met | | Dissociative Experiences Scale-II (DES-II) | 05/05/2026 | Kiritaki self-report | 31 (above clinical threshold of 30) | | Minnesota Multiphasic Personality Inventory-3 (MMPI-3) | 12/05/2026 | Kiritaki self-report | Validity scales within acceptable range; no evidence of feigning or symptom over-endorsement | | Alcohol Use Disorders Identification Test (AUDIT) | 05/05/2026 | Kiritaki self-report | 1 (consistent with reported abstinence) | Comment on results: The kiritaki's PCL-5 total score of 58 substantially exceeds the clinical cutoff of 33 and is consistent with severe PTSD symptomatology across all four DSM-5-TR symptom clusters. DASS-21 scores fall in the severe range across all three subscales, with depression and anxiety symptoms reaching clinically significant levels. The ITQ supports a diagnosis of complex PTSD by ICD-11 criteria, with both core PTSD criteria and disturbances in self-organisation criteria met. The DES-II score of 31 confirms clinically significant dissociation that warrants attention in treatment planning. MMPI-3 validity scales are within acceptable limits, providing no evidence of feigning, symptom over-endorsement, or response distortion; the elevated clinical scales are consistent with the clinical interview presentation. The AUDIT score of 1 supports the kiritaki's report of sustained alcohol abstinence since November 2023. **7. Clinical symptoms or diagnosis** 1. Diagnoses: Post-Traumatic Stress Disorder (DSM-5-TR; ICD-11 criteria for Complex PTSD also met). Criterion A is met by the documented Schedule 3 events occurring over 1991 to 1995. Criterion B (intrusion) is met by intrusive memories, nightmares, and trauma-related distress at exposure to cues. Criterion C (avoidance) is met by active avoidance of trauma-related thoughts and external reminders. Criterion D (negative alterations in cognitions and mood) is met by persistent negative beliefs about self, persistent shame, diminished interest in significant activities, and detachment from others. Criterion E (alterations in arousal and reactivity) is met by sleep disturbance, irritability, hypervigilance, exaggerated startle, and concentration difficulties. Criterion F (duration greater than one month) and Criterion G (clinically significant distress and functional impairment) are clearly met. ICD-11 disturbances in self-organisation criteria (affect dysregulation, negative self-concept, interpersonal disturbance) are also met, supporting a diagnosis of Complex PTSD. Major Depressive Disorder, recurrent, severe, without psychotic features (DSM-5-TR). Current episode meets criteria with depressed mood, anhedonia, fatigue, reduced appetite with weight loss, sleep disturbance, feelings of worthlessness, reduced concentration, and recurrent passive suicidal ideation, present for more than two weeks and causing significant impairment. Prior episodes in 2015 and 2018 also met criteria. Alcohol Use Disorder, in sustained remission (DSM-5-TR). History of moderate to severe Alcohol Use Disorder between 2018 and 2023, currently in sustained remission since November 2023 (full criteria not met for over 12 months). 2. Significant difficulties: In addition to the diagnoses above, the kiritaki experiences clinically significant dissociative episodes that contribute to occupational impairment and to limitations in current capacity to engage in trauma-focused therapy. Formulation and summary: The kiritaki's presenting difficulties have developed in the context of repeated Schedule 3 events during a critical developmental window, occurring in the family home with a perpetrator in a position of trust. The chronicity and developmental timing of the events, combined with the absence of disclosure or support at the time, contributed to the development of complex post-traumatic symptomatology with disturbances in self-organisation. Premorbid personality traits of conscientiousness, self-criticism, and reluctance to seek help, while strengths in many domains, delayed recognition and treatment of distress and contributed to the development of avoidant coping including the period of heavy alcohol use between 2018 and 2023. The Major Depressive Disorder is best understood as both a comorbid mental injury reaching diagnostic threshold under the cumulative weight of trauma symptoms and as a recurrent vulnerability with onset in the postnatal period. Recent life events, including the disclosure to her husband, the police process, and the death of the perpetrator, have intensified intrusion and avoidance symptoms and precipitated the current acute episode of incapacity. Multiple protective factors, including a stable marital relationship, ongoing engagement with therapy, and demonstrated motivation to recover, support a favourable prognosis with appropriate support. **8. Opinion on mental injury** a. Clinical evidence supporting a causal relationship between the Schedule 3 events and proposed mental injuries: The kiritaki's presenting PTSD and Complex PTSD symptoms have content, themes, and triggers that map directly and specifically onto the Schedule 3 events. Intrusive memories, nightmares, and avoidance behaviours all carry sensory and contextual detail tied to the events. The disturbances in self-organisation features (negative self-concept, affective dysregulation, interpersonal disturbance) are consistent with the developmental timing and relational context of repeated childhood Schedule 3 events. Symptoms intensify on exposure to reminders associated with the events and ease during periods of safety and supportive contact. Psychometric findings (PCL-5 58, ITQ confirming PTSD and complex PTSD, DES-II 31) are consistent with the clinical interview. Premorbid functioning, as established through collateral history from the kiritaki's husband and longitudinal GP records, was within normal limits prior to the cumulative emergence of symptoms in early adulthood. b. Clinical evidence supporting a causal relationship between other life factors and proposed mental injuries: The Major Depressive Disorder has a first episode in the postnatal period in 2015, suggesting an interaction between postnatal hormonal and psychosocial factors and underlying vulnerability. The death of the kiritaki's father in 2008 was a significant loss that may have contributed to her general vulnerability. The Alcohol Use Disorder developed in the context of unaddressed trauma symptoms and reflects avoidant coping rather than an independent etiology. In the clinician's opinion, these non-Schedule 3 factors are best understood as contributing to but not independently causing the current presentation. The Schedule 3 events are assessed as the principal causal factor in both the Complex PTSD presentation and the recurrent Major Depressive Disorder. ***Date mental injury suffered*** Proposed Mental Injury: Post-Traumatic Stress Disorder (DSM-5-TR) and Complex PTSD (ICD-11) Date: 01/03/1995 Proposed Mental Injury: Major Depressive Disorder, recurrent Date: 14/06/2015 Clinical evidence and rationale for the dates above: For PTSD and Complex PTSD, the diagnostic threshold is assessed as having been reached during the latter period of the Schedule 3 events, by approximately March 1995, when the kiritaki was nine years old. Retrospective evidence supporting this includes the kiritaki's own report of nightmares, social withdrawal, and intrusive memories beginning during the events; reports from her mother (via the kiritaki) of sleep disturbance and behavioural changes during this period; and her decline in school performance documented in school reports she has retained. Symptoms have persisted in a fluctuating course since that time without ever fully remitting. For Major Depressive Disorder, the first episode meeting diagnostic threshold occurred postnatally in June 2015, with documented presentation to her GP, sertraline treatment, and a clear depressive episode lasting more than 12 weeks. Subsequent episodes in 2018 and the current episode also reach diagnostic threshold. **9. Treatment** Treatment recommendations: The kiritaki would benefit from continued engagement with the Sensitive Claims Service under a Tailored Support to Wellbeing Package, with a focus on phase-based trauma treatment over an extended timeframe. Recommended interventions include continued individual psychological therapy with a clinician experienced in complex trauma and dissociation, with phase one focused on stabilisation, dissociation management, and safety, before moving to evidence-based trauma processing (EMDR, Trauma-Focused CBT, or schema-informed approaches) in phase two. Concurrent psychiatric review for ongoing medication management is recommended, with consideration of antidepressant augmentation. Couple's therapy is recommended at an appropriate point to support the kiritaki's husband and to strengthen the marital relationship as a protective factor. Group-based support for complex trauma survivors would be beneficial at the consolidation phase. For non-injury related difficulties, ongoing GP review and engagement with a registered dietitian for ongoing IBS management are recommended. Vocational rehabilitation support is recommended as detailed in the Function Assessment below. **10. Prognosis** The prognosis for the proposed mental injuries is moderate to favourable in the medium to long term, contingent on access to extended, properly resourced trauma-focused treatment. The kiritaki has multiple protective factors including a stable marital relationship, motivation, and demonstrated capacity to engage with treatment, all of which support a favourable trajectory. Potential barriers to treatment include the chronicity and complexity of the presentation, the presence of dissociation requiring careful management before trauma processing, the recurrent depressive symptoms requiring concurrent management, intermittent passive suicidal ideation requiring monitoring, and the kiritaki's tendency to mask distress and under-report symptoms. Without access to appropriate extended treatment, the prognosis would be guarded, with risk of further occupational withdrawal, ongoing risk of relapse to alcohol use, and persistent functional impairment. Realistic timeframes for meaningful recovery are 24 to 36 months of structured treatment. **Part C: Function Assessment** **Only complete Part C if ACC approval has been given to complete a Function Assessment** **11. Current and ongoing functional effects** a. Symptoms of the proposed or covered mental injuries: Intrusive memories occurring multiple times daily; nightmares five or more nights per week; hyperarousal including hypervigilance and exaggerated startle; avoidance of trauma reminders; emotional numbing and reduced positive affect; dissociative episodes occurring weekly; persistent depressed mood with anhedonia and fatigue; reduced appetite; sleep onset and continuity disturbance; concentration and short-term memory impairment; intermittent passive suicidal ideation; persistent shame and negative self-concept. b. Effects of symptoms on current functioning, with examples of impact on activities of daily living: The kiritaki manages personal self-care independently (showering, dressing, toileting) but reports that her morning routine takes substantially longer than premorbidly due to dissociative episodes and fatigue. She prepares simple meals for her family on most days but has reduced cooking to a smaller, repeated repertoire and increasingly relies on her husband for evening meal preparation. She manages medication using a pill organiser and her phone alarm. Household tasks including laundry and cleaning are now shared with her husband on a more even basis than previously. She drives for short, familiar local trips but has stopped driving on motorways or in unfamiliar areas due to dissociative episodes that have occurred while driving. Sleep is significantly disrupted; she typically obtains four to five hours of fragmented sleep per night. Concentration is impaired such that she struggles to read more than a paragraph of a novel; she has stopped reading for pleasure, an activity she previously valued. Social engagement is reduced; she sees her two close friends approximately monthly and has withdrawn from her previous book club and walking group. c. Effects impacting work activity not already outlined in 11(b): The kiritaki has been unable to return to her teaching role since November 2025. She reports specific difficulties that prevent return to a classroom environment: triggers from interactions with students of a similar age to her childhood self at the time of the events; panic attacks at school sites; inability to manage the cognitive and emotional load of a classroom of 30 children; difficulty with the planning, multitasking, and decision-making demands of teaching; difficulty managing her own emotional regulation in front of children; sleep disturbance leading to fatigue incompatible with sustained work; and avoidance of school-based meetings and parent interactions. Two attempted return-to-work trials, in February 2026 and March 2026, were unsuccessful, with the kiritaki experiencing acute panic attacks at the school gate on the first day of each attempt. d. Potential safety concerns that may cause a barrier to work, with rationale: Several safety concerns are identified. Dissociative episodes pose a safety concern for the kiritaki, the children in her care, and her colleagues. Her capacity to respond appropriately to playground emergencies, escalating student behaviour, or first-aid situations would be compromised by ongoing dissociation. The intermittent passive suicidal ideation, while not currently active, presents a relative safety concern in the context of cumulative work stress; structured monitoring and a clear return-to-work safety plan would be required. The persistent sleep disturbance, with four to five hours of fragmented sleep, increases the risk of impaired judgment in safety-critical situations. e. Comorbid conditions affecting current functioning: Major Depressive Disorder contributes to fatigue, reduced concentration, and reduced motivation. Alcohol Use Disorder in sustained remission does not currently affect functioning but represents a vulnerability that could be reactivated under work stress. IBS contributes to discomfort during the school day and to absenteeism in primary care follow-up. Migraines, occurring approximately monthly, contribute to additional incapacity on those days. f. Material contribution of proposed or covered mental injuries to multifactorial impact: The functional impact is multifactorial, with contributions from the proposed mental injuries (PTSD, Complex PTSD, MDD), comorbid physical conditions (IBS, migraines), and treatment-related side effects (sedation from quetiapine, occasional gastrointestinal effects of sertraline). In the clinician's opinion, the proposed mental injuries (PTSD and Complex PTSD) are the principal materially contributing factor to the current functional impairment, particularly with respect to work capacity. The comorbid conditions are contributing but secondary in their functional impact. g. Comments about the impact and the specific work types in the referral: The referral identified primary school teaching as the kiritaki's pre-incapacity work type. The current presentation is incompatible with primary school teaching in the foreseeable future, particularly with respect to the trigger profile of the work environment. The referral did not identify alternative work types. The kiritaki has expressed a desire to remain in education in some form, with a possible future direction toward adult education, curriculum development, or one-to-one literacy support. h. Recommendations to reduce adverse effects and support return to work: For any future return to work, the following recommendations are made. Graduated return through a structured plan with workplace involvement of the school principal and pastoral team. Initial return should not exceed two days per week for at least the first eight weeks. Phased reintroduction of teaching duties starting with one-to-one work with older students before moving to full classroom responsibilities. Identification of a workplace mentor available for in-day check-ins. Access to a quiet, private space at the workplace for use during dissociative episodes. Avoidance of split-class or relief teaching configurations. Consideration of part-time work indefinitely, or a transition to a non-classroom role within education (curriculum, advisory, mentoring, or adult education) if a return to classroom teaching proves unsustainable. Concurrent continuation of trauma-focused therapy throughout the return-to-work period. Realistic timeframe for any return-to-work trial is not expected to be earlier than 12 months from the date of this report. **12. Effects on past functioning** Records provided support a longitudinal pattern of functional impact dating back to 2015. GP records document recurrent absenteeism from work between 2015 and 2018 (postnatal depressive episode) and again between 2022 and 2023 (escalation of alcohol use and ED presentations). Workplace correspondence and the kiritaki's own account suggest that performance reviews in 2022 and 2024 noted concerns regarding concentration, emotional regulation, and absenteeism. Specific dates of functional impact on work activity include June 2022 (ED presentation, two-week period of acute incapacity), November 2023 (ED presentation, four-week period of acute incapacity), and the current episode from November 2025 onwards. In the clinician's opinion, the covered mental injuries (PTSD and Complex PTSD with comorbid MDD) have likely been a barrier to optimal work functioning on a fluctuating basis since at least 2015, with three discrete periods of acute incapacity as identified above. **Part D: Other information and declarations** **13. Other information** Please provide the date of the last face-to-face meeting with the kiritaki that informed this report: Date: 15/05/2026 Date of disengagement by the kiritaki (if applicable): Date: Please provide any other information that you consider relevant to assist in determining cover or to assist in the recovery of the kiritaki: The kiritaki participated thoughtfully and openly across all assessment sessions. She has expressed a clear preference for being kept informed throughout the cover decision process and has consented to ACC corresponding directly with her by email. Her husband has been a consistent supportive presence and may benefit from his own support at an appropriate point in her recovery. [x] I have attached other documents, eg clinical reports, psychometric results. List these: PCL-5, DASS-21, ITQ, DES-II, and AUDIT score sheets dated as above; MMPI-3 score profile dated 12/05/2026; collateral information summary from session with Tom Bellingham dated 15/05/2026; self-completed mental health timeline dated 30/04/2026. List other providers who contributed to the assessment: Contact name: Maeve Connelly, Registered Clinical Psychologist (Lead Service Provider, treating team correspondence) Contact email: maeve.connelly@whaiorapsych.co.nz Contact name: Dr Amelia Roy, General Practitioner (longitudinal GP records and treating history) Contact email: areception@hagleymed.co.nz **14. Provider declaration** [x] I have explained to the kiritaki that ACC will send a copy of this report to their Lead Service Provider (if relevant). [x] The kiritaki would like ACC to send them a copy of this report. [x] I have explained to the kiritaki that they can participate in a feedback session before this report is submitted to ACC. [x] I have informed the kiritaki that the information collected for this report will be sent to ACC to support cover decisions and treatment and rehabilitation needs. I have kiritaki authority for this. [x] I confirm that the information contained in this report is accurate and that I have followed the standards set out in the Sensitive Claims Service operational guidelines. The kiritaki: [x] Participated in the feedback session. [ ] Did not participate in the feedback session. Provide reasons why: Assessment Provider name and profession: Dr Eleanor Park, Consultant Clinical Psychologist Provider ID: NZP3284 Supplier name: Park Specialist Assessment Services Supplier ID: S15904 Date: 28/05/2026 In the collection, use, disclosure, and storage of information, ACC will at all times comply with the obligations of the Privacy Act 2020, the Health Information Privacy Code 2020 and the Official Information Act 1982. **Items for Clinician Review** [ ] Section 1, Contact details: confirm whether evening voice contact is acceptable in addition to the stated 09:00 to 15:00 weekday window. [ ] Section 3, Schedule 3 events: police complaint outcome is recorded as "closed without charges due to the death of the perpetrator in 2023"; verify the year and the official basis of closure with the kiritaki and the relevant ACC file documentation before submission. [ ] Section 4a, Background: father's date of death recorded as 2008; confirm with the kiritaki for accuracy before submission. [ ] Section 4e, Current medications: quetiapine prescribed for sleep and acute anxiety; verify with Dr Roy that this is an off-label indication and whether documented review is in place. [ ] Section 6, Psychometrics: MMPI-3 was completed during session 3; confirm the scoring report has been generated and is attached to this submission. [ ] Section 8, Date of mental injury suffered (PTSD): date recorded as 01/03/1995 as a representative date within the assessed onset period; this is an approximation supported by retrospective evidence and should be flagged for ACC's reviewing clinician as an estimate within the documented onset window of 1991 to 1995. [ ] Section 11h, Return-to-work recommendations: timeframe of "not expected to be earlier than 12 months" is contingent on continued therapy engagement; review at the next ACC case conference scheduled for 22/06/2026. [ ] Section 14, Declarations: confirm that the feedback session occurred on 22/05/2026 and that the kiritaki's comments were incorporated into the final report before submission.