WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; appellant submits that the Medical Assessor (MA) erred in his assessment of five of the psychiatric impairment rating scale categories; MA's findings were inconsistent with some of his assessments; re-examination required; Appeal Panel found no errors; much of the evidence was more relevant to other categories; Held - Medical Assessment Certificate revoked.

1. On 27 August 2025 Jacqueline Flanagan (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Ankur Gupta a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on

1 August 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 the worker should undergo a further medical examination because we determined that the Medical Assessor erred with respect to some of his whole person impairment (WPI) assessments of several categories of the psychiatric impairment rating scale (PIRS) (which we will set out more fully below) contrary to the history he obtained, and failed to give adequate reasons.

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 as outlined above, specifically with respect to five of the six PIRS categories.
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 WPI in respect of a primary psychological/psychiatric injury occurring on a date of injury of 6 October 2022.
4. The Medical Assessor obtained the following history:

"Ms Flanagan says that she was working as a case work support worker in the child protection team. She had been in the position for seven years, until the injury. Her duties included gathering information regarding child welfare. She liaised with agencies, including the police, and went out on home visits. She supervised contact with the children and families. She was working full-time hours. She says that she had started suffering from insomnia and 're-living the experiences' around April 22. She says that she had started suffering nightmares and flashbacks about some of the jobs she had been on over the years. She says that she continued working despite that, but had to seek help eventually in October 22. She says that she took a week off and then stopped working. She has not worked since."

Ms Flanagan is not taking any medication. She sees her psychologist, Dr Mary Tempel, fortnightly. She sees a chiropractor for tension headaches every two weeks. She has not seen a psychiatrist. She says that she was prescribed medication by her general practitioner, but did not take any as she is fearful of getting addicted.

Ms Flanagan workplace for nearly three years. The treatment has not helped her much either. Ms Flanagan says that she continues to suffer from nightmares and flashbacks. She avoids going to the town as she does not want to run into people from her workplace or her ex-clients. She says that she avoids having contact with people and goes to the gym early in the morning because of that. She says that her mood is 'up and down'. She has 'outbursts of anger' and says that she 'lacks patience.' She feels anxious most of the time and does not feel she is the same person. She does not experience panic attacks, but can get overwhelmed with anxiety. She says that her appetite is not great and she misses meals. She says that her clothes are a little bit loose but not overtly so. She says that she is constantly on edge and has had gate alarms installed so that she becomes aware of anyone walking up her driveway. She says that she is constantly vigilant of that. Ms Flanagan says that she jumps whenever the gate buzzer goes off. She changed her hair colour to hide her appearance after coming across a client who had threatened to kill her. She says that her concentration and memory are 'really poor.' She says that she relies on her phone for keeping appointments and is unable to read for long. She says that words become 'blurry' after a few lines. She is unable to watch a full show on the TV and says that she is unable to focus for more than twenty minutes as she 'can't relax enough'. She forgets names and gets her daughter to manage her administrative tasks. She does manage her own money and pays her bills on time. She says that she starts feeling tired after lunch and has to lie down. She says that she constantly cleans the house with strong chemicals and is obsessed with her personal hygiene. She says that she has the images in her head of the houses that she visited, and she has to clean her house constantly to stop those images from coming into her head. She showers four times and her teeth ten times per day. Her dentist has advised her to reduce that as it is impacting her teeth. She says that she washes her clothes two or three times before they come out of the washing machine. She denies having any perfectionist traits or other symptoms of OCD before the injury. She denies checking or counting. She says that she does not describe a phobia of germs and does not wash her hands excessively. She denies any obsessions but has constant thoughts of jobs that she has been to in her head. She says that she is fearful of her future because she is unable to work. She says that she feels suicidal and has stopped riding her bike as she is fearful that she may intentionally kill herself. She denies making any active plans and has not attempted suicide either."

Ms Flanagan says that she drives locally only as she has thoughts of committing suicide. Her father drives her to her psychology appointments, which are 130 kilometres away. She says that she has not driven outside her town since the injury. She avoids driving near her previous workplace. She can drive to her gym or the local Coles. She says that her partner shops for her. She says that she only goes to her local IGA early in the morning. She has not had any holiday with her partner since the injury. She has not been out for a meal since the injury. She can prepare salads and vegetable preparation, but her partner cooks. She says that she eats whatever is in the fridge when her partner is away. She cuts her hair and her partner's hair as well. Not being on holiday has impacted her relationship with her partner. She says that her daughter visits her occasionally. She is unable to visit her daughter since the latter got a dog, as she cant stand the smell. She used to visit her daughter before that. She visits her parents, who live in a retirement village. She takes her mother for the latter's medical appointments if needed.

She says that her mental her relationship as her partner does not understand her condition. She said that she physically assaulted him on a few occasions. This has included hitting him across the head and throwing a cleaver knife at him once, which did not hit him. She says that she wanted to hurt him, but not kill him, because he made comments regarding her cleaning and mental state. They have not had any periods of separation. She says that her social life is non-existent as she does not want to be judged. She has lost contact with her friends as a result. She has one friend who lives in a different town. They keep in touch with texts. She says that she spends her time at home, cleaning. She has no other hobbies. She goes to the gym, but that is part of the treatment and is not enjoyable. She has not attended any social events since the injury. She says that seeing her daughter is the only thing that gives her pleasure. She says that she does not have the capacity to work 'in her head' as she has reduced concentration and she is triggered easily."

1. No findings on mental state examination were reported.
2. The Medical Assessor summarised the injury as: "PTSD, Compulsive Disorder."
3. The Medical Assessor assessed 7% WPI.
4. He then summarised the evidence before him and said:

"Psychiatrist Dr Abdul Khan provided an independent medical examination report dated 18 November 24. He did not note any psychiatric history. He advised that Ms Flanagan was suffering from obsessive-compulsive disorder, post-traumatic stress disorder, and major depressive disorder. He assessed her to have 22% impairment of the whole person.

Treating psychologist Ms Elizabeth Lloyd provided a report dated 20 July 23. She advised that Ms Flanagan was being treated with cognitive behavioural therapy and did not have any capacity to work.

Psychologist Ms Mary Temple provided a report dated 11 March 24. This report was provided after two sessions. She noted that Ms Flanagan met the criteria for post traumatic stress disorder and did not have any capacity to work.

Injury management officer Kieran Roberts provided a report dated 09 May 24 in which it was stated that Ms Flanagan would never be able to return to her pre-injury role with the Department of Communities and Justice.

Treating general practitioner Dr Duc Phan Huy provided a total and permanent disability certificate report dated 06 September 24 based on a diagnosis of post-traumatic stress disorder and depression related to workplace events.

Treating psychologist Ms Mary Temple provided a letter dated 21 October 24. She described obsessive and compulsive behaviours with cleaning, along with ongoing anxiety and avoidance. A reduced frequency of teeth cleaning, from nine to ten times to four times, was also described.

My opinion is consistent with that of other specialists in terms of diagnosis. However, the impairment rating is different from that provided by Dr Khan, as explained in the attached psychiatric impairment rating scale."

1. Dealing with the specific PIRS categories, the appellant submits as follows:

(a) the appellant's obsessions and compulsions related to cleaning

(showering 4 times per day, cleaning her teeth up to 10 times per day and cleaning her home constantly with strong chemicals) demonstrate that she has suffered far worse than 'no deficit' in this category. The Medical Assessor's own findings are more consistent with a class 2 impairment rating;

(b) both Dr Abdal Khan and Dr Juan Carlos D'Abrera, the insurer's IME, assessed the appellant as having a class 2 impairment in relation to self-care and personal hygiene;

(c) the appellant worker's evidence in her statement (at page 8 of ARD) is consistent with the assessments of Dr Khan and Dr D'Abrera, and both appear to be consistent with the Medical Assessor's findings at page 2 of the MAC, however these are inconsistent with the Medical Assessor's assessment of a class 1 impairment rating, and

(d) the Medical Assessor is required to provide adequate reasons as to why the lower-class rating was preferred in circumstances where a class 2 rating was available.

(a) no longer being able to go on holiday, or go out for a meal, and being

unable to visit her daughter, demonstrates that the appellant has suffered far worse than a mild impairment in this category. The Medical Assessor's own findings are more consistent with a class 3 impairment rating;

(b) both Dr Abdal Khan and Dr D'Abrera assessed the appellant worker as having a class 3 impairment in relation to social and recreational activities;

(c) in his reasoning at page 7 of the MAC, the Medical Assessor states "...she can go to her local shop independently if needed...she takes her mother to medical appointments and visits her parents regularly. Her daughter visits her, which she enjoys". It is submitted that these comments do not substantiate or provide adequate reasoning of the Medical Assessor 's assessment of a class 2 impairment rating. Having her daughter visit her at her home is consistent with the Appellant Worker's evidence that she keeps to herself and stays at home (page 9 of ARD). Being able to take her mother to medical appointments does not demonstrate that she is actively involved in social and recreational activities. Further, the Medical Assessor reasons at page 7 of the MAC that the appellant worker "avoids going to certain places because she does not want to come across anyone associated with her previous workplace, but she can visit other places." This is consistent with the appellant worker's evidence that she is able to travel to familiar areas, it does not demonstrate that she is engaging in social recreational activities. It is also submitted that the appellant worker's ability to drive or travel to familiar areas is not a relevant consideration in assessing the category social and recreational activities, as established in Ballas v Department of Education (State of NSW) [2020] NSWCA 86 (Ballas). There is clearly a difference in the histories recorded by both Dr Khan and Dr D'Abrera, compared to the history provided by the Medical Assessor in relation to the appellant worker's engagement in social and recreational activities. The difference being stark, and being significant in applying the PIRS, the Medical Assessor should have put this difference to the appellant worker so that the appellant worker could give an explanation.

(a) the Medical Assessor found a class 2 impairment which is inconsistent with his findings in the body of the MAC;

(b) the Medical Assessor's findings at page 3 of the MAC are consistent with the descriptor for a class 3 impairment rating, noting the appellant worker's relationship is severely strained, evidenced by periods of domestic violence, and

(c) both Dr Khan and Dr D'Abrera assessed a class 3 impairment rating in relation to social functioning. The Medical Assessor's reasoning at page 7 of the MAC is at odds with his findings in the body of the MAC.

(a) the Medical Assessor found a class 2 impairment wherein he states at page 8 of the MAC:

"As described in the main body of the report, there is mild impairment. She describes reduced concentration and memory, but can keep her appointments with the help of reminders. She manages her finances and pays her bills on time. She can watch TV for up to 20 minutes";

(b) the Medical Assessor's reasoning is more consistent with a class 3 impairment rating. The descriptor for a class 3 impairment is: "Moderate impairment: Unable to read more than newspaper articles. Finds it difficult to follow complex instructions, eg operating manuals, building plans, make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting";

(c) the Medical Assessor failed to take into account relevant considerations, including the appellant worker's evidence contained in her statement (page 10 of ARD) where she outlines if she were to sit and watch a movie or even flip through a magazine, it is near impossible as her mind is constantly racing and she has the compulsion to clear or do something, as she cannot sit still. Consistent with the Appellant Worker's evidence, both Dr Khan and Dr D'Abrera assessed her as having a class 3 impairment rating, and

(d) the appellant worker's evidence is consistent with the assessments of Dr Khan and Dr D'Abrera, and both appear to be consistent with the Medical Assessor's findings at page 2 of the MAC where he reports that the appellant worker "relies on her phone for keeping appointments and is unable to read for long", however these are inconsistent with the Medical Assessor's assessment of a class 2 impairment rating.

(a) in relation to employability, the Medical Assessor found a class 4 impairment wherein he states at page 8 of the MAC: "In my clinical opinion, her ability to work is severely impacted because of her psychosocial circumstances. She is afraid of going to several places, but as such, can take up a less stressful job for one or two days per week. She is not totally incapacitated from working, in my opinion";

(b) both Dr Khan and Dr D'Abrera assessed the appellant worker as having a class 5 impairment rating, on the basis that she is totally incapacitated for work. The appellant worker has been unable to return to any form of employment as a result of her psychological/psychiatric injury and there was no evidence before the Medical Assessor which would suggest that she "can take up a less stressful job for one or two days per week", and

(c) the appellant worker's evidence contained in her statement, together with the medical material before the Medical Assessor , is clearly evidence that she is totally impaired. It is submitted that it was incumbent upon the Medical Assessor to question the appellant worker further in relation to employability where his clinical findings were so at odds with the evidence before him.

1. The Panel agreed with the thrust of the appellant's submissions and noted that the assessments he made were often contrary to the history he obtained and inconsistent with his own findings, such that a re-examination was required.
2. We also agreed that the Medical Assessor's reasons were often inadequate.
3. Medical Assessor John Baker of the Panel re-examined Ms Flanagan on 27 January 2026 and reported to us as follows:
   1. "The worker's medical history, where it differs from previous records.

The worker provided no history of any pre-existing psychiatric condition.

The worker reported the following history at the time of this re-examination:

The worker was born in Inverell, NSW. Her father was 85 years old and a retired mixed dry-land crop farmer. He did not graze cattle on his 1000Ha property. Her mother was 83 years of age and suffered from vascular dementia following a stroke about 3 years ago. Both her parents lived in the same retirement village, with her father supporting her mother. The worker also had one younger brother aged 53 years. He worked as a weed control officer for Kempsey City Council. She said she was not exposed to any childhood trauma, abuse, or neglect. She did not report suffering from any pre-existing psychiatric condition as a child.

The worker said she was aged 56 years at the time of this re-examination. She reported having lived in a 12-year relationship with her defacto partner (Phillip). Phillip worked in construction in the local region. There were no children to this union.

The worker said she had one prior union. She had married her daughter's father about 27 years ago. He was a teacher aged 52 years. The marriage was dissolved when her daughter was about 18 months. The worker rarely had contact with her daughter's father. The worker's daughter to this union was aged 26 years and worked as a Deputy of the local court in Tweed Heads as well as other locations in NSW. The worker had no grandchildren.

The worker was educated at St. Philomena Catholic Primary School, Inverell, NSW between Kindergarten to Year 6. She progressed to St Ursula's Catholic Ladies College and was a term boarder between Year 7 to Year 12. She completed her high school education in Toowoomba, QLD.

The worker was a state representative swimmer. She commenced swimming as a primary school student and continued squad training throughout her high school education. During the vacations she would race junior motocross with her brother and father. She enjoyed her sports and was not injured racing as a child. The worker had continued her hobby of riding touring motorcycles on day tours after leaving school.

The worker said she had her appendix surgically removed when she was aged 19 years. She recovered without impairment from this surgery. She reported suffering from mild seasonal hay fever. She does not smoke tobacco. She does not gamble. She does not drink alcohol daily however, she might drink a small quantity of alcohol at a special event like a wedding.

The worker attended a business college in Brisbane after leaving school. She learnt shorthand typing and administrative skills. She worked in office administration in Brisbane before returning to Inverell, NSW. On return to Inverell the worker commenced employment with a stock and station agent. She worked for this agent until she was 29 years of age.

The worker took time off after she gave birth to her daughter. She did not suffer from any post-natal depression. The worker returned to the work force in administration for an insurance broker and raised her daughter as a single mother in Inverell. Before working for this employer, she had not lodged any personal injury claims.

The worker commenced work for this employer in about 2007. Her last day of work was 6 October 2022. She commenced her work in the administration office. She initially worked part-time and on short contracts. She had worked in various locations within the region. In 2010 she was promoted to work fulltime in Inverell. She said the regional director's office was in Tamworth, NSW. She said initially she worked as a customer service officer in the office. She was the Disaster Welfare Officer at the time of her last day of work. She said she volunteered to provide this essential service that was organised through her department.

The worker said she had been asked to work as a case worker in child protection. She said she was not trained to work in this role. She reported that her scope of work became increasingly broad and she was placed in more violent and threatening circumstances whilst employed in this role.

The worker reported that she had to assist with the return of children under state supervision, and in foster care. She had returned children who had left care services in numerous places within NSW as well as Victoria. She reported she had to work with NSW Police, health services and non-government organisations (NGO's) like Pathways.

The worker reported that she had experienced many threats of violence towards herself and her daughter whilst working for this employer. She stated that she was approached on the street whilst performing her usual activities of daily living by parents who were distressed by the content of her reports. A mother of a child threatened the worker whilst the child was being restored to the family. The mother had previously stabbed the father of the child with a Stanley knife. The child was removed and restoration had been attempted on three occasions. Each episode of restoration was accompanied by the worker being verbally threatened by the mother of the child saying, 'I kill your daughter'.

The worker reported that whilst returning the child who had left her foster care, and was located living on the streets of Melbourne, the child tried to exit the rear seat of the car they were travelling in. The child protection locks were successful in stopping the door from opening, however the child then lowered the window and exited the car. The worker, who was in the back seat, and trying to restrain her, was also pulled through the window whilst the child escaped again from care.

The claimant reported that she had witnessed may episodes of violence between adults and children during her years of service for this employer. She reported that she had another serious incident when a boy threw a heavy chain as a weapon at her legs to try and stop her moving towards him. She said the boy continued to physically assault her during the incident. She said she was in an office and was required to use the duress alarm to get support from other workers.

The worker stated that she had commenced suffering from psychiatric symptoms for the first time in about April 2022. She said that she would use exercise to manage her anger, frustration and distress caused by the nature of her work. She reported that she began to suffer from distressing, intrusive thoughts, memories, visual and auditory images of the most distressing events that she was involved with during her employment. She reported that she had also developed a distressing intrusive olfactory smell, 'like burnt skin' after she had started working in her Disaster Welfare Officer role. She said she saw and smelt a severely injured person who was burnt in the bush fires. She said her mental health deteriorated and she began to suffer from symptoms consistent with obsessive-compulsive disorder and posttraumatic stress disorder.

The worker reported she was separated from her partner since 22 January 2026 - the worker's birthday. She said she had another angry argument with her partner who walked soil on his boots into her house. He had left the house, taken clothes from his cupboard and stopped speaking to her since the last angry argument with him. She expected he would not return to the relationship as the couple have prolonged strain and violent acts during the worker's angry outbursts, which include throwing knives at her partner and hitting him physically when she is enraged. The worker said her partner has not understood or accepted the nature of her injury since its onset in October 2022.

The worker presented to her local medical practitioner, and she was referred to a psychologist. She was also prescribed mirtazapine 15mg at night by her doctor. She decided not to use this medication. She said she was fearful of becoming addicted to mirtazapine. She said she had not spoken to her doctor about her concerns regarding the risk of addiction to this antidepressant. She had not used this medication since the onset of this injury.

The worker reported that her first psychologist was Ms Elizabeth Lloyd. She reported that Ms Lloyd declined to write work injury reports. The worker changed her psychologist to Dr Mary Tempel. The worker was treated with EMDR (eye movement desensitisation and reprocessing), a specific treatment for posttraumatic stress disorder.

The worker also received treatment for her obsessive-compulsive disorder with exposure therapy and response prevention strategies. The worker said she had not received treatment from a consultant psychiatrist for this work injury. The worker had also received treatment from her dentist because of her frequent daily overbrushing of her teeth. She said she had worn away the enamel of her back upper molar teeth due to her brushing her teeth and rinsing her mouth with mouth wash up to ten (10) times daily. She was provided with a mouth guard and advised not to brush more than twice daily. She was advised to put toothpaste in her mouth without brushing to try and break the obsessional urge and compulsive brushing of her teeth.

The worker reported the following symptoms consistent with Posttraumatic Stress disorder:

1. Directly experiencing recurrent traumatic events to her person.

She reported suffering from repeated physical assaults whilst working in her role. She reported being threatened with a Stanley knife whilst working in her role. She also reported having witnessed repeated episodes of violence between family members of children at risk whilst performing her role. She also had witnessed and smelt the severely burnt victim of a bush fire, whilst performing her emergency role for the employer.

The worker reported recurrent intrusive visual memories of the smell of burnt skin and intrusive visual and auditory memories of the violence she had witnessed whilst working in her role.

The worker reported recurrent distressing dreams about the nature of the injuries suffered by children at risk whilst working for this employer.

The worker demonstrated frequent efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic events.

This criterion was satisfied by the worker who reported she smelt an unpleasant smell which distressed her frequently and made her feel agitated and distressed. On initial inquiry she stated that the smell was associated with her work as a Disaster Welfare Officer and had a close association to her work during bushfire disasters in her region. Later in the same re-examination she stated without prompting that she remembered seeing a severely burnt person during the bushfire and she described the bad smell as 'like burnt skin'. She currently refuses to allow any cooking with meat in her home as she could not tolerate the smell of cooked meat which would agitate her.

This criterion is satisfied with the worker having frequent feelings of anger when thinking about the injured children and people she has attended whilst working.

Markedly diminished interest or participation in significant activities.

This criterion is satisfied with the worker having stopped motorcycle riding with her partner. She experienced loss of her friendship circle within the local community due to her not attending annual events and celebrations.

Persistent inability to experience positive emotions (e.g. inability to experience happiness, satisfaction, or loving feelings).

This criterion is satisfied with the worker no longer reporting happiness or loving feelings with her partner with her demonstrating frequent acts of anger towards him such as throwing kitchen knives at him. Her partner has now left the relationship due to these violent arguments.

This criterion is satisfied with the worker not able to type long reports and documents. She reported that she had failed to complete her taxation forms for many years, requiring her daughter to organise her records and complete the taxation bookkeeping records so that her daughter's accountant could bring the worker's records up to date with the ATO.

Sleep disturbance (e.g. difficulty falling or staying asleep or restless sleep).

This criterion is satisfied with the worker not able to initiate sleep because of intrusive ruminating thoughts about the traumatic events she has witnessed throughout her career working for this employer.

Duration of disturbance (Criteria B, C, D, and E) is more than 1 month.

This criterion is satisfied with the worker's date of injury documented as 6 October 2022 which is many months greater than the 1-month minimum requirement.

The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.

This criterion has been satisfied as the worker had not worked since the date of injury documented as 6 October 2022. She reported that she was separated from her partner about 5 days before the re-examination.

The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

This criterion has been satisfied as the worker's disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.

For these reasons, the diagnosis of DSM-5-TR F43.1 posttraumatic stress disorder is confirmed.

The worker reported the following symptoms consistent with Obsessive-Compulsive Disorder:

The individual attempts to ignore or suppress such thoughts, urges, or images, or neutralise them with some other thought or action (i.e., by performing a compulsion).

This criterion is satisfied because the worker tries to suppress the olfactory image of 'burnt skin' by her compulsion to ignite matches (3 to 5) and inhale the sulphuric smoke many times each day. She reports consuming between 50 to 90 matches daily, stating nothing else stops the smell.

Repetitive behaviours (e.g., handwashing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession according to rules that must be applied rigidly.

This criterion is satisfied because the worker repetitively ignites matches in response to the obsessional olfactory stimulus she smells many times daily. She feels driven to perform the lighting of these matches and reports no other action capable of providing any relief from this distressing symptom - even though the benefit is of a brief duration.

The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other areas of functioning.

This criterion is satisfied because the worker is unable to socialise and engage in her compulsive lighting of matches in her friendship group. This repetitive behaviour would cause significant impairment in her capacity to return to her office where she worked prior to the onset of the injury.

The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance (e.g., drug of abuse, a medication) or another medical condition.

This criterion has been satisfied as the worker's symptoms are not attributable to the physiological effects of a substance (e.g., drug of abuse, a medication) or another medical condition.

The disturbance is not better explained by the symptoms of another mental disorder.

This criterion has been satisfied as the worker's disturbance is not better explained by the presence of another mental disorder. Whilst the claimant might have some symptoms in common, the behaviours in relation to the symptoms in common are definable as related to two co-morbid psychiatric diagnoses. No symptom that is in common is sufficient to diagnose any psychiatric condition in isolation.

For these reasons, the diagnosis of DSM-5-TR F42.2 Obsessive-compulsive Disorder is confirmed.

Other psychiatric symptoms consistent with obsessive-compulsive disorder included the worker reporting cleaning her teeth up to 10 times daily, causing dental injury to her upper jaw and the need to wear a mouth guard; rewashing laundry - first wash in disinfectant and the second wash with standard washing power to control the excessive 'number of germs' on the clothes.

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

The worker was asked about the nature and frequency of her verbal arguments with her partner.

The worker stated that her partner Phillip had been working in construction since they first met when the worker was about 45 years of age. She stated that this relationship was warm and affectionate prior to the onset of the injury. She reported that they would enjoy day tours to their favourite places and share coffee and meals at cafes and other locations. She had purchased a new touring motorcycle so that she could drive independently of Phillip. He had his own motorcycle. Phillip maintained both motorcycles.

The worker stated that she commenced having suicidal thoughts whilst riding her motorcycle. She reported her riding was becoming increasingly reckless since the onset of the injury. She commenced thinking about riding her motorcycle head-on into a truck whilst on the open road. She informed Phillip and this hobby ceased with him removing her motorcycle starter motor battery from her machine. The battery remains out of her motorcycle at the time of the re-examination.

The worker reported that she would clean her home excessively. She said she would become enraged if Phillip walked in on her clean floors. She reported having physically punched him and assaulted him on many occasions. She also threw a kitchen knife at him during these angry incidents. The worker said on her birthday 22 January 2026, Phillip again walked on her clean floors with his dirty work boots. She became enraged and the couple had another angry verbal argument. He left the house. He has not spoken to her since that day. Phillip has not responded to her text messaging or phone calls. The worker believes that this is Phillip indicating the relationship is finished and she believes that the relationship loss is permanent because of the many years of arguments about the nature of her condition, with him 'not understanding my injury'.

The worker presented as a neatly groomed, irritable woman with washed and brushed hair. She would have angry outbursts during the re-examination when asked to remember her distressing symptoms and events while employed with this employer.

The worker spoke in a loud voice when angry. She was provided time and reassurance which enabled her to settle slowly after each outburst. Rapport was difficult to establish and maintain. When rapport was lost, the worker was provided time to settle and use her relaxation and cognitive skills prior to proceeding with the re-examination.

The worker spoke about her inability to trust others. The worker reported that she experienced the smell of 'burnt skin' many times each day. Each onset of this symptom resulted in her lighting matches to suppress the distressing obsession. The claimant reported negative cognitions about the trauma she had experienced and witnessed in her employed role. She said her distressing thoughts of death, dying, and suicide had not persisted after she stopped riding her motorcycle.

The worker reported her time being consumed by 'useless things,' for example, lighting matches to suppress the smell she experienced many times a day, over-washing her clothes, overcleaning her teeth and over mopping her floors.

The worker explained that she was unable not to engage in these activities, as if she were to delay or not complete a task, she would become more symptomatic and frustrated with herself. She said she had told Phillip many times about her condition, and he 'does not understand'.

The worker said she had all her food cooked outside her house as she does not want to have fumes of meat cooking in the house. She said that since Phillip left her mother has begun to bring her cooked food.

The worker was insightful into her condition. Her judgment was fair. She did not have psychotic symptoms or delusional ideas. She did understand that her symptoms were part of the injury.

The worker's primary psychological injury can be fully defined using DSM-5-TR criteria. As documented above in the section 'Current symptoms and review of diagnoses,' the primary psychological injury can be fully defined as DSM-5-TR F43.1 Posttraumatic Stress disorder and DSM-5-TR F42.2 Obsessive-Compulsive Disorder.

The worker did report more symptoms than the minimum required for the diagnosis of the injury.

1. Assessment of psychiatric whole person impairment caused by the injury

The worker reported that she could attend the local supermarket, which was close to her home. She said that whilst she was slower in her daily activities of living, which included excessive cleaning of the house, excessive washing of her laundry, and the need to have meals cooked outside of the house, she was able to live independently in her local community. Her excessive cleaning behaviour is an impairment, as it is driven by her psychopathology and can cause damage to her body, and is not a normal variation of the general population. This description of functioning was assessed as a mild impairment Class 2.

The worker reported that she was unable to socialise because of her obsession and compulsion, which impaired her in groups.

The worker reported that she could attend the gym. She reported that she preferred to attend when there were few other people attending.

The worker reported that she did participate in a small family Christmas with her mother and daughter.

The worker had stopped riding her motorcycle with Phillip.

The worker reported she was able to support her mother when her mother needed assistance to attend a local doctor.

This description of functioning was assessed as a mild impairment Class 2, because whilst the worker had lost some functions due to the injury, she had not lost the most important functions that she would have performed before the onset of the injury.

The worker reported that her relationship with Phillip had been marred by her repetitive symptoms and behaviours caused by the injury. The worker had repeatedly shown verbal anger, physical violence, and the throwing of kitchen knives at Phillip.

The worker's last major verbal conflict with Phillip was on 22 January 2026. He has left the home and has been uncontactable for five days. The worker expects the relationship has ended because Phillip will not answer her telephone calls, return her text messages, or communicate with her since leaving the house.

The claimant reported strain in her relationship with her daughter because her daughter is required to assist the worker.

The same history was reported to the MA, and is consistent with domestic violence caused by her psychological injury. This description of functioning was assessed as a moderate impairment Class 3.

The worker could not return to her prior employment because of the severity of the injury symptoms alone. She had behaviours that would not be safe in office environments, like the repetitive ignition of matches to suppress her obsession with 'the smell'.

The worker could work less than 20 hours per fortnight, and up to 2 days per fortnight. Her pace of completing employable duties would be markedly reduced because of the injury symptoms alone.

This description of functioning was assessed as a severe impairment Class 4.

The worker had not suffered from any pre-existing psychiatric or psychological condition before the commencement of employment with this employer.

The worker had contributed to voluntary roles within the department in which she was employed, working as a Disaster Welfare Officer, as well as her primary child welfare role. The worker had not had any training in relation to her child welfare role or an understanding of the complexity of this role before the commencement of her employment.

The claimant had witnessed many traumatic events whilst working for this employer. The claimant developed a clinically known but less clinically common comorbid condition of posttraumatic stress disorder with obsessive-compulsive disorder. The nature of the worker's injury resulted in physical conflict between the worker and her partner, Philip. Her partner had separated from the worker about five days prior to this re-examination.

The separation occurred on 22 January 2022; this is the worker's birthday. The worker and Phillip again were involved in an angry verbal argument about him soiling her clean floors, which she had spent an excessive amount of time cleaning the same day. The worker reported Phillip had stopped communicating with her. He had not returned to the house whilst having initially removed essential clothing so he could work whilst she was absent from the house. This strongly indicates that the relationship was finished after about 3 years of psychological injury, which had not entered remission since the date of injury in October 2022.

The attendance of the worker's daughter during the summer holidays resulted in many years of outstanding taxation documentation being discovered, as the worker had avoided this complex task for many years. The worker's daughter organised and took control of lodging the necessary bookkeeping with supporting documents to the family's accountant. The complex task had been avoided because of the worker's inability to complete the task to a standard she could present. The worker subsequently avoided the task, having the documents placed in an old shoe box in the cupboard. Avoidance of tasks is frequently seen as part of a primary psychological injury and is consistent with the diagnosed psychiatric conditions that caused the injury.

The worker's assessment of whole person impairment has reached maximum medical improvement. The worker does not use psychiatric medication by preference. She does use cognitive behavioural therapy with her psychologist. The benefits provided by cognitive therapies have peaked, and the worker is unlikely to have her assessment of whole person impairment changed by more than 3% in the next 12 months with or without medical treatment.

1. Psychiatric Impairment Rating Scale - Table 11.8 PIRS Rating Form.

The following is the table of functioning in relation to the severity of whole person impairment caused by the injury diagnosed as DSM-5-TR F43.1 posttraumatic stress disorder and DSM-5-TR F42.2 Obsessive-Compulsive Disorder.

The worker reported that she could attend the local supermarket, which was close to her home. She said that whilst she was slower in her daily activities of living, which included excessive cleaning of the house, excessive washing of laundry, and the need to have meals cooked outside of the house, she was able to live independently in her local community. This description of functioning was assessed as a mild impairment Class 2.

The worker reported that she was unable to socialise because of her obsession and compulsion which impaired her in groups.

The worker reported that she could attend the gym. She reported that she preferred to attend when there were few other people attending.

The worker reported that she did participate in a small family Christmas with her mother and daughter.

The worker had stopped riding her motorcycle with Phillip.

The worker reported she was able to support her mother when her mother needed assistance to attend a local doctor.

This description of functioning was assessed as a mild impairment Class 2, because whilst the worker had lost some functions due to the injury, she had not lost the most important functions that she would have performed before the onset of the injury.

The worker reported that her relationship with Phillip had been marred by her repetitive symptoms and behaviours caused by the injury. The worker had repeatedly shown verbal anger, physical violence, and had thrown kitchen knives at Phillip. The worker's last major verbal conflict with Phillip was on 22 January 2026. He has left the home and has been uncontactable for five days. The worker expects the relationship has ended because Phillip will not answer her telephone calls, return her text messages, or communicate with her since leaving the house.

The claimant reported strain in her relationship with her daughter because her daughter is required to assist the worker.

This description of functioning was assessed as a moderate impairment Class 3.

The claimant reported she was slower in her capacity to complete complex tasks. She has avoided the completion of her annual taxation return form as she would not order her documents to her satisfaction for presentation to her accountant. During her daughter's attendance, her daughter completed the many years of outstanding documents that had been avoided and abandoned by the worker.

The worker had her daughter organise her routine automatic utility payments, so she did not have to perform complex bill payments or banking. She stated that she feared not paying her bills on time, and this was the reason for her daughter's assistance.

The re-examination was for about 90 minutes. Progress through the re-examination was slow. The worker required pauses and time to settle throughout the assessment because of her symptoms while recalling the events during her employment.

This description of functioning was assessed as a moderate impairment Class 3.

The worker could not return to her prior employment because of the severity of the injury symptoms alone. She had behaviours that would not be safe in office environments, like the repetitive ignition of matches to suppress her obsession with 'the smell'.

The worker could work less than 20 hours per fortnight, and up to 2 days per fortnight. Her pace of completing employable duties would be markedly reduced because of the injury's symptoms alone.

This description of functioning was assessed as a severe impairment Class 4."

The worker's whole person impairment would not change should she receive or not receive future psychiatric treatment. The claimant has been symptomatic for many years due to symptoms caused by the injury. The assessment of the effects of treatment was assessed as 0% WPI.

Degree of permanent impairment caused by the injury

The assessment of whole person impairment was assessed as 17% WPI. The changes in assessment and the measured whole person impairment are fully accountable by changes in Tables 11. 1 Selfcare and personal hygiene, 11.4 Social Functioning, and 11.5 concentration, persistence and pace.

The worker has a permanent psychiatric impairment measured as 17% WPI. The certificate under review, dated 1 August 2025 by Medical Assessor Gupta, should be revoked and a new certificate issued."

1. The Panel agrees with the thorough and comprehensive report by Medical Assessor Baker.
2. He obtained a much more detailed history than the Medical Assessor, and his diagnoses and assessments were consistent with the totality of the evidence
3. For these reasons, the Appeal Panel has determined that the MAC issued on 1 August 2025 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

Secretary, Department of Communities and Justice

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 Ankur Gupta and issues this new Medical Assessment Certificate as to the matters set out in the table below:

Chapter, page and paragraph number in WorkCover Guides

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)