WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological Injury; lump sum claim; appellant worker challenged assessment in four of the six psychiatric impairment rating scale categories; self-care and personal hygiene, travel, social functioning, and concentration, persistence and pace; error found in inadequate path of reasoning and inadequate record of findings on mental state examination; re-examination considered necessary in the circumstances of a finding of error; Held - Medical Assessment Certificate revoked.

1. On 10 September 2025 the worker Estelle Quiggin (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

13 August 2025. 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 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 sought 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. 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 Michael Hong of the Appeal Panel conducted an examination of the worker on 16 January 2026 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: 3 July 2023 (deemed)
• Body parts/systems referred: Psychological/Psychiatric 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:

Chapter, page and paragraph number in NSW workers compensation guidelines

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

deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed

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

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 mild impairment. She does not look after her hygiene and needs prompting from her family for showering and cleaning her teeth. Her appetite is maintained and

she did not describe needing to be prompted to eat.

As described in the main body of the report, there is moderate impairment. She has stopped socialising and does not go out for meals or coffee. She attended her daughter's graduation, but not on her own. She has been to an art gallery but was accompanied by her daughter. There is moderate impairment in her engagement with social and recreational activities

As described in the main body of the report, there is no impairment. She can travel without much impediment and can drive for 30 to 40 minutes to get to her psychologist. She has driven up to Sydney CBD as well. She has avoided travelling interstate and did not visit her mother. There is mild impairment.

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

As described in the main body of the report, there is mild impairment. She describes reduced concentration

and impaired memory. She is unable to help her daughter with university applications. She does manage her finances and remembers to take her medication. It was noted that during the assessment, she was able to remember the years when she started

She has not worked since she stopped on 3 Jul 2023. She was doing well in her job and now feels stressed by the prospect of working in an office environment because she is fearful of being bullied and harassed. Clinically, however, she does have the capacity to work from home but not in an office environment.

able to work for up to 10 hours per week in a home- based role with one or two days per week.

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 four of the six PIRS categories, namely self-care and personal hygiene, social and recreational activities, travel and employability causing him to make an error in the assessments in these domains as follows:

(a) in assessing Class 2 for self-care and personal hygiene when he should have assessed Class 3;

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

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

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

1. In summary it was submitted that these errors arose because the Medical Assessor did not provide an adequate path of reasoning for his findings in the contested domains and findings were made on the basis of incorrect criteria and failing to take adequate account of the evidence.
2. In summary, the employer RSL Life Care Limited (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. It was submitted that the MAC was adequately reasoned when read as a whole and the findings were open to the Medical Assessor applying his clinical expertise to the assessment.
3. 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.
4. 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 Appeal Panel considered that the path of reasoning was inadequate, there were no findings recorded of the mental state examination and it was not clearly discernible from the reasons given that the assessments under the contested PIRS categories were based upon the correct criteria.
5. In these circumstances of the above finding of error, the Appeal Panel considered that a re-examination by a Medical Assessor member of the Appeal Panel was necessary. Medical Assessor Michael Hong was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):

1. HISTORY RELATING TO THE INJURY
   • Brief history after the MAC:

Ms Quiggin reported she joined RSL LifeCare as a case manager in October 2016, and became the service manager in December 2022, and ceased work in July 2023. She has not worked since then, and remains on Workcover payment. She confirmed the work injury history recorded previously.

In terms of major life events after the assessment with Dr Gupta, she said her mother in Queensland has had a major health decline and is currently having palliative care in a nursing home. Her husband was hospitalised in November 2025 and admitted to the stroke ward, with transient global ischemia. Her husband has recovered and is home now.

After Dr Ankur Gupta's MAC, she continues to have regular treatment with the same psychologist and psychiatrist, Kathy Ebert and Dr Erin Dougherty, and for a while, Mirtazapine was increased, but due to sedative side effects, it was reduced back 45 mg. She has not had psychiatric admissions or group-based treatment. She had presented to the Emergency department for chest pain previously, which was attributed to a panic attack, and this was in March 2023.

In terms of Ms Quiggin's psychological symptoms, she said she has chronic anxiety and depression, these have not changed, and depression is present daily, and she feels hopeless and is constantly exhausted and does not feel joy. She is overwhelmed with simple activities and with her personal care. She said she is in a dark place and has had suicidal ideations, without acting on them.

She has anxiety and panic attack-like symptoms, and her anxiety symptoms are triggered by being out, crowded places and being in cars. Loud noises and the doctors' offices can cause anxiety, and she no longer goes to cafés, restaurants or busy shops. She walks the dog with her husband in an open area only as she avoids crowded places.

She has sleep problems and wakes up in an anxious state, but does not know why she is anxious. She described free-floating anxieties. Mirtazapine helps her sleep. She talks in her sleep, and engages in sleepwalking intermittently, as noted by her husband to her. She sleeps during the day as she feels overwhelmed.

She said everything is an effort, she struggles with her self-care, the laundry and the household chores.

Ms Quiggin described feeling frustrated without anger problems.

She has reduced her alcohol intake. Initially, she drank much more as a coping mechanism, and with her psychiatrist's assistance, her alcohol intake reduced and her liver function test has improved. In the last 7 days, she drank 2-3 glasses of wine.

She noticed she has been distracted and has difficulties concentrating. She said she has not been able to write reports, read, compile care plans as she did when at work. She said she can read IME reports, make comments on the reports and respond to her solicitors, but this takes a couple of weeks.

Ms Quiggin described chronic fatigue symptoms and wakes up tired.

She is now 96kg, and said she is 15kg more than her normal weight. She said her weight increased since Mirtazapine and I noted Dr Gupta recorded she gained 15kg, and her weight has not changed significantly since that assessment.

Ms Quiggin is 56 years old and living with her husband and her only daughter, who is 19 years old and attends university.

Ms Quiggin does not do much day-to-day and has no daily routine. On weekends, her daughter is home and so she spends time with her, but feels fatigued after walking the dog with her. She struggles to stand for long and described being deconditioned.

She eats two meals a day, and does not have an appetite. She no longer enjoys cooking, and rarely cooks now. Her husband does most of the cooking at home, and sometimes she helps. She no longer shops in person, and she buys the groceries online. She said her diet is healthy. When her husband was unwell and in hospital, she was at hospital with him most of the time, her daughter looked after herself, and her home was neglected.

Ms Quiggin does not have family in NSW and her mother and brother are in Queensland, and she has not seen them for 3 years now. She talks to her mother twice a week, but the relationship with her brother is not great, as he is not aware of her work injury and feels she neglected their mother, especially with her mother being in a nursing home. She talks to her brother only when there is something to do with their mother.

Ms Quiggin has one good friend in Newcastle and another friend who still contacts her. She said she had 3-4 girlfriends previously, but some of her friends pulled away, including the godparents of her daughter. She said she does not know why they pulled away, but people contacted her less over time, and she does not put effort into the relationships, and said she does not feel she has the mental capacity to deal with relationships. She confirmed there is no fallout with her friends. The relationship with her husband and daughter is good.

She showers every 3-4 weeks, and said this is due to fatigue. She had gum infections previously and still has bleeding gum recently, and has scalp psoriasis. Her husband prompts her to shower, and her daughter helps brush her hair sometimes.

She leaves home only when needed. Her daughter asks her to drive her to work sometimes. She drives on her own to her psychologist, but sometimes struggles being out and changes to telehealth. She walks the dog on her own and with her family. She feels judged when out and worries she would be attacked. She said she went out twice in the past 7 days, and saw her psychologist and dropped her daughter to work, at a local shopping centre.

On enquiry, I confirmed there have been no trips away or holidays since Workcover. Her brother had open heart surgery in Queensland in November 2024, but she did not go to see him.

Ms Quiggin has never been one to read books. She previously liked reading for work, reading articles related to dementia or health in the elderly, and information related to her industry. She described how she struggled with her daughter's university application. She does not read articles now, not even short articles. She manages her finances, and said everything is set up for direct debit. She checks the statements monthly and checks the mortgage repayments. She can transfer money and said this does not take much time.

She said she is very anxious today, and worries she would lose control of her bladder and bowel as had happened previously. I noted to her, her concentration and memory was reasonable on assessment, even after 40 minutes, and she reported she said she can remember her history.

She said she sets phone alarms to remind her important things, including her medications.

Ms Quiggin's husband performs in public and plays blues guitar, but she no longer goes to watch him.

Ms Quiggin was assessed by video. She was alone, and her daughter was also at home during the assessment.

Ms Quiggin was bespectacled and had greying hair, which was tied back. She engaged well with the assessment process. Ms Quiggin had mild manners and spoke spontaneously in a soft voice, generally giving long answers. She was moderately restricted in her affect and reactivity. She was not thought disordered. She was attentive and gave a clear history, and remained focused throughout the assessment.

At the end of the assessment, I asked for further information that may be relevant and Ms Quiggin discussed she did not mention to Dr Gupta, but there is nothing normal or the same in her family, since her work injury. She was confident, capable and happy, and enjoyed social interaction, and after her nervous breakdown, she is fearful to be out, and has no interest in her self-care, and it upsets her to see her family see her neglecting herself.

Ms Quiggin presented largely the same as when seen by Dr Gupta, although there were some additional stresses in the family since his assessment. She has chronic Major depressive disorder, and has not developed a new psychiatric diagnosis after Dr Gupta's assessment, and whilst her antidepressant was briefly increased, it has been reduced to the same dose as previously when seen by Dr Gupta. Overall, her psychological condition is entrenched and remains in a state of permanency.

I have found no inconsistency in Ms Quiggin's presentation.

Ms Quiggin only showers every 3 to 4 weeks and does not brush her teeth regularly, and developed gum and scalp problems, including infections. She eats two meals a day without prompting. She buys the groceries online and avoids the shopping centre. Her husband prompts her to take a shower.

She is incapable of independent living without regular support.

Ms Quiggin has anxiety out, and avoids crowded places. She is home most of the time. She is able to travel alone locally but avoids longer journeys.

Ms Quiggin's relationship with her husband and daughter is reasonable. She talks to her mother regularly, and occasionally with her brother, and they are in Queensland.

She is anxious and socially avoidant, and the relationship with a couple of close friends has become strained and they are no longer in contact.

Ms Quiggin described having difficulties with her concentration. She does not read articles as she has no interest. She can manage her finances and read legal paperwork, but takes longer than normal, and can focus on intellectually demanding tasks for up to 30 minutes.

1. The Appeal Panel considers that the examination undertaken by Medical Assessor Michael Hong was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Michael Hong 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 self-care and personal hygiene, travel, social functioning and concentration, persistence and pace. The Appeal Panel notes that Medical Assessor Michael Hong 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 recommendations to the Appeal Panel about the assessments of the contested PIRS categories. The Appeal Panel notes Medical Assessor Michael Hong's findings on clinical examination of the appellant and his diagnosis made after clinical examination of the appellant as follows:

"Ms Quiggin presented largely the same as when seen by Dr Gupta, although there were some additional stresses in the family since his assessment. She has chronic Major depressive disorder, and has not developed a new psychiatric diagnosis after Dr Gupta's assessment, and whilst her antidepressant was briefly increased, it has been reduced to the same dose as previously when seen by Dr Gupta. Overall, her psychological condition is entrenched and remains in a state of permanency."

1. The Appeal Panel agrees with and adopts the findings of Medical Assessor Michael Hong.
2. In respect of Self-care and personal hygiene, Table 11.1 of the Guidelines provides as follows:

Table 11.1: Psychiatric impairment rating scale - self care and personal hygiene

No deficit, or minor deficit attributable to the normal variation in the general population

Mild impairment: able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.

Moderate impairment: Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2-3 times per week to ensure minimum level of hygiene and nutrition.

Severe impairment: Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.

Totally impaired: Needs assistance with basic functions, such as feeding and toileting.

1. Medical Assessor Hong reported to the Panel his finding on re-examination as follows:

"Ms Quiggin only showers every 3 to 4 weeks and does not brush her teeth regularly, and developed gum and scalp problems, including infections. She eats two meals a day without prompting. She buys the groceries online and avoids the shopping centre. Her husband prompts her to take a shower.

She is incapable of independent living without regular support."

1. The Appeal Panel adopts the findings on re-examination and agrees with the recommendation that the findings are consistent with a rating of a moderate impairment (Class 3) for self-care and personal hygiene. This rating is higher than that assessed by the Medical Assessor.
2. In respect of Travel, Table 11.3 of the Guidelines 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 history taken and findings of Medical Assessor Michael Hong re-examination as follows:

"She leaves home only when needed. Her daughter asks her to drive her to work sometimes. She drives on her own to her psychologist, but sometimes struggles being out and changes to telehealth. She walks the dog on her own and with her family. She feels judged when out and worries she would be attacked. She said she went out twice in the past 7 days, and saw her psychologist and dropped her daughter to work, at a local shopping centre.

On enquiry, I confirmed there have been no trips away or holidays since Workcover. Her brother had open heart surgery in Queensland in November 2024, but she did not go to see him."

1. The Appeal Panel adopts the findings of Medical Assessor Hong as follows:

"Ms Quiggin has anxiety out, and avoids crowded places. She is home most of the time. She is able to travel alone locally but avoids longer journeys."

1. The Appeal Panel agrees that the findings are consistent with a rating of a mild impairment (Class 2) for travel. This is higher than the rating given by the Medical Assessor.
2. In respect of social functioning, Table 11.4 of the Guidelines 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 (eg lost partner, close friends). Unable to care for dependants (eg 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 findings of Medical Assessor Hong on re-examination as follows:

"Ms Quiggin's relationship with her husband and daughter is reasonable. She talks to her mother regularly, and occasionally with her brother, and they are in Queensland.

She is anxious and socially avoidant, and the relationship with a couple of close friends has become strained and they are no longer in contact."

1. Social functioning is concerned with the quality of relationships. The appellant continues to have a reasonable relationship with family members but has lost friendships. The Appeal Panel considers that the impairment is mild consistent with a rating of Class 2. This is higher than assessed by the Medical Assessor.
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 (e.g. 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 Hong's on re-examination as follows:

"Ms Quiggin described having difficulties with her concentration. She does not read articles as she has no interest. She can manage her finances and read legal paperwork, but takes longer than normal, and can focus on intellectually demanding tasks for up to 30 minutes."

1. The Appeal Panel agrees that the best fit is a mild impairment at Class 2 for concentration, persistence and pace. This is the same as the rating by the Medical Assessor.
2. What this means is that the classes assessed by the Appeal Panel are in accordance with the classes assessed by the Medical Assessor for the contested PIRS category of concentration, persistence and pace. For the contested categories of self-care and personal hygiene there is a higher rating at Class 3 or moderate impairment. For the contested category of travel there is a higher rating at Class 2. For the contested category of social functioning there is a higher rating at Class 2.
3. This means the calculations become as follows:

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

13 August 2025 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.