WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; claim for permanent impairment; Medical Assessor found that the appellant had not reached maximum medical improvement (MMI); appellant worker appealed on the failure to give reasons; error found by the Appeal Panel in the failure to give adequate reasons; re-examination was considered necessary in the circumstances of a finding of error; Held - MAC confirmed.

1. The worker (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Michael Hong, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 8 May 2025.
2. The appellant relies on the following ground 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 requested 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 necessary for the worker to undergo a further medical examination because the Appeal Panel found error.

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. Medical Assessor Nicholas Glozier of the Appeal Panel conducted an examination of the worker and reported to the Appeal Panel.

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

• Date of injury: 7 January 2021
• Body parts/systems referred: Psychiatric/Psychological disorder
• Method of assessment: Whole Person Impairment"

1. On 8 October 2024 the Medical Assessor issued a MAC that maximum medical improvement (MMI) had not been reached. The matter was restored to the list and referred back to the Medical Assessor who on 8 May 2025 again certified that MMI had not been reached.
2. The worker appealed.
3. In summary, the appellant submitted that the Medical Assessor made his assessments that MMI had not been reached on the basis of incorrect criteria and/or made demonstrable errors in so doing because he did not give adequate or any reasons for so doing.
4. In summary it was submitted that the Medical Assessor did not provide an adequate path of reasoning for his finding that MMI had not been reached.
5. In summary, the employer the Secretary, Department of Communities & Justice (respondent) submitted that the Medical Assessor neither erred nor made an assessment on the basis of incorrect criteria and the MAC should be confirmed. Essentially it was submitted that the MAC was adequately reasoned when read as a whole and the finding that MMI had not been reached was open to the Medical Assessor applying his clinical expertise to the assessment.
6. 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.
7. 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. The Appeal Panel considered that the path of reasoning was inadequate, and it was not clearly discernible from the reasons given why he considered that MMI had not been reached.
8. In these circumstances of the above finding of error, the Appeal Panel considered that a re-examination by a Medical Assessor member of the Appeal Panel was necessary. Medical Assessor Nicholas Glozier was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):

Secretary, Department of Communities and Justice (Corrective Services)

[BZY] was assessed via the Teams platform on 12 November 2025. There were no technical difficulties and she was sitting in the back of a car.

1. The worker's medical history, where it differs from that in the Medical Certificate

1. Additional history since the original Medical Assessment Certificate was performed

[BZY] reported significant psychosocial stressors, treatment, hospitalisation and changes in her life since the Certificate in May 2025. She reported that very soon after the assessment by the Medical Assessor she developed significant suicidal ideation and 'tried to kill myself.' She could not describe much more about the circumstances, e.g. whether there were any other specific additional stressors at that time or any other contextual factors. She said that she cut her wrists and was found in the shower by her younger daughter. She showed me her wrists but said that she tattoos over any scar. There were no observable longitudinal scars and she did not cause any arterial damage. She could not recall whether there was any overdose or other means of self-harm at that time. As the police were called as part of the emergency service response, her partner initially stayed away (the context of this became apparent over the assessment) however she said her ex-partner, the father of the two girls, came and took the children to live with him. She recalls being admitted to the psychiatric unit in Maitland for a few days. She said there was no change to her medication or other treatment but she was followed up by the Community Mental Health Team briefly. She said she carried on seeing her GP and her previous psychologist.

Although difficult due to [BZY] wariness with specific details, and compounded by what appears to her having been really quite unwell, alongside marked stressors, I could elicit only the following over the winter. She said that really all she was trying to do was 'breathe, take each day as it came.' She said that she was prevented from seeing her daughters, aged 18 and 12, by their father. She said during the month when their father works away, they went to stay with her mother, and she would drive to Wallsend and see them. She would not stay overnight and would drive back. She reported that her ex-husband claimed there was FACS involvement but there was not.

Over 2025 she has developed a new partnership. Although she would not reveal the person's name and was quite reticent to give any of her details, I was left with the impression that this was the man, 'Ben,' in the last Medical Assessment Certificate. She said there were difficulties because he had previously been an inmate. As a result this led to further abuse by her ex-Corrections colleagues because consorting with ex-inmates was 'frowned upon'. She said her ex-partner described her behaviour as 'putrid,' compounding his view that she should not be allowed to have the children.

There were also difficult altercations with her new partner's family including aggressive threats on her doorstep - that led to her having to call the police - and take out an AVO.

She also crashed her car into a telegraph pole outside her home and the police attended this. She denied any intoxication, charges, and she still obviously has her licence.

These interactions with the police further compounded her views that 'everyone was against her/talking about her.' She said that everyone knew where she was, she was watched, there were footprints in the backyard where people had been in, and that this was linked with her previous Corrections' colleagues. She knows this 'seemed somewhat silly' and no-one believed her, even though she called the police. Others ex-colleagues reached out to her saying that they needed to talk about her consorting with this new man but she found this threatening and coercive.

These stressors led to further deterioration in her mental health such that she asked her father to take her to the psychiatric hospital in Maitland in early September. Initially they were not going to admit her but she self-harmed in the Emergency Department.

She was admitted for approximately a week (from her self-report), being discharged on new medication of Olanzapine 5mg and Mirtazapine 5mg. She was placed in contact with a non-NDIS psychosocial support network (Hunter Primary Care) and referred to a new psychologist whom she is due to see for a different treatment approach.

These new medications have improved her sleep and appetite, reduced her anxiety. She says she continues to improve and is seeing how things will change, knowing that she has to give these more time.

She has only been out of hospital for a month or so. She was discharged back to home but had already made the decision to move away from this very threatening environment. By this stage her new partner had been incarcerated. She would not tell me what for or why, although he is in gaol in the mid-north coast. As a result of her very difficult psychosocial context, she arranged to move further north to go and live near her cousin, Danny, in Buladelah. She has only been there a couple of weeks now. She arranged a van, packed, Danny came to help her and the two of them drove the truck up with much of her furniture. Over the past few weeks she has been setting up her new home, although says it is 'not completely there yet' but several of the rooms are there, e.g. lounge, TV, bedroom but it is 'liveable.'

The only people she knows there are Danny, and a new friend, Noeline. On several occasions she used the word 'carer' throughout the interview and it was difficult to identify who she was referring to as she does not appear to have anyone who is actually a carer. It transpired that she uses this word to describe people who might provide any form of support e.g. her ex-partner and now Noeline whom she has only met over the past couple of weeks, in whose car she was today. None of these people live with her or provide what would normally constitute the role of a 'carer.'

She lives her own and does most of the housework although slowly. She can prepare her own meals although these generally are basic e.g. preparing sandwiches/cereals or chops. She shops in the local IGA every few days. Her weight is currently 66kg and she is 164cm: a normal range of BMI of 24. She makes sure she eats fruit and vegetables and her diet is not particularly unhealthy. She feels much safer in the new context and particularly in her home, preferring to keep herself to herself.

She goes to bed remarkably early, e.g. 7pm or 8pm. It might be later if she is playing Mahjong on her phone. Unsurprisingly she does not fall asleep for several hours, until 10pm or 11pm. She tosses and turns, waking around 6am or 7am. As such she actually achieves a normal sleep duration although this is somewhat broken and has a poor sleep efficiency, going to bed too early.

In the morning she says she makes herself coffee, wonders what to do with the day, will do some basic chores, and continue to unpack. She has established some new indoor plants, e.g. petunia, sage, noting that she 'liked purple plants'. She will do some drawing with charcoals or painting, as well as diamond-dot which she finds somewhat mindful. She reports no physical activity, does not walk her dog but continues to care for her snakes. She and Noeline were attempting to 'go out for the day' today. She uses her phone for phone-banking/emails, says she does not have a computer and that her TV 'barely works.'

She says she has not drunk any alcohol since arriving in Bulahdelah. She vapes regularly and intermittently uses cannabis.

She has visited her partner once in mid-north coast gaol, driving down there. She does appear to be able to drive as and where she needs, although can be anxious when doing so and prefers to be at home.

She says she likes to listen to music and plays it - 'almost dancing' - while she is doing her housework.

Her moods have improved since her hospitalisation and continues to do so now she has moved. She is aware that the medication and therapy 'won't cure what's happened' and that she needs to 'move on.' She is somewhat future-focused, knowing that she needs to find something to do, but is unclear what. She does not feel guilty about what happened and is resentful of the events at Corrective Services, knowing that she is 'not guilty of anything bad.' However it has left her feeling worthless, never good enough, with significant negative cognitions, low self-confidence and doubt. She has lost some interest, but not complete lack of joy. She misses her children and this compounds her low moods, and is aware that they almost certainly would not want to come and live where she is, particularly now her eldest daughter is working. She has a normal sleep duration but poor sleep efficiency. She finds herself frequently thinking and ruminating about the events at work

[BZY] was casually-dressed, sitting in the back of a car with the 'blur' on behind her. She is heavily-tattooed with some that were clearly professional and others on her arms that appear more home-made which she stated. She was apprehensive, wary, guarded and it was very difficult to extract specific details. She requested that much of what she told me would not be made public and we agreed that I would ask for the entirety of the Panel's Certificate to be redacted or potentially have her name protected. She continues to experience both cardinal features of depression, with a significant number of associated features, a high level of safety behaviours, rumination, frequent thoughts of multiple adverse experiences over her life, in particular the events at Corrective Services and also those more recently in her psychosocial context associated with her partner and loss of children. She can be highly aroused, hypervigilant, but says that many of her symptoms are slowly improving. She knows she needs to call and engage with the psychologist she has been referred to and stated that she is 'a decent person and good worker deep-down.'

She sees herself as having established herself in this new locale with a new life, and when her partner is released potentially moving on.

1. Results of any additional investigations since the original Medical Assessment Certificate

[BZY]continues to meet the diagnostic criteria for a Major Depressive Disorder although it has improved somewhat and is continuing to improve. She would probably also meet the criteria for a complex Posttraumatic Stress Disorder.

She reported no physical health problems although intermittent cannabis use.

Her treatment has been radically changed with two short admissions since the Medical Assessment Certificate and the latest changes only put in place approximately a month ago. She reports that she is improving, looking to engage with a new psychologist and establish a new life following her relocation and the multiple adverse experiences over the past few months since the last Certificate.

[BZY] cannot be considered as having reached maximum medical improvement. The new medication is still continuing to improve her symptoms, enhanced by leaving a threatening environment, a new psychologist impending, and she is awaiting her partner's release from gaol, all of which will very likely lead to a potential change in her whole person impairment by 3% or quite possibly more in the near future.

As such, although this is for different reasons, and I agree with the appellant that it was unclear what the reasons were from the MA, I would suggest that we confirm the Certificate - i.e. that the degree of permanent impairment is not fully ascertainable."

1. The Appeal Panel considers that the examination undertaken by Medical Assessor Nicholas Glozier was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Nicholas Glozier has provided in his report to the Appeal Panel. The Appeal Panel notes that Medical Assessor Nicholas Glozier had clear regard to the other evidence before him, has not relied on self -report alone and has used his clinical expertise on the day of assessment to make recommendations to the Appeal Panel that MMI has not been reached. The Appeal Panel notes Medical Assessor Nicholas Glozier's findings on clinical examination of the appellant and his diagnosis made after clinical examination of the appellant, namely, [BZY]continues to meet the diagnostic criteria for a major depressive disorder although it has improved somewhat and is continuing to improve. She would probably also meet the criteria for a complex post-traumatic stress disorder. The Appeal Panel agrees with and adopts the findings of Medical Assessor Nicholas Glozier.
2. The Appeal Panel agrees with and adopts the findings of Medical Assessor Glozier on re-examination as follows:

"Her treatment has been radically changed with two short admissions since the Medical Assessment Certificate and the latest changes only put in place approximately a month ago. She reports that she is improving, looking to engage with a new psychologist and establish a new life following her relocation and the multiple adverse experiences over the past few months since the last Certificate.

[BZY] cannot be considered as having reached maximum medical improvement. The new medication is still continuing to improve her symptoms, enhanced by leaving a threatening environment, a new psychologist impending, and she is awaiting her partner's release from gaol, all of which will very likely lead to a potential change in her whole person impairment by 3% or quite possibly more in the near future.

As such, although this is for different reasons, and I agree with the appellant that it was unclear what the reasons were from the MA, I would suggest that we confirm the Certificate - i.e. that the degree of permanent impairment is not fully ascertainable."

1. The Appeal Panel finds that the degree of permanent impairment is not fully ascertainable as a result of injury on 7 January 2021 and as such the Appeal Panel will confirm the MAC.
2. For these reasons, the Appeal Panel has determined that the MAC issued on

8 May 2025 should be confirmed. 3. The Appeal Panel has considered the request made by the appellant worker directly to Medical Assessor Glozier who conducted the re-examination that the decision be de-identified. The Appeal Panel makes the following orders in this regard. 4. These reasons contain sensitive personal information. Having weighed the matters referred to in r 132(4) of the Rules, including the safety, health and wellbeing of the appellant worker, and whether the public interest in giving the direction significantly outweighs the public interest in open justice, the Appeal Panel is satisfied that its decision should be de-identified before it is published. 5. The Appeal Panel directs that, pursuant to r 132 of the Rules, the decision be de-identified.