WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether the ratings the Medical Assessor (MA) made of the appellant's impairment in the psychiatric impairment rating scale (PIRS) domains of self care and personal hygiene, social and recreational activities, and travel involved error; Held - MA's ratings did not involve error; MAC confirmed.

1. On 19 September 2025 Michelle Kelly, the appellant, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by

Dr Samuel Lim, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 22 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 working as a case worker for the New South Wales Government in 2005, within its Department of Communities and Justice. In 2010 she was promoted to a client services manager.
2. The Secretary of the Department of Communities and Justice, the respondent, is in accordance with s 26(1) and Part 1 of Schedule 1 of the Government Sector Employment Act 2013, the employer of the appellant.
3. The appellant suffered a psychiatric injury due to her interactions with directors that the respondent employed from late 2017. The appellant claimed compensation for permanent impairment from her psychiatric injury, relying on a report her solicitors obtained from psychiatrist Dr Abdal W Khan dated 11 April 2024. In that report Dr Khan diagnosed the appellant's psychiatric injury is a persistent depressive disorder with anxious distress. He made that diagnosis in accordance with the criteria detailed in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. He also variously referred to her injury in his report as a major depressive disorder with anxious distress. He advised in his report that he assessed the degree of the appellant's permanent impairment from her psychiatric injury is 16% WPI. That assessment was based on his ratings of the appellant's impairment in the several categories of conduct and function comprising the psychiatric impairment rating scale (PIRS) detailed in Chapter 11 of the Guidelines, and an additional rating of 1% WPI he assessed the appellant had in accordance with paragraph 1.32 of the Guidelines.
4. His ratings of the appellant's impairment in the several PIRS categories are Class 3 for self-care and personal hygiene and for social and recreational activities, Class 2 for travel and for social functioning and for concentration, persistence and pace (CPP), and Class 3 for employability. The medium of those is 3 and the is 15, which in accordance with Table 11.17 of the Guidelines converts to 15% WPI. Hence, when the 1% WPI that Dr Khan added in accordance with paragraph 1.32 for the effect of treatment, the result is 16% WPI.
5. The respondent's insurer denied liability for the appellant's compensation claim. It relied on a report its solicitors obtained from psychiatrist Dr Alan Doris, following a consultation

Dr Doris had with the appellant on 13 August 2024. Dr Doris advised in his report that his diagnosis of the appellant's injury accorded with the diagnosis Dr Khan had made. He advised he assessed the degree of the appellant's permanent impairment from her injury is 6% WPI. That was based on his rating the appellant's impairment in the several PIRS categories as Class 3 for self-care and personal hygiene for employability, Class 2 for social and recreational activities and for CPP, and Class 1 for travel and for social functioning, the medium of which is 2 and the aggregate of which is 12, which converts to 6% WPI in accordance with Table 17.11 of the Guidelines. Dr Doris did not add any percentage WPI for the effects of treatment. 6. A medical dispute having arisen between the parties relating to the degree of the appellant's permanent impairment resulting from her injury, the appellant initiated proceedings in the Personal Injury Commission (Commission) seeking the Commission determine her claim for compensation. 7. The Medical Assessor examined the appellant on 19 August 2025 and, as said, issued the MAC on 22 August 2025, in which he certified he assessed the degree of the appellant's permanent impairment from her injury is 7% WPI. His assessment was based on his rating the appellant's impairment as Class 1 in travel, Class 2 in self-care and personal hygiene and in social and recreational activities and in social functioning, Class 3 in CPP, and Class 4 in employability. 8. In her appeal against the medical assessment the appellant has challenged the Medical Assessor's ratings of her impairment in self-care and personal hygiene, social and recreational activities and travel. 9. The reasons the Medical Assessor provided in the PIRS Rating Form, that forms part of the MAC, for his rating of the appellant's impairment in self-care and personal hygiene are:

"Ms Kelly reported receiving support from various nieces who visit her at least three times a week to assist with various household chores. She noted that this assistance was due to her difficulties associated with her orthostatic tremor. However, she also noted reduced motivation to engage in tasks within her physical capacity, as well as her susceptibility to an exacerbation of her orthostatic tremors related to her mental state. From a psychiatric perspective, she presents with a mild impairment."

1. Within the body of the MAC the Medical Assessor also recorded that the appellant suffers from an orthostatic tremor for which she was previously prescribed clonazepam and for which she also had a spinal cord stimulator implanted in November 2022, that was not effective. The Medical Assessor noted that the appellant had a deep brain stimulation device implanted on 22 May 2025 which the Medical Assessor noted had enabled the appellant to stand up more frequently without needing to hold on to things and being able to walk upright slightly better. The Medical Assessor noted that the appellant reported that she had been informed it may take up to 12 months for her to realise the full benefits from the deep brain stimulation surgery. The Medical Assessor noted that the appellant reported to him that stress makes her orthostatic tremor worse.
2. The Medical Assessor provided brief remarks relating to the documentary evidence that was before him, which included a report dated 29 June 2023 that Maria Garcia wrote to

Dr Stephen Dumar. The Appeal Panel notes that Maria Garcia is a neurologist and a Fellow in movement disorders, working within the Department of Neurology at Westmead Hospital. The Medical Assessor remarked that Maria Garcia described in her report that the appellant had a long-standing orthostatic tremor, a chronic neurological condition. The Medical Assessor noted that Dr Garcia described the appellant as considerably disabled from the severity of her symptoms from the orthostatic tremor and had difficulty undertaking tasks that required her to stand longer than 30 seconds. The Medical Assessor noted Dr Garcia described that the appellant needed assistance with most instrumental activities of daily living including showering. The Medical Assessor noted that Dr Garcia said the appellant was unable to cook, hang washing or go grocery shopping because those activities required the appellant to stand and the appellant relied on her partner and her nieces to assist her with those activities of daily living which the appellant found frustrating. The Medical Assessor noted that Dr Garcia described further treatments were being considered for the appellant, including deep brain stimulation and a spinal cord stimulator. 3. The Medical Assessor also briefly referred to reports of Dr Khan and Dr Doris, but did not specifically comment on their respective ratings of the appellant's impairment in the several PIRS categories. 4. The reasons the Medical Assessor provided in the PIRS Rating Form for his rating of the appellant's impairment in social and recreational activities are:

"Ms Kelly stated that she largely confines herself to Menindee and her social activities revolve around her family members. She has ceased her participation in bigger community events, particularly those which take place in Broken Hill, due to her anxiety symptoms related to her psychiatric condition. She presents with a mild impairment."

1. Within the MAC Medical Assessor also noted that the appellant experiences anxiety when she has to travel to Broken Hill and tries to avoid doing so when possible. The Appeal Panel notes that the location of the appellant's workplace with the respondent was Broken Hill and that in a statement the appellant signed on 30 May 2025 she said that she avoids Broken Hill "to prevent any chance of encountering former colleagues".
2. The Medical Assessor recorded in the MAC that the appellant's family members visit her at least three times a week and she also visits their homes.

1. The reasons the Medical Assessor provided in the MAC for his rating of the appellant's impairment in travel are that "Ms Kelly did not report any difficulties in this domain relating to her psychiatric condition". The Medical Assessor also noted in the MAC that the appellant harbours concerns that she will encounter her former director should she travel to Broken Hill.

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 Appeal Panel came to the view that the appellant had not established either of the grounds for appeal on which she relied, and consequently the Appeal Panel had no reason or power to examine the appellant.[1]

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 erred by rating her impairment in self-care and personal hygiene as Class 2, rather than Class 3. The appellant submitted that her reliance on her nieces for domestic assistance demonstrates that her impairment in self-care and personal hygiene is moderate. The appellant observed that both Dr Khan and Dr Doris rated her impairment in self-care and personal hygiene as Class 3, and she recited in her submissions the reasons they provided for their respective ratings. The appellant also referred to paragraphs 41 and 42 of her statement wherein she contrasted her ability in self-care and personal hygiene before and after her injury. The appellant submitted that the Medical Assessor did not provide adequate reasons why a lower rating of Class 2 was preferred than the Class 3 rating that Dr Khan and Dr Doris had both assigned.
3. The appellant submitted the Medical Assessor's reasons for his rating of her impairment in social and recreational activities as Class 2 are more consistent with a Class 3 impairment rating. The appellant submitted that she has become socially estranged from former friends and acquaintances and confines herself to social activities involving her family members. The appellant submitted this demonstrates she has a greater than mild impairment in social and recreational activities. The appellant noted that Dr Khan rated her impairment in social and recreational activities as Class 3 and the appellant recited Dr Khan's reasons for so doing.
4. The appellant referred to Medical Assessor noting within the MAC that she sees her family members three times a week and visits their homes, that she looks after her grandson for two hours on the weekend, that her son lives across the road from her, and that she avoids larger community events particularly those held in Broken Hill, and submitted that those matters do not substantiate or provide adequate reasoning for the Medical Assessor's rating of her impairment in social and recreational activities as Class 2. The appellant submitted that those matters are consistent with her evidence that she has become withdrawn and isolated and relies on the support of family members. The appellant submitted that visiting family members in her local area and looking after her grandson for two hours at a time does not demonstrate that she is actively involved in social and recreational activities.
5. The appellant referred to the Medical Assessor recording in the MAC that she harbours concerns that she will encounter her director should she travel to Broken Hill.
6. The appellant submitted that she cannot travel to Broken Hill because of her psychological injury. The appellant submitted that she can travel without a support person but only in her local area. The appellant referred to paragraphs 45 and 46 of her statement wherein she described being able to travel long distances before her injury and using public transport without assistance but now completely avoids traveling to Broken Hill. The appellant also referred to her ability to travel being more difficult because the severity of her tremors increases with anxiety.
7. In reply, the respondent submitted that the appellant lives independently, and also is able to care for her grandson on weekends. The respondent submitted that the appellant's inability to cook is due to her tremors. The respondent submitted that the Medical Assessor accurately assessed the appellant's level of impairment arising from her psychological injury. The respondent submitted that the requirement of the appellant to have family members visit and assist her is due to her inability to perform tasks due to her orthostatic tremor.
8. The respondent submitted that the appellant's family members visiting her home and her visiting her family members is not a rare occurrence because it occurs at least three times a week. The respondent submitted that the appellant does not need a support person for that activity. The respondent submitted that the appellant has not become socially withdrawn and isolated.
9. The respondent submitted that the Medical Assessor correctly rated the appellant's impairment in social and recreational activities as Class 2.
10. The respondent submitted that the Medical Assessor's rating of the appellant's impairment in travel is based on the history the appellant provided the Medical Assessor during the Medical Assessor's assessment of the appellant. The respondent noted that the appellant's ability to travel is made more difficult because of the severity of her tremors. The respondent highlighted that the Medical Assessor had noted that the appellant's difficulty in traveling to Broken Hill is not a consequence of her inability to travel but rather her not wanting to see individuals with whom she previously worked in Broken Hill. The respondent submitted that there is no evidence that the appellant cannot travel to unfamiliar areas due to her psychological injury.

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 submissions that the Medical Assessor made any error with respect to his rating of her impairment in self-care and personal hygiene, social and recreational activities, and travel. Further, the Appeal Panel considers that when the MAC is read as a whole, the Medical Assessor has adequately explained his reasons for his assessment of the appellant's permanent impairment in those challenged PIRS categories.
4. The appellant's need for support with respect to her self-care and personal hygiene is not a result of her psychiatric injury, but rather is due to a physical ailment she has, specifically orthostatic tremor. Whilst the appellant has said in her statement that anxiety exacerbates her orthostatic tremor, that is her impression. The Medical assessor noted a susceptibility to an exacerbation of her orthostatic tremors related to her mental state and that "stress" makes it worse, that is these are time limited effects. Further the Medical Assessor noted that her anxiety is provoked when out of her home, for example, 'Ms Kelly informed me that she experiences anxiety when she has to travel to Broken Hill and tries to avoid this where possible' and 'Due to the loss of her self-esteem, she reported feeling anxious about the prospect of interacting with community members outside of her immediate family.'
5. The Appeal Panel observes from the report of Dr Garcia dated 29 June 2023 that the appellant's orthostatic tremors are long standing and precedes by several years the occurrence of her psychological injury. Ms Garcia's report confirms the appellant's orthostatic tremor is an organic ailment.
6. What that means is that the appellant's day to day need for domestic assistance to ensure her self-care and personal hygiene does not result from a psychological injury, but from her orthostatic tremor. Saying that in different words, her recurrent need for support is a consequence of a physical ailment and not her psychological injury. Dr Khan and Dr Doris appear to have conflated the impact of this neurological condition with that of her injury in their respective ratings and neither provided any reasons to show whether or how they had considered this.
7. The Medical Assessor explained that, in substance, when explaining why he rated the appellant's impairment in self-care and personal hygiene as Class 2. He also explained that as a consequence of the appellant's reduced motivation, which the Appeal Panel notes is a consequence of the appellant's psychiatric injury, there has been an adverse effect on the appellant's self-care and personal hygiene. The Medical Assessor has taken account of that to rate the appellant's impairment as being mild. Essentially, as the Appeal Panel comprehends the Medical Assessor's reason for his rating, it is that absent the appellant having an orthostatic tremor she would be able to look after herself adequately although with mild impairment. The Appeal Panel considers that is a correct conclusion based on the evidence.
8. The Appeal Panel consequently discerns no error in the Medical Assessor's rating. Further, the Appeal Panel finds that the Medical Assessor based his assessment on the correct criteria, given that he applied the criteria of Chapter 11 of the Guidelines.
9. As said, the Appeal Panel also considers the Medical Assessor correctly rated the appellant's impairment in social and recreational activities. What the Medical Assessor's reasoning for his rating reveals is that the appellant engages in social events with her family on more than rare occasions and does so without having to be prompted. The appellant does not need a support person to engage in social activities with her family members.
10. Contrary to the appellant's submission, the Medical Assessor did not in his reasoning for rating the appellant's impairment in social and recreational activities as Class 2 take into account the fact that the appellant has the ability to look after her grandson.
11. The Medical Assessor also had regard to the appellant's statement. That is apparent from his detailing within the MAC certain elements of the appellant's statement. Consequently, he was aware what the appellant said in her statement regarding her withdrawal from social interaction and her now picking and choosing what events she attends, conduct entirely consistent with a mild impairment. The history the Medical Assessor obtained however was that the appellant visits her family members and her family members visit her three times a week. He had regard to the fact that the appellant has ceased participating in bigger community events. In the Appeal Panel's view that accords with a level of severity of impairment described by the examples in Table 11.2 for a Class 2 impairment, more so than a Class 3 impairment. The examples for a Class 3 impairment are that a worker rarely goes out to events and mostly when prompted by family or close friends and not go out with a support person. That does not describe the appellant's situation.
12. To repeat, the Appeal Panel discerns no error with the Medical Assessor's rating of the appellant's impairment in social and recreational activities as Class 2. The Appeal Panel finds that the Medical Assessor applied correct criteria to make his assessment, given that he applied the criteria in Chapter 11 of the Guidelines.
13. The Appeal Panel also considers that the Medical Assessor did not err with his rating of the appellant's impairment in travel as Class 1. The only issue the appellant has with respect to travelling is that she does not travel to Broken Hill and that is in order to avoid her former director. She has no impairment with her actual capacity to travel, which is the conduct rated in this scale. She travels to Sydney without need of a support person. She is able to travel in her local area without a support person.
14. All that indicates that the appellant has no impairment in her functioning relating to travelling. The only restriction is to avoid a particular person, or a locale where they may be. That squarely accords with a Class 1 impairment, the descriptors for which are, "no deficit, or minor deficit attributable to the normal variation of the general population: can travel to new environments without supervision".
15. Again, the Medical Assessor was aware of what the appellant had said in her statement regarding her ability to travel, which included that she avoids using public transport because of anxiety and tremors. She said that her tremors worsened when she is standing. She said the severity of her tremors fluctuates with her anxiety, but as already said that is impression and there is no clinical evidence to support that. Insofar as the appellant's capacity to travel is affected by her orthostatic tremor, it is unrelated to her psychological injury.
16. In the Appeal Panel's view the Medical Assessor has made no error in rating the appellant's impairment in travel as Class 1. Again, the Medical Assessor has based his assessment on the correct criteria, given that he has applied the criteria detailed in Chapter 11 of the Guidelines.
17. For these reasons, the Appeal Panel has determined that the MAC issued on

[1] New South Wales Police Force v Registrar of the Workers Compensation Commission of New South Wales [2013] NSWSC 1792 at [33]; Finnegan v Komatsu Forklift Australia Pty Ltd [2023] NSWSC 38 at [125]- [130].