1. The worker Kim Maree May (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Ankur Gupta, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 16 December 2024.
2. The appellant relies on the following ground of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
   • the availability of additional relevant information (being evidence that was not available to the appellant before the medical assessment appealed against or that could not reasonably have been obtained by the appellant before the medical assessment),
   • 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 grounds 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. The appellant requested that she undergo a re-examination by a Medical Assessor who is also a member of the Appeal Panel. As a result of its preliminary review, the Appeal Panel determined that it was necessary for the worker to undergo a further medical examination because the Appeal Panel found error.

1. Section 328(3) of the 1998 Act provides that evidence that is fresh evidence or evidence in addition to or in substitution for the evidence received in relation to a medical assessment appealed against may not be given on an appeal by a party unless the evidence was not available to the party before the medical assessment and could not reasonably have been obtained by the party before that medical assessment.
2. The appellant seeks to admit statements from the appellant dated 31 January 2025.
3. The appellant submits that the evidence is relevant. The respondent opposes the admission of the additional evidence.
4. The Appeal Panel determines that the evidence should not be received on the appeal because the appellant has had the opportunity to provide a statement of evidence and an opportunity to provide a history to the Medical Assessor as well as histories to the various doctors including IMEs whose reports are in evidence. There is no basis for the admission of additional evidence from the appellant in the form of a further statement at this point in the proceedings.

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 Ash Takyar of the Appeal Panel conducted an examination of the worker and reported to the Appeal Panel.

1. The parts of the medical certificate 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.

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 matter was referred to the Medical Assessor for assessment as follows:

"The following matters have been referred for assessment (s 319 of the 1998 Act):

• Date of injury: 17 June 2014
• Body parts/systems referred: Psychiatric and Psychological Disorder
• Method of assessment: whole person impairment."

1. The Medical Assessor issued a MAC certifying 7% whole person impairment (WPI) as a result of the injury as follows:

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA5 Guides

WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)

Sub-total/s % WPI (after any deductions in column 6)

Chapter 11 NSW workers compensation guidelines for the evaluation of permanent impairment 4th edition

Total % WPI (the Combined Table values of all sub-totals)

1. The assessment was based on his assessment under psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows:

As described in the main body of the report, there is no impairment. She manages her hygiene well and looks after her household independently.

She reports being unable to go out because of a fear of retribution. She avoids going to the shop. She only attends events because of her family. Considering her premorbid personality, there is a severe impairment.

As described in the main body of the report, there is no impairment. She travels to see her brother and can drive locally. She worked as a rideshare driver in Queensland.

As described in the main body of the report, there is no impairment. She has not fallen out with her friends or family and remains close to her daughter.

As described in the main body of the report, there is mild impairment. Her concentration is up and down and she can be forgetful. She was unable to remember the name of her medication during the assessment.

She has some capacity to work but is severely restricted because of being in Dubbo. She is only suited to a home-based role, working one to two days per week at present.

1. The worker appealed.
2. In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments he made under three of the six PIRS categories, namely travel, social functioning and concentration, persistence and pace causing him to make an error in the assessments in these domains as follows:

(a) in assessing Class 1 for travel when he should have assessed Class 2;

(b) in assessing Class 1 for social functioning when he should have assessed Class 2, and

(c) in assessing Class 2 for concentration, persistence and pace when he should have assessed Class 3.

1. In summary, the employer the Secreaty, Depart of Education (the respondent) submitted that the Medical Assessor neither erred nor made an assessment on the basis of incorrect criteria and the MAC should be confirmed. Essentially it was submitted that the MAC was adequately reasoned and the findings were open to the Medical Assessor applying his clinical expertise to the assessment.
2. The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS for mere difference of opinion but must be satisfied as to error.
3. The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self-report can be properly evaluated in the context of other evidence before the Medical Assessor. The Medical Assessor recorded no findings as to his mental state examination and there is no record of how long the examination took. Even when reading the MAC as a whole, the Appeal Panel considered that the path of reasoning was inadequate, and it was not clearly discernible from the reasons given that the assessments under the contested PIRS categories were based upon the correct criteria.
4. In these circumstances of the finding of error, the Appeal Panel considered that a

re-examination by a Medical Assessor member of the Appeal Panel was necessary. Medical Assessor Ash Takyar was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):

• Date of birth and age at examination: 57 years old

• Details of who attended the examination: Daughter, Jess

• Employer and occupation: Department of Education - SLSO (School Officer Learning Support)

Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:

Ms May was examined over an hour and 31 minutes via Microsoft Teams with respect to re-examination for the Medical Appeal Panels in relation to the disputed matter before the Commission for an accepted injury sustained in 2014 in the course of her employment with the Department of Education at Delroy Senior School, where she joined in May 2002. She worked full time pre-injury.

She reported that on 6 June 2014 a child had a birthday, which was being celebrated and MB, a male teacher's aide was present; she confirmed that she previously had seen him making videos of children with special needs as they had nappies and catheters changed and that he had shown a video of a child sitting naked on a toilet seat, and she said that in response, the teachers present viewing the video laughed. She said it was also correct that they had laughed at a video of a non-verbal child running with his nappy coming off.

On reporting these circumstances, she was asked to leave the matter alone by the principal, and she then contacted a support person at the Department who asked her to raise the complaint to a higher level - when another child approached her crying, telling her that they had been videoed in the showers and that MB was showing the video to the teachers, she took further action. She also confirmed that teachers had stood around and laughed when she was helping a child warm soup in the microwave but it dropped on the leg of another child with disability - no one helped, with teachers instead laughing at her.

Over time, she escalated the complaint progressively higher, and an investigation upheld her complaint. She said it was not true that MB was asked to leave the school - as reported in the MAC by her. Ms May clarified, 'He was never asked to leave the school. After that... six months after that, he videoed a kid in the shower, I've got that in proof, I can supply that. And when I went to Queensland, he supplied alcohol to kids'.

Ms May reported that her anxiety and depression began 'Then, when they started bullying me... it didn't happen straight away, I'd say late 2014, 2015. That's when they started bullying me. And I stayed there, to 2017'. She said this involved teachers.

At the end of the examination, she reported, 'I wish I could be back to how I was before... cos I was a happy person, I was'.

She sees Dr Shiraj Athambawa at Western Plains Medical & Dental Centre in Dubbo for certificates of capacity. She is prescribed venlafaxine 75mg daily, and she noted, 'He was talking about putting it up again, like for the anxiety again... like the 10th, this month, of August cos I just said to him, 'I just haven't been real good myself'.' She said that her doctor organised blood tests for fatigue but no increase has occurred at this point.

She sees her psychologist, Brenda Dobia fortnightly these days. Ms May described the use of cognitive behavioural therapy (CBT) and mindfulness, which she felt had been helpful earlier on when she felt more determined to recover but she finds it harder to cope though she still tries to use the techniques.

This history was obtained with respect to a period of the last two months, as an average, unless otherwise stated.

Before her injury, Ms May slept "Probably the eight hours, but then I was working a lot then". It was uninterrupted and she fell asleep quickly.

She reported that there are days when she does not sleep at all - on pressing to get some detail (she replied, "once in a blue moon"), she said that in the last two months she does not sleep at all on 'I'd say two or three nights' in the week, which on further discussion she verified. On the other nights, Ms May will sleep 'three or four hours', and it takes her 'ages' to fall asleep, adding that she tries to go to bed around 10pm and sometimes she is still awake at 12.15am; exploring this further, she estimated needing 'two hours' to fall asleep. She wakes spontaneously and then ruminates, sitting up in bed, eventually falling asleep using techniques from her psychologist; the history was marked by tangentiality and concentration loss. Ms May thought it might take her two hours to return to sleep each time, sometimes not returning to sleep once she wakes (it was not possible to ascertain how often this occurs due to her lack of concentration and highly circular discussion).

Prominent disturbance pervaded the examination. Ms May said this was "Great" before the injury but is poorer now. If she watches a show she likes, her focus lasts "Not long", and she watches for ten to fifteen minutes but her focus drops in an out in this time and her understanding is pock-marked, missing parts of the plot. She said she used to watch thriller movies but she lacks the interest now along with not being able to follow them. On discussion, she loses track in conversations with her daughter.

Deficits were present on and off during the history. Ms May said she forgets what she is talking about with others at times, and she loses and misplaces things at home more now. Sometimes she forgets to tell her daughter to get her essential grocery items that she needed.

She reported feeling depressed all the time, rating her mood at 3/10 (where 1-2 reflect severe depression, 3-4 moderate depression, 5-6 mild depression, 7-8 normal mood and 9-10 elated mood), and she said she finds it easier to cry and she cries more often. She lacks energy, which led to recent blood tests; she rated it nowadays at 30% of her previous full baseline, and she naps 'sometimes' - she was unable to quantify this easily and it took a few attempts before she reported, 'Lately it can be twice a week, and sometimes I just go to my room and lay there cos I don't want to be bothered', sleeping for 20 minutes and then she remains in bed in isolation. She said she hates her daughter seeing her like this. Enjoyment was also rated at 30%, and she reported that she feels like closing her eyes and not waking up. She recalled that in 2016, she attempted to end her life due to the bullying at the school, with another attempt around 2018 from what she recalled (2020, on correcting herself). Ms May said she last experienced suicidal thinking two months ago, which she told her GP and psychologist about; she denied any self-harm or suicidal ideation, intent or plans. She described diminished hope for her own recovery, and "most of the time" she feels helpless and worthless, along with having amotivation.

Meal intake has dropped from three meals a day to one meal now per day, and she spoke of a lack of motivation to cook vegetables, now eating Weetbix for dinner. She said her meal intake has 'got worse over the... while this was happening, I was not too bad, eating two meals, I always made sure I had the main meal, with the vegies, but it has got worse'. She was asked about enjoyment of food but responded in terms of lacking enjoyment in hobbies; refocused, she reported lacking enjoyment in food and the meal she eats is now 'way smaller, I probably only eat three to four Weetbix'. She said she has lost weight through the injury from around 130kg or so to under 100kg now.

This is ongoing, elevating on leaving the home, and at home this worsens if she hears sudden sounds like phone calls. Ms May said she leaves the home at 5 or 5:30am, leaving then as she does not want to see others - she now drives to the dog park and lets them run beside the car when she goes home (two months ago, before this she walked them from home but anxiety limits her). She was asked to rate anxiety on a scale, but she described it out of the home as "right up there, I can't wait to get home, I start shaking the legs, I get the itches, I can feel me heart going, 'boom boom boom boom boom' and I feel sick in the guts". She reported having elevated heart rate and palpitations; these changes occur together (panic attacks) three times a week. She was asked to rate her anxiety again, rating it at 7-8/10 out of the home and 5/10 at home (where 1-3 reflect low anxiety, 4-6 moderate anxiety, 7-8 high anxiety, and 9-10 severe anxiety).

Anxious irritability and lowered frustration tolerance was described. Anxious muscle tension occurs _'_in me neck, I do' and sometimes in her legs. Along with contributing to sleep, concentration and fatigue problems, anxiety drives restlessness and she said she tries to use techniques from her psychologist and she sometimes tries to use chores to burn the anxiety out.

Details of any previous or subsequent accidents, injuries or condition:

She denied having any other accidents or injuries since the work injury.

Ms May said she smokes around 30 cigarettes a day now, more than before the injury - around five per day. She said she has never really consumed much alcohol and she is not consuming any at the current time ('None at all'). She does not use substances, gambling or have any criminal history.

• Hypercholesterolaemia
• Diabetes myelitis type 2
• GORD (in the past) and h. pylori triple therapy

She was not aware of any psychiatric history in the family; she noted that her father died when she was 12 months old. However, 71 minutes into the history she said her daughter had a brief episode of depression or anxiety in 2019-2020, which resolved when they returned to where they live.

Ms May had no previous history of mental illness or of having treatment with a psychiatrist, psychologist or on psychotropic medication.

Work history including previous work history if relevant:

After she left Year 10, she worked for 'five months, I did polo cross horses' on a horse property. She missed the family, and she then returned to her town, Geurie, '20 miles from town [Dubbo]'. For six years, she 'worked for Optex, making glasses, in Dubbo... reading glasses. Every and now and then I would have to travel to Melbourne", in that role. She then reported she was employed there from the age of 16 for three years - not six years (which is what is listed in the previous MAC). From there, she was "A Zookeeper out at Western Plains Zoo, for six years. In 1988, I had Jess, I didn't know I was pregnant... six weeks premmie". She left the Zoo in 1993, but she said they would ring her for casual work when they needed a Zookeeper. 'Then I didn't work for about a year, I used to go around and do the pensioners, that's when the digital came out with the TV, and then I would go do the pensioners and rewire the roof and tune the TVs in, and as well as that I did farmwork and plough. My confidence was up there, to be a Zookeeper. Then after that, I worked at Delroy and I did that for twenty years. While I was working at Delroy, I was also working at the Gordon Estate... nearly every night and day.' She was unable to estimate her hours there, as they varied, though she said she stopped working there 'When they didn't have the funding', around 2013. She then worked at the school, running programs - describing the pre-injury role.

Currently, she lives with Jess, her 35-year-old daughter; she had fostered two children when she was younger (about 33 years ago) and she has two dogs and two cats.

A history was obtained of Ms May's typical daily routine over the last two months - she wakes at 4.00 or 4.30am, needing 'not long' to exit bed (around five minutes), and she puts the kettle on, she washes the pet food dishes and then feeds them. She said she does the washing at night - on redirecting her to the morning routine she said she tends to watch the morning news then 'I go and pick the dog poo up... I used to vacuum every day but I don't now'. At 5:30 or 6am, she takes her dogs to the park to run around, driving there in the last two months (walking previously) and she returns home just before 6am. She struggled to describe the rest of the day, but said she might play solitaire for two hours at times, two or three times a week. Sometimes she might go out with her little dog, sitting on the grass in the backyard and throwing the ball to it though she noted, 'before I used to get out there and build things, my veggie garden but now I can't be bothered', reporting that the only garden work she does now was lopping part of a bush tree (trimming) a month ago to contain its size. She has dinner at 5pm these days and asked what else she might do before that, she replied, 'Honest truth nothing, I don't really do nothing, I just sit on the verandah. Unless it's cold, I just lay on the lounge. I go to my room and lay on me bed'. She goes to bed around 10:30pm, but once a week at 7:30 or 8pm 'cos I get over tired'.

Meal intake has dropped from three meals a day to one meal now per day, and she spoke of a lack of motivation to cook vegetables, now eating Weetbix for dinner. She said her meal intake has 'got worse over the... while this was happening, I was not too bad, eating two meals, I always made sure I had the main meal, with the vegies, but it has got worse'. She was asked about enjoyment of food but responded in terms of lacking enjoyment in hobbies; refocused, she reported lacking enjoyment in food and the meal she eats is now 'way smaller, I probably only eat three to four Weetbix'. She said she has lost weight through the injury from around 130kg or so to under 100kg now. Jess prompts her to eat "two or three times a week... if I didn't have her, I probably wouldn't hardly eat at all. I don't know why, but I just don't feel as hungry as I used to'.

She showered nightly pre-injury, then said she used to run a bath but no longer does, reporting that she might skip showers sometimes twice a week and have a flannel bath; Jess does not prompt her to shower (here she stated in passing, 'No, she's got her intellectual disability'). She said she often puts her nightie on in the daytime; she changes her underwear daily but other clothes every two days. Hair washing was done three times a week, but this is weekly now, and she spoke of being well-presented then.

Cooking was done 'every night', which has declined; the history had to be refocused several times - she estimated that she has cooked three times in the last two months, eating Weetbix or Sultana Bran instead. She cooked pork and vegetables on Sunday. Ms May would grocery shop on Thursdays, but her daughter now goes due to elevated anxiety, which she felt began in 2020; on further history if urgent top-up items are needed, she organises a Woolworths delivery. She said her daughter picks up her medication from the pharmacy - she avoids both due to anxiety. The chores are done less due to the depression.

Travel: She reported not driving to new places anymore, adding that she used to visit her brother in Geurie twice a week and she reported that she has not been there since last Christmas. She drives only to the park where she takes her dogs nowadays - a distance of around two or three minutes by car, she felt. She had done a caravan trip around Australia with her daughter to Queensland 'in 2018, cos I had leave without pay, and they said I had to make my mind up and in 2019 I decided to leave'. Her intention had been to travel around the country, and she got as far as Cairns. Ms May denied any similar trips since then. In this history, she reported that she had been Uber driving in Queensland for 'probably three months, when I was up there', in 2019 (noting the MAC, she later said this must have been in 2017). She also did cleaning for the NDIS while there (and lifting disabled persons out of bed, she noted) in that time for 'fifteen months'. She does not take public transport, nor did she need to pre-injury.

Outside of work hours, she saw friends daily pre-injury, at their house or to the Zoo for a day out 'cos I get there free'. These days, Ms May sees 'None at all, really', and asked when this changed, she replied, 'I can't really say, cos I was sick of them... I'd say three months ago, when all this started. I've told them to go, go away - they'd tell you I am a rude bitch'. Until then, friends would visit her on lunchbreaks once or twice a week or she would visit them sometimes (10-15 minutes, "on the other side of Dubbo"). She said she has received calls from them since, sometimes not answering - Ms May said she last spoke to one of these friends three weeks ago. Late in the history, she said she was well-known and well-respected in the local Aboriginal community.

Ms May said she now has conflict or arguments with Jess, with the relationship "worse than it used to be, cos she rips it into me. She's told me - she's straight-out like me - and say, 'I'm sick of it, mum'. She has not been in a relationship since the injury "But I never really have, cos Jess' father died in a truck accident" - they were together "off and on" (it was difficult to get a sense of the duration of the relationship, eventually she felt they were together intermittently for eight years; this does not affect her mental state now. Jess was 8/9 when he died).

She used to do artwork daily before the injury, but this has stopped, as has the gardening other than in a very limited way (every two weeks) and she mows the lawn every two or three weeks (three times a week pre-injury, "cos I loved it absolutely perfect"). She was asked about crystal puzzles, and she reported, "I haven't done them for ages... a couple of months, easy, I won't even do them, I just don't have the interest, I don't do them".

On mental state examination, Ms May presented as a 57-year-old female with short dark hair, unstyled under a cap, casually dressed, with her skin appearing a little oily. She looked tired during the 91-minute examination via Microsoft Teams. The video connection was good throughout. Some restlessness was apparent in the second half of the interview, of a mild grade, evidenced by movement in her upper body. Rapport was formed without difficulty, eye contact was fair and she wept at the end of the interview when she summed up the impacts of the work injury on her. Speech was of a reasonably normal rate (increasing where the injury history was discussed at the end), volume was a little louder at times and thought stream was normal. Thought form was frequently tangential, requiring redirection regularly. Mood was low, affect was restricted in range of emotions expressed, and in quality it was teary at the end of the assessment and prominently anxious throughout, consistent with what she described and appropriate to context. Thought content featured depressive and anxious themes; she denied any acute self-harm or suicidal ideation, intent or plans on examination. Concentration and short-term memory deficits were obvious and prominent throughout the history. Insight and judgement were intact overall.

Ms May is a 57-year-old female of Aboriginal heritage who was employed at the Department of Education and sustained an accepted injury in the course of her employment as a SLSO/teacher's aide.

She described the development of anxiety and depressive symptoms through the work injury events and the lack of action when she reported concerns about a male colleague's behaviour at work, as he would share videos of disabled children in vulnerable states, such as having nappies or catheters changed, on the toilet naked or running naked, with their nappy coming off.

Depressive and anxiety symptoms began in the context of bullying and harassment by teachers after her complaint.

On examination, she presents with a range of broad depressive and anxiety symptoms of a severe grade, entrenched, reflecting a diagnosis under DSM-5-TR of major depressive disorder with anxious distress

The injury is stabilised and not likely to change by more than 3% in the next year, with or without medical treatment.

In assessing the three domains of functioning that have been challenged, it is apparent in travel that Ms May is limited to local and familiar domains in driving, mostly to a park she drives to take her dogs to exercise at - until two months ago, she walked there but anxiety now limits her ability to, so she drives there when it is quiet in the early morning. She has not been on a caravan trip since that of 2019-2020, and she drove Uber rideshares for three months there, but has not since.

Her concentration was moderately degraded throughout the history, as is commented on, and prominent memory disturbance featured throughout the hour and 31 minute examination.

There is strain with her daughter and with friends, but those friends still try to contact her even though she does not always pick up and despite Ms May withdrawing and isolating more, seeing them less often. Despite this, she and her daughter have a functioning relationship.

Ms May's presentation was consistent in terms of her history, including of her symptoms and functioning, her mental state examination features and the material in the brief provided by both parties. No inconsistency was evident."

1. The Appeal Panel considers that the examination undertaken by Medical Assessor Ash Takyar was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Ash Takyar has provided in his report to the Appeal Panel, including the history as to the appellant's ability to function in the PIRS categories that has been challenged on appeal, namely travel, social functioning and concentration, persistence and pace. The Appeal Panel notes that Medical Assessor Ash Takyar had clear regard to the other evidence before him, has not relied on self -report alone and has used his clinical expertise on the day of assessment to make findings and recommendations to the Appeal Panel about the assessments of the contested PIRS categories. The Appeal Panel agrees with and adopts the findings of Medical Assessor Ash Takyar.
2. In respect of Travel, Table 11.3 of the Guides provides as follows:

Table 11.3: Psychiatric impairment rating scale - travel

No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision.

Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.

Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.

Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person.

Totally impaired: may require two or more persons to supervise when travelling.

1. The Appeal Panel adopts the findings of Medical Assessor Takyar on

She reported not driving to new places anymore, adding that she used to visit her brother in Geurie twice a week and she reported that she has not been there since last Christmas.

She drives only to the park where she takes her dogs nowadays - a distance of around two or three minutes by car, she felt.

She had done a caravan trip around Australia with her daughter to Queensland "in 2018, cos I had leave without pay, and they said I had to make my mind up and in 2019 I decided to leave". Her intention had been to travel around the country, and she got as far as Cairns. Ms May denied any similar trips since then.

In this history, she reported that she had been Uber driving in Queensland for "probably three months, when I was up there", in 2019 (noting the MAC, she later said this must have been in 2017). She also did cleaning for the NDIS while there (and lifting disabled persons out of bed, she noted) in that time for "fifteen months". She does not take public transport, nor did she need to pre-injury.

1. The Appeal Panel considers that based on these findings, the best fit is a mild impairment or Class 2 for travel.
2. In respect of Social Functioning, Table 11.4 of the Guides provides as follows:

Table 11.4: Psychiatric impairment rating scale - social functioning

No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).

Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.

Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.

Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (e.g. lost partner, close friends). Unable to care for dependants (e.g. own children, elderly parent).

Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.

1. The Appeal Panel adopts the following findings of Medical Assessor Takyar on re-examination:

"Ms May said she now has conflict or arguments with Jess, with the relationship 'worse than it used to be, cos she rips it into me. She's told me - she's straight-out like me - and say, 'I'm sick of it, mum'.' She has not been in a relationship since the injury 'But I never really have, cos Jess' father died in a truck accident' - they were together 'off and on' (it was difficult to get a sense of the duration of the relationship, eventually she felt they were together intermittently for eight years; this does not affect her mental state now. Jess was 8/9 when he died)."

1. Social functioning is concerned with the quality of relationships. The appellant most significant relationship is with her daughter Jess and that relationship is strained, with tension and arguments. This is consistent with the criteria for Class 2 or mild impairment.
2. In respect of concentration, persistence and pace, Table 11.5 of the Guidelines provides as follows:

No deficit, or minor deficit attributable to the normal variation in the general population. Able to pass a TAFE or university course within normal time frame.

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 (eg operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.

Severe impairment: can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.

Totally impaired: needs constant supervision and assistance within institutional setting.

1. The Appeal Panel adopts the findings of Medical Assessor Takyar on re-examination as follows:

Prominent disturbance pervaded the examination, requiring refocusing often in the hour and 31 minute-long assessment - sometimes repeatedly. Ms May said this was 'Great' before the injury but is poorer now. If she watches a show she likes, her focus lasts 'Not long', and she watches for ten to fifteen minutes but her focus drops in an out in this time and her understanding is pock-marked, missing parts of the plot. She said she used to watch thriller movies but she lacks the interest now along with not being able to follow them. On discussion, she loses track in conversations with her daughter.

Deficits were present on and off during the history. Ms May said she forgets what she is talking about with others at times, and she loses and misplaces things at home more now. Sometimes she forgets to tell her daughter to get her essential grocery items that she needed."

1. The Appeal Panel agrees that based on these findings, the best fit is a moderate impairment or Class 3 for concentration, persistence and pace.
2. In summary, the classes assessed by the Appeal Panel are for the contested PIRS categories of travel and social functioning at Class 2 mild impairment. In respect of the classes of concentration, persistence and pace there is moderate impairment at Class 3.
3. This means the calculations become as follows:

1. For these reasons, the Appeal Panel has determined that the MAC issued on

16 December 2024 should be revoked and a new MAC 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 Pane revokes the Medical Assessment Certificate of Medical Assessor Ankur Gupta and issues this new Medical Assessment Certificate as to the matters set out in the table below:

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA5 Guides

WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)

Sub-total/s % WPI (after any deductions in column 6)

Total % WPI (the Combined Table values of all sub-totals)

The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.