1. On 19 December 2025 Giancarlo Crino lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Clayton Smith, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 21 November 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 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. As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because although one was requested, we consider that we have sufficient evidence before us to enable us to determine this appeal for reasons that will be addressed in due course.

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 submits that the Medical Assessor erred in his assessments under two categories of the psychiatric impairment rating scale (PIRS), namely social functioning and employability.
3. In reply, the respondent submits that no errors were made.

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 appellant was referred to the Medical Assessor for assessment of whole person impairment (WPI) in respect of a primary psychological injury on a date of injury of

17 November 2023. 4. The Medical Assessor obtained the following history:

"Mr Crino is a 38-year-old man living alone in Botany, where he has resided for approximately four years, and owns his home with a mortgage. He is currently single, with his last serious relationship lasting approximately 18 months and ending five years ago. He has no children. He is not currently working and receives workers' compensation benefits. He was employed as a site foreman by AW Edwards at the time of his injury, having worked there for approximately three years starting in 2022.

He reported experiencing workplace conflict and harassment during 2023 including alleged belittling, critical behaviour and racially derogatory remarks from his project manager. He reported that safety concerns were dismissed. He described a breach of privacy when his personal mental health information was circulated within the workplace without his consent. This occurred in the context of multiple personal stressors, including the death of a friend from an overdose in August 2023, his mother's cancer diagnosis in October 2023 and contact from an ex-partner. These events led to a relapse of substance use after three years of sobriety. His last day at work was 10 November 2023, following which he was unable to return due to psychological deterioration.

He was admitted to Gordon Private Hospital from 28 November 2023 to 10 December 2023 under Dr Artin Jebejian for worsening depression and anxiety in the context of substance use. He had another brief admission to Prince of Wales Hospital, Randwick, in early 2025 following a cocaine relapse and psychotic episode. He has been seeing a psychologist since August 2023, initially weekly and now fortnightly. He completed six months of EMDR therapy with Dawn Russell in early 2024. He continues to see Dr Jebejian quarterly for medication management. He has engaged in DBT programs and neurofeedback therapy with a psychologist. He has received biofeedback therapy."

"He takes agomelatine 50 mg and gabapentin 100 mg three times a day when anxious. He is prescribed clonidine 50 mcg daily for attention deficit hyperactivity disorder and lamotrigine 100 mg as a mood stabiliser. He is prescribed CBD and THC oil. He is seeing a psychologist every two weeks. He is seeing his psychiatrist quarterly for medication reviews."

1. The Medical Assessor then noted present symptoms as follows:

"Mr Crino reported ongoing instability of mood, with fluctuations that are typically anxiety-driven and highly responsive to stressors. His anxiety presents with hypervigilance in social situations, heightened anxiety in crowds, and a persistent fear of being judged. He shops at off-peak times and wears a hat and sunglasses to avoid interaction. He also describes periods of paranoid thinking, characterised by concerns that people known to him are speaking negatively about him. He denied any current hallucinations, thought broadcasting, ideas of reference or other psychotic phenomena. He denied panic attacks.

He described low motivation, 'heaviness', lack of initiative, and feelings of guilt and shame in relation to his circumstances. He ruminates about perceived failures, financial difficulties, and his inability to work. He reported recurring thoughts about death and a reduced sense of life's value. He denied active suicidal intent.

He reported difficulties with motivation. He experiences guilt and shame about his current state. He ruminates about his perceived failures and inability to work. He reported frequent thoughts about death and diminished value for life. He denied active suicidal thoughts.

His sleep had been inconsistent. Some nights he sleeps adequately, while on others he experiences difficulty falling asleep or frequent awakenings. He stated that he used prescribed cannabis to assist with sleep. He is tired during the day. His appetite had been reduced, and he has lost weight.

He reported that health anxiety has emerged as a new symptom, leading to recent investigations for chest pain and bowel changes with normal results. He described obsessive thinking about potential illnesses despite medical reassurance.

He described hypomanic periods lasting four to five days, involving racing thoughts, increased spending, multiple concurrent projects and irritability. He recalled a longer episode following an Easter family gathering, during which a conversation with his brother led to several days of reduced sleep and accelerated thinking. He is tired during the day. He naps during the day at times. His appetite is low and he has lost 8 kg. He said he does not enjoy food. His mood is irritable at times."

1. When asked to provide "Details of any previous or subsequent accidents, injuries or condition" the Medical Assessor said:

"His primary school history was notable for academic difficulties, oppositional defiant behaviour, poor focus requiring special education class placement and school suspensions for behavioural issues. He had no formal mental health treatment during his primary or high school years. His early environment was shaped by stress associated with his father's serious medical illness. He witnessed his father's decline from around the age of 10 and again during late adolescence, losing his father at the age of 18. His first psychiatric contact occurred at the age of 22, reportedly for anger management. Unresolved grief relating to his father's death was referenced in the intake documentation from Gordon Hospital. He saw a psychologist through Beyond Blue for six sessions under a Medicare plan. He described his treatment engagement as superficial due to a lack of understanding about the therapy process.

In his twenties, he reported taking antidepressants intermittently during this period in response to anger, irritability and mood instability and engaged in psychological treatment for anger management during a period of workplace stress. He developed a pattern of cocaine dependence in his late twenties and early thirties, accompanied by problematic alcohol use. He experienced several episodes of cocaine-induced psychosis requiring brief crisis hospital admissions under the Mental Health Act. He claimed to have achieved a period of relative abstinence for approximately three years until his relapse in 2023.

Psychiatric records from Gordon Private Hospital listed pre-existing conditions, including bipolar 2 disorder, ADHD, autism spectrum disorder, and generalised anxiety disorder, in addition to a history of cocaine dependency and past psychosis.

In his statement dated 21/8/25, he writes: 'I have suffered from depression for in excess of 5 years and would have started experiencing anxiety after being laid off from Lend Lease when the Covid-19 pandemic began.'

His substance use re-emerged during 2023 in the context of the overdose death of a friend and his mother's cancer diagnosis, failed bitcoin investments and contact with a former partner. These events preceded his psychological deterioration in the workplace and are documented as contributing factors in his presentation.

He had depressive episodes documented since age 20 with periods of hypomania. Substance use began recreationally at age 16, primarily cocaine, and escalated in his late twenties. He had several brief admissions to the Royal North Shore Hospital in his early thirties for drug-induced psychosis requiring sedation and stabilisation. He attempted antidepressant therapy in his early thirties through his GP, but discontinued due to sexual side effects. He has never attended formal drug and alcohol rehabilitation.

The family history includes an older brother with OCD and substance use, with a history of alcohol abuse in his extended family.

According to the allied health treatment request dated 5 March 2025, before the injury he was working full-time as a site supervisor undertaking long hours and managed a range of supervisory and administrative responsibilities and maintained a structured routine including daily showering, weekly grocery shopping, ordering premade meals for the week on Sundays, cleaning and laundry undertaken regularly and consistently, daily driving for work and personal tasks, car cleaning monthly, intensive physical activity, gym five to six days per week, regular beach walks with his dog and weekly family contact and intermittent social outings with friends."

1. The Medical Assessor then set out details of the impact of his injury on his social activities and activities of daily living (ADL's) as follows:

"He described a heaviness that stops him from doing things, with a lack of motivation, inertia, and a loss of initiative, so he has to push himself to get things done or avoids doing them.

He cleans his house and does the washing. He cooks and prepares meals. He occasionally skips brushing his teeth or tidying the house. His mother helps with housework from time to time.

He said his shower frequency varies. He makes sure he showers for appointments but may go several days without showering when his mood is low. He changes his clothes daily but struggles with regular laundry. He replaces his bedsheets about once a month. He keeps up basic grooming like shaving his head and trimming his beard for appointments. He can cook simple meals but often lacks motivation, leading him to resort to takeaway despite financial constraints. His mother visits occasionally with food. He can manage his medications on his own.

His social circle has contracted to two friends; one in Willoughby, whom he speaks to daily on the phone, and another in Malabar, who attempts to engage him by taking him to the beach. He declines most social invitations. He avoids his extended family due to conflict. His mother calls daily, and they meet in person about once a month. He attempted to attend weekly family dinners with his cousins for three months, but withdrew because the family dynamics were overwhelming. He has refused invitations to attend the local CrossFit Gym despite encouragement from his neighbours. He has had no romantic relationships since a casual relationship in early 2024, which he terminated due to perceived toxicity. He avoids construction industry contacts entirely.

His routine is to get up, take his dog for a walk, and buy a takeaway coffee. He tries to eat at home to keep healthy and attends the gym three times per week. He said he prefers to stick to activities close by. He avoids driving to Chatswood to see his mother. He meditates and listens to music. He said he is reading Atomic Habits, noting that after 10 minutes, his mind becomes distracted. He attempts to meditate but has difficulty with racing thoughts. He sets multiple alarms to ensure he attends appointments. He has difficulty absorbing information and cannot read for more than 10 minutes.

He drives and owns a car. He mostly drives from Botany to Bondi to see his psychologist, to Maroubra Junction to go to the gym, or to Newtown to eat out. He avoids going to the North Shore and is avoiding his brothers, who have been concerned that his behaviour impacted their reputation in the industry, and were unhappy that his mother had to lend him money. He noted that his brothers live two streets away from his mother. He talks to a friend in Willoughby and Malabar most days. He said he feels judged in large groups.

He said his friends try to take him out every 3 to 6 months, for example, for dinner at a restaurant. He said he can get dressed up and usually manages to go to a bar with his friends and be home by 9:30 pm.

He worries about his capacity to control his emotions should he return to work, noting that he has a temper, is emotionally labile, and is concerned about his reliability. He said he cannot contemplate returning to the construction industry due to his emotional fragility. He reported being overwhelmed by basic social interactions and a heightened sensitivity to perceived criticism."

1. Findings on examination were reported as follows:

"Mr Crino was a heavyset man with tattoos on his legs, a freshly shaved head, and a clipped beard. He was pleasant and cooperative, though anxious and tearful at times. He engaged well and was unguarded in the interview. He described his mood as anxious and variable with a labile affect. He became emotional when discussing his perceived failures. His thought content revealed themes of shame, guilt and worthlessness, particularly regarding his inability to work and maintain relationships. He expressed thoughts about death without active suicidal thoughts or plans. There was no evidence of psychotic symptoms. He described interpersonal sensitivity verging on paranoid thoughts. He was alert and oriented with no overt cognitive deficits. Cognition was not formally assessed. His insight and judgment were intact, though he was overly self-reliant and confident regarding his abstinence from substances."

1. The Medical Assessor then summarised the injuries and diagnoses as follows:

"Mr Crino is a 38-year-old man with a complex psychiatric history, including bipolar 2 disorder, possible Cluster B personality traits and a background of significant substance misuse, particularly cocaine dependence and episodes of drug-induced psychosis. While his deterioration occurred in the context of the workplace, I note the impact of multiple personal stressors, including bereavement and family illness.

He has a long history of chronic mood disturbance, impaired coping mechanisms, emotional dysregulation, cognitive and interpersonal vulnerabilities linked to his pre-existing diagnoses and reliance on substances as a coping method. He was actively symptomatic at the time of the workplace injury. Mr Crino had pre-existing psychiatric conditions and personality vulnerabilities, leaving him highly susceptible to psychological destabilisation when exposed to perceived and actual workplace stressors.

He meets DSM-5 criteria for bipolar 2 disorder with at least one hypomanic episode and major depressive episodes causing clinically significant distress or impairment, periods of elevated or irritable mood, increased energy, reduced need for sleep, impulsivity, pressured behaviour and increased goal-directed activity in addition to criteria for major depressive episodes including persistently low mood, anhedonia, sleep disturbance, reduced energy, impaired concentration, hopelessness, social withdrawal and diminished function.

He does not meet the criteria for post-traumatic stress disorder in the absence of a

Criterion A stressor. He described experiencing trauma in relation to his father's illness and death.

He meets criteria for ADHD with evidence of enduring inattention and hyperactive or impulsive symptoms since childhood, with difficulties with distractibility and sustained

attention, disorganisation, forgetfulness, difficulty completing tasks, emotional impulsivity and functional impacts at work and in relationships.

I defer any diagnosis of autistic spectrum disorder based on the limited information provided. He has Cluster B personality vulnerabilities, including emotional instability, fear of rejection, interpersonal sensitivity, mistrust and hypervigilance, difficulties maintaining stable relationships and identity instability.

He meets DSM-5-TR criteria for a moderate-to-severe stimulant use disorder currently in remission with a history of cocaine dependence, multiple substance-induced psychotic episodes, impaired functioning and hospital presentations and periods of abstinence with subsequent relapse."

1. The Medical Assessor assessed 8% WPI from which he deducted 2/10ths in respect of the pre-existing condition.
2. He then set out a summary of the material he had before him which we do not intend to repeat here but will refer to that material where relevant in our discussion below.

1. As regards the category of social functioning, the appellant submits:

(a) The Medical Assessor conducted an examination and recorded the following relevant information in respect of social functioning at page 5 of the MAC:

"His social circle has contracted to two friends; one in Willoughby, whom he speaks to daily on the phone, and another in Malabar, who attempts to engage him by taking him to the beach. He declines most social invitations. He avoids his extended family due to conflict. His mother calls daily, and they meet in person about once a month. He attempted to attend weekly family dinners with his cousins for three months, but withdrew because the family dynamics were overwhelming. He has refused invitation to attend the local CrossFit Gym despite encouragement from his neighbours. He has had no romantic relationships since a casual relationship in early 2024, which he terminated due to perceived toxicity. He avoids construction industry contacts entirely."

(b) The Medical Assessor incorrectly assigned Class 2 for this category.

(c) The evidence recorded by the Medical Assessor is more consistent with Class 3 - moderate impairment.

(d) The other matters referred to by the Medical Assessor in respect of refusing most social invitations including attending CrossFit are irrelevant considerations for this category but are relevant to the category of social and recreational activities. Referring to those activities in the context of social functioning constitutes an error.

(e) The purpose of this PIRS category is to assess the impact of the injury on the appellant's personal relationships, whether he has been able to maintain them and the degree of regularity of seeing a friend or friends. It is clear from the recorded evidence that he has lost many, if not most, friendships/relationships because of the effects of the injury and, although his mother has continued to support him by checking in and helping him domestically, he can no longer see any of his former co-workers and does not see them, in fact purposely avoiding them. The fact that his mother and two of his friends continue to support him is not determinative of a capacity to maintain personal relationships and representative of a mild impairment.

(f) It is notable that at page 4 of the MAC, the Medical Assessor recorded the appellant's functioning prior to his injury, stating he attended the gym five to six days per week, had weekly family contact and intermittent social outings with friends. He was clearly maintaining his personal relationships prior to the injury but following the work injury, it is clear that he has lost most of his former friendships and attempting to engage with family members is overwhelming and he cannot do it. The evidence is that he has withdrawn from other family members. The impact is clearly significant, and it cannot be said that the impairment resulting from the injury is mild.

(g) The Medical Assessor assigned Class 4 to the PIRS category of employability, explaining that: "He cannot work more than one or two days at a time, less than twenty hours per fortnight. He cannot work at all in the same position. Pace is likely to be reduced, and attendance erratic."

(h) There is no evidence to support this conclusion, and if there were, it has not been recorded in the SOR.

(i) A careful review of the evidence recorded by the Medical Assessor in the MAC demonstrates that the appellant would have difficulty working at all.

(j) Under the heading "Present Symptoms" at page 2 of the MAC the Medical Assessor recorded that:

"Mr Crino reported ongoing instability of mood, with fluctuations that are typically driven and highly responsive to stressors. His anxiety presents with hypervigilance in social situations, heightened anxiety in crowds, and a persistent fear of being judged. He shops at off-peak times and wears a hat and sunglasses to avoid interaction. He also describes periods of paranoid thinking, characterised by concerns that people known to him are speaking negatively about him."

(k) Further evidence recorded by the Medical Assessor is:

(i) he has to push himself to get things done or avoids doing them;

(ii) his shower frequency varies and he can go several days without showering when his mood is low;

(iii) he has difficulty with racing thoughts;

(iv) he sets multiple alarms to ensure he attends appointments;

(v) he has difficulty absorbing information and cannot read for more than 10 minutes;

(vi) he worries about his capacity to control his emotions should he return to work noting he has a temper and is emotionally labile;

(vii) he is concerned about his reliability;

(viii) he is overwhelmed by basic social interactions;

(ix) he has a heightened sensitivity to perceived criticism;

(x) his mood is unstable and with fluctuating anxiety;

(xi) he has heightened anxiety in crowds;

(xii) he has a persistent fear of being judged;

(xiii) he wears sunglasses and a hat to avoid interaction;

(xiv) he has inconsistent sleep and used prescribed cannabis to assist with sleeping;

(xv) he naps during the days at times, and

(xvi) he experiences hypomanic episodes which can last for days.

(l) None of these matters appear to have been considered by the Medical Assessor when assessing employability, and the Medical Assessor appears to have failed to consider the requirements of attending employment and retaining employment.

(m) The employability scale looks to an injured worker's ability to work in the real world. Working in the real world requires an ability to interact with other people, participate in an environment that requires compliance with directions, cooperate with co-workers, maintaining a routine, be accountable, be subject to the prospect of discipline, and being subordinate to others. None of these matters have been considered or given due regard. It is clear that the appellant struggles with keeping appointments, being on time, interacting with others, regulating his emotions, dealing with his anxiety, and his need to sleep during the day would impact his ability to maintain concentration and follow directions.

(n) The explanation provided by the Medical Assessor in Table 11.8 is not supported by the evidence recorded by the Medical Assessor.

(o) The Medical Assessor has not exposed his process of reasoning as he is required to do and he has not even provided any reasons.

(p) Dr Kumagaya considered that Class 5 was appropriate because, in his opinion, the appellant could not realistically work at all.

1. As indicated earlier, the respondent submits that no errors were made.
2. Turning firstly to the category of Social functioning, the Medical Assessor assessed a Class 2 rating and said:

"His social circle has contracted to two friends; one in Willoughby, whom he speaks to daily on the phone, and another in Malabar, who attempts to engage him by taking him to the beach. He declines most social invitations. He avoids his extended family due to conflict. His mother calls daily, and they meet in person about once a month. He attempted to attend weekly family dinners with his cousins for three months, but withdrew because the family dynamics were overwhelming. He has refused invitations to attend the local CrossFit Gym despite encouragement from his neighbours. He has had no romantic relationships since a casual relationship in early 2024, which he terminated due to perceived toxicity. He avoids construction industry contacts entirely."

1. The descriptor for a Class 2 rating reads: "Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships."
2. For a Class 3 it reads: "Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children."
3. We agree with the appellant that some of the matters referred to by the Medical Assessor were not relevant to this category.
4. Having said that, the appellant clearly has daily contact with his mother.
5. He also clearly has a good relationship with his neighbours who contact him to suggest various outings.
6. His attempts to have weekly family dinners with his family he ceased due to "the family dynamics" which does not suggest that this was due to his psychological condition.
7. We also note that in the general practitioner's notes in February 2025 there is a reference to him receiving "good support" from his girlfriend, and enjoying going to church.
8. Despite the appellant's urging of a Class 3 rating in this category, there is simply no evidence of separation from his mother in particular nor his other friends and neighbours, nor of any domestic violence.
9. In our view, the Medical Assessor's assessment was consistent with the evidence and we see no error.
10. Turning next to the category of Employability, the Medical Assessor assessed a Class 4 rating and said:

"He cannot work more than one or two days at a time, less than twenty hours per fortnight. He cannot work at all in the same position. Pace is likely to be reduced, and attendance erratic."

1. In this instance, we agree with the appellant.
2. The Medical Assessor seems to have simply noted the descriptor for a Class 4 rating without any analysis of the evidence or explanation.
3. As the appellant pointed out in paragraph (k) of his submissions above, his symptoms such as difficulty with racing thoughts, his temper, his unreliability, his difficulty with basic social interactions and unstable mood with fluctuating anxiety would all impede his ability to function in a workplace.
4. We also agree with the appellant's submission that:

"Working in the real world requires an ability to interact with other people, participate in an environment that requires compliance with directions, cooperate with co-workers, maintaining a routine, be accountable, be subject to the prospect of discipline, and being subordinate to others."

1. For these reasons we agree that a Class 5 rating in this category is consistent with all the evidence.
2. We did not consider that it was necessary to re-examine Mr Crino because the evidence before us was extensive and sufficient for us to determine this appeal.
3. The appellant did not challenge the assessments in any other PIRS category nor the 2/10ths deduction pursuant to s 323 made by the Medical Assessor.
4. This means that the aggregate score is as follows: 2, 2, 2, 2, 3, 5 = 16, median of 2, and a WPI of 9%.
5. After the s 323 deduction of 2/10ths, the final WPI is 7%.
6. For these reasons, the Appeal Panel has determined that the MAC issued on

21 November 2025 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 Clayton Smith and issues this new Medical Assessment Certificate as to the matters set out in the Table 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)