State of New South Wales (Ambulance Service of NSW)

WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; appeal from finding that maximum medical improvement not achieved; whether Medical Assessor (MA) failed to consider Chapter 1.16 of the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021 (the Guidelines); whether deduction remarks erroneous; whether adequate reasons given; Held - MA erred in not applying the tests in Chapter 1.16 and 1.17 of the Guidelines; further error in failing to explain his finding in the light of unanimous expert opinion; El Masri v Woolworths Ltd, and Wingfoot Australia Partners Pty Ltd v Kocak applied; deduction remarks irrelevant and not binding; Cole v Wenaline Pty Ltd applied; appellant re-examined by Appeal Panel; Medical Assessment Certificate revoked.

1. On 6 May 2025 the appellant, Eleanor Davy, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Yu Tang Shen, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 17 April 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 Guides) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5). "WPI" is reference to whole person impairment. "Baseline WPI" is a reference to the total WPI assessed before deduction for the effect of pre-existing injury, condition or abnormality pursuant to s 323 of the 1998 Act.

1. On 14 March 2025 this matter was referred to the Medical Assessor for an assessment of psychiatric/psychological disorders caused on a deemed date of 15 July 2023.
2. We note the history taken by the Medical Assessor. He described an incident when, as she was doing some filming for Ambulance Australia at Liverpool, her colleague was stabbed 40 times. Ms Davy returned to Bulli, where somebody spat in her face, and she had to be tested for HIV. We find this history to be a somewhat disjointed account of the relevant history, with respect. Ms Davy claimed in her ARD form that she had sustained a psychological/psychiatric injury due to exposure to traumatic events at various sites where she was performing her work as a paramedic[1]. The referral to the Medical Assessor was by consent.
3. She lodged a 12-page list of the traumatic events that she had attended, both in the UK between 2001 and 2009, and in Australia thereafter.[2]
4. She joined the New South Wales Ambulance in 2009 having emigrated from England where she was also working as a paramedic. She was exposed to multiple traumatic incidents including suicides, homicides, multiple fatalities and serious injuries from motor vehicle accidents, and domestic violence incidents which were more fully set out in her list of traumatic events.
5. As will be seen, the Panel determined that a re-examination was required, and Dr Hong further considered the history in the course of his reasons.
6. The Medical Assessor found that maxim medical improvement had not been achieved.

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 necessary for the worker to undergo a further medical examination for the reasons set out below.

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 Michael Hong of the Appeal Panel conducted an examination of the worker on 9 October 2025 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 which have been considered below 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 (Vegan) 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.

1. The Medical Assessor took a truncated history of Ms Davy's history with the Ambulance Service, as already mentioned. As to her present treatment the Medical Assessor said:[3]

She is currently on fluvoxamine 100mg, clonidine 200mcg, propranolol, naltrexone 50mg daily, Monjauro.

She is seeing her GP every 3 months. She is seeing her psychologist Lisa Densley, from twice a week to once a week, and other times every couple of weeks. She is seeing her psychiatrist Dr Al Griskaitis, every couple of months.

She intends to ask her psychiatrist to increase her fluvoxamine. There has been some discussion to commence EMDR when she is more stable, which she hopes to do when she is more stable.

They are intending to start within the next couple of months.

She is motivated for further escalation of treatment to improve her symptoms. She said that further treatment will hopefully improve her symptoms and functioning."

1. In summary the Medical Assessor said:[4]

• ➢ Posttraumatic Stress Disorder (F43.10), due to meeting Criterion A via repeated

exposure to deceased patients; meeting Criterion B due to experiencing symptoms of

intrusive recollections, distressing dreams; meeting Criterion C due to avoidance of

potential triggers; meeting Criterion D due to a persistent feeling of shame, marked

diminished interest in her previous activities, feeling detached from friends, difficulties

experiencing positive emotions; meeting Criterion E due to irritability, sleep

disturbances, exaggerated startle reaction and hypervigilance, and problems with

concentration; meeting Criterion F as the duration of her symptoms are more than 1

month; meeting Criterion G as she has had significant distress and there has been

impairment with her social and occupational functioning; and meeting Criterion H as

these conditions are not wholly attributable to any other conditions.

• ➢ Persistent Depressive Disorder (F34.1), due to meeting Criterion A with her depressed mood; Criterion B due to appetite changes, insomnia, anergia, low self-esteem, reduced concentration and feelings of hopelessness; meeting Criterion C as she has complained of persistent depressive symptoms over the course of the past few years; meeting Criterion D as there has been depressive symptoms longer than 2 years, and Criterion E and F have been met due to absence of manic episodes or psychosis; and meeting Criterion G as this episode is not attributable to another condition or effect of a substance; and Criterion H has been met due to significant functional impairment.
• ➢ Alcohol Use Disorder, with an escalation of her alcohol use, with some difficulty in reducing her intake.

The history obtained from the claimant was inconsistent with the prior medical reports

regarding her pre-existing psychiatric and alcohol use history, which was addressed in the course of the assessment; and some inconsistencies regarding her response to treatment. During the assessment, this claimant's presentation was consistent and appropriate."

1. In answer to the templated question at 8b, "Have all the body parts/systems stabilized/reached maxim medical improvement?" the Medical Assessor said:[5]

"She has had extensive psychological therapy, and medication treatment. There has been some recent improvement with her alcohol use disorder, and she intends to have her antidepressant increased and embark on EMDR therapy. Given these available avenues of further treatment escalation, and ongoing improvement in her symptom control, including her alcohol use, it would be premature to say she has stabilised and reached her maximum medical improvement."

1. The Medical Assessor indicated that maximum medical improvement (MMI) would occur within 6 to 12 months.
2. At [10] of the MAC the Medical Assessor referred to the medical opinion before him. He noted that the expert retained by Ms Davy, Dr Abdul Khan, had assessed 22% WPI and that for the respondent, Dr Abhishek Nagesh had also assessed 22%. Dr Nagesh deducted one-tenth leaving a final entitlement of 20%. In a later report, the Medical Assessor noted that Dr Nagesh had amended his assessment to 6% WPI.
3. At [11] of the MAC stated that Ms Davy had a pre-existing condition of anxiety. The Medical Assessor said:[6]

"(i) She has had pre-existing anxiety, which would predispose her to developing further anxiety symptoms, without which her current impairment would not have been as great."

1. Firstly, she asserted that the Medical Assessor had "failed to take into account relevant considerations, and had erred in in finding that maximum medical improvement had not been established."
2. We were referred to AAI Limited t/as AAMI v Phillips[7] and to Chapter 11.6 of the Guides, in support of a submission that the Medical Assessor had failed to properly take into account bot that her injury had occurred some 21 months before, and that she had been diligent in obtaining treatment from her health professionals, including her psychologist and her psychiatrist. She referred to Dr Nagesh's opinion that MMI had been reached and she also referred to her own expert, Dr Khan, who also agreed that she was well-stabilised.
3. Ms Davy submitted that the Medical Assessor's opinion stood alone, and that whilst that did not indicate error of itself, his failure to provide any persuasive reasons as to why the unanimous opinion of the opposing experts should be rejected did constitute a demonstrable error.
4. Ms Davy submitted that the Guides did not require a finding of instability simply because further treatment was being sought. The question is whether future treatment was likely to "change substantially" the nature of the condition.
5. The referral to possible further treatment by way of EMDR therapy or antidepressant treatment had not been raised by Ms Davy's treating psychologist, she said.

1. We were referred to Minister for Immigration and Border Protection v WZARH[8] as to the concept of procedural fairness.
2. She also referred to Chapter 1.27 of the Guides which require an assessor to take account of all available evidence.
3. Ms Davy said therefore the 1/10th deduction was not appropriate, as any anxiety mentioned by the Medical Assessor arose in the context of her employment, and there was no basis upon which to make such a deduction.
4. Ms Davy referred to the opinion of her psychologist, Ms Densley, in that regard.
5. We were referred to Dr Nagesh's opinion and his disagreement with Dr Khan about any deduction. Procedural fairness had been denied, Ms Davy asserted.

1. Ms Davy also submitted that the medical assessor had erred in making a deduction when he had not assessed any permanent impairment in any event. We were referred to Ainsworth v Criminal Justice Commission[9] which was a reference to a general statement that an authority conferred by statute must be exercised within the limits and in the manner that the statute prescribes.
2. We were referred to s 323(1) of the 1998 Act in furtherance of an argument that an assessment pursuant to that section could only be made where there had been a permanent impairment assessment of the original of the subject injury. There was no justification for making a deduction when there was no assessment, it was argued.
3. We were referred to cl 1.16 of the Guides regarding circumstances under which MMI could be found and it was submitted that the deduction made by the Medical Assessor was beyond power.

1. The fourth submission was that the Medical Assessor had failed to provide adequate reasons for his decision that a deduction should be made. We were referred to further authority, but we found, with respect, this ground to be repetitive.
2. It was also submitted that the Medical Assessor had not provided proper reasons to reject

Dr Khan and Dr Nagesh on the basis of stabilisation, which again was essentially a repeat of Ground 1.

1. The respondent referred to Chapter 1.15 of the Guides regarding the definition of maximum medical improvement. The respondent accepted that Ms Davy had been diligent in her treatment but submitted that the Medical Assessor's remarks could not be designated as speculation because Ms Davy herself reported those intentions to him.
2. We referred to the May 2024 report of Dr Khan, who noted a plan for psychological treatment involving some of the treatments mentioned by the Medical Assessor such as "EDMR CBPT etc".
3. Reference is made also to the February 2025 report by Ms Davy's psychologist, Ms Densley.
4. The respondent conceded that there was no suggestion that Ms Davy's medication dosage should increase, but noted that Ms Davy said that she planned to speak to her psychiatrist about it. That discussion, it notes, had clearly not happened at the time of the assessment.
5. The respondent submitted that the question went further than whether "the administration of further treatment would change substantially" the nature of the condition with respect to Chapter 1.16 of the Guides.
6. The treating reports, it was submitted, made it plain that both Ms Davy's psychologist and psychiatrist had always intended to commence her on EDMR/CBPT treatment when she was ready.
7. Accordingly, the Medical Assessor was quite entitled to form the view that this treatment, which was going to begin within two months or so, would likely improve her condition.
8. With regard to the submissions that the Medical Assessor had erred in finding that the

pre-existing condition existed, the respondent referred to clinical notes from Ms Davy's medical practice which showed that in August 2022 and April 2023 she had other concerns than her post-traumatic stress disorder, as her husband and she had split after 14 years. 9. We were we were also referred to other clinical notes, but the concession was made that Ms Davy commenced with the respondent in 2009 and that there was no contemporaneous evidence of any pre-2009 injury or condition. 10. There were references to ADHD in the more contemporaneous material, and it was submitted that those diagnoses "if established" would likely have been present prior to 2009. 11. We were referred to the opinion of Dr Nagesh and his reasons for finding there was a deductible proportion. It was submitted that procedural fairness had been shown because the Medical Assessor pointed the evidence regarding ADHD and OCD and borderline personality out to Ms Davy and offered her an opportunity to respond. 12. The respondent, in replying to the suggestion that there was no power to make a s 323 deduction in these circumstances, referred to the templated question at part 8(e) of the MAC and submitted that there is nothing in that part that suggested that a Medical Assessor should not answer if he was of the view that MMI had been reached. Such a submission, as will be seen, is misconceived. 13. The respondent conceded that there was no evidence to support a diagnosis of anxiety prior to Ms Davy's employment with the respondent, but that evidence did support "possible inattentive difficulties" which included ADHD, OCD and borderline personality. It was not necessary for the Medical Assessor to quantify the deductible proportion, as he had appropriately deferred to the assessment of impairment in any event.

1. The argument about the comments by the Medical Assessor's findings at [11] may be shortly dealt with. The Medical Assessor said, to repeat:

"(i) She has had pre-existing anxiety, which would predispose her to developing further anxiety symptoms, without which her current impairment would not have been as great."

1. We read with interest the competing submissions about the effect of this statement. We would observe that it is of no more effect than a non-binding opinion. The section that permits a deduction from an assessment is s 323 of the 1998 Act. For there to be a deduction, there has to be a baseline WPI assessed from which the deduction is to be made.[10] These submissions are accordingly rejected.
2. A more compelling ground, however, is that raised regarding the Medical Assessor's reasons for finding that MMI had not been reached. Chapter 1.15 and 1.16 of the Guides provide:

1.15 Assessments are only to be conducted when the medical assessor considers that the degree of permanent impairment of the claimant is unlikely to improve further and has attained maximum medical improvement. This is considered to occur when the worker's condition is well stabilised and is unlikely to change substantially in the next year with or without medical treatment.

1.16 If the medical assessor considers that the claimant's treatment has been inadequate and maximum medical improvement has not been achieved, the assessment should be deferred and comment made on the value of

additional or different treatment and/or rehabilitation."

1. Both experts agreed that MMI had occurred. Dr Khan, for the appellant, said on 18 June 2024:[11]

"Ms Davy has reached maximum medical improvement. Her condition is well stabilised and is unlikely to change substantially in the next year, with or without medical treatment."

1. For the respondent, Dr Nagesh said on 28 October 2024:[12]

"In my opinion she has reached maximum medical improvement. It has been 15 months since the worker ceased work. She has had reasonable treatment with which her condition has not improved and with further treatment her condition is highly unlikely to improve and lead to improvement in functional capacity or whole person impairment of more than 3%."

1. Whilst a Medical Assessor is not obliged to choose between competing medical opinions, but to form his own opinion based on his expertise and experience,[13] he is required to adequately demonstrate his path of reasoning.[14] The Medical Assessor encapsulated his reasoning, as shown above, by saying:

"As she has yet to reach maximum medical improvement, I have deferred any whole person impairment.

In making that assessment I have taken account of the following matters:-

The information from the assessment and my observations of her, which can be found above, as well as information from the relevant documents, which have been summarised below...

In light of the recent progress she has made, and further plans of treatment escalation, I have considered her yet to have reached maximum medical improvement, so I have deferred a whole person impairment calculation."

1. The Medical Assessor failed to consider the test required by Chapters 1.16 and 1.17. He did not consider, as did Dr Khan, whether Ms Davy's condition was likely to change substantially in the next year, nor did he consider the test cited by Dr Nagesh of that further treatment was highly unlikely to improve Ms Davy's condition and lead to an improvement in functional capacity or WPI of more than 3%, which was formerly the test provided by the guideline.
2. Further, the Medical Assessor had before him the unanimous opinions of the medico-legal experts on each side of the record. Such unanimity required an explanation in sufficient detail to enable a court or an appellate body to see whether his opinion did or did not involve error, which the Medical Assessor's reasons failed to do.[15]
3. We determined in the face of these errors that Ms Davy should be re-examined. Medical Assessor Hong's report follows:

Ms Davy became a paramedic in 2001, and was sponsored to Australia in 2009, and ceased working in July 2023. She has not worked since.

She commenced Fluoxetine in August 2021, during COVID-19 lockdown. She said her doctor said she had OCD and she did not. She said she could not stop crying, and thinks this happened after her daughter was in a car, near a fatal motor accident on Picton Road. She said she did not take Fluoxetine for long, and carried on working in Liverpool and later, she joined the TV filming.

We discussed her file showed Fluoxetine was prescribed in 2021 and 2022, and ceased in April 2023.

She said she did not have childhood symptoms of ADHD or other psychological symptoms, or treatment with psychologist or psychotropic medication at other times.

She reported exposure to deaths and people with horrific injuries, violence and major accidents over the years as a paramedic. Towards the end of her career in 2023, there were several major incidents within a short space of time:

• She said she was doing television filming for a show, and around that period, a colleague was murdered nearby, and was stabbed 40 times and had a young family. All the other paramedics were talking about that colleague, and she felt very upset hearing the news.
• There was an incident with a large man who weighed 130 kilograms, who almost hit her.
• There was another patient who had suffered convulsions, and the saliva went to her face, and she had to be tested for HIV.
• She did CPR resuscitation on the man with a heart attack in Bulli Hospital.

Ms Davy described symptoms consistent with PTSD, with anxiety and depressive symptoms from 2021, and started drinking alcohol to excess in 2023, when she was still involved in filming the TV show.

Previously, she had 10 standard drinks in a session. Her alcohol intake reduced over time. In the past 4 weeks, she said she has 1-2 glasses wine at night, generally daily, and not drank in the last 2 days.

Ms Davy was gambling on pokies at the club, and has ceased for a long time, but did it again last Saturday.

Ms Davy took many psychotropic medications over time.

• Mounjaro (Tirzepatide) weekly injection, around 8 months.
• Fluvoxamine 100 mg.
• Propranolol as needed for anxiety.
• Clonidine 100 mcg for nightmares.

She has been consulting Dr Al Griskaitis, psychiatrist every couple of months, and her psychologist Lisa Densley since September 2023, usually, the sessions are every 1-2 weeks and she had eye movement desensitisation and reprocessing (EMDR). She does not think EMDR helped much, as she has too many traumatic jobs and they all merge.

Ms Davy stated that her mental health is not constant, with there are good and bad days, and she puts on a mask and pretend to be fine. She said she wants to be on her own. She has anxiety and depressive symptoms, and does not want to socialise with people, and cut people out from her life due to "their drama" and because her friends drink alcohol. She said her partner does not want to socialise much either, so they are on the same wavelength and he understands her history, as he is also a paramedic.

She reported that she started putting on weight from about 2022 and was 82 kilograms at one point, some medications contributed to weight gain, and she was also eating too much. She had been using Mounjaro and is now 68 kilograms, and said that her normal weight was about 70 kilograms.

Ms Davy reported chronically disrupted sleep and has nightmares, and takes Clonidine as needed. She described middle insomnia. She has intrusive memories related to work.

Ms Davy reported having major problems with her concentration and memory. She said she bought a book recently, but cannot read it. She is easily distracted. She said she helps her daughter with her study (a Real estate course), she pretends to be a client, she reads a script and they filmed it, over and over, for the tutor, which took an hour recently.

Ms Davy is 47 and living with her partner and has two children, who are 12 and 18. She has 50% custody with her ex-partner.

Her mother has passed away, and her father and sister live in the UK. Her father usually visits her on a yearly basis.

Ms Davy has anxiety driving on Picton Road, due to the traumatic job related to her daughter. Her in-laws are in Goulburn, so they take that road to visit them.

She was in a relationship and separated in 2023 due to her mental health. She has been with her current partner around 18 months, and they previously worked together. They have been friends for a long time.

Ms Davy stated that she does the school drop-off and uses a running machine treadmill and swims at home, on her own. Sometimes, she naps during the day.

She does bush walking and "cold plunge" with her partner. They go to a nearby trail, recently every 2 weeks. She said taking walks also helped her lose weight.

She spends time with the children, and drives them and helps them. She taught her daughter driving previously, but only a bit and now, her daughter is on a green P.

Ms Davy reported going to Melbourne in January 2024 with her father and daughter, she only drove a bit during that trip. They rented a place with a pool, and they went to see the jail. She said she spent most of her time at the pool, and her family did other activities without her.

Ms Davy went to Rottnest Island with her partner and had a surprise swim with whale shark, in June 2024, for her birthday, and recalled it was after the Melbourne trip. She flew to Perth with her partner, and they were there for 6 nights. They visited Rottnest island to have a look around. She said she tried to live a normal life with her partner. She said her psychologist knew about it and supported it. There have been no other trips away.

She manages the household chores, and goes to the shops, but does not enjoy it. She said she can do it, but has anxiety. She cooks sometimes and skips meals. She said she tries to have more protein and wants to lose more weight. She showers daily without prompting, and she brushes her teeth and changes into clean clothes. She showered a few times a day prior to her injury.

Ms Davy has 2 main friends, and said she dropped some friendships as there were too much drama, and they do not understand her PTSD, and make her feel bad. She said those friends were into drinking, so she does not want to associate with them. The 2 friends understand her mental health, and she sees one recently when her friend visited with her children, they used the pool and spa at her home, and they socialised. That friend is busy with work, so they only catch up every couple of months.

Last Saturday, she went to the club with her partner, then she played pokies and he was not happy with it. She said she had a dopamine hit, but lost $1000 and would not gamble again.

She has another friend living around the corner, and they go to a cold plunge venue with a sauna, called Eden Spa, in the past 3 months and usually go weekly, then get a Bao or Vietnamese chicken bun afterwards and socialise. She said her psychiatrist thought it is a good idea.

Ms Davy has maintained contact with another friend, but they are not that close.

With the family, she said they eat out at the club for dinner, only twice since they bought their house and moved in, in April 2025.

Her father came last year and will visit again in November 2025. She talks to her sister but has not seen her a couple of years. She has a good relationship with her family overseas.

She and her partner go to visit his parents in Goulburn, usually monthly.

Ms Davy stated that she had some difficulties with her now 12 years old daughter, and wants to be there for her, and so she offered to help with coaching netball. Every Tuesday, she helped, but she does not know how to play netball. She threw the ball and did drills with the girls, and they split up into groups of 5. Her daughter subsequently did not want to continue with netball.

Previously, she went to the club with her friends to drink or gamble, once a month, and ceased in 2024, when she realised it was not healthy.

Ms Davy confirmed she did not do the half marathon, as she had a fractured leg.

Ms Davy was assessed by video. She was at home during the assessment. She wore glasses and was neatly attired, and had long light colour hair. She engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. She was not restricted in her affect range and reactivity, smiled and laughed appropriately, and was generally talkative and gave a good history. She spoke spontaneously and logically.

I confirmed that Ms Davy has never had a psychiatric disorder previously, and never had any treatment. There was no evidence of childhood ADHD, and she only started treatment for her mental health in 2021 and started taking fluoxetine because of the job on Picton Road.

Ms Davy had been a paramedic for many years, and there is no evidence of pre-existing psychiatric injury before her paramedic career.

She did not have regular treatment until 2023, after she ceased working. Since then, she has had regular treatment with some improvement in the past 2 years. Her gambling and alcohol are better managed, but her mental health continues to fluctuate and overall has maintained a similar trajectory for a long time now. There is no plan for new treatments at this point, and her psychological condition is stabilised and MMI has been reached.

Ms Davy's self-care has declined. She showers daily without prompting, but this is less than before the work injury. She skips meals and has successfully lost weight, partly due to medication to help with weight loss, and also with attention to exercise and diet.

She has occasional social and recreational activities. She has different recreational activities with different people. She also enjoys solitary activities. She initiates some activities and is actively engaged, and does not need prompting or a support person. The Panel noted some recreational activities are social by nature and her participation in recreational activities is not rare. She had a couple of holidays and trips away since her psychological injury. Whilst she is actively engaged, she has fewer activities than before the subject injury, therefore this is not 1. As she does not need a support person or prompting, and her recreational activities are not rare, a class 3 rating cannot be supported.

Ms Davy has anxiety on Picton Road, she does not like driving there but can drive on the same road. She shared driving, when they drove to Melbourne. She is independent with local travel but has someone with for on longer journeys.

Ms Davy's relationship with her previous partner ended, and she has a good relationship with her new partner.

She cut ties with some of her friends, who are into excessive alcohol drinking. She has maintained a few long-term friendships.

The relationship with her father and sister is reasonable.

Ms Davy reported having reduced concentration. She used to read books, and this has stopped because of concentration difficulties. She can help her daughter with her study, by reading scripts, but this is not an intellectually demanding task.

Ms Davy has not worked since the subject injury and her anxieties and problems with confidence impact her capacity to work. She has no work capacity.

1. We adopt Medical Assessor Hong's report.
2. It follows that the appeal must be upheld. However, a concomitant of the finding that MMI had been achieved was that a PIRS assessment was required, and we confirm that we adopt Dr Hong's assessment in that regard.
3. For these reasons, the Appeal Panel has determined that the MAC issued on 17 April 2025 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

State of New South Wales (Ambulance Service of NSW)

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 Dr Yu Tang Shen 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)

[7] [2018] NSWSC 710.

[9] [1992] HCA 10.

[10] See eg Cole v Wenaline Pty Ltd [2010] NSWSC 78 at [38].

[13] Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43 at [47].

[14] Wingfoot Australia Partners Pty Ltd v Kocak. See also Vegan.

[15] El Masri v Woolworths Ltd [2014] NSWSC 1344 per Campbell J at [50].