1. On 17 October 2024 Isabella Fontez (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Wayne Mason, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 19 September 2024.
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.
3. The Appeal Panel has concluded that in light of the Supreme Court decisions in Quintiliani-Johns v Secretary, Department of Education [2024] NSWSC 1200 (25 September 2024) and Southwell v Qantas Airways Ltd [2024] NSWSC 497 where there is a dispute regarding s 323 of the 1998 Act, it is necessary for the worker to be re-examined in respect of all Psychiatric Impairment Rating Scale (PIRS) categories before determining whether there was any part or portion of the impairment which was solely due to the pre-existing condition and not the workplace injury (alone or together with the pre-existing condition).

1. The Appeal Panel has before it all the documents that were sent to the MA 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 MA erred in his assessments under two categories of the PIRS, namely Self -care and personal hygiene and Social Functioning, and further erred in the deduction he made pursuant to s 323 of the 1998 Act.
3. In reply, SYC Ltd (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 MA for assessment of whole person impairment (WPI) in respect of a primary psychological injury on a deemed date of injury of 20 June 2022 (deemed).
4. The MA obtained a history of the circumstances of the injury which we do not intend to repeat here.
5. Present symptoms were noted as follows:

"Ms Fontez said she is now more comfortable with the gender transition process but is not happy with the professional side of her life. She said she trusted the employer and they did not help. She still finds it difficult to go outside because of anxiety and has to plan in advance. She does go out occasionally to walk the dog. She now lives in a suburban area in Southwest Sydney and said she feels weird and judged when she goes out; this was not the case when she lived in an inner suburban area. She said she continues to have panic attacks when she goes out but she could not provide an estimate of how many per week. She said she goes out 2 or 3 times per week and her work with the psychologist and psychiatrist has enabled her to prevent the onset of severe attacks. She continues to experience dissociative episodes in order to deal with heightened anxiety. She described ongoing social anxiety and is attempting to adjust. She said she does not believe she is depressed and does not have suicidal ideation. She said in the past there were dark times arising from the fact that she was in the wrong body but this is now not the case."

1. After setting out details of her general health and work history, the MA then turned to consider the impact of Ms Fontez's injury on her social activities and activities of daily living (ADL's) and said:

"When asked to describe a normal routine Ms Fontez said she had none. She said she usually goes to bed at 9:30 PM or 10 PM and sleeps for approximately 6 hours. She wakes at 4:30 AM or 5 AM and plays on her phone. She said she may stay in bed all day and watch Netflix. She said she had been homeless for 5 months and now lives in social housing. Since commencing on the disability support pension she is no longer eligible and is expected to move when they find other accommodation.

Self-care and personal hygiene: Ms Fontez said she showers daily and changes her clothes regularly. She regularly goes to a beauty salon for nails and eyelashes. When asked about nutrition she said this varies. She had recently been commenced on Ozempic 1 mg weekly for weight loss and her weight has reduced from 94 kg to 73 kg. She is unimpaired.

Social and recreational activities: Ms Fontez said she does not do very much. Her dog is her regular companion and they go out for walks 2 or 3 times per week. She visits her mother in Pyrmont and her paternal grandmother in Carramar. She had recently reconnected with one friend and they visit each other. She does not go out for coffee or meals or to entertainment venues. She does infrequently attend an RSL club with her paternal grandmother who enjoys playing poker machines. She is moderately impaired.

Travel: Ms Fontez has her own car and can drive wherever she wishes. She said she had lost her license for either DUI or speeding but has currently regained her green provisional licence. She is unable to use public transport because of anxiety. She has not used air travel. She is mildly impaired.

Social functioning: Ms Fontez was not in a relationship at the time of the work injury. She had been in a relationship for 5 months during 2023 but this did not work out. She reconnected with her mother one year after the work injury and that relationship is solid. She had reconnected with her father prior to the gender transition. Subsequent to the transition her father has rejected her. She has no connection with her sisters and her range of friendships is greatly reduced. Overall she is mildly impaired.

Concentration, persistence and pace: Ms Fontez said this is variable. She has panic attacks if she attempts to respond to an email or fill in a document. She said her psychologist has suggested writing a journal in order to improve her skills in this regard but she struggles to do so. She has the TV on for background noise because she hates silence. Prior to the work injury she would watch every episode of every franchise of 'Real Housewives' but cannot do so now. She said she is much slower with tasks and tends not to complete things. There was evidence of impaired concentration and distractibility throughout the interview. She is moderately impaired.

Employability: Ms Fontez said she could not manage to hold herself together in the workplace with an employer or a client because of anxiety. Although she has managed to work as an escort, I do agree with this assessment. She is totally impaired."

1. Findings on mental state examination were reported as follows:

"Ms Fontez is a 37-year-old right-hand dominant woman whose appearance is consistent with her stated age. She was identified from her photograph on her green provisional NSW driver licence. She was located alone in a room in her home in South West Sydney. She was interviewed using the Microsoft Teams application with a good internet connection. Her mother was present throughout the interview on another device but did not contribute to the interview. When personal details were discussed Ms Fontez turned off the audio on the other device. The interview commenced at 11 AM and concluded at 12:40 PM.

Ms Fontez was cooperative with the interview and provided information willingly and without prompting. She was initially anxious and somewhat restricted in her responses but this improved as the interview proceeded. She was not depressed in appearance and denied suicidal ideation. She described significant anxiety symptoms including social anxiety, generalised anxiety and panic attacks. Her range of affective expression was full and appropriate. There was some evidence of distractibility and impaired concentration and memory throughout the interview consistent with severe anxiety.

Ms Fontez was fully oriented in time, person and place and displayed no evidence of organic or psychotic psychopathology."

1. In summarising the injuries and diagnoses, the MA said:

"As a consequence of perceived lack of support in the workplace for the gender transition process Ms Fontez suffered an exacerbation of pre-existing complex post-traumatic stress disorder and social and generalised anxiety disorders. In addition she developed a panic disorder.

Ms Fontez meets DSM-5 criteria for Panic Disorder as follows: Criterion A is met by the presence of recurrent unexpected panic attacks. Symptoms consist of palpitations and an accelerated heart rate, trembling, shortness of breath, nausea, paraesthesia years, and a sense of having to go home. Criterion B is met by persistent worry about additional panic attacks and adaptive change in behaviour in order to avoid panic attacks. Criterion C is met because it is not due to a substance or another medical condition. Criterion D is met because it is not better explained by another mental disorder."

1. The MA assessed 17% WPI from which he deducted 3/10ths pursuant to s 323, leaving a total WPI of 12%

"Ms Fontez was questioned about various entries in the documentation. She confirmed the GP entry in March 2013 that she had attended psychologist Ms Despina Sfakinos for a number of years and was using venlafaxine. She confirmed she had been dismissed by both Wise Employment and Workskil but stated she had always met her KPIs. She said she had ceased work with another employer after they were bought out by APM. She confirmed she had been admitted for 6 days to the psychiatric unit of Concord Hospital in March 2020 for severe anxiety arising from difficulties while living with her sister. When asked about a GP report on 15 June 2021 that she experienced anxiety in social situations she confirmed this was the case but said it was more related to her gender identity dysphoria. She confirmed she had been successful in obtaining a payment from Victims Services for intimate partner violence. She also confirmed she had been successful in the unfair dismissal case against Workskil Australia. In addition she confirmed she had worked as an escort since finishing work with SYC Ltd for 2 separate periods when she had no income. She said she had not been a sex worker prior to this. In general terms Ms Fontez was an open and consistent historian."

1. When asked: "Is any proportion of loss of efficient use or impairment or whole person impairment, due to a previous injury, pre-existing condition or abnormality?" the MA replied "yes" adding:

"There is a childhood history of domestic violence by her father involving both Ms Fontez and her mother which extended over 15 years. This has resulted in a complex Post Traumatic Stress Disorder with dissociative features and anxiety. This in turn was exacerbated by rape at 23 years of age. In addition there is long standing gender dysphoria with attendant anxiety. In March 2020 there was a 6 day psychiatric admission to Concord Hospital for severe anxiety arising from difficulties in the relationship with her sister who was living with her at that time. The documents also indicate difficulties with previous employers involving extended time off work. Finally, the decision to initiate the gender transition process is in itself likely to be anxiogenic, even if the outcome is fully desired and satisfactory."

1. He then turned to consider the other medical opinions and material before him in considerable detail.
2. Again, we do not intend to set out these opinions at this point, but will refer to the material where relevant in our discussion of the evidence.

(a) a Class 2 assessment should be made.

(b) In her statement dated 3 July 2024 the appellant said:

"The anxiety that I feel causes me to lose motivation in my day-to-day life. I do not want to dress myself and get ready to leave my place of residence...I continue to struggle with self-care and leaving my place of residency...I now eat less frequently and have lost appetite for food I once had due to feelings of poor self-worth...I try to shower daily and clothe myself, but often stay in my pyjamas all day as I lack the motivation to take care of myself... I struggle to cook for myself and order takeout when I am hungry as I lack the motivation to care for myself properly."

(c) Dr Assaad Saboor assessed a Class 2 rating.

(d) Dr Bisht also assessed a Class 2 rating.

(a) a Class 3 rating is appropriate.

(b) Her statements support this.

(c) Dr Bisht also assessed a Class 3 rating.

(a) The MA provided 3/10th deduction for pre-existing condition without using the same method for calculating current impairment level as required by the Guidelines.

(b) Given the MA did not provide a separate PIRS and WPI assessment for the pre-existing condition, the MA should have made a deduction of 1/10th (at most) pursuant to s 323.

(c) The following evidence indicates that any pre-existing condition was not affecting the PIRS or WPI for the current condition:

(i) the appellant worked without incident for the respondent for nine months prior to the alleged injury as per her statements;

(ii) Dr Philip Tam report dated 29 June 2023 records an employment history prior to the alleged injury indicating high functionality;

(iii) the MAC records an employment history prior to the alleged injury indicating high functionality, and

(iv) there should be no deduction or at most, a one-tenth deduction.

1. As stated earlier, the respondent contends that no errors were made, adding:

(a) the loss of appetite and eating less frequently is due to the appellant commencing Ozempic. In fact, the MA records that the appellant commenced on Ozempic (Semaglutide) for weight loss and had reduced her weight from 94kg to 73kg. While the appellant mentions variability in her eating habits and has been prescribed Ozempic for weight loss, the reduction in weight from 94kg to 73kg signifies an active effort toward managing her health. This suggests that she is at least partially managing her nutrition effectively.

(b) Dr Bisht reported that the worker has gender dysphoria and discusses its impact on her mental health, but also illustrates that the complexities of her psychological condition do not entirely preclude her from self-care activities.

(c) The MA assessed a Class 2 for social functioning, noting that "the appellant was not in a relationship at the time of the work injury" and characterised her relationships with her family and friends as diminished, stating "she has no connection with her sisters and her range of friendships is greatly reduced." However, he also acknowledged that she had re-connected with her mother and maintained a relationship with her grandmother.

(d) Dr Bisht and Dr Saboor both assessed a Class 2 rating in this category.

(e) The MA's deduction pursuant to s 323 was appropriate.

1. As indicated earlier, in light of the decisions to which we referred, a re-examination was required.
2. Dr Douglas Andrews of the Appeal Panel did this on 9 April 2025 and reported to the Appeal Panel as follows:

"1. The worker's medical history, where it differs from previous records

Ms Fontez is a 38-year-old transgender woman who lives alone in stable social housing, a two-bedroom apartment, in Marrickville. She has been on a disability support pension since April 2024, backdated to August 2023, for generalised anxiety disorder, social anxiety disorder, panic disorder and depression.

She had been working as a business development consultant for SYC since 29 November 2021. Her responsibility was to liaise and network with employers regarding youth clients aged 17 to 25. Ms Fontez says she loved her job and believed she was good at it. She had been headhunted from her previous employer.

Ms Fontez recalled that SYC promoted their credentials as a diversity-aware employer and knew of her identification as a transgender woman. She openly used the pronouns she and her in the workplace, although she initially dressed as a male.

During this period, Ms Fontez dressed as a male in a professional setting but as a female on the weekend. On 20 June 2022, she told her manager of her intention to come out as a woman in the workplace. She was aware that there would be personal and professional challenges. She said, 'I felt safe and told Kelly [her manager]; after then I felt not taken seriously.' She had requested support and plans to assist with dealing with the change in her gender presentation with colleagues and clients. She was surprised this was not forthcoming and said, 'Things unravelled, this professionally ruined me.'

Ms Fontez developed increasing feelings of anxiety and panic. She started calling in sick more frequently. She left work and claimed WorkCover around 9 September 2022.

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

Ms Fontez feels there has been only minor improvement since starting treatment, and said, 'There has been slight improvement, a minor reduction in panic.'

She continues to take fluoxetine 20 mg daily, Lorazepam 1 mg daily and alternates temazepam 10 mg and zopiclone 7.5 mg at night.

She sees her psychiatrist, Dr Vladimir Sahzin, about every 2 to 3 months, where her medications and current state are monitored. She has reduced her frequency of attendance because she cannot afford Dr Sahzin's fee.

She sees her psychologist, Mr Muhamad Zeidni, weekly.

Ms Fontez has recently consulted a new psychologist specialising in gender transition issues.

Ms Fontez's general health is good. She is on hormone therapy for her gender transition and takes semaglutide (Ozempic) for weight loss. She has lost significant weight using the latter medication and is now about 73 kg (her self-determined ideal weight is 69 kg). Her semaglutide dose is being reduced to a maintenance regimen.

Ms Fontez experiences more anxiety than depression. She has pervasive anxiety, worse in social situations, and she experiences 6 or 7 classic panic attacks weekly. Consequently, she tends to isolate herself.

Although she said her mood is not overly low, she has reduced experience of positive emotions.

She experiences some affect instability related to her hormonal treatment but considered this mild and felt that she could differentiate it from anxiety-related swings.

Earlier, she had thoughts of suicide but no longer.

Her sleep is disturbed with initial and middle insomnia.

Her appetite is 'up and down', and her semaglutide medication impacts this.

Ms Fontez was reluctant to discuss pre-existing mental health problems. She expressed concern that I and others might fail to understand the profound impact of her workplace injury on her well-being. I explained the necessity of discussing these things, given that she had appealed the S323 determination. She said she understood and was cooperative.

Ms Fontez has experienced several adverse circumstances.

She experienced rhabdomyolysis at age 5. The reason in her case is unknown.

Her father was violent toward her mother, and she recalled lying awake as a child and wondering if she would need to call the police. Her father left the family when she was 15 years old.

Ms Fontez's grandmother died when she was 21, and she went through a period of grief. She consulted her general practitioner and was put on an antidepressant medication for about 2 months. Ms Fontez believes she was misdiagnosed as having depression.

She was sexually assaulted at age 23 by an intimate partner and received Victims Compensation for this.

These things described adverse circumstances in her life and are not, in themselves, mental health conditions.

She said, 'I have always known I was in the wrong body.' This and associated beliefs would meet Criterion A for gender dysphoria starting in childhood and persisting into adulthood. Criterion B requires that "'he condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning.' Ms Fontez said that she is quite comfortable with what she considers to be her 'authentic self', and her gender preference does not, of itself, cause significant distress or impairment in any of the relevant domains. Ms Fontez argues that the unsupportive response of her employer to her desire to live openly as a woman in the workplace caused distress and a lack of trust in others.

She was admitted to the mental health unit at Concord Hospital for six days in 2020. Her sister had come to live with her for support while struggling with drug-related issues. Ms Fontez found this stressful.

General practice clinical records provided on 4 October 2023 by the Marrickville Metro Medical Centre detail consultations referring to mental health challenges going back to 2013 and continuing through to at least 26 October 2021. For example:

• 12 March 2013 - Efexor-XR Capsule 75 mg daily
• 9 April 2013 - Effexor-HR capsule 75 mg ceased... Lexapro tablet 10 mg 1 daily for 2 weeks then increased to 20 mg daily.
• 11 August 2014 - Review GP mental health care plan... Standard referral to Ms to Ms Despina Sfakinos [psychologist]
• 30 December 2015 - mental health care consultation... Denies suicidal ideation and no plan... Mood is okay... Lexapro tablet 20 mg 1 daily
• 20 March 2016 - mood being good, anxiety well-controlled... Lexapro tablet 20 mg ceased.
• 22 January 2017 - 'depression has been well-controlled. Mood has been good, and no longer on Lexapro. Anxiety well-controlled.... Has quite a stressful job helping people with difficult circumstances find a job. Has found it good because he can relate as was in the same circumstance.'
• 10 November 2017 - 'mood been a bit more down in the last few months. Been trying to ignore it but getting worse, stressful work. Lexapro tablet 10 mg.'
• 19 November 2017 - 'mood improved a little, going back to work tomorrow.'
• 29 January 2018 - 'incident at work on 15/1.... Supportive counselling, will continue to see Zeidni, has weaned off Lexapro and feeling okay, uses a Valium occasionally for anxiety.'
• 31 March 2020 - 'very stressed at the moment. Hasn't been at work since 08/01/20.'
• 9 June 2021 - 'a client was verbally abusive, texts, emails, and verbally abusive, this happened on 2/6/20 one. Distressed and anxious. Has been going to work, no support and no follow-up at work.'
• 15 June 2021 - 'is suffering from anxiety symptoms, affecting his normal life, when he is in normal social situations, gets choked up feeling, feels awkward, self-aware, feels like he gets in his head, he feels overwhelmed and self-conscious. This has been more prominent since the incident work, and the lack of support he is getting from management.'
• 29 June 2021 - 'mental health, improving, working from home, refer to another psychologist, headaches...'
• 26 October 2021 - 'anxiety, distress, needs review with the psychologist, due for a mhr [mental health review], counselled.... Valium tablet'

I put this series of consultations to Ms Fontez, and she agreed that she had intermittent mental health problems related to work stress. She tended to downplay the significance of this.

Ms Fontez meets the DSM-5 diagnostic criteria for a generalised anxiety disorder, social anxiety and panic disorder. She has some mood symptoms that are secondary to her anxiety.

Her anxiety disorders were present before the work injury but were relatively mild in nature and manageable. Her conditions were only mildly symptomatic in the months leading up to her work injury.

She had a prejudicial upbringing and experienced a violent sexual assault as a young adult. Despite these adverse life circumstances, there is no evidence that this caused a long-standing condition such as personality dysfunction or complex post-traumatic stress disorder. The experience of trauma in the absence of symptoms is not sufficient to make such a diagnosis.

Although Ms Fontez is comfortable with her gender transition now, she likely has had some past gender-related dysphoria.

Ms Fontez has had reasonable pharmacological and psychological treatment without significant benefit. Her condition and associated impairment will not improve over the next 12 months with or without further medical treatment. She has reached maximum medical improvement.

Ms Fontez had been living independently and had no problems maintaining her hygiene, diet, or household environment. Her weight was stable.

She recalled having 'very few friends' but enjoyed social interaction with work colleagues. However, she rarely saw them outside of the work setting. She enjoyed going to shops and occasionally went to entertainment venues or restaurants. She mentioned she had seen Mrs Brown's Boys and Oliver.

She has a driver's license and was comfortable driving herself around Sydney. She travelled to Melbourne a couple of times and visited Thailand with her family for her 30th birthday.

Ms Fontez had difficult relationships with her family members. She had no contact with her father and was estranged from her mother and siblings. She remained close to her other grandmother, whom she saw occasionally.

Before the work injury, Ms Fontez had no problems with concentration, persistence or pace. She managed her job and enjoyed television shows.

Ms Fontez recalled no problems managing her workload between November 2021 and June 2022. Before starting with SYC, she worked for about four companies over 7 years. She found the work stressful but performed adequately. She was headhunted for a position with SYC.

Ms Fontez lives alone in her two-bedroom apartment. She manages housework, including cleaning, shopping, and meal preparation. She attends to her hygiene and showers daily. She is attentive to her appearance. She eats a healthy diet and has lost significant weight (weight that she had gained after her work injury) using semaglutide.

She often spends the day in her pyjamas, leaving the television on for background noise. She does not read and has no hobbies.

She is not in an intimate relationship. She formed a five-month relationship in 2023 but has been unable to maintain it. She has a male friend who visits weekly to check on her, and they occasionally go out to a restaurant together. She also has a female friend whom she sees less frequently. She keeps in touch with her grandmother, and they go to the RSL and do 'old people things' about once a week.

She had reconciled with her mother, who had attended the earlier PIC assessment as a support person. However, they fell in December and are no longer in contact. Ms Fontez suggested that her mother struggled to cope with issues around gender transition. She has no other friends or social contacts.

Ms Fontez stopped working for SYC in September 2022. She has worked intermittently as an escort but struggles to tolerate being with other people because of her anxiety. She attempted to do this a week or two ago but failed. Her last successful outing was in October 2024.

I have taken a detailed history of Ms Fontez's functioning in all domains pre- and post-injury. I asked her to concentrate on her activities and functioning in the latter half of 2021 and in 2022 until her injury.

Self-care and personal hygiene - Ms Fontez was independent and maintained hygiene and a healthy lifestyle in a manner that showed no evidence of impairment. - Class 1.

Social and recreational activities - Ms Fontez had a limited social life outside her work. However, she attended restaurants and occasional shows with a small circle of friends. She was functioning in a manner consistent with the normal variation in the general population. - Class 1.

Travel - Ms Fontez was comfortable travelling alone in the local area and could travel further afield, such as to Melbourne. She rarely used public transport because she didn't need to. There is no evidence of any impairment in this domain. - Class 1.

Social functioning - Ms Fontez had evidence of social anxiety and a limited social circle. She was not in an intimate relationship and has not maintained such relationships long-term. She had a prejudicial childhood and was estranged from her parents and siblings. She had reasonable but superficial relationships with work colleagues. - Class 3.

Concentration, persistence and pace - Ms Fontez performed her work duties without difficulties. She managed her home and personal affairs. She watched television with comprehension. There is no evidence of any impairment in this domain. - Class 1.

Employability - She was employed full-time in a challenging role as a business development manager for SYC. Although she had found previous similar work stressful, she was functioning within the normal variation in the general population. - Class 1.

The appellant challenged self-care and personal hygiene and social functioning. The findings the MA for social and recreational activities, travel, concentration, persistence and pace and employability were unchallenged.

Self-care and personal hygiene - the MA had determined a Class 1. Ms Fontez is independent in activities of daily living. She is attentive to her appearance and hygiene. She has her nails and eyelashes done every second week and has other beauty treatments. She showers daily and wears clean clothes. She maintains her living environment and prepares her meals. She has been trying to maintain her health by eating a healthy diet and using semaglutide for weight loss. She is functioning within the normal variation in the general population. - Class 1.

Social functioning - the MA determined a Class 3.

Social functioning - the MA had determined a Class 2. Ms Fontez is socially isolated. She has maintained two friends, one she sees weekly and the other less frequently. She reconciled with her mother, but they again became estranged. She remains estranged from her father and siblings. She had an intimate relationship for 5 months in 2023 but was unable to sustain. She continues to have moderate impairment. - Class 3

Concentration, persistence and pace - the MA had determined a class 3

Pre-existing impairment - The appellant had an aggregate of 8, a median of 1, equating to a pre-existing 1% WPI.

Current impairment - The appellant had an aggregate 17, median 3, equating to a 19% WPI.

Ms Fontez was seen via an audiovisual link to her home for over 90 minutes. The connection quality was adequate to do a comprehensive assessment.

She presented casually attired, wearing neat pyjamas and a headscarf. Her fingernails and eyelashes were professionally done, and she said that she attends a salon every two weeks. She appeared to have lip filler. She was wearing necklaces.

She said that she was anxious rather than depressed and mentioned that she found it difficult to discuss some aspects of her history. She was friendly and cooperative, and her anxiety was readily apparent.

There was no evidence of any disorder of thought form or perception.

She has no current thoughts of self-harm or suicide.

She gave a coherent and detailed history despite her reluctance to discuss some issues, particularly her pre-existing mental health.

During my interview, I detected no sign of lapses in attention or memory."

1. The Appeal Panel accepts the findings and assessments of Dr Andrews following his thorough and comprehensive assessment of the appellant.
2. For these reasons, the Appeal Panel has determined that the MAC issued on

15 October 2024 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 Wayne Mason Ankur 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)