1. On 29 August 2025 Loren Keegan, the appellant, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Surabhi Verma, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on

6 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. The appellant commenced employment as a carer with Murravale Retirement Home Ltd, the respondent, in 2019. Her employment was terminated on 8 December 2023. Due to circumstances that occurred in her employment she suffered a psychological injury.
2. The appellant claimed compensation from the respondent for permanent impairment from her injury. She relied on a report dated 21 October 2024 that psychiatrist Dr Aman Suman provided to her solicitors. Dr Suman had examined the appellant on that date and in his report advised that he assessed the degree of the appellant's permanent impairment is 23% whole person impairment (WPI). He assessed the appellant had 24% WPI pursuant to the psychiatric impairment rating scale (PIRS), which the Appeal Panel notes is detailed in paragraphs 11.11 - 11.12 of the Guidelines, to which he added 1% WPI pursuant to paragraph 1.32 of the Guidelines because the treatment the appellant had received for her injury had resulted in an apparent substantial elimination of her permanent impairment that would likely revert if she were to cease treatment. The Medical Assessor also deducted 10% of her overall impairment on the basis that a pre-existing psychological condition the appellant had contributed to her permanent impairment.
3. The insurer of the respondent disputed the appellant was entitled to compensation for permanent impairment. It relied on a report its solicitors had obtained from psychiatrist

Dr Timothy Berry dated 9 April 2025, who had assessed the degree of the appellant's permanent impairment from her injury is 8% WPI. Dr Berry's assessment was based on his assessing the appellant had 9% WPI pursuant to the PIRS less 10% of that for a proportion of her permanent impairment that he also considered was due to a pre-existing condition. 4. Following the respondent's rejection of the appellant's claim, the appellant initiated proceedings in the Personal Injury Commission (Commission), seeking the Commission determine her claim for compensation for permanent impairment. The matter was duly referred to the Medical Assessor by a delegate of the President of the Commission, who examined the appellant on 4 August 2025. In the MAC, he certified he assessed the degree of the appellant's permanent impairment from her injury is 6% WPI. That was on the basis that he assessed the appellant had 7% WPI pursuant to the PIRS less a deduction of 10% of that that he considered was due to a pre-existing condition. 5. The Medical Assessor's ratings of the appellant's impairment in the several PIRS categories are Class 2 for self-care and personal hygiene, Class 2 for social and recreational activities, Class 1 for travel, Class 2 for social functioning, Class 2 for concentration, persistence and pace (CPP), and Class 5 for employability. In her appeal against the medical assessment, the appellant has challenged the Medical Assessor's ratings of her impairment in the categories of self-care and personal hygiene, social and recreational activities, and CPP. 6. In the PIRS rating form attached to the MAC the Medical Assessor provided the following reasons for rating the appellant's impairment as Class 2 for self-care and personal hygiene:

"Ms Keegan reported that she 'brushes once a week and showers once a week and her house is in a mess.' She is able to do household chores and is able to cook simple meals like putting frozen things in air fryer. She would order food for herself. She is able to do other household chores like cleaning, laundry, etc, after procrastinating for a long time.

Her current presentation is consistent with mild impairment as she is able to live independently without regular supports and there has been no need of any community nurse or family members to ensure minimum level of hygiene and nutrition."

1. In the body of the MAC the Medical Assessor detailed in the history she recorded that the appellant had commenced using drugs when 16 years of age and had resumed doing so, until January 2025, due to the symptoms she suffered from her injury. The Medical Assessor recorded the appellant drank a bottle of scotch a day until 2021. The Medical Assessor recorded that the appellant now drinks one margarita when she visits her neighbour. The Medical Assessor noted that the appellant struggles with day to day activities and that there are times when she stays in bed with no motivation to care for herself or her house. The Medical Assessor noted that on a typical day the appellant wakes at varying times depending on the needs of her dog and that when she rises she makes herself a cup of coffee and eats whatever is available. The Medical Assessor noted that at times the appellant does not eat depending upon her appetite and that at other times "munches like crazy". The Medical Assessor noted that the appellant might try to do housework like washing, but sometimes just stays in bed watching TV and playing video games.
2. The Medical Assessor also noted that her rating of the appellant's impairment in self-care and personal hygiene differed from the rating Dr Suman made and had advised in his report of 21 October 2024.
3. The Medical Assessor provided the following reasons in the PIRS rating form for her rating of Class 2 for the appellant's impairment in social and recreational activities:

"Ms Keegan reported that previously she enjoyed kayaking, camping on her own and at times with her cousins and a dog. She also liked horse riding. She has, however, not engaged in kayaking or camping in the last two years. She has friendships which she has been able to maintain. Her best friend Sean works in mines and works long hours and has visited her a couple of times and she is busy. She talks to her own [sic: on the] phone but not as much as she used to earlier.

Her cousins too have been quite helpful and help her whenever she needs them. Her next door neighbours too have been very supportive. She visits her neighbours at least once or twice a week and has Margarita and dinner with them. Her other friend Vicky who lives in Marrickville is fantastic. She will visit her, and her friend will also come and visit her at times. She also goes and stays with her uncle whenever she goes to see her GP or her psychologist. She is planning to again see him on 14th August when she goes there for a GP visit."

1. The Medical Assessor again observed that her rating of the appellant's impairment in social and recreational activities differed from the rating Dr Suman made. The Medical Assessor noted that her rating also differed from the rating that Dr Berry made and had reported in his report of 9 April 2025. With respect to that, the Medical Assessor commented, "kindly note that Dr Berry's report does not mention her socialisation with her neighbour and multiple other close friends where she actively engages and have [sic] long conversations with them".
2. The Medical Assessor provided the following reasons in the PIRS rating form for her rating of Class 2 for the appellant's impairment in CPP:

"She reported that her attention and concentration is poor and is unable to focus on things. She loses interest quickly when she tries to read things. She has tried watching YouTube and has tried video games.

She plays video games. She plays number video games for at least 10 to 15 minutes and word games for at least 30 minutes. She is able to improve her levels however not as before. She was able to focus well and was not distracted at all during the assessment."

1. The Medical Assessor detailed in the history she recorded in the MAC that the appellant struggles with a lack of motivation. The Medical Assessor also recorded that she found during her examination that the appellant was able to focus, pay attention and was not distracted. She found the appellant's thoughts were logical and goal directed.
2. The Medical Assessor noted in the MAC that her assessment of the appellant's impairment in CPP differed from the assessment that Dr Suman had made.

1. The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
2. As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the appellant to undergo a further medical examination. This is because the material before the Appeal Panel is sufficient for the Appeal Panel to deal with the appeal.

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 submitted that the Medical Assessor's finding that her impairment in employability is total, that is Class 5, indicates that the behavioural consequences of her injuries are such that her impairment in several other of the PIRS categories ought to be rated as moderate, that is Class 3. The appellant submitted that while she does not challenge the Medical Assessor's rating of her impairment in employability, the Medical Assessor's reasoning for her rating regarding employability is deficient because a reader is unable to assess her behavioural consequences relating to employability in terms of their relevance to the other PIRS categories.
3. The appellant noted that the Medical Assessor recorded that she showers once a week, "brushes once a week", puts frozen food in an air fryer, orders food, has the ability to do household chores although her house is a mess, has no need for a community nurse or family members to ensure a minimum hygiene or nutrition, and that her cousins have been helpful and help her whenever she needs them. The appellant submitted that her bathing and brushing once a week "does not sound like the maintenance of minimum hygiene", and that the fact a community nurse or family do not attend to assist her with her house does not mean she does not need them. The appellant submitted that the Medical Assessor did not detail the nature of the help that her cousins provide her nor how frequently it is provided. The appellant submitted that an inference could be made that she needs community or family assistance. The appellant submitted that she is incapable of living independently without support. The appellant submitted that, given she showers once a week, she needs prompting to shower daily.
4. The appellant submitted that prior to her injury she did not engage in sedentary social and recreational activities or domestic hobbies such as playing a music instrument, painting writing or gardening. The appellant highlighted that prior to her injury her recreational activities comprised kayaking, camping and horse riding. The appellant highlighted that she no longer engages in kayaking, camping and horse riding.
5. The appellant submitted to the effect that the Medical Assessor, when rating her impairment in social and recreational activities, considered her ability to maintain social relationships, rather than her capacity to engage in social and recreational activities. The appellant submitted that the only activities the Medical Assessor identified when rating her impairment in social and recreational activities were her dining once or twice a week with her neighbours and her visits with her cousins, a single friend and her uncle. The appellant submitted that this was relevant to the assessment of her impairment in social functioning, rather than her impairment social and recreational activities.
6. The appellant submitted that the Medical Assessor was required to consider other medical opinions and was "requested to comment, where applicable, the reason why his [sic] opinion differs". The appellant submitted that the Medical Assessor did not do that with respect to

Dr Suman's assessment of her impairment in social and recreational activities. The appellant noted that Dr Suman rated her impairment in social and recreational activities is moderate (Class 3), referring to her inability to attend her niece's birthday party and her struggling in any environment with a crowd or loud noises. The appellant submitted that a reader cannot tell why the Medical Assessor's rating of her impairment social and recreational activities differed from Dr Suman's rating and this was a demonstrable error. 7. The appellant submitted that the Medical Assessor provided scant reasoning for her assessment of her impairment in CPP and that "the most significant objective observation was [her] capacity to focus on the assessment itself". The appellant submitted that the Medical Assessor did not reveal whether she had the capacity to undertake a retraining course or engage in intellectually demanding tasks or whether she could read more than a newspaper or follow complex instructions. The appellant submitted that the history Dr Suman obtained ought to have provided "a cue" for the Medical Assessor to make her own enquiries regarding her ability to participate in these activities. 8. In reply, the respondent submitted that the Medical Assessor made no error with her rating of the appellant's impairment in self-care and personal hygiene, bearing in mind the history the Medical Assessor detailed in the MAC. 9. The respondent submitted similarly with respect to the Medical Assessor's rating of the appellant's impairment in social and recreational activities, submitting that the Medical Assessor was entitled to exercise her clinical judgement and allocate the rating she did having regard to the history she had recorded. 10. The respondent submitted that the history the Medical Assessor detailed relating to the appellant's impairment in CPP supported the rating she made of the appellant's impairment in this category.

1. The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons.
3. The Appeal Panel does not accept the appellant's submission that the Medical Assessor's reasoning for her rating of the appellant's impairment in employability is deficient and that, by virtue of that, it is unknown whether the Medical Assessor's ratings of the appellant's impairment in other categories also involved error.
4. The Medical Assessor's reasons were that the appellant has no capacity to work, notwithstanding that she wanted to work in aged care, and that her symptoms from her injury would impact her ability to work. That was sufficient detail and explanation to support her rating of the appellant's impairment as being total. There was no need for the Medical Assessor to provide further reasons. Indeed, had the Medical Assessor considered the conduct of the appellant, insofar as it is germane to her ability to engage in employment, when rating the appellant's impairment in the other PIRS categories, the Medical Assessor would have made an error. Those elements of the appellant's impaired conduct or behaviour that relate to her impairment in employability were required to be assessed by the Medical Assessor when rating her impairment in employability, and not when rating her impairment in any other of the PIRS categories.[1]
5. The Appeal Panel also does not accept the appellant's submissions to the effect that the Medical Assessor erred by rating her impairment self-care and personal hygiene as Class 2, that is a mild impairment.
6. The examples provided in Table 11.2 of the Guidelines for a Class 2 and Class 3 impairment in SRA are:

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

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

1. The examples of impaired conduct provided for the various class ratings in the several PIRS Tables are just that; examples. They are not prescriptive. They are illustrative of how a worker's impairment may be rated. A worker may exhibit impaired conduct that correlates with an example listed for one of the class ratings within a PIRS category and also exhibit other impaired conduct that correlates with an example listed for another of the class ratings of that particular PIRS category. The fact that a worker may exhibit conduct described in one class rating, does not necessarily compel a Medical Assessor to rate the worker's impairment within that class. The particular example can be surmounted by other relevant facts.[2]
2. A Medical Assessor must evaluate all the material before him or her to compose a relevant clinical history by which to determine what the level of impairment of the worker is in a particular PIRS category and it is not uncommon that every aspect of the worker's impairment within a PIRS category does not fall completely within one class. The Medical Assessor must weigh all relevant conduct of the worker relating to the particular PIRS category in order to evaluate the degree the worker's impairment in the particular category. That involves the exercise by the Medical Assessor of his or her clinical expertise and judgement. That will permit some latitude of opinion.
3. The history the Medical Assessor obtained reveals the appellant can prepare her meals, although simple, is able to order food for herself, can attend to her household chores, although she has a messy house, and showers once a week and "brushes" once a week. The Appeal Panel understands the Medical Assessor's reference to "brushes" to be a reference to the appellant brushing her hair once a week.
4. The Medical Assessor's reference to the assistance the appellant receives from her cousins was in the context of the Medical Assessor describing the appellant's capacity in social and recreational activities. The Medical Assessor also observed that the appellant does not receive outside assistance for her self-care or personal hygiene. That is the appellant does not receive help from a community nurse or family members for her self-care and personal hygiene.
5. The Medical Assessor's statement of reasons is not to be read with an eye fine tuned for error or over zealously.[3] Given that, and noting the Medical Assessor referred to the assistance the appellant receives from her cousins when describing her capacity in social and recreational activities and that the Medical Assessor explicitly said the appellant does not receive outside assistance for her self-care and personal hygiene, the Appeal Panel considers that the Medical Assessor's reference to assistance from her cousins is to be fairly read as the appellant's cousins helping her engage in social and recreational activities and not with respect to the appellant's self-care and personal hygiene.
6. In those circumstances, it is the Appeal Panel's view that the Medical Assessor was not in error in concluding that the appellant can live independently without regular support. The appellant's level of impairment best accords, in the Appeal Panel's view, with the descriptors provided for a Class 2 level of impairment in self-care and personal hygiene in that the appellant is looking after herself adequately without support, but may look upkept. As the Medical Assessor said the appellant is able on her own to maintain a minimal level of hygiene and nutrition. She is able to attend to her household chores, although her house is messy.
7. The Appeal Panel finds that the Medical Assessor did not make an error and that he applied correct criteria to assess the appellant's impairment self-care and personal hygiene.
8. The Appeal Panel also does not accept the appellant's submissions that the Medical Assessor, when rating the appellant's impairment social and recreational activities, has considered conduct that should have been characterised as relating to social functioning. As mentioned earlier, a Medical Assessor must correctly characterise the conduct of a worker as falling in one or other of the PIRS categories. If a Medical Assessor wrongly assigns a conduct to a category when it should have been assigned to another then the Medical Assessor will have considered an irrelevant consideration when evaluating degree of seriousness of workers' permanent impairment in the former category.[4]
9. However, an activity in which a worker engages may involve several types of conduct. What a Medical Assessor is required to do is to characterise the various elements of conduct that comprise a particular activity, and to correlate the elements of conduct into the correct PIRS categories. If a Medical Assessor correctly does that then the Medical Assessor will not have made an error of the type identified in Ballas at [94].[5]
10. So, relevant to the matter at hand, a worker's engagement in social and recreational activities will frequently be done with persons with whom the worker maintains social relations, that is members of the worker's family and the worker's friends. The conduct of a worker when participating in such activity, insofar as it relates to the social and recreational elements of the activity, must be assessed by a Medical Assessor within the PIRS category of social and recreational activities, whereas the conduct of the worker insofar as it relates to keeping and maintaining the worker's relationship with family and friends and maintaining the strength of those relationships, must be assessed by a Medical Assessor within the PIRS category of social functioning.
11. Saying that another way, a particular activity in which a worker engages with family or friends will involve at least two types of conduct, and frequently more e.g. travelling for such activities, and what Ballas requires is the Medical Assessor assign each type of conduct to the respective PIRS domain to which it relates. So as long as a Medical Assessor's focus is on the social and recreational elements of a particular activity in which the worker engages with family or friends when assessing the worker's impairment in social and recreational activities and the Medical Assessor's focus is on the sustenance of the worker's relationship with family and friends when engaged in the same activity when assessing the worker's impairment in social functioning, then there will be no error on the part of the Medical Assessor of the type identified in Ballas at [94].
12. The Appeal Panel considers the Medical Assessor has done that with respect to evaluating the appellant's impairment in social and recreational activities. That is the Medical Assessor focused on the appellant's ability to engage socially with her friends and with her extended family in social activities when rating the appellant's impairment in social and recreational activities. The Medical Assessor had regard to the appellant engaging socially with her next door neighbours, her close friend and her uncle. The Medical Assessor had regard to the fact that the appellant has dinner with her neighbours on at least one or two occasions a week and has a margarita with them. The Medical Assessor was cognitive of the fact that the appellant no longer engages in her outdoor recreations of kayaking and camping. The degree of impairment is rated using the class descriptors, taking into account cultural and demographic factors, not by comparison with the worker's function at some timepoint in their life prior to the injury.
13. The examples provided in Table 11.2 of the Guidelines for a Class 2 and Class 3 impairment in SRA are:

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

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

1. What the Medical Assessor has described in the PIRS rating form to explain why she assessed the appellant's impairment in social and recreational activities as Class 2, best correlates, in the Appeal Panel's view, with a level of impairment described by the examples for a Class 2 impairment Table 11.2. What she has described, in essence, reveals that the appellant is going out more than occasionally and going out for social activities. What she describes does not indicate that the appellant rarely goes out or engages in recreational activities, that she needs prompting from her family or close friends to do so, and/or requires a support person to go out.
2. Consequently, the Appeal Panel discerns no error in the Medical Assessor's rating. The Appeal Panel finds that the Medical Assessor applied the correct criteria to rate the appellant's impairment in social and recreational activities.
3. The Appeal Panel accepts the appellant's submission that the Medical Assessor erred in rating her impairment in CPP as Class 2.
4. The descriptors provided in Table 11.5 for a Class 2 impairment for CPP are:

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

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

1. What the Medical Assessor has described in the PIRS rating form relating to her assessment of the appellant's impairment in CPP reveals that appellant would be unable to follow complex instructions and would be unable to read more than newspaper articles. It reveals that her concentration and attention is limited to relative mundane matters such as a "word game', not intellectually demanding matters. Her ability to concentrate on such matters is limited to 30 minutes, less for video games, and she cannot persist with reading, losing interest quickly. What she has described does not reveal that the appellant is able to focus on intellectually demanding tasks for period of up to 30 minutes. The Appeal Panel also observes from the evidence before it that the appellant had to cease a course she was previously doing, which also confirms a moderately severe impairment in her CPP.
2. Simply put, the Medical Assessor was wrong to assess the appellant's impairment in CPP as mild on the history she obtained. The history she obtained revealed that the appellant had a moderate impairment in CPP. That error on the part of Medical Assessor amounts to the MAC containing a demonstrable error. The Appeal Panel must consequently correct that error which does by rating the appellant's impairment in CPP as Class 3.
3. For these reasons, the Appeal Panel has determined that the MAC issued on 6 August 2025 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act 1998.

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Surabhi Verma 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)

[1] Ballas v Department of Education (State of New South Wales) [2020] NSWCA 86 at [93] - [94].

[2] Rogers v Help Service Union NSW [2025] NSWSC 291 at [43] - [45].

[3] Minister for Immigration and Ethnic Affairs v Wu Shan Liang [1996] HCA 6.

[5] Keelan v Pearl Beach Real Estate Pty Ltd [2024] NSWSC 1430 at [61].