1. On 1 December 2023, Raelene Teresa Keelan (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Professor Nicholas Glozier, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 1 November 2023.
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 appellant was employed by the respondent managing holiday properties in the Pearl Beach, Umina Beach and Patonga areas. The appellant claimed that she sustained a psychological injury due to the nature and conditions of her employment between October 2018 and March 2019.
2. Liability for the psychological injury was accepted by the respondent's insurer. On

19 March 2020, the appellant made a claim for lump sum compensation pursuant to s 66 of the Workers Compensation Act 1987, relying on an assessment by psychiatrist, Dr Martin Allan, of 15% whole person impairment (WPI) resulting from the injury. 3. The respondent's insurer disputed that the appellant was entitled to lump sum compensation, relying on an assessment by Dr Ashwinder Anand of 7% WPI. 4. Proceedings were commenced in the Personal Injury Commission (Commission) and the medical dispute was referred to the Medical Assessor who issued a MAC on

28 September 2020 in which he found 7% WPI resulting from the injury. The proceedings in the Commission were discontinued prior to a certificate of determination being issued. 5. On 24 August 2022, the appellant was re-examined by Dr Allan who made an assessment of 19% WPI. An appeal against the decision of the Medical Assessor was lodged on

28 February 2023 on the grounds of deterioration and additional relevant information. 6. On 9 May 2023, the matter was listed for conference before a Member of the Commission who made orders for the filing of late material and submissions and remitted the matter to the President for determination pursuant to s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998. 7. The matter was then listed for conference before a Principal Member of the Commission on 26 May 2023. The Principal Member revoked the orders made on 9 May 2023. Orders were made restoring the proceedings in the Commission and the matter remitted to a delegate of the President to determine whether a ground of appeal was made out for the purposes of s 327(4) of the 1998 Act. 8. The President's delegate determined on 6 June 2023 that the ground of appeal in s 327(3)(a) of the 1998 Act was made out. The matter was referred to an Appeal Panel who determined on 27 July 2023, that the appropriate course was to refer the medical dispute back to the Medical Assessor for further assessment pursuant to s 329 of the 1998 Act. 9. On 1 November 2023, the Medical Assessor issued a second MAC in which he made an assessment of 9% WPI. 10. On 1 December 2023, the appellant lodged an Application to Appeal Against the Decision of a Medical Assessor. The matter was considered by an Appeal Panel who rejected the appeal and confirmed the MAC in a decision dated 13 March 2024. 11. The appellant sought judicial review of the Appeal Panel's decision in the Supreme Court. On 11 December 2024, Elkaim AJ made orders setting aside the Appeal Panel's decision and remitting the matter for redetermination according to law. 12. The current (differently constituted) Appeal Panel was convened pursuant to the Supreme Court's orders.

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 appellant should undergo a further medical examination due to the Supreme Court's findings and the period of time that had elapsed since the MAC was issued. The Appeal Panel was satisfied that the MAC contained a demonstrable error.

1. The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.

1. Medical Assessor John Lam-Po-Tang of the Appeal Panel conducted an examination of the worker on 13 March 2025 and reported to the Appeal Panel.

1. The parts of the MAC given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

1. Both parties made written submissions. They are not repeated in full but have been considered by the Appeal Panel.
2. In summary, the appellant submits that the Medical Assessor applied incorrect criteria in his assessment of the psychiatric impairment rating scale (PIRS) category of "Concentration Persistence and Pace". The Medical Assessor found a class 2 impairment whereas the appellant submits she ought to have been assessed as having a class 3 moderate impairment.
3. The appellant referred to her statement of 1 December 2022 in which she stated that she felt overwhelmed most of the time and could not think properly. The appellant stated,

"I cannot focus properly or concentrate much on anything. I try and watch TV, but I cannot follow what is going on. I do not read much anymore. I get too easily distracted. I end up reading the same thing over and over. What happened to me in the workplace at Pearl Beach Real Estate is constantly on my mind, from the minute I wake up to when I go to bed."

1. The appellant noted that the Medical Assessor did not refer to this statement or its contents in the MAC despite it being placed before him.
2. The appellant submitted that the references to statements in the history relating to the injury were a reference to the appellant's earlier statement dated 30 July 2020, noting that the MAC contained a number of passages cut and pasted from the first MAC dated

28 September 2020. 3. The appellant submitted that her statement dated 1 December 2022 was a crucial document. 4. The appellant submitted that the silence with respect to the new statement suggested that the Medical Assessor overlooked crucial evidence which, had he considered, might lead to a different conclusion. This gave rise to a demonstrable error due to failure to take into account a relevant consideration. 5. Alternatively, the appellant submitted that the Medical Assessor failed to disclose his actual path of reasoning or denied the appellant procedural fairness, giving rise to demonstrable error. 6. The appellant also submitted that the Medical Assessor had made a number of factual errors that were relevant to his assessment of the category of Concentration, Persistence and Pace. 7. The Medical Assessor recorded,

"Ms Keelan undertakes some hours of an engaging computer game each day, prefers to watch cognitively-demanding television shows and showed no objective cognitive difficulties or problems with the persistence and pace of the assessment today."

1. In the history, the Medical Assessor recorded that the applicant had a regular set of television programs that she watched, starting with The Bold and the Beautiful and then The Chaser. The appellant preferred shows which she could be involved in and challenged her, such as quiz shows.
2. The appellant submitted that the assumption that The Bold and the Beautiful was a cognitively demanding television show was wrong. It was also wrong to find that passively watching television was a cognitively demanding activity. In the appellant's statement of

1 December 2022, she indicated that she tried to watch television but could not follow what was going on. 3. The appellant also noted that Dr Anand had taken a history that she used to be an avid reader but tended to lose concentration in his most recent assessment. In her statement dated 1 December 2022, the appellant said that she did not read much anymore and got too easily distracted. Dr Allan recorded that the appellant could not read to any extent and had not done this for several years. The MAC was, however, silent on the topic of reading. The appellant submitted that this amounted to demonstrable error, noting the reference to reading in the Guidelines for the assessment of this category. 4. The appellant also took issue with the Medical Assessor's reference to playing games.

Dr Anand noted that the applicant played games on her mobile phone. Mobile phone games were not mentioned in the Guidelines. The appellant submitted that the Medical Assessor applied incorrect criteria in relying on the appellant's playing of a game on her mobile phone as evidence of concentration, persistence and pace. 5. Finally, the appellant submitted that the Medical Assessor "double counted" in respect of the mobile phone game activity, by referring to it in the PIRS category of "Social and Recreational Activities" as well as Concentration, Persistence and Pace. This was said to be contrary to the reasoning in Ballas v Department of Education (State of NSW) [2020] NSWCA 86. 6. The appellant submitted that a further medical examination was required. A properly informed Appeal Panel would find that a class 3 in the PIRS category of Concentration, Persistence and Pace was the best fit. 7. In opposing the appeal, the respondent submitted that following the further examination of the appellant on 25 October 2023, the Medical Assessor took a detailed, updated history and recorded the appellant's current symptomology and activities of daily living. 8. The respondent noted that the appellant was able to keep regular appointments, spent a couple of hours playing a house design game, was able to accommodate regular, if not frequent, visitors and watched other television shows such as quiz and news shows that engaged her cognitively. 9. The respondent referred to the Medical Assessor's own observations and findings on mental state examination. 10. The respondent submitted that the fact that the Medical Assessor did not explicitly refer to the statement did not provide a basis for an attack upon the integrity of his findings during the clinical examination. The respondent referred to the decisions in Ferguson v State of New South Wales [2017] NSWSC 887 and NSW Police Force v Daniel Wark [2012] NSWWCCMA 36 with regard to the pre-eminence of clinical observations. 11. The respondent submitted that the Medical Assessor had regard to all relevant facts relating to the appellant's functioning during his examination and that his path of reasoning for concluding the appellant ought be assigned a class 2 on the PIRS domain of Concentration, Persistence and Pace was evident from the observations set out in the MAC and summarised in the table.

1. In setting aside the first Appeal Panel's decision, the Court noted that the Panel had used the presumption of regularity to overcome the absence of any reference by the Medical Assessor to the appellant's statement of 1 December 2022. The first Panel inferred that the Medical Assessor did have regard to the statement.
2. The Supreme Court noted that the Medical Assessor was specifically being asked to consider a deterioration in the appellant's condition. This necessitated an up-to-date history, which ought to have been considered and analysed in examining the deterioration.
3. The Supreme Court noted that the appellant's supplementary statement included observations about her reading. The appellant's solicitors had made submissions about reading and reading was specifically mentioned as an example in the Guidelines. The Court commented:

"...the updated statement did contain significant extra information, especially about reading and concentration, and specific submissions had been made about the statement. The Medical Assessor should have commented on the statement. The Appeal Panel should not have ignored the assessor's error by simply placing it under the presumption of regularity.

Accordingly, I think there is an error on the face of the record. This might also be described as denial of procedural fairness to the plaintiff whose statement and written submissions have not received appropriate, if any, consideration.

I am satisfied that there are demonstrable errors in both Prof Glozier's second certificate and in the Appeal Panel's reasons."

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 Appeal Panel has considered the MAC, the documents provided to the Medical Assessor, the parties' submissions and the Supreme Court's decision. The Appeal Panel agrees with and adopts the Court's comments regarding the Medical Assessor's failure to comment on the updated statement and the information contained within it, especially about reading and concentration. The Appeal Panel is satisfied that the MAC is affected by demonstrable error.

1. As noted above, Medical Assessor Lam-Po-Tang re-examined the appellant on

14 March 2025. Medical Assessor Lam-Po-Tang provided the following report:

"1.The workers medical history, where it differs from previous records

At some stage since moving to the Cairns region, Ms Keelan and her husband, have made friends with people who moved into neighbouring houses. She explained that of the 4 closest houses to her and her husband's, she has become friends with 3 of the couples, over recent years.

Ms Keelan advised that she obtained a copy of Prince Harry's memoir, 'Spare', after its release (in 2023). She estimated she read it 'over a couple of months', but could not recall in which year this occurred. She reported struggling with reading the book, citing her own concentration as reason for this, not the style or content of writing. This is the only book she has read in the last 5 years, and she reported significant issues with having to re-read pages.

Moduretic 1 tablet daily (amiloride/hydrochlorothiazide; dose unclear)

Anoro 1 puff daily (umeclidinium 62.5 mcg/vilanterol 2.5 mcg)

Dr Katy Williamson, general practitioner, who provides monthly consultations of around 15 minutes

Ms Kathleen Ager, psychologist, who provides hour-long monthly consultations

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

The original Medical Assessment Certificate was performed on 25 October 2023. Since that time, Ms Keelan has continued to consult her general practitioner, Dr Katy Williamson, on a regular basis. She has also continued with individual psychological consultations with Ms Kathleen Ager, whom she consults in Cairns, with hourlong monthly sessions. The description of consultations suggests an eclectic approach to Ms Keelan's symptoms. She has not had a course of eye movement desensitisation and reprocessing (EMDR) since the original assessment in October 2023.

In June 2024, Ms Keelan's sister and niece travelled to Cairns to celebrate Ms Keelan's birthday: 'We went out for my birthday. We didn't do a lot of the tourist things', as her sister and niece had previously visited them. She advised they went into Cairns for lunch on one of the days. She estimated the trip was 7 or 8 days.

Around mid-2024, Ms Keelan advised that she reduced her regular alcohol consumption from around 6 or 7 standard drinks, comprising 4 glasses of wine, then a mixed spirits drink (2 or 3 nips) and then possibly a port or Bailey's Irish coffee. She confirmed she was drinking every day. She disclosed that at times, 'I'd feel a little dusty the next day'. Since that time, she has been drinking 2 - 3 glasses of wine, drinking every day. She said would exceed this amount "three times a year", on special occasions.

In September 2024, a former neighbour of Ms Keelan's travelled from NSW and stayed with her and her husband for a week. He was working on a boat nearby, and in the afternoon or evenings, they would go for dinner locally.

Up until September or October 2024, Ms Keelan advised she had been smoking around a packet of cigarettes per day. She ceased cigarette use at this time, and has been prescribed a nicotine vaping device.

In early December 2024, Ms Keelan's husband fell off a ladder and was taken to hospital in Cairns, and was discharged on the same day. Ms Keelan advised that she was able to drive from their home to the hospital, and back to collect her husband. He has subsequently completely recovered.

On Xmas Day 2024, Ms Keelan and her husband spent lunch with two neighbours, spending a couple of hours over the meal. She explained that she cooked roast pork and vegetables to contribute to the meal.

On 21 February 2025, Ms Keelan and her husband had dinner at the Blue Water Club to celebrate his birthday. No others were present. She could not recall the last time prior to this she visited this club.

Ms Keelan reported ongoing insomnia since November 2023. She has been prescribed melatonin at a dose of up to 6 mg nightly, as well as a compounded melatonin preparation, the dose of which she could not recall. She advised that her psychologist discussed referral to a sleep physician, but this has not been organised. At no point has Ms Keelan been prescribed benzodiazepines or similar medications, nor has she taken antihistamines, for her sleep.

Ms Keelan advised that at no stage since November 2023 has she experienced even brief freedom from her psychiatric symptoms. She has not been referred to a psychiatrist, required psychiatric hospitalisation, been referred to a community mental health service, or been prescribed psychotropic medications other than those mentioned above.

In terms of reported psychiatric symptoms at the time of the evaluation, Ms Keelan described her mood as 'somewhat emotional'. She rated it at 2 - 3/10 on a 10-point scale, where 0/10 represents a profoundly depressed mood. She reported no diurnal mood variation. She reported the capacity to enjoy spending time in her pool or with her dog. She reported elevated anxiety levels, with heightened anticipatory anxiety prior to attending social gatherings. She reported variable food intake, but advised she can feel hungry, and can enjoy her food. Her weight is stable, at around 53 - 55 kg. Her energy levels were described as 'low'. She retires to bed at around 21:30 - 20:00, taking between 15 and 90 minutes to fall asleep. She 'wakes up at 2:30 AM with boring monotony - I am bang wide awake', and will remain so for at least an hour, sometimes for the rest of the night. Sleep is 'not refreshing at all'. She reported subjective impairment in concentration, forgetting what she has read or discussed. She reported subjective impairment in short-term memory, including recent events and conversations. By contrast, she said, 'I think my long-term memory is good: I can remember things from childhood and teenage years'.

Ms Keelan presented as a Caucasian woman of stated age, with grey hair and a tanned complexion. Her hair was wet, and she was wearing a sleeveless top and swimming costume - she explained she had been in the pool when contacted by the PIC regarding her assessment. She was deeply and repeatedly apologetic about having mixed up the time of the appointment, due to the time difference between NSW and Queensland. She appeared of stated age. She made reasonable eye contact though the videoconferencing platform. She was polite, pleasant, and co-operative throughout the evaluation.

Ms Keelan's speech was spontaneous, fluent, and normal in volume, rhythm and rate. Whilst there were occasional pauses prior to answering questions, there was no persistent delays in responses. Her affect was mildly restricted in range and intensity, however, she retained the capacity to smile. She was tearful on several occasions during the interview, when discussing her workplace injury. Her mood was subjectively anxious and depressed. Objectively, she was not irritable, apathetic or elevated in mood. Her thought form was logical and sequential, with no formal thought disorder. Her ideas were expressed with an appropriate degree of elaboration - there was no poverty of ideation, nor overinclusiveness. No delusional thought content was expressed or noted at any stage. She reported some ideas of hopelessness, but denied any ideas of worthlessness or personal guilt. Whilst she denied suicidal ideation at the time of the assessment, she admitted to intermittent thoughts of taking her floatation device to the sea and 'floating away' every few weeks.

Ms Keelan presented as alert and oriented throughout the assessment, which lasted 95 minutes. She was not drowsy at any stage; no fluctuation in level of consciousness was observed at any stage. She was able to persist with the interview, and maintain pace throughout. She did not present as easily distracted during the evaluation.

4.Results of any additional investigations since the original Medical Assessment Certificate

Ms Keelan advised she showers 'every day, in the morning', adding, 'I clean my teeth twice a day'. She washes her hair every second day, and has a haircut every 6 weeks. With respect to clothes, she explained, 'You live in your swimmers and a sarong', changing into fresh clothes if attending an appointment or travelling to Cairns. When Ms Keelan was asked if she considered herself capable of spending a night alone in the home, she replied, 'I think I'd be OK, because I've got the dog'. She does not require any care, assistance or prompting for her husband. She does not provide care for her husband.

Ms Keelan advised she typically eats a light lunch and more substantial dinner, and stated she has maintained this pattern of eating since her late teenage years. She advised she is able to make meals and snacks for herself and her husband, including making salads, cooking 'a steak and salad, or vegetables'. She occasionally makes a roast.

Ms Keelan advised she walks to the beach or to the main road about once a fortnight; she is able to do this alone. The walk is an estimated 5 to 15 minutes. She is able to visit neighbours' houses for social gatherings, and has hosted them at her residence, but these gatherings are infrequent. She estimated she went to the local tavern every 2 or 3 weeks, when invited by one of her neighbours, spending an hour there on these occasions. She has been out to meals with friends or family on a number of occasions within the last 12 months.

Ms Keelan advised she is a member of 3 local clubs, the Blue Water Club, the Sports Club Trinity Beach, and the yacht club at Yorkies Knob. She said that she last attended the Blue Water Club on 21 February 2025, but does not attend the clubs often. She was unable to recall when she last went to the Sports Club. She does not participate in any sport or get regular exercise, but advised she follows the tennis, watching Wimbledon and the Australian Open, but mainly the later matches.

Within the home, Ms Keelan described watching some programs on TV: 'I don't mind watching renovation shows because it's in one ear and out the other'. She said she has watched 'The Voice', and typically watches 'The Bold and the Beautiful', which she explained is on 5 days per week in the afternoon. She listens to music 'once a fortnight, when I feel in the mood', listening to a mix of 1980's or 1990's tracks, or classical music. She has a Facebook account, commenting she accesses it 'every second, every third day, sometimes longer... 5 minutes at the most'. She no longer posts photos but occasionally responds to those of others.

Ms Keelan advised she is able to leave her home alone, but does so less frequently than previously. She is able to drive a car alone: 'I don't drive very often, normally Alan drives. If I need bread or milk or something I'll obviously drive'. She advised she could drive to Cairns from her home alone, a trip of 25 minutes or longer. She was uncertain if she could use public transport.

Ms Keelan is married, and has been in a relationship with her husband for the past 15 years. She reported no periods of separation. She maintains contact with family members, communicating with her sister one a week, by messaging services or phone calls. She estimated that calls may last '10 to 15 minutes or longer'. She has established friendships with 3 couples of live in the same community as her, and socialises with them every few weeks. She has maintained a friendship with at least one former neighbour from the NSW Central Coast.

Ms Keelan reported subjective impairment in attention and concentration, resulting in poor immediate recall. By way of example, she said her husband will tell her something, and she will forget details. She advised that when she last read a book, she had to re-read pages. She can watch short TV shows; she advised she cannot watch movies. She said that she will forget things she has recently told herself.

Ms Keelan has not worked in any paid or unpaid capacity since 2019. She has not worked in any voluntary capacity. She is not undertaking any study, informal or otherwise."

1. Medical Assessor Lam-Po-Tang assessed the appellant as having a class 3 impairment in the PIRS category of Concentration, Persistence and Pace. Medical Assessor Lam-Po-Tang reasoned:

"Ms Keelan reported subjective impairment in attention, concentration and short-term memory.

Ms Keelan reported difficulty reading a book, having to repeatedly re-read pages. She advised she could not watch a movie, but can watch short TV shows.

Ms Keelan was able to persist with the assessment, and maintain the pace of the interview process."

1. The Appeal Panel has considered and adopted the report and findings of Medical Assessor Lam-Po-Tang. The Appeal Panel agrees with the assessment made by Medical Assessor Lam-Po-Tang in relation to the PIRS Concentration, Persistence and Pace category. There is no basis on which to interfere with the Medical Assessor's assessment in relation to the other PIRS categories.
2. As a result, the appellant's PIRS classes are sequentially 2, 3, 2, 2, 3 and 5. This gives a median class of 3 and aggregate score of 17, resulting in 19% WPI.
3. For these reasons, the Appeal Panel has determined that the MAC issued on

1 November 2023 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 Glozier 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)