State of New South Wales (Western NSW Local Health District)

WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of two of the six assessments under the psychiatric impairment rating scale categories, namely self-care and personal hygiene, and travel; the challenged assessment in respect of self-care and personal hygiene was revoked on appeal; Held - Medical Assessment Certificate revoked.

1. The worker Teena Archer (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Clayton Cowper Smith, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on

4 December 2025. 2. The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act): * the assessment was made on the basis of incorrect criteria, and * the MAC contains a demonstrable error. 3. The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the grounds of appeal on which the appeal is made. 4. Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules. 5. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed

1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).

1. The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
2. The appellant did not request that she undergo a re-examination by a Medical Assessor who is also a Member of the Appeal Panel. As a result of its preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because although the Appeal Panel found error, there was sufficient material before the Appeal Panel to enable a determination to be made.

1. The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.

1. The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

1. The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
3. The matter was referred to the Medical Assessor for assessment as follows:

"The following matters have been referred for assessment (s 319 of the 1998 Act):

• the degree of permanent impairment of the worker as a result of an injury (s319(c))
• whether any proportion of permanent impairment is due to any previous injury or pre-existing condition or abnormality, and the extent of that proportion (s319(d))
• whether impairment is permanent (s319(f))
• whether the degree of permanent impairment of the injured worker is fully ascertainable (s319(g))
• Date of injury: 3 November 2021 - deemed
• Body parts/systems referred: Psychological/Psychiatric disorder
• Method of assessment: Whole Person Impairment"

1. The Medical Assessor issued a MAC certifying 13% whole person impairment (WPI) as a result of the injury as follows:

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA5 Guides

WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)

Sub-total/s % WPI (after any deductions in column 6)

Total % WPI (the Combined Table values of all sub-totals)

1. The assessment was based on his assessment under psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows:

1. Persistent depressive disorder with anxious distress.

Psychotropic medication, psychotherapy and psychiatric review

Ms Archer reported that she showers once a week. She had trouble remembering to eat, usually only eating after work if she has the energy. Housework is performed only when the environment becomes overwhelming for her. She reported that she puts things off, becomes easily overwhelmed and often starts but does not finish domestic tasks. She no longer walks her dog and has difficulty maintaining basic routines, such as consistently watering her plants. She lives alone and can independently maintain a minimum level of hygiene and nutrition.

She rarely leaves the house outside work and essential errands and described being easily overwhelmed in social settings and suspicious of people's motives. Her current recreational activities are largely solitary and limited. She reported "doom scrolling" on her phone, reading short articles and memes, catching up on messages and binge-watching series and movies. She has ceased her pre-injury social and recreational activities.She goes out for a pub meal on her own every two months when her budget allows, choosing places where nobody knows her. After initial enthusiasm, she has been inconsistent with self-care activities like yoga, breathing and stretching, and has lost interest in metal detecting and candle making. Although she can go out without a support person, she does so with modifications to reduce her anxiety, and rarely. This is consistent with a class 3 moderate impairment.

She can drive independently and travel substantial distances when necessary. She drives between Bathurst, Orange and Minnamurra and reported that she drives freely on these longer trips. She plans to drive to South Australia for Christmas, with one daughter travelling by train to join her and assist with driving and fuel costs. She travelled to Queensland by plane for a weekend trip, which she undertook alone. She was anxious, used headphones to cope, but ultimately had a good time and reported feeling better away from the Orange/Central West area. She generally restricts her local travel to a narrow circuit that includes work, the supermarket, the smoke shop, Amanda's house, her father's house in Orange, and the chemist. This is not inconsistent with a minor deficit attributable to the normal variation in the general population.

She has good relationships with her immediate family. She reported that her previously larger friendship network has reduced because she has become suspicious of people's motives. She now maintains only a small core of supportive relationships. At work she reported that she can "hold it together and interact with people" during shifts at the service station, managing routine customer interactions from behind the counter with some distress.

She reported a busy mind and difficulties with concentration, persistence and pace. She described being easily distracted, having difficulty concentrating while reading, and often managing only a short article before losing focus. She passively engages with social media. She reported starting but not completing projects, difficulty getting to tasks, and becoming easily overwhelmed by tasks such as housework or garden care. She reported difficulty remembering to eat and maintaining a routine. She reported difficulties paying her bills on time and was on a hardship payment plan; she also has difficulty with organisation, planning, and follow-through. At work, she can function adequately during her shifts, interact with customers, and complete expected tasks; however, this consumes a large proportion of her available cognitive and emotional resources, leaving her exhausted at the end of her shifts. The extent of her interaction with customers is also limited by the overnight shifts she works. I consider this consistent with a class 3 moderate impairment.

Ms Archer works 28 hours per week on midnight to 7:00 am shifts at a BP Service Station, where she has been employed for approximately 18 months. She works in blocks of four nights, then has at least one night and day off. After completing her fourth night, she does not work on Saturday and may spend much of that time in recovery sleep.

At work, she can function adequately during her shifts, interact with customers, and complete expected tasks; however, this consumes a large proportion of her available cognitive and emotional resources, leaving her exhausted at the end of her shifts.

Before each shift, she reported physical and psychological distress such as vomiting, muscle tension and agitation, but pushes herself to work out of financial imperative. She can sustain casual relatively low-complexity employment in a non-clinical setting with limited interpersonal demands and no exposure to the hospital environment. Her employability is restricted to carefully chosen, low-stimulus roles that create some psychological distress.

1. He deducted one-tenth under s 323 to take account of the pre-existing condition, abnormality or injury and then added 1% WPI for the effects of treatment.
2. The worker appealed. There was no appeal in respect of the 1% for treatment effects or the deduction of one-tenth.
3. In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments he made under two of the six PIRS categories, namely self-care and personal hygiene and travel causing him to make an error in the assessment in this domain as follows:

(a) in assessing Class 2 for self-care and personal hygiene when he should have assessed Class 3, and

(b) in assessing a Class 1 for travel when he should have assessed a Class 2.

1. The appellant pointed to, among other things, an inadequacy of reasons leading the Medical Assessor into error.
2. In summary, the employer State of New South Wales (Western NSW Local Health District) (the respondent) submitted that the Medical Assessor neither erred nor made an assessment on the basis of incorrect criteria and the MAC should be confirmed. It was submitted the findings were open to the Medical Assessor applying his clinical expertise to the assessment.
3. The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS for mere difference of opinion but must be satisfied as to error.
4. The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self-report can be properly evaluated in the context of other evidence before the Medical Assessor.
5. The Medical Assessor recorded a history as follows:

"● Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:

Ms Archer is a 56-year-old divorced woman living alone in Bathurst with her dog. She currently works 28 hours per week as a console operator/barista at a service station on night shift (midnight to 7:00 am). She has been divorced since 2008 and has been single for over a decade, with only brief relationships since. She has two adult daughters: one living in Melbourne and the other in Minnamurra. Ms Archer is experiencing housing instability, is struggling to maintain her rental payments, and is considering her options as her lease expires soon. She reported previous periods of homelessness, reporting that she has been displaced in the last two years. She receives income solely from her part-time work at the service station with no current workers' compensation payments.

Ms Archer worked as an enrolled nurse at Orange Base Hospital from 2015 until November 2021. She reported a gradual accumulation of workplace stressors, particularly feeling bullied, excluded and pressured around return to work expectations following a COVID-19 test. The final trigger occurred when she was pressured to return to work while awaiting COVID-19 test results, discovering her medical information had been accessed inappropriately. By late 2020, she developed anxiety, tearfulness, panic episodes, cognitive problems and overwhelming dread associated with attending the workplace. Her mental state deteriorated further after leaving work, becoming largely housebound with depression, including loss of motivation, poor appetite, impaired hygiene and sleep disturbance. Several attempts to return to work between November 2021 and July 2022 were unsuccessful with recurrence of anxiety and emotional instability. Even attempts at administrative duties was overwhelming. Her condition worsened again in late 2023 during work capacity assessments, experiencing daily panic attacks, uncontrollable crying, vomiting and suicidal thoughts. Around this time, she experienced housing instability, moving from Orange to Bathurst and was intermittently couch-surfing.

After relocating to Bathurst by 2024 to 2025, she had achieved partial work capacity performing TAFE class progression duties for six months at 8 to 12 hours per week, and her current role, service station console operator, working midnight to 7:00 am, approximately 28 to 30 hours per week, for the past 18 months. She noted that these roles were tolerated because they avoided hospital environments, interpersonal triggers and complex clinical responsibilities. She was unable to continue with her TAFE role.

She was referred for psychiatric assessment and diagnosed with mixed anxiety and depressive disorder, and commenced on antidepressants. Between 2023 and 2025, Dr Michael Scott provided ongoing psychiatric care, prescribing methylphenidate for ADHD and continued escitalopram. She received regular psychological therapy. She participated in exercise physiology programs and social and emotional well-being sessions. She attempted enrolment in a remedial massage diploma but withdrew due to psychological instability and competing stressors. She has not required psychiatric hospitalisation or participated in group programs. She has completed some online courses and EMDR therapy with her psychologist.

She receives ongoing psychological treatment from Alison Crotty every three to four weeks. She continues six-monthly reviews with her psychiatrist, Dr Scott. Current medications include long-acting methylphenidate 40 mg daily at midnight, escitalopram 30 mg at midnight and as required, immediate-release methylphenidate 10 mg around 2:30 am.

Ms Archer reported a chronically depressed mood accompanied by anhedonia, emotional blunting and a sense of being flat, exhausted and chronically overwhelmed. She wakes most days feeling unmotivated with diminished capacity to initiate or sustain routine activities. Her energy levels remain low, and she reported fatigue after minimal exertion. She reported anxiety, including pervasive worry, physical tension and episodes of panic, particularly when exposed to reminders of her former workplace or interpersonal conflict. She described hypervigilance, jitteriness and a constant sense of being on edge. She remains avoidant of Orange Hospital and its surrounds, reporting that she experiences an immediate surge of fear, shaking, crying and cognitive disorganisation if she approaches the area around the hospital.

She described feeling anxious in the supermarket, keeping her head down and not paying attention to others, and is particularly fearful of encountering former colleagues. She parks in a specific location at the mall and uses a particular Coles and Chemist. After unexpectedly encountering a former colleague at a supermarket and experiencing a panic attack, Ms Archer reported that she no longer goes to that supermarket.

She reported poor concentration, distractibility, difficulty sustaining focus for more than short periods, mental slowness and difficulty sequencing tasks. She experiences memory lapses, losing track of what she is doing mid-task and requires lists and prompts to manage daily activities. She noted that although stimulant medication offers some benefit, her cognitive function is inconsistent and is easily disrupted by emotional distress.

She has difficulty falling asleep, non-restorative sleep, and frequent awakenings.

She reported becoming easily overwhelmed and tearful, particularly when discussing her injury, her treatment experiences or the workers' compensation process. She reported episodes of heightened distress, including crying spells, shaking and a sense of being unable to cope.

She described intermittent passive suicidal ideation in the past during periods of acute distress, though she denied any current intent or plan. She reported that her mood remains fragile with episodes of hopelessness and emotional lability, and she expressed ongoing concerns about her long-term capacity to manage stress or return to her pre-injury level of function.

She manages her current work in hospitality and as a console operator, but only because the roles are simple, predictable and devoid of interpersonal conflict. She reported that even in these settings, she experiences periodic spikes in anxiety, mental fatigue, sensory overload during busy periods and emotional exhaustion after shifts.

• Details of any previous or subsequent accidents, injuries or condition:

Ms Archer experienced depression after her divorce in 2008, briefly trying antidepressants which she could not tolerate. She was diagnosed with attention deficit hyperactivity disorder in late 2021 by Dr Scott. She reported previous episodes of anxiety and depression managed through 'coping mechanisms' without formal treatment.

She denied exposure to developmental trauma. She was exposed to domestic violence in her marriage. I note psychosocial stressors after the injury, including financial stress and housing instability. She denied a family history of mental illness.

Ms Archer has a history of chronic obstructive pulmonary disease, osteoarthritis, episodic bronchitis and menopausal symptoms. She has a consistently low BMI and poor dentition requiring dentures.

She is a current smoker, approximately 10 cigarettes per day. She reported rare alcohol use, approximately one drink every six months. She has used prescribed medicinal cannabis when financially able. She denied any illicit drug use, gambling problems or legal issues.

• Work history including previous work history if relevant:

Ms Archer completed Year 11, leaving school due to financial constraints. She initially worked as a secretary through a traineeship and completed beauty courses. She first trained as an enrolled nurse in the 1980s but left the profession after marriage to support husband's business aspirations. She returned to nursing, completing her enrolled nursing qualification in December 2016 after her divorce, and worked at Orange Base Hospital from 2015 until November 2021. Following her workplace injury, she has worked as a TAFE class preparation assistant for six hours, 8 to 12 hours per week and has been a console operator/barista at a service station for the past 18 months, for 28 hours per week.

Ms Archer reported that she showers once a week. She had trouble remembering to eat, usually only eating after work if she has the energy. Housework is performed only when the environment becomes overwhelming for her. She reported that she puts things off, becomes easily overwhelmed and often starts but does not finish domestic tasks. She no longer walks her dog and has difficulty maintaining basic routines, such as consistently watering her plants. On non-work days, particularly after a block of night shifts, she may require prolonged recovery sleep of 15 to 23 hours.

Pre-injury, she reported enjoying mowing the lawn, caring for plants, creative projects, and socialising, noting that she had a larger circle of friends. She reports that these activities have largely ceased. She rarely leaves the house outside work and essential errands and described being easily overwhelmed in social settings and suspicious of people's motives. Her current recreational activities are largely solitary and limited. She reported 'doom scrolling' on her phone, reading short articles and memes, catching up on messages and binge-watching series and movies. She goes out for a pub meal on her own every two months when her budget allows, choosing places where nobody knows her. After initial enthusiasm, she has been inconsistent with self-care activities like yoga, breathing and stretching, and has lost interest in metal detecting and candle making.

She maintains contact with a close friend, Amanda, primarily through Amanda's visits, which occur approximately every three weeks.

She remains close to her daughters and maintains regular contact with them, describing strong relationships, though financial constraints limit the frequency of contact. She visits her daughter and sister in Minnamurra approximately every three to four months, and she anticipates travelling to South Australia for a family Christmas and her mother's eightieth birthday. However, she noted a longstanding, strained relationship with her mother and only periodic contact. Her other daughter lives in Melbourne and has not visited this year. She can see her daughter at Minnamurra only when she has petrol money. They maintain contact remotely. She has not been overseas.

She can drive independently and travel substantial distances when necessary. She drives between Bathurst, Orange and Minnamurra and reported that she drives freely on these longer trips. She plans to drive to South Australia for Christmas, with one daughter travelling by train to join her and assist with driving and fuel costs. She travelled to Queensland by plane for a weekend trip, which she undertook alone. She was anxious, used headphones to cope, but ultimately had a good time and reported feeling better away from the Orange/Central West area. She generally restricts her local travel to a narrow circuit that includes work, the supermarket, the smoke shop, Amanda's house, her father's house in Orange, and the chemist.

She reported that her previously larger friendship network has reduced because she has become suspicious of people's motives. She now maintains only a small core of supportive relationships. She reported being very close to her sister, who has stage 4 cancer. At work she reported that she can 'hold it together and interact with people' during shifts at the service station, managing routine customer interactions from behind the counter with some distress. She reported experiencing anticipatory anxiety and physical symptoms of anxiety before work, including the urge to vomit, muscle tension in her neck and jitteriness, pushing through because 'I have to pay my bills'.

She reported a busy mind and difficulties with concentration, persistence and pace. She described being easily distracted, having difficulty concentrating while reading, and often managing only a short article before losing focus. She passively engages with social media. She reported starting but not completing projects, difficulty getting to tasks, and becoming easily overwhelmed by tasks such as housework or garden care. She reported difficulty remembering to eat and maintaining a routine. She reported difficulties paying her bills on time and was on a hardship payment plan; she also has difficulty with organisation, planning, and follow-through. At work, she can function adequately during her shifts, interact with customers, and complete expected tasks; however, this consumes a large proportion of her available cognitive and emotional resources, leaving her exhausted at the end of her shifts.

Ms Archer works 28 hours per week on midnight to 7:00 am shifts at a BP Service Station, where she has been employed for approximately 18 months. She works in blocks of four nights, then has at least one night and day off. After completing her fourth night, she does not work on Saturday and may spend much of that time in recovery sleep.

She previously held a class preparation assistant role at TAFE, working 8 to 12 hours per week for about six months, but had to pull back from this due to the difficulty of managing both that role and night work in another town, citing safety and sleep concerns. She has expressed interest in remedial massage training, but this was deferred because the combination of study in Sydney, workplace harassment at the time and financial stress became unmanageable. She incurred a debt and has not yet returned to the course.

Before each shift, she reported physical and psychological distress such as vomiting, muscle tension and agitation, but pushes herself to work out of financial imperative."

1. The Medical Assessor conducted a mental state examination and reported his findings as follows:

"Ms Archer presented as a thin, drawn woman appearing older than her stated age with poor dentition. Her hair was casually arranged in a bun with minimal attention to appearance. She was accompanied by her support person, Amanda. Her mood was flat and depressed with a restricted matter-of-fact affect. There was no formal thought disorder or evidence of psychotic symptoms. She expressed depressive and anxious themes but denied current suicidal thoughts. She was alert and oriented but presented as a rambling historian requiring frequent redirection. Cognition was not formally assessed. Her recall for recent and remote events was intact. Her insight and judgment were intact."

1. The Medical Assessor summarised the injury and his diagnosis as follows:

Ms Archer is a 56-year-old former enrolled nurse who has developed a persistent depressive disorder with anxious distress following the events of 3 November 2021. Her persistent depressive disorder has evolved in a manner consistent with chronic stress models of depression, with symptoms entrenched over time and maintained by anxiety-linked avoidance and persistent anxiety. Since the injury, she has reported depressed mood for most of the day, more days than not, persisting for over two years, anhedonia, insomnia, impaired motivation, lowered self-esteem, impaired concentration, intrusive depressive thoughts, appetite changes, weight fluctuation and social withdrawal. She has never been free of these symptoms for more than two months at a time. There is associated functional impairment across domestic, social, cognitive and occupational domains.

She experiences features of anxious distress, including feeling keyed up and tense, restlessness, difficulty concentrating due to worry and a persistent fear that something bad will happen when she leaves the home or on encountering individuals associated with her former workplace. She also reported episodes of physiological anxiety, racing thoughts, shaking, gastrointestinal upset before work and panic-like symptoms in public settings.

She has a pre-existing history of anxiety and depression for which she had been treated before the workplace incident. She has been diagnosed with ADHD, a lifelong developmental disorder causing functionally significant impairments in executive function, concentration, persistence and pace. I agree with the other independent medical examiners that a one-tenth deduction is warranted in the absence of evidence suggesting that a higher deduction would be required, noting that she maintained full-time nursing duties until late 2021.

Ms Archer presented as a consistent historian. There was no evidence of exaggeration, hyperbole or malingering. Her presentation was consistent with the medical evidence provided by her treating clinicians. Her presentation was consistent with the mechanism of the injury and the mental state examination."

1. The Medical Assessor explained that in making that assessment he took into account the following matters:

"The information contained in the documents listed above and my clinical assessment of the patient."

1. The complaint on appeal concerns two of the six PIRS categories namely self-care and personal hygiene and travel. The Appeal Panel will deal with each in turn.
2. In respect of self-care and personal hygiene Table 11.1 of the Guidelines provides as follows:

Table 11.1: Psychiatric impairment rating scale - self care and personal hygiene

No deficit, or minor deficit attributable to the normal variation in the general population

Mild impairment: able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.

Moderate impairment: Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) two to three times per week to ensure minimum level of hygiene and nutrition.

Severe impairment: Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.

Totally impaired: Needs assistance with basic functions, such as feeding and toileting.

1. The Medical Assessor assessed Class 2 or mild impairment with the following reasoning:

"Ms Archer reported that she showers once a week. She had trouble remembering to eat, usually only eating after work if she has the energy. Housework is performed only when the environment becomes overwhelming for her. She reported that she puts things off, becomes easily overwhelmed and often starts but does not finish domestic tasks. She no longer walks her dog and has difficulty maintaining basic routines, such as consistently watering her plants. She lives alone and can independently maintain a minimum level of hygiene and nutrition."

1. The Appeal Panel considers that there has been an error in the assessment of a mild impairment for self-care and personal hygiene. The respondent submitted that the Medical Assessor has exercised his clinical judgment which the appellant is merely seeking to cavil with and the Appeal Panel should not interfere. However, the assessment of a mild impairment does not accord with the criteria for this class. The appellant showers once a week only. The Guidelines refer to the need for prompting to shower daily. The appellant lives alone and there is no one to prompt her to do so, so she only showers once a week. She frequently forgets to eat. She only cleans the house when it is so overwhelming that she has to attend to it. However, she is easily overwhelmed and does not finish domestic tasks. She has difficulty maintaining a basis domestic routine. This level of impairment is not consistent with a Class 2 but is consistent with a moderate impairment at Class 3. Whilst she does live alone her self-care is impaired such that she is not achieving basic minimum hygiene and nutrition. The panel do not view this as supplanting their opinion for that of the assessor, but that the impairment elicited is below that which would be considered minimum hygiene and self-care for a competent adult, and has led to poor dentition. She could not be classified as a Class 4 because that requires a need for supervised residential care.
2. In respect of Travel, Table 11.3 of the Guidelines provides as follows:

Table 11.3: Psychiatric impairment rating scale - travel

No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision.

Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.

Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.

Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person.

Totally impaired: may require two or more persons to supervise when travelling.

1. The Medical Assessor rated Class 1 (no or minor deficit) with the following reasoning:

"She can drive independently and travel substantial distances when necessary. She drives between Bathurst, Orange and Minnamurra and reported that she drives freely on these longer trips. She plans to drive to South Australia for Christmas, with one daughter travelling by train to join her and assist with driving and fuel costs. She travelled to Queensland by plane for a weekend trip, which she undertook alone. She was anxious, used headphones to cope, but ultimately had a good time and reported feeling better away from the Orange/Central West area. She generally restricts her local travel to a narrow circuit that includes work, the supermarket, the smoke shop, Amanda's house, her father's house in Orange, and the chemist. This is not inconsistent with a minor deficit attributable to the normal variation in the general population."

1. The appellant submitted that she should have been rated as having a mild impairment. However a rating of Class 2 impairment requires that travel is only possible without a support person in familiar areas. The appellant can travel significant distances by herself. The fact that some anxiety may be experienced does not equate to impairment because that would be to conflate symptoms with impairment. The fact is that the appellant is able to travel to various places beyond the local area and is able to do so without a support person. There is no error in the rating of a Class 1.
2. This means the calculations become as follows:

1. The Medical Assessor noted the worker had reached MMI, ie the impairment rated is that having received treatment. He made an allowance of 1% for the effect of this treatment such that it must have led to elimination of a prior higher impairment but at the current WPI clearly not eliminated it. This has not been appealed.
2. This means the current WPI is 15% plus 1% for the effects of treatment, which equals 16%.
3. As in table 2 of the Commission's template the final step is to determine the deductible proportion for the prior condition under s 323 which 'should be deducted from the degree of permanent impairment determined by the assessor' [1.32] and follows the order of process laid out in [1.46]. This has also not been appealed. This results in 16% - 1.6% which equals 14.4% or 14% WPI after rounding [1.26] as the degree of impairment resulting from injury.
4. For these reasons, the Appeal Panel has determined that the MAC issued on

4 December 2025 be revoked and a new MAC issued. The new certificate is attached to this statement of reasons.

State of New South Wales (Western NSW Local Health District)

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act 1998.

The Appeal Pane revokes the Medical Assessment Certificate of Medical Assessor Clayton Smith and issues this new Medical Assessment Certificate as to the matters set out in the table below:

The above assessment is made in accordance with the Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA5 Guides

WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)

Sub-total/s % WPI (after any deductions in column 6)

Total % WPI (the Combined Table values of all sub-totals)