"During the interview, Michele reported that her mood had declined significantly since the onset of her pain and that she felt depressed most days. Her affect at the time of the interview was congruent with her self-reports. Michele stated that she regularly experienced low levels of energy, low motivation, frequent bouts of melancholy and irritability, moderate levels of anhedonia and mild impairments to her memory, concentration and decision making, as well as the propensity to comfort eat. Michele stated that she had not been formally diagnosed with depression and was not taking an antidepressant or linked up to psychological help to assist her with the management of her mood. She reported nil suicidal history or ideation (current). As well as her pain being a maintaining factor of her lowered mood, Michele stated that she had lost her job and had filed for bankruptcy, resulting in high levels of hopelessness for the future regarding her ability to be employed as a nursing assistant. Michele also reported high levels of anger and grief from the loss of her job and the way she was treated by her former employer. A strength that Michele discussed was that she had recently completed a Certificate Ill in Practice Management with the aim that she may be able to work as a practice manager for a medical office in the future. However despite attaining this qualification, Michele stated that she was uncertain of her ability to fulfil this role due to her persistent pain and its effect on her emotional stability and functioning. In addition to a depressed mood, Michele disclosed that she experiences heightened levels of anxiety in social situations involving the following symptoms: shakiness, nausea, butterflies in her stomach and the fear of being appraised negatively by others. This has consequently led her to becoming more withdrawn, avoidant and socially isolated from friends and family. In addition to these symptoms, Michele also reported experiencing nocturnal panic attacks with the last episode occurring a few months ago."

(h) At page 228 of the Reply, Dr Rowe made a diagnosis of mild post-traumatic stress disorder. This psychiatric diagnosis is secondary to her physical injury. He reported that it was Ms Matheson's physical condition rather than her emotional state which was the main impediment to her securing employment. He wrote: "She does have a vulnerable personality, but she did not have an impairment prior to her injury." At page 256 of the Reply, Dr Rowe reiterates that Ms Matheson's "psychiatric diagnosis is secondary to her physical injury" and "although she had a vulnerable personality, her psychological state is secondary to her physical injury".

1. In respect of other pre-existing psychological symptoms, the appellant referred to the following evidence:

(a) Ms Christine Reeves, noted on page 20 of the Reply at paragraph 8 that prior to her injury if Ms Matheson was "moody on arrival" at work, she could be quite lazy, suggesting symptomatic mood issues prior to the work injury.

(b) In her statement dated 16 August 2022, at paragraphs 6 to 8 on page 1 and paragraph 11 and 12 on page 2 of the ARD, Ms Matheson wrote:

"6. I had anxiety as a child which improved in my late teenage years.

1. In or around 1990 I suffered sore knees after a motor vehicle accident from which I made a full recovery. I also suffered PTSD as a result of the accident.
2. In or around 1998 I felt depressed for a few months after my father died on my birthday from pancreatic cancer...
3. I received a short period treatment for symptoms of anxiety and depression including taking antidepressants following the breakup of my marriage and divorce around 12 years ago.
4. I have experienced periods of stress and grief due to my mother's cancer diagnosis."

(c) Dr Chow, in his report dated 4 March 2022, under "Past Medical/Psychiatric History" wrote:

"Ms Matheson has chronic back pain, high blood pressure, gastric reflux and asthma.

She has had some anxiety since she was young and she was a shy child. She had a MVA in 1988 and she had PTSD. She said she saw a psychologist and she was able to recover.

She was depressed when she separated from her ex-husband 22 years ago. She admitted to being depressed after her father passed away 20 years ago and was on antidepressant for six months.

In 2005 and 2007 she was on Workers' Comp claims briefly for two physical injuries".

Dr Chow noted that Ms Matheson reported that she eventually became suicidal "after the nursing home close down in July 2013". Dr Chow noted that byer childhood was good with no childhood trauma. He wrote:

"She was previously married in 1980 and separated 20 years ago. She still has contact with her ex-husband who comes and helps with mowing her lawn. She has three children and ten grandchildren. She has regular contact with one son and three grandchildren and some contact with her other children. There are no other psychosocial stressors."

(d) Dr Rowe in his report of 10 October 2018, noted that Ms Matheson still had some mid back pain but it was not as severe as it was for months or so following the injury in June 2012. Under "Past Health" he reported:

"About 2011 she was taken to hospital when she was 'not feeling too well' (this seems to have been the time when she was somewhat distressed when her daughter was having problems with her partner who was apparently abusing their daughter, which resulted in her daughter taking out an AVO against him sometime later. It was discovered at that time that Ms Matheson had a significantly raised blood pressure and has been taking medication for her raised BP since then. Her daughter and grandchild were living with her for a while at that time, but they have since moved to Coomera, in Queensland.

She had her gallbladder removed when she was aged about 24.

Mrs Matheson developed a phobia about winds and storms since their caravan was

blown over in 1979 when she and her husband were living in a caravan park.

She states she has always been 'shy' and uncomfortable with new people".

Dr Rowe noted that she had a good but unremarkable childhood. Dr Rowe expressed the opinion that Ms Matheson had a "lifelong insecure personality and therefore quite vulnerable to feeling anxious and despondent". He wrote "There is no deduction for any previous condition as she had no impairment as such prior to her back injury."

(e) A "Summary of Session" by Dr Juluis Petroff, dated 16 March 2016, recorded that Ms Matheson suffered from a mixed episode of a bipolar II disorder, a pain disorder, associated with both psychological factors and a general medical condition as well as personality traits contributing to an axis I disorder. Dr Petroff also recorded that Ms Matheson had suffered "lifelong" depression, and declared bankruptcy on a personal loan for dental work in 2015. In a handwritten note on Dr Petroff's summary dated 27 June 2016, he noted Ms Matheson's "platform of mental, chronic pain and psychiatric issues are underscored by a Bipolar II disorder and a severely prejudicial [sic] childhood". On 20 March 2018 in Dr Petroff's summary, he noted Ms Matheson suffered bereavement when "her father-in-law's brother died 96". It was also recorded that Ms Matheson had suffered from "lifelong shyness, relative isolation and simple phobias. Couple of friends only but not seen for years.". In a handwritten note on that same summary dated 16 April 2018, Dr Petroff noted Ms Matheson's anxiety in the context of her mother's cancer operation.

(f) In a report from psychologist, Mr Matt Wagner, dated 22 February 2020, he noted Ms Matheson reported "significant psychosocial stressors within her family" which further impacted her mood. In a report dated 11 March 2020, Mr Wagner wrote: "ichelle has a history of complex Post Traumatic Stress Disorder, Major Depression, and Chronic Pain concerns. Her trauma is primarily related to severe bullying she experienced when she was working as an AIN in a nursing home" and then reported: "Michelle reports that she has significant family stressors at the moment which are further impacting on her mental health."

(g) Treatment notes of the clinical psychologist of the Pain Clinic at Lismore Base Hospital dated 17 November 2015, at pages 196 and 197 of the ARD (see above).

(h) A report from Wendy Borislavsky, clinical psychologist at Lismore Base Hospital Pain Management Clinic dated 19 November 2015, noted that Ms Matheson had been anxious since early childhood and that it had affected her participation and enjoyment in a range of life activities.

(i) Psychological assessment undertaken by Lismore Base Hospital Pain Management Clinic on 30 September 2015 at page 259 of the ARD, under significant trauma/stressor history noted bankruptcy issues and father's death as significant traumas/stressors.

(j) Gina Bremner of Procare Injury Management provided a monthly status update dated 12 February 2014 which noted at page 278 of the Reply, under "Current Status", that Ms Matheson was experiencing some psychosocial issues, as she had been supporting her daughter and grandson through an Apprehended Violence Order before the court. It was noted the daughter's partner had abused Ms Matheson's grandson and this had been playing on her mind. However, Ms Bremner noted that Ms Matheson continued to participate in job seeking activities.

(k) In an email from the insured dated 16 May 2013, it was noted Ms Matheson:

"...had a bad week that week, with children and school, other family matters that all added pressure. Michelle informs me that she is supported at work, however there are times when her fellow employees may not 'understand' however has agreed it is better to report these things to Rita than to bring in an outsider unnecessarily".

1. The Appeal Panel notes that Ms Matheson addressed this in her statement describing difficulties with other workers on that day, including being yelled at by the Acting Manager. She stated that she had seen Mr Boyd later that day for an exercise class and broke down in tears in front of him because she was very upset at the way she had been treated at work. She wrote: "I understand that Mr Boyd was concerned about me so he wrote a letter to my employer."
2. The appellant submits that the evidence before the Commission clearly establishes Ms Matheson had suffered a secondary psychological injury as a result of an accepted physical work injury on 5 June 2012, as well as a host of prior psychological symptoms related to other events in her life.
3. The Appeal Panel agreed with the appellant that the Medical Assessor has not taken any history in relation to the bullying and harassment alleged by Ms Matheson to be causative of the primary psychological injury deemed to have occurred on 13 July 2013, apart from the following:

(a) "She reported that after a back injury in June 2012 she was subject to bullying and harassment at work. She reported that she was attacked by a client while cleaning him after he had lost control of his bowels." (Page 2 of the MAC)

(b) "General health: Back injury in 2012..." (Page 2 of the MAC)

1. The parties had agreed that the applicant has suffered a primary psychological injury as alleged, deemed to have occurred on 13 July 2013 and a secondary psychological condition resulting from physical injury sustained on 5 June 2012.
2. Thus, a secondary psychological injury should have been identified and then disregarded in calculating the degree of permanent impairment arising from the injury the subject of the claim.
3. The Appeal Panel accepts that the Medical Assessor failed to consider the question of a secondary psychological injury due to physical injury sustained on 5 June 2012. The failure to consider the secondary psychological injury was a demonstrable error. This ground of appeal is made out.

1. The appellant submits that the assessment from the Medical Assessor contains a demonstrable error due to his failure to apply a deduction under s323 in view of all the evidence before him.
2. Under "Details of any previous or subsequent accidents, injuries or conditions" the Medical Assessor wrote:

"She suffered from anxiety as a child which improved in her teenage years.

She had a MVA in 1990 and had some psychological symptoms for a number of months after.

She felt depressed after the death of her father in 1988 from pancreatic cancer.

Around 12 years ago in the context of marriage breakdown she had anxiety and depressive symptoms and was treated with antidepressants and made a recovery."

1. Under "Evaluation of Permanent Impairment" the Medical Assessor wrote:

"e. Is any proportion of loss of efficient use or impairment or whole person impairment, due to a previous injury, pre-existing condition or abnormality? no

1. If so, please indicate which body part/system is affected by the previous injury, preexisting condition or abnormality. No".

"(1) In assessing the degree of permanent impairment resulting from an injury, there is to be a deduction for any proportion of the impairment that is due to any previous injury (whether or not it is an injury for which compensation has been paid or is payable under Division 4 of Part 3 of the 1987 Act) or that is due to any pre-existing condition or abnormality.

(2) If the extent of a deduction under this section (or a part of it) will be difficult or costly to determine (because, for example, of the absence of medical evidence), it is to be assumed (for the purpose of avoiding disputation) that the deduction (or the relevant part of it) is 10% of the impairment, unless this assumption is at odds with the available evidence.

Note. So if the degree of permanent impairment is assessed as 30% and subsection (2) operates to require a 10% reduction in that impairment to be assumed, the degree of permanent impairment is reduced from 30% to 27% (a reduction of 10%).

(3) The reference in subsection (2) to medical evidence is a reference to medical evidence accepted or preferred by the medical assessor in connection with the medical assessment of the matter.

(4) The WorkCover Guidelines may make provision for or with respect to the determination of the deduction required by this section".

1. The approach to be taken in assessing the s 323 deduction was considered by the Supreme Court in Cole v Wenaline Pty Limited [2010] NSWSC 78 (Cole). Schmidt J said:

"29 ...The section is directed to a situation where there is a pre-existing injury, pre-existing condition or abnormality. For a deduction to be made from what has been assessed to have been the level of impairment which resulted from the later injury in question, a conclusion is required, on the evidence, that the pre-existing injury, pre-existing condition or abnormality caused or contributed to that impairment.

1. Section 323 does not permit that assessment to be made on the basis of an assumption or hypothesis, that once a particular injury has occurred, it will always, 'irrespective of outcome', contribute to the impairment flowing from any subsequent injury. The assessment must have regard to the evidence as to the actual consequences of the earlier injury, pre-existing condition or abnormality. The extent that the later impairment was due to the earlier injury, pre-existing condition or abnormality must be determined. The only exception is that provided for in s 323(2), where the required deduction 'will be difficult or costly to determine (because, for example, of the absence of medical evidence)'. In that case, an assumption is provided for, namely that the deduction 'is 10% of the impairment'. Even then, that assumption is displaced, if it is at odds with the available evidence.
2. ...That is a matter of fact to be assessed on the evidence led in each case".
3. At [38] of Cole, Schmidt said:

"38. What s 323 required, however, was that the evidence be considered, so that it could be determined, firstly, what the level of impairment after the second injury was. Secondly, whether a proportion of that impairment was due to the first injury. Thirdly, what that proportion was. Undoubtedly in undertaking this exercise, the medical members of an Appeal Panel must utilise their medical judgement, knowledge and experience. Nevertheless, all stages of the statutory exercise must be undertaken in the light of the evidence and without the making of assumptions not provided for by the section."

"Pre-existing impairment: To measure the impairment caused by a work-related injury or incident, the psychiatrist must measure the proportion of WPI due to a pre-existing condition. Pre-existing impairment is calculated using the same method for calculating current impairment level. The assessing psychiatrist uses all available information to rate the injured worker's pre-injury level of functioning in each of the areas of function. The percentage impairment is calculated using the aggregate score and median class score using the conversion table below. The injured worker's current level of WPI% is then assessed, and the pre-existing WPI% is subtracted from their current level, to obtain the percentage of permanent impairment directly attributable to the work-related injury. If the percentage of pre-existing impairment cannot be assessed, the deduction is 1/10th of the assessed WPI".

1. The appellant submits that the assessment of the Medical Assessor contains a demonstrable error due to his failure to apply a deduction under s 323 in view of all the evidence before him.
2. In Vitaz v Westform (NSW) Pty Limited [2011] NSWCA 25 the Court said at [43]:

"The resulting principle is that if a pre-existing condition is a contributing factor causing permanent impairment, a deduction is required even though the pre-existing condition had been asymptomatic prior to the injury. In the absence of any medical evidence establishing a contest as to whether the pre-existing condition did contribute to the level of impairment, the complaint about a failure to give reasons must fail. An approved medical specialist is entitled to reach conclusions, no doubt partly on an intuitive basis, and no reasons are required in circumstances where the alternative conclusion is not presented by the evidence and is not shown to be necessarily available."

1. The Appeal Panel noted that neither of the independent medical examiners (IMEs) made a deduction for pre-existing condition.
2. Dr Rowe, in his report of 10 October 2018 (page 785), wrote:

"9. Would you also please consider the issue of whether any psychological injury can be classified as a primary psychological injury or whether it is a secondary psychological injury (le. arising as a consequence of, or secondary to, a physical Injury).

Although she had a vulnerable personality, her psychological state is secondary to her physical injury".

1. Dr Rowe wrote: "The assessment of whole person impairment is provided on a separate page. There is no deduction for any previous condition as she had no impairment as such prior to her back injury".
2. Dr Chow in his report of 8 March 2022 made no deduction for any pre-existing injury, condition or abnormality.
3. The Appeal Panel notes that the appellant referred to evidence concerning pre-existing psychological symptoms in the submissions regarding the first ground of appeal. This evidence has been considered above by the Appeal Panel. We see no reason to repeat that evidence as it concerned various stressors and symptoms but did not address the question of whether the pre-existing condition did contribute to the level of impairment assessed.
4. The Appeal Panel accepts that the Medical Assessor reported a history of pre-existing psychological symptoms and some treatment. However, the Medical Assessor found that there was no proportion of the impairment due to a previous injury, pre-existing condition or abnormality. In the absence of any medical evidence establishing a contest as to whether the pre-existing condition did contribute to the level of impairment, the complaint by the appellant about a failure to give reasons fails. This ground of appeal is not made out.

1. The appellant submitted that the Medical Assessor assessed 1% WPI for the effects of treatment, but provided no comment, rationale or reason for that assessment.
2. Under "Present treatment" on page 2 of the MAC, the Medical Assessor wrote: "She sees her psychiatrist every 3-4 months and her psychologist monthly. She takes desvenlafaxine (antidepressant) and alprazolam as required generally using 0.5mg 2-3 times a week".
3. The Medical Assessor noted that present symptoms included: "ongoing low mood, rumination, feelings of anxiety, feelings of hopelessness, poor concentration, occasional suicidality but not for a month with no active plan". He noted that Ms Matheson had not returned to work.
4. Under "Reasons for Assessment" on page 3 of the MAC, the Medical Assessor wrote:

"c. My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reasons why my opinion differs

Dr Rowe 10/10/18 WPI 15% + 1% treatment effect = 16%

1. In Table 2 of the MAC, the Medical Assessor in the column under "WPI deductions pursuant to s 323 for pre-existing injury, condition or abnormality" wrote "+1% treatment". Dr Chow considered that Ms Matheson continued to suffer from significant depressive features.
2. Dr Kai Tai Chow, consultant psychiatrist, in his report dated 9 March 2022, added 1% for treatment effect to his assessment of 22 % WPI, which resulted in a final WPI of 23%.
3. Dr William Rowe, consultant psychiatrist, in his report dated 10 October 2028, added 1% for treatment effect to his assessment of 15 % WPI, which resulted in a final WPI of 16%.
4. The Guidelines at 1.32 provide:

"Where the effective long-term treatment of an illness or injury results in apparent substantial or total elimination of the claimant's permanent impairment, but the claimant is likely to revert to the original degree of impairment if treatment is withdrawn, the assessor may increase the percentage of WPI by 1%, 2% or 3%. This percentage should be combined with any other impairment percentage, using the Combined Values Chart. This paragraph does not apply to the use of analgesics or anti-inflammatory medication for pain relief".

1. The Appeal Panel was not satisfied that the treatment including medication taken by Ms Matheson resulted in an apparent substantial or total elimination of her permanent impairment, as required by Cl 1.32 of the Guidelines. The Appeal Panel finds that the Medical Assessor made the assessment in relation to effects of treatment on the basis of incorrect criteria. Further, the Medical Assessor failed to adequately set out his reasons for adding 1% WPI for effects of treatment.
2. This ground of appeal is made out.
3. The Appeal Panel, having found error, concludes that it was necessary for the appellant to undergo a further medical examination because there was insufficient evidence on which to make a determination in respect of any reduction to be made for the secondary psychological injury. The Appeal Panel notes that in order to determine the impact of the secondary condition (which occurred before the primary psychological injury) on current WPI, a comparative exercise is necessary and it would be logically incoherent to simply begin the exercise from a fixed starting point, ie, the 17% WPI Psychiatric Impairment Rating Scale (PIRS) assessment made by the Medical Assessor (Coca-Cola Europacific Partners API Pty Ltd v Pombinho [2024] NSWCA 191).
4. As noted above, Dr Micheal Hong of the Appeal Panel examined Ms Mattheson on 3 June 2025. Dr Hong provided the following report:

Ms Matheson reported she joined the nursing home in 2002 and worked as an Assistant in nursing up to 72 hours per fortnight. She was also doing study.

Ms Matheson has a long history of anxiety and depression, and we discussed:

Ms Matheson was born in Australia, the fifth of six siblings, and grew up with her parents. Her father was an alcoholic and passed away more than 20 years ago, and they had a 'love-hate' relationship. Her mother was critical when she was little. She experienced 'teasing' by her peers at school. She confirmed she had anxiety as a teen. There is a family history of bipolar disorder.

At age 18, Ms Matheson was living with her husband in a caravan and there was a storm, and she developed trauma memory and fear related to that incident, which was repeatedly noted in combination with trauma memory related to her 2012 workplace injury with a demented patient. She said she developed a phobia and needed to hide from the wind, and avoided caravans and small enclosed spaces since then. She will go inside a lift but needs to hang on to the railings in a lift, due to her experience of rolling inside the caravan.

She was in a car accident in the 1990s, with a PTSD diagnosis. She said it was nearly a head-on collision and she sustained a knee injury. Her children were in the car screaming. She took a psychotropic medication for a while.

Then in early 2000, after her marital break-down, she took antidepressants for 6 months, and she has a reasonable relationship with her ex-husband now. They catch up sometimes, and they are better as friends than being married. She has not had another partner since.

She said her last psychological and psychiatric treatment was early 2000. We discussed Dr Petroff noted in 2015, when they first commenced treatment, she had life-long anxiety and depression, she said she it was on-and-off and not life-long, and does not agree with his assessment. She does agree she has some phobic behaviour, especially with enclosed spaces, and that she is shy by nature and has social anxiety, and few friends over the years. She described not trusting people and said it takes a longer time to establish relationships with people, and this is a life-long pattern.

In terms of work injury, 5/6/2012 is the secondary psychological injury:

Ms Matheson stated that she was at work and helping a demented client with another AIN, when she fell and sustained a back injury. They cleaned the client but he pushed himself over the bed and fell, and she was dragged by his fall. She was off work for 2 weeks, and consulted her GP and had ultrasound scans, which showed a tear in her latissmus dorsi muscle, and subsequently, she had physiotherapy. She returned to work on light duties, in the same workplace, same hours with the same people. She said her mental health after her back injury declined, because she could not do many things she used, she developed self-doubt. Ms Matheson could not help clients out of bed, dress them, help them with toiletry, or shower them. At work, she checked paperwork, cut clients' nails and said she did anything that was not heavy. She said her anxiety and depression started after her back injury.

She gradually increased to full-time work, but could not do night shifts, and did light duties only.

On the days off work, she stayed at home most of the time, did household chores, read books and did art. She enjoyed books by Christine Feehen, about paranormal mysteries. She said she had friends, and ate out, had dinner with them and watched their children play sports together.

Ms Matheson experienced bullying and harassment on return to work, by a couple of managers and some colleagues, who belittled her behind her back. She felt 'I wasn't any good'. They made comments like 'she cannot help us, we need to find someone else'. She said a manager made it like it was her fault, and claimed they did not know what she was doing at work. She developed severe depression, as a result of bullying, but she did not take time off work.

The nursing home was eventually closed down in July 2013 and she has not worked since.

She continued her TAFE study 2 days per week, and was doing certificate 4 in Aged Care and almost completed it, however, she said her managers would not respond when she contacted them in relation to her practical work component at the nursing home, and then due to the nursing home closure, she could not complete her study.

Following the workplace issues, the first psychologist or psychiatrist treatment was at the Lismore pain clinic, and she recalled a psychologist at the pain clinic advised her to see a psychiatrist. She started treatment with Dr Julius Petroff, in 2015, and recently having reviews every 3 to 5 months. She has been consulting Matthew Wagner, every 3-4 weeks, altogether for 3-4 years. She has not had psychiatric admission, nor had group-based treatment.

We discussed her bankruptcy around 2014 or 2015. She said she had a loan for dental treatment but could not repay it as she lost her job.

Her file noted Dr Petroff treated her from November 2015, repeatedly noted 'life-long depression, life-long phobia, lifelong shyness and few friends'. He diagnosed type II Bipolar disorder with a history of hypomania with irritability, on Lurasidone in 2015. Conflict with sister, as she felt her sister was critical.

We discussed her diagnoses, she said she has anxiety and depression, and previously PTSD. I asked her about type II Bipolar disorder, she said she is not sure. I asked her about hypomanic symptoms and she does not remember any symptoms consistent with it. I noted irritability was one of the main symptoms recorded, which may not be hypomania and in any case, she does not take Lurasidone or any Bipolar disorder medication anymore.

• Pristiq 100 mg tablet, 4 tablets daily.
• Alprazolam 0.5 mg, as needed for anxiety, 2-3 tablets sometimes, but not daily.
• Thyroid replacement
• Anti-hypertensive medication
• Gastric reflux medication
• Cholesterol-lowering medication
• She does not take Lurasidone anymore.

Ms Matheson said she has ongoing anxiety and depression, and when her back pain increases, she has more anxiety and depression. If she cannot do things due to pain, she has more depression.

Ms Matheson reported chronically poor sleep and said her mind does not stop, and back pain wakes her too. She only has 2-3 hours sleep. She reads on waking, or paints, even during the night. She has bad dreams, related to the demented patient, and said not so much with the caravan, and said that has improved.

She binge-eats and her weight fluctuated. She said her weight is between 120 to 140kg in 2025.

She reported being easily frustrated and being upset, and 'go off for no reason,' and then said she pulled herself up. She is not physically aggressive.

She said she has problems with her concentration and memory, and forgets what she is doing sometimes. Sometimes she has to rereads the same material or same page.

Physically, Ms Matheson said she has ongoing pain, and she can lift 7kg but not more. She said she takes it easy with household chores, due to her chronic pain symptoms being exacerbated by overuse. She said she struggles make the bed due to back pain. She does back exercises, and takes walks almost daily, and can manage 30 minutes, but then her back starts to hurt. She struggles with stairs due to back pain. She generally takes walks by herself.

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

We discussed Ms Matheson's previous psychiatric history. She maintained that the last time she had a psychological condition and had treatment was in 2000 and did not agree with her psychiatrist, who reported that she had lifelong depression and anxiety in several of her treatment entries. It appeared that Bipolar disorder was diagnosed, but she does not confirm any symptoms consistent with it. In any case, she is no longer taking mood stabiliser medication for it and it does not appear that she has ever suffered from Bipolar disorder.

Ms Matheson is 53 and lives by herself. She has three adult children, one son and two daughters, with two living locally.

She said she cannot get a job, due to the physical demands of the jobs, and she is on a pension from Centrelink, but it is not Disability support pension.

She goes to her children's home and helps the grandchildren get ready for school most days. She has 13 grandchildren. She sees her son and his children a couple of times a week as he is nearby. She sees her daughter's sons one day per week. She babysits her grandchildren sometimes, and said it gives her something to do. She has a good relationship with her family. Her mother passed away 3 years ago and her father passed away many years ago. She said her relationship with her siblings is ok, but does not see them much as everyone is far away. She said she does not talk to one sister much, as she is critical.

Around 4 to 5 months ago, she had had lunch out with a friend, and said outings with her friends only happen every 1 or 2 years. She does not have contact with any work-related friends since she ceased working, and said a couple of friends passed away over time, and a few people moved too far away. She still contacts some friends on Facebook social media.

She said her driving is fine, but she struggles with turning her head to the right. She said she does not trust herself driving too far, and generally only drives in the local area.

In terms of trips away, Ms Matheson reported going to Brisbane with her son, who drove there with several stops, to visit her daughter, and this was 2 years ago during Christmas. There have been no other trips away in the past few years.

She reads books and novels for around 1 hour each time, and reads ebooks and physical books. She reads most days. She does bead painting, similar to diamond art until her back hurt, usually for 30 to 60 minutes. She sews, knits and crotchets for a couple of hours, on-and-off and follows patterns.

Ms Matheson has a son and a daughter living locally, and generally only celebrates Christmas and not at other times.

She said she has not watched her son race cars for a while now, nor watch her daughter play netball, as she does not want to respond to people asking questions about her back injury.

Ms Matheson does all household chores, cooking and shopping. She goes to the shops when it is quiet and not many people are there, as she worries about having an accident and having more back pain. She worries someone would deliberately hurt her, because her experience of being hurt by the clients at the nursing home, and said some clients deliberately do things to hurt her.

Ms Matheson eats regularly but eats too much at times. She showers every second day without prompting.

Ms Matheson was assessed by video. She attended her solicitor's office and was assessed on her own for more than 1 hour. She had dyed hair and grey roots were visible.

She engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. She was moderately restricted in her affect range. She spoke spontaneously and fluently. She was not thought disordered and the provided history was easy to follow. She remained focused throughout the assessment. She spoke at a normal speed and spoke at a steady pace.

Ms Matheson had previous psychiatric symptoms and was able to continue with general daily functioning, and performed her employment without difficulties.

After a fall with a back injury, Ms Matheson started having depression and anxiety and the symptoms at the time were consistent with an Adjustment disorder, which is a secondary psychological injury, although she never sought help for it and did not take time off work. There were no specific psychiatric impairments arising from her anxiety and depression at that time. Furthermore, in the period when she first returned to work after her secondary psychological injury, she described working light-duty full-time with the same people, and there was no discernible psychiatric impairment at that time. Her second injury was at a steady state at that point.

After returning to work and being subjected to bullying and harassment, Ms Matheson developed significant depression and anxiety symptoms with significant weight gain over time, consistent with a Major depression disorder and this is a primary psychiatric injury. She has engaged in treatment with her psychiatrist and taken psychotropic medications, and received long-term effective treatment for her psychiatric condition.

I do not believe she has ever experienced a work-related stressor consistent with PTSD, and given the car accident happened many years ago, I do not believe there is an aggravation of previous PTSD.

On 9 March 2022, Dr Chow diagnosed a major depression disorder.

He assessed Ms Matheson's self-care as 3, but he had factored in pain as part of the impairment, which is not assessable in the PIRS. On reassessment, she described being independent in all self-care, and a rating of 3 cannot be supported.

In terms of concentration, persistence and pace, Dr Chow rated 3 and said that she cannot read more than 10 minutes. This is quite different to how she reports her capacity on reassessment. While she rereads sometimes, she says she can focus on following patterns when doing crocheting. Ms Matheson reads books for about half an hour to an hour. She does diamond art. Therefore, a rating of 3 cannot be supported.

Dr William Rowe, 10 October 2018, had noted Ms Matheson's injury and that she stopped working when the nursing homes are closed. Her interests include going to watch her son race cars, every few months, going to the beach, reading, and doing jigsaw puzzles. He diagnosed mild PTSD as a secondary to her physical injury (Comment: PTSD cannot be a secondary psychological injury by definition, as PTSD is a primary psychological injury). He provided WPI, which came to 15%.

He rated her social functions as 3 and said she lived by herself and her son stayed over sometimes. She has not formed a relationship since the divorce and lost some friendships. On reassessment, Ms Matheson reported her relationship with her family is generally good, but with some siblings, they are not close because some people are critical. She reported some friends have passed away, some moved away. She has contact with some friends on social media. She had only a few friends to begin with and mainly has contact with one friend now, and since she stopped working she has not had contact with her friends from work. Ms Matheson still has a good relationship with her ex-husband who comes and helps her sometimes at home. Taken all together, there is no evidence of separation or domestic violence and a rating of 3 cannot be supported.

Dr Julius Petroff provided several reports in 2015 and 2016 and noted Ms Matheson has pain disorder, bipolar 2 disorder, personality traits, as well as agoraphobia, Generalized anxiety disorder, conflict at times with a sister who is critical, has been binge eating, lifelong shyness and simple phobia, nightmares, including about the caravan and a demented patient. In terms of 'social', he noted lifelong shyness and simple phobia, few friends, and relative isolation.

There is a ProCare functional assessment report 23 October 2023 which noted that she was 118 kg at the time.

WPI before Ms Matheson's primary psychological injury:

I accept Ms Matheson's assertion she had no impairment, as she was able to present herself well at work with adequate hygiene and eating patterns.

I accept Ms Matheson's assertion she had no impairment, as she regularly enjoyed attending sporting activities that her children participated in.

I accept Ms Matheson's assertion she had no impairment, as she was able to go out without a support person, including going to work and everywhere else.

I accept Ms Matheson's assertion she had no impairment, and related well with her friends and family.

I accept Ms Matheson's assertion she had no impairment, as she could work and was passing her TAFE study.

I accept Ms Matheson's assertion she had no impairment in performing her work.

Therefore, her pre-primary psychological injury WPI was 0%.

Ms Matheson eats regularly without prompting but eats too much at times. She showers every second day without prompting. She binge-eats and her weight fluctuated. She said her weight is between 120 to 140kg in 2025. She is capable of independent living and lives by herself.

She relinquished previous social and recreational activities, and she can tolerate having visitors. She said she has not watched her son race cars for a while now, nor watch her daughter play netball. Around 4 to 5 months ago, she had had lunch out with a friend, and said outings with her friends only happen every 1 or 2 years. Overall, her participation in social and recreational activities is rare.

Ms Matheson reported going to Brisbane with her son, who drove there with several stops, to visit her daughter, and this was 2 years ago during Christmas. She struggles to be out, and needs a companion for long trips. She is independent in travel locally.

She has been isolative, and has rare contact with her friends and this is a reduction since the subject injury. She babysits her grandchildren sometimes, and can do it well. She has a good relationship with her family.

She reads books and novels for around 1 hour each time, and reads ebooks and physical books. She reads most days. She does bead painting, usually for 30 to 60 minutes. She sews, knits and crotchets for a couple of hours, on-and-off and follows patterns. She can focus on intellectually demanding tasks for 30 minutes and more.

Ms Matheson experienced bullying and harassment on return to work, by a couple of managers and some colleagues, who belittled her behind her back. She developed severe depression, as a result of bullying, but she did not take time off work. The nursing home was eventually closed down in July 2013 and she has not worked since.

She did not stop work due to her psychological injury. The Panel concluded she could not work in her pre-injury workplace or with the same manager, due to her psychological symptoms, but she could continue working less than 20 hours per week in a different workplace, doing lower stress roles.

The Panel has assessed Ms Matheson's functioning before and after treatment, and there were no apparent substantial or total elimination of her permanent impairment with treatment.

1. The Appeal Panel adopts the report and findings of Medical Assessor Hong.
2. In relation to the secondary psychological injury, the Appeal Panel accepts that a two-step approach is required, that is, to calculate the WPI using the PIRS and to then assess the impairment resulting from the secondary psychological injury and to deduct or exclude it. The deduction is not a deduction to which s 323 of the 1998 Act applies.
3. The Appeal Panel also notes that Ms Matheson's physical injuries and pain are not assessable in the PIRS, as per Guidelines, and this is separate to secondary psychological injury assessment.
4. Medical Assessor Hong assessed Ms Matheson as having no impairment caused by the secondary psychological injury. He completed an assessment using the PIRS scales in terms of Ms Matheson's level of functioning immediately before the primary psychological injury and assessed 0% WPI. The Appeal Panel has adopted this assessment.
5. Therefore, the Appeal Panel assessed 7% WPI in respect of the primary psychological injury. As no impairment has been assessed for the secondary psychological condition, this does not need to be taken into account and disregarded in the assessment of permanent impairment. No addition is made for effects of treatment. The Appeal Panel assesses 7% WPI in respect of the primary psychological injury on 13 July 2013.
6. For these reasons, the Appeal Panel has determined that the MAC issued on 18 September 2023 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons

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

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Gerald Chew and issues this new Medical Assessment Certificate as to the matters set out in the yable below:

Chapter, page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA 5 Guides

Proportion of permanent impairment due to pre-existing injury, abnormality or condition

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

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