1. On 11 September 2025 Andrew Creagh, the appellant, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Christopher Canaris, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 2 September 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 ground(s) 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. The appellant worked for Komatsu Australia Pty Ltd in a managerial position. Due to incidents that occurred in his employment he suffered a psychological injury.
2. The appellant claimed compensation from the respondent's insurer for a permanent impairment he said he had resulting from his injury. He relied on a report of psychiatrist Dr Elsa Yeung dated 13 May 2024 that his solicitors obtained and who had examined the appellant on 19 May 2023 and 13 May 2024. In her report she advised she assessed the degree of the appellant's permanent impairment from his injury is 17% whole person impairment (WPI).
3. Dr Yeung noted in her report that the appellant was then taking Escitalopram 10mg daily. She noted that this medication had been increased previously from 10mg daily to 20mg, but was lowered to 10mg daily after the appellant suffered side effects from it. Dr Yeung also noted that the appellant was seeing a psychologist on a monthly basis. She noted that he had never been referred to a psychiatrist. Dr Yeung noted that the appellant had increased his alcohol use since September 2023 and that he was drinking five to six beers a night. Dr Yeung advised in her report that the appellant was not keen to change his psychotropic medication and was ambivalent about addressing his alcohol use. Dr Yeung advised that as the appellant was not motivated to seek treatment, she considered that the appellant was "fit for the purposes of assessing the permanent impairment". In other words, Dr Yeung was satisfied that the appellant's permanent impairment was fully ascertainable. She also said however that if the appellant were to change his mind and accept potential modification of his psychotropic medication and see a psychiatrist to address his alcohol use then his condition would likely improve.
4. The respondent's insurer declined the appellant's claim, relying on a report of psychiatrist Dr Peter Young dated 15 October 2024. Dr Young had consulted with the appellant on 11 October 2024 in order to produce that report. Dr Young had previously consulted with the appellant, at the request of the respondent's insurer, on 16 February 2023, and produced reports dated 24 February 2023, 3 March 2023 and 18 October 2023 relating to that earlier consultation.
5. In his report of 15 October 2024 Dr Young recorded that the appellant was taking psychotropic medication of Escitalopram 10mg daily and that since his prior consultation the appellant's alcohol consumption had increased substantially such that he was drinking between 8 and 12 standard drinks a day. Dr Young noted that the appellant was reluctant to increase the dosage of Escitalopram because of potential adverse side effects. Dr Young noted that the appellant had not been referred to a psychiatrist. Dr Young noted that the appellant's psychological therapy had generally been appropriate, but he also expressed his view that the appellant had not reached maximum medical approval because he was willing to participate in further treatment that was likely to be effective.
6. Dr Young undertook an evaluation of the appellant's impairment in the several categories comprising the Permanent Impairment Rating Scale (PIRS), his ratings being Class 2 for self-care and personal hygiene, Class 2 for social and recreational activities, Class 1 for travel, Class 2 for social functioning, Class 2 for concentration, persistence and pace (CPP), Class 4 for adaptation. The Appeal Panel observes that would convert to 7% WPI in accordance with paragraph 11.20 of the Guidelines.
7. There being medical disputes between the parties relating to whether the appellant's impairment is permanent, whether the degree of his permanent impairment is fully ascertainable and the degree of his permanent impairment, the appellant initiated proceedings in the Personal Injury Commission (Commission), seeking the Commission determine his claim for compensation for permanent impairment.
8. The matter was referred to the Medical Assessor on 7 August 2025. In the MAC the Medical Assessor issued on 2 September 2025 he answered "yes" in response to a question "have all body parts/systems reached maximum medical improvement?", which is a standard question in the form approved for a medical assessment certificate. By that answer, the Medical Assessor was expressing his conclusion that the appellant's impairment from his injury is permanent and that it is fully ascertainable.
9. The Medical Assessor further certified that he assessed the degree of the appellant's permanent impairment from his injury is 9% WPI. His ratings of the appellant's impairment in the several PIRS categories were Class 2 for self-care and personal hygiene, Class 2 for social and recreational activities, Class 2 for travel, Class 2 for social functioning, Class 2 for CPP and Class 5 for employability.
10. In his appeal against the medical assessment the appellant has raised issues with respect to the Medical Assessor's ratings of his impairment in social and recreational activities and in CPP.
11. In the PIRS rating form, forming part of the MAC, the Medical Assessor provided the following reasons for his rating of the appellant's impairment in social and recreational activities:

"He goes out less than before and 'our weekends were pretty much full being empty nesters as they say - there's always something to do'. He would go out with his wife and a few friends 'most Friday nights' to the local RSL club for the raffles. He enjoys the evening as 'they are good close friends' ".

1. Within the body of the MAC the Medical Assessor also observed that Dr Yeung had rated the appellant's impairment in social and recreational activities as Class 3, and noted too that his rating is Class 2. The Medical Assessor noted, by way of explaining the difference in the ratings, that the appellant reported to him that he goes out to a club at least once a week. The Appeal Panel observes that the reasons Dr Yeung provided for her rating of the appellant's impairment in social and recreation activities were that the appellant would only attend social gatherings if prompted by his wife and that he would remain quite and withdrawn during those times.
2. The Medical Assessor provided the following reasons in the PIRS rating form for rating the appellant's impairment as Class 2 in CPP:

"His concentration is 'absolutely hopeless' saying, 'You're part of a conversation and you go to say something and it's just gone'. He 'used to read a fair bit but not so much' and 'I can't get through a chapter...I've got a book that I've had there for a couple of months...it's all about the town I grew up in in New Zealand - I've got to about chapter 3...'. He tends to watch YouTube rather than tv and does not watch the news saying, 'things are bads (sic) enough without getting depressed by that sort of thing - I'd rather watch a car restoration channel or something like'. He has not done any work on his car saying 'I just didn't have the interest any more...'. He did do a little bit of work on a friend's car replacing suspension bushes which was a reasonable straight forward job. He would be able for example to tune an older car but not a modern vehicle which is computerised. He does 'odds and ends' at home 'but not what I used to do' and he has been a (sic) 'doing all out paining and decorating - the desk I'm sitting at the moment, I made it up and fitted it into the spare room - I'm pretty handy with most things - it's just the motivation...'. He would low (sic) the lawns and do outside work 'but I have to kick myself into gear to just do that'. He has most of his bills set up on automatic payments but will make changes on his phone when he has to. He said he 'wouldn't keep an eye on the accounts as much as I should do'."

1. Within the body of the MAC the Medical Assessor observed that Dr Yeung had rated the appellant's permanent impairment in CPP at Class 3. To explain the difference between his rating and that which Dr Yeung made, the Medical Assessor said that "while there is evidence of impairment with lack of motivation, he is able, for example, to make simple repairs on a motor vehicle and complete tasks around the home". The Appeal Panel observes that the reasons Dr Yeung provided for her rating of Class 3 for the appellant's impairment in CPP are:

"His concentration was poor. He cannot read for more than 30 minutes. He would struggle to follow complex instructions such as operation manuals or building plans, or home improvement projects. He requires a list to get things done now."

1. The appellant in his appeal against the medical assessment has also raised an issue relating to whether the Medical Assessor should have, in accordance with paragraph 1.32 of the Guidelines, adjusted the assessment of his permanent impairment from his injury for the effects of treatment. Relevant to that issue the Medical Assessor noted that the appellant currently sees his psychiatrist once every six weeks or so, that he currently takes Escitalopram 20mg daily and Mirtazapine 15mg at night, and that he sees his psychologist every four to six weeks. The Medical Assessor referred to a report of the appellant's treating psychiatrist Dr Tarun Yadav dated 27 May 2025 wherein Dr Yadav advised that he had commenced the appellant on Mirtazapine at night to improve his sleep and mood and that he considered the appellant should continue with Escitalopram 20mg daily but with a plan to taper that once Mirtazapine had been established. The Medical Assessor did not in the MAC explicitly address whether he considered paragraph 1.32 of the Guidelines could be engaged.

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. As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the appellant to undergo a further medical examination. This is because the Appeal Panel came to the view that the appellant had not established the ground for appeal on which he relied, and consequently the Appeal Panel had no reason or power to examine the appellant.[1]

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. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
2. In summary, the appellant referred to evidence he provided in a statement he signed on 11 July is that he only goes out on Friday nights with his wife and brother. The appellant noted that Dr Yeung recorded that he only attends social gatherings if prompted by his wife and will remain quiet and withdrawn. The appellant submitted that there is no suggestion that he goes out alone and that the evidence suggests that when he goes out it is only with his wife and brother.
3. The appellant submitted that the key difference between a Class 2 rating and a Class 3 rating in social and recreational activities is whether a worker can go to social events without a support person as opposed to only going out with a support person.
4. The appellant submitted that the Medical Assessor ought to have rated his impairment in social and recreational activities as Class 3.
5. The appellant noted that in his statement he said he had a considerable decline in his level of concentration and often found himself going to get something but would then forget the reason for doing so or forget what he was getting, and that this happened regularly.
6. The appellant also noted that in his statement he said that he only watches videos on YouTube for an hour before he disengages, and that he finds paperwork difficult to concentrate on and complete. The appellant noted that in his statement he also said that he listens or engages less in conversation and that he struggles to follow conversations as he drifts off and that when he regains focus he is lost in the middle of the conversation.
7. The appellant also noted that in his statement he said that for most instructions he needs them to be written as he is forgetful.
8. The appellant referred to Dr Yeung's reasons for her rating of his impairment in CPP. The appellant submitted that the Medical Assessor, whilst reciting features of his symptomology, did not provide a rationale for the rating he made of his impairment in CPP. The appellant submitted that the Medical Assessor neglected several features relating to his CPP to which he referred to in his statement.
9. The appellant submitted that the main difference between a Class 2 and a Class 3 impairment in CPP is whether a worker has the capacity to concentrate beyond 30 minutes and to follow complex instructions.
10. The appellant submitted the Medical Assessor did not consider paragraph 1.32 of the Guidelines. The appellant submitted that the medications the Medical Assessor recorded he takes are significant and are an important part of his ongoing treatment. The appellant submitted that "a WPI assessment should be made on the basis of the effects of the treatment".
11. In reply, the respondent submitted that the appellant's attendance at social activities in a RSL club is "not occasional", and is regular. The respondent submitted that the appellant's attendance at an RSL club with his wife and brother indicates that he is participating in social and recreational activity with his family and also with his friends. The respondent noted that in the appellant's statement he said that his younger brother, who has a handicap, enjoys the outings at an RSL club. The respondent submitted that that is evidence that the appellant's brother is not a support person. The respondent submitted that the evidence indicates that the appellant participates in his outings at RSL clubs. The respondent submits that the appellant's wife also is not a support person for the appellant.
12. The respondent noted that the appellant had travelled to New Zealand on three occasions to visit and help family and did not require a support person or require prompting to undertake these visits. The respondent noted that the appellant in his statement said: "I continue to try and go out and normalise having a social life as I fear I would otherwise fall into really destructive habits".
13. The respondent submitted that the Medical Assessor's rating of the appellant's impairment in social and recreational activities is consistent with the evidence.
14. The respondent submitted that the activities to which the Medical Assessor referred when explaining his rating of the appellant's impairment in CPP requires a level of concentration commensurate with the responsibility of working on motor vehicle and making it safe to drive. The respondent submitted that the appellant does not work on his car because he has lost interest, rather than because of difficulties with concentration.
15. The respondent submitted that the activities to which the Medical Assessor referred when explaining his rating of the appellant's impairment in CPP "are indicative of a mild impairment as they would require focus for up to 30 minutes".
16. The respondent submitted that the Medical Assessor did consider the effects of treatment. The respondent submitted the Medical Assessor "did not conclude that the medication is impacting the appellant's symptoms or improving them".

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.
3. The examples provided in Table 11.2 of the Guidelines for a Class 2 and Class 3 impairment in social and recreational activities are:

Mild impairment: occasionally goes out to such events e.g. without needing a support person, but does not become actively involved (e.g. dancing, cheering favourite team).

Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.

1. The Appeal Panel does not accept the appellant's submissions to the effect that he requires a support person so as to go out to and enjoy social and recreational activities. The appellant regularly attends an RSL club on a Friday evening with his wife and his handicapped brother. His wife and his brother are the persons with whom he engages in this social and recreational activity. They are not his support persons. The evidence, including the history the Medical Assessor obtained, does not indicate that the appellant's wife and handicapped brother are prompting the appellant in social and recreational activities or supporting him in that. Indeed, the appellant in his statement of evidence at [42] says that he and his wife take his brother to the local RSL club because he does not have opportunity to go out otherwise and that his brother enjoys this activity. What this reveals is that the appellant is prompting and supporting his brother to engage in this activity and support him in it, rather than the reverse.
2. In his statement of evidence, the appellant also revealed that he had taken three trips to New Zealand for two weeks at a time to visit his family. He said that he did that to have a social life and to avoid falling into destructive habits. That also is a social and recreational activity. The appellant in his statement did not indicate that he was prompted by anyone to do that or that he needed support to do that.
3. What the evidence reveals, including the history that the Medical Assessor obtained, and by which he rated the appellant's impairment in social and recreational activities, is that the appellant more than occasionally goes to a social and recreational activity and that he does not need a support person to do that and that he is actively involved in that social and recreational activity. That squarely accords with the seriousness of impairment reflected by the examples in Table 11.2 for a Class 2 impairment. It does not meet a level of seriousness of impairment described by the examples for a Class 3 impairment.
4. Hence, the Appeal Panel finds that the Medical Assessor did not make any error regarding his assessment of the appellant's impairment in social and recreational activities. The Appeal Panel also finds that the Medical Assessor applied the correct criteria to assess the appellant's impairment in social and recreational activities in that he applied the criteria of chapter 11 of the Guidelines.
5. The examples provided in Table 11.5 of the Guidelines for a Class 2 and Class 3 impairment in CPP are:

Mild impairment: can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.

Moderate impairment: unable to read more than newspaper articles. Finds it difficult to follow complex instructions (e.g. operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.

1. The fact that a worker may exhibit conduct according to one or some of the descriptors provided in the Guidelines for a particular class does not compel a Medical Assessor to rate a workers' impairment by reference to that class. The Medical Assessor must evaluate all the material and data before him or her, which includes the clinical history the Medical Assessor has elicited for the purpose of determining the level of impairment the worker has in a particular PIRS category. That history, and the detail otherwise within material before the Medical Assessor, may reveal that a worker exhibits conduct that accords with a specific example provided within a class rating for a particular PIRS category, but when all the evidence relevant to the conduct of the worker falling within that PIRS category is evaluated and weighed, it would not permit a Medical Assessor rating the worker's impairment in that PIRS at that class level containing the example. Ultimately the task of the Medical Assessor is to consider and weigh all conduct of a worker relevant to a PIRS category and exercise their clinical judgement so as to evaluate what the degree of impairment of the worker is in the particular category.[2] That may involve the Medical Assessor give greater weight to the history she or he has obtained over some of the other evidence.
2. It is apparent from the MAC that the Medical Assessor had regard to the appellant's statement evidence. This is apparent because the Medical Assessor said he had reviewed "the documentation" and that he had "noted the worker's statement dated 11 July 2025". Hence the Medical Assessor was aware of what the appellant said therein at [47] and [48] regarding his functioning in CPP.
3. The matters the Medical Assessor took into account to rate the appellant's impairment as mild in CPP are that the appellant lacks motivation, forgets things during conversations, does not read as much as previously and cannot get through a chapter of a book, watches YouTube but not the news, no longer works on his car but has helped his friend do work on his friend's car, is able to tune an older car, is able to do odds and ends around the home (which has included constructing a desk and fitting it into a spare room), and is able to use his phone to change his bill payments but does not keep as much an eye on his accounts as he did in the past.
4. The Appeal Panel considers that those matters encompass the matters that the appellant highlighted in his statement of evidence relating to his function in CPP. Perhaps the only additional matters are that he described in his statement that he often forgets his reasons for going into a room, he finds paperwork difficult to complete, and he prefers instructions to be written rather than verbal. In the Appeal Panel's view those few matters fall within the parameters of the matters the Medical Assessor has described for when evaluating the appellant's impairment in CPP is Class 2.
5. Whilst the appellant may be unable to do some matters that accord with the examples provided in Table 11.5 for a Class 3 impairment, such as being unable to type long documents, the Appeal Panel considers that the Medical Assessor was not wrong to evaluate the appellant's impairment in CPP as correlating with a level of seriousness of impairment that is described by the examples in Class 2. The other matters the Medical Assessor has detailed for his evaluation of the appellant's impairment in CPP accord with the examples provided for a Class 2 impairment. The matters the Medical Assessor has described indicate that the appellant can focus on intellectually demanding tasks for up to 30 minutes, in that the appellant is able to tune an older motor vehicle, has helped his friend work on his friend's vehicle, and has been able to construct a desk and fit it into a room in his house. The appellant can change his bill payments using his phone.
6. In terms of the appellant's reliance on the assessment Dr Yeung made of his impairment in CPP, the Medical Assessor observed that her assessment occurred 15 months earlier than the assessment he undertook. That observation on the part of the Medical Assessor is to the effect that the appellant's impairment in CPP has improved between the time he examined the appellant and the time Dr Yeung examined him. That is a logical explanation.
7. In the Appeal Panel's view the Medical Assessor has exercised his clinical expertise as a psychiatrist to evaluate the appellant's impairment in CPP and the opinion he formed from doing so is valid. The Medical Assessor members of the Appeal Panel come to the same conclusion.
8. Consequently, the Appeal Panel does not discern that the Medical Assessor made an error with respect to his assessment of the appellant's impairment in CPP. Further, the Medical Assessor applied the correct criteria to assess that matter, noting that the Medical Assessor utilised the criteria of chapter 11 of the Guidelines.
9. The Appeal Panel accepts the appellant's submission that the Medical Assessor did not explicitly explain why paragraph 1.32 of the Guidelines did not apply such that a percentage WPI could not be added to his assessment of the appellant's permanent impairment from his injury.
10. Deciding whether paragraph 1.32 of the Guidelines applies requires consideration of three matters:

"1. Whether there has been effective long-term treatment of a workers' illness or injury;

1. Whether, if so, that treatment has result in apparent substantial or total elimination of the workers' permanent impairment;
2. Whether, if so, the worker is likely to revert to the original degree of impairment if treatment is withdrawn."[3]
3. The Appeal Panel considers that paragraph 1.32 cannot apply in the appellant's circumstances for various reasons. The appellant's long-term treatment has not been effective. The appellant has only recently commenced consulting a psychiatrist who is currently in the process of titrating the appellant's psychotropic medication. The evidence does not demonstrate that the treatment that the appellant has received thus far has resulted in an apparent substantial or total elimination of the appellant's permanent impairment. At best, his treatment thus far has only mildly improved the level of his impairment. Further, the appellant has not had enduring consistent treatment over any significant length of time that would lead to remission sufficient for paragraph 1.32 to be engaged.
4. Whilst the Medical Assessor did not explain he did not engage paragraph 1.32, it is to be inferred that he did not do so because it could not be engaged in the appellant's circumstances. Given that, the Appeal Panel does not consider the Medical Assessor made an error by not providing an explanation for why paragraph 1.32 did not apply. But even if the Appeal Panel is wrong with respect to that conclusion, that is that the Medical Assessor did make an error by not explaining why he did not apply paragraph 1.32 of the Guidelines, then the Appeal Panel would correct that error by offering the explanation it just has detailed in the preceding paragraph for why paragraph 1.32 of the Guidelines does not apply in this case and would make no addition of WPI to the appellant's permanent impairment assessed by reference to PIRS.
5. For these reasons, the Appeal Panel has determined that the MAC issued on

[1] New South Wales Police Force v Registrar of the Workers Compensation Commission of New South Wales [2013] NSWSC 1792 at [33]; Finnegan v Komatsu Forklift Australia Pty Ltd [2023] NSWSC 38 at [125]- [130].

[2] Rogers v Help Service Union NSW [2025] NSWSC291 at [43]-[45].

[3] Zoric v Secretary, Department of Education & ORS [2024] NSWSC 131 at [59]; Peachey at [57]; Marks at [29].