WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; whether ratings the Medical Assessor (MA) made of the appellant's impairment in psychiatric impairment rating scale categories of self-care and personal hygiene, social functioning and concentration persistence and pace, accorded with the facts; Held - Appeal Panel determined the MA's ratings of the appellant's impairment in self-care and personal hygiene and in social functioning accorded with the facts and evidence, but not his rating relating regarding the appellant's impairment in concentration persistence and pace; MAC revoked.

1. On 23 September 2025 Richard Ratcliffe, the appellant, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Yu Tang Shen, 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 worked for the State of New South Wales, the respondent, as a paramedic for the NSW Ambulance Service for in excess of 20 years. Due to incidents that he experienced during his employment, he suffered a psychological injury.
2. Relying on a report his solicitors obtained from consultant psychiatrist Dr Shannon Paisley dated 27 May 2022, he claimed compensation for permanent impairment from his injury.

Dr Paisley advised in his report that he assessed the degree of the appellant's permanent impairment from his injury is 19% whole person impairment (WPI). 3. The respondent's insurer, on whom the appellant made his claim, denied the appellant was entitled to compensation for permanent impairment from his injury. It relied on a report dated 27 January 2023 that its solicitors obtained from psychiatrist Dr Yajuvendra Bisht, who assessed the degree of the appellant's permanent impairment from his injury is 7% WPI. 4. Shortly after this medical dispute arising between the parties relating to the appellant's degree of permanent impairment from his injury, the appellant instituted proceedings in the Personal Injury Commission (Commission) seeking the Commission determine his claim for compensation for permanent impairment. Those proceedings in the Commission bear Commission matter no. W3873/23. A delegate of the President of the Commission referred the matter to Medical Assessor Gerald Chew, who examined the appellant on

21 September 2023 and issued a Medical Assessment Certificate on 29 September 2023. In that he said he was of the opinion that the degree of the appellant's permanent impairment is not fully ascertainable and declined to assess the degree of the appellant's permanent impairment. 5. Subsequent to that, the appellant's solicitors arranged for the appellant to be examined again by Dr Paisley on 5 February 2025 and in a report of that date Dr Paisley expressed his view that he considered that the appellant had achieved maximum medical improvement and that his permanent impairment could be assessed. He assessed the degree of the appellant's permanent impairment to then be 22% WPI. 6. Thereupon the appellant again initiated proceedings in the Commission, bearing matter no. W8139/25. 7. On 6 August 2025 a delegate of the President issued a referral to the Medical Assessor to assess the medical disputes between the parties relating to the appellant's injury. The Medical Assessor examined the appellant on 25 August 2025 and, as said, issued the MAC on 27 August 2025, in which he certified he assessed the degree of the appellant's permanent impairment is 9% WPI. He made his assessment by reference to the psychiatric impairment rating scale (PIRS), detailed in Chapter 11 of the Guidelines. His rating of the appellant's impairment in the several categories comprising PIRS are Class 2 in self-care and personal hygiene, Class 3 in social and recreational activities, Class 2 in travel, Class 3 in social functioning, Class 2 in concentration, persistence and pace (CPP), and Class 5 in employability. 8. The appellant, in his appeal against the medical assessment, has challenged the Medical Assessor's ratings of his impairment in the PIRS categories of self-care and personal hygiene, social functioning, and CPP. 9. In the PIRS rating form that forms part of the MAC, the Medical Assessor provided the following reasons for rating the appellant's impairment as Class 2 in self-care and personal hygiene:

"Since the subject injury, he said he is showering every few days, and he said he does not require assistance. He said he has [sic] makes breakfast for himself, which consists of toast with peanut butter. He said he has been doing the mowing once or twice a fortnight, more often in summer, and he has not mowed for the past few months on account of the weather. He said he has been shopping very rarely and usually with his wife. He said he struggles to get out on his own, as he gets anxious being around people.

As he has been able to self-care independently, albeit with a degree of self-neglect, he has mild impairment."

1. Within the body of the MAC the Medical Assessor also recorded that the appellant reported he showered every day before suffering his injury, and would rarely cook but would do barbecues. The Medical Assessor also recorded the appellant reported he did not clean a great deal before his injury but would mow the lawns and garden regularly. The Medical Assessor recorded that the appellant said that before his injury he and his wife would do the shopping together regularly.
2. The Medical Assessor noted that his assessment of the appellant's impairment in self-care and personal hygiene differed from the assessment Dr Paisley had expressed in his report of 5 February 2025. The Medical Assessor remarked, by way of highlighting the reason for that difference, is that the appellant retained sufficient independence and was not reliant on others although he may benefit from some informal support.
3. The reasons the Medical Assessor provided in the PIRS rating form for rating the appellant's impairment in social functioning as Class 2 are:

"Since the subject injury, he said his relationship with his wife has "strained" and they no longer sleep in the same bed, as he wakes at all times of the night. He said he still loves her, but they have grown apart, and he has been short-tempered. He said there has not been any physical violence or separation. He said his relationship with his children have [sic] been 'pretty good most of the time', though from time to time there is 'argy-bargie' over the discipline over the grandchildren. He said he sees his grandchildren in the mornings and after school, and he helps prepare lunches for his grandchildren and get them ready in their uniforms. He leaves it to his wife to do their hair. His wife takes them to school, and his daughter will pick them up from school. He remains in regular contact with his youngest daughter.

Since the subject injury, he said he has lost some of his friends, and he has one friend he remains in contact. He talks to him once a week or so; and he sees his friend about once every couple of months. He said they have a round of golf, but this has been sporadic. He no longer goes out for dinner or lunches.

While he has become somewhat more withdrawn from family and friends, he has not had any period of separation from his wife, and still helps look after the grandchildren to some degree. Hence, he has mild impairment."

1. Within the body of the MAC the Medical Assessor also noted that the appellant reported that prior to his injury he had a "quite good" relationship with his wife and they did not have any significant fights nor was there any separation. The Medical Assessor further noted that the appellant reported that he had a good relationship with both his daughters. The Medical Assessor noted that the appellant said that before his injury he had a close group of friends that would see each other two to three times a month and play golf together and get together once a month.
2. The Medical Assessor noted that his assessment of the appellant's impairment in social functioning differed from the assessment Dr Paisley had made and the Medical Assessor remarked with respect to that, and again by way of explaining the difference, that the appellant had retained a reasonable functioning relationship with his family and one friend.
3. The reasons the Medical Assessor provided in the PIRS rating form for his rating of the appellant's impairment in CPP as Class 2 are:

"Since the subject injury, he said his concentration has been 'terrible' and has not been able to concentrate on reading a book for longer than 15-20 minutes.

He was alert. He was able to provide a detailed account of his injuries and function. He was able to sustain his concentration for the duration of the assessment.

As he can read a book up to 20 minutes, and absent any objective findings of impairment in the assessment, he has mild impairment."

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

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

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
2. In summary, the appellant submitted that the Medical Assessor's rating of his impairment in self-care and personal hygiene did not correspond with the facts. The appellant noted that he only showered every few days, which he submitted is consistent with his having poor hygiene most of the time. The appellant noted that the examples provided in Table 11.1 for a Class 2 impairment included "may look unkempt occasionally". The appellant submitted that there is a difference between the possibility of sometimes looking unkempt and of being regularly unkempt. It is implicit from this submission of the appellant that he contends that his showering every few days results in his being regularly unkempt.
3. The appellant noted that the Medical Assessor recorded that he had lost some of his friends and has one friend with whom he remains in contact. The appellant submitted that that is non-sensical because to have lost all but one friend is not to have retained some friends. The appellant noted that the Medical Assessor recorded that he sees his one friend about once every couple of months.
4. The appellant submitted that the examples provided in Table 11.5 for a Class 2 impairment in CPP included that a worker can focus on intellectually demanding tasks for up to 30 minutes. The appellant submitted that he can only focus for approximately half of that time. The appellant submitted that a Class 3 rating is appropriate because the examples within Table 11.5 for such a rating include where someone can only engage in reading to a limited degree. The appellant further submitted that it can be inferred from his being unable to return to work that he has impaired concentration.
5. In reply, the respondent submitted that the functioning of the appellant the Medical Assessor detailed in the MAC for rating the appellant's impairment as Class 2 in self-care and personal hygiene is consistent with a Class 2 rating rather than a Class 3 rating. The respondent submitted that the appellant has the ability to live independently and can look after himself adequately.
6. The respondent submitted that the Medical Assessor's reasoning for his rating of the appellant's impairment in social functioning indicates the appellant has an ability to maintain some friendships although existing relationships are strained. The respondent noted that the appellant can take care of his grandchildren and that there have been no periods of separation or domestic violence. The respondent submitted that the Medical Assessor provided clear reasons for his assessment.
7. The respondent submitted that the appellant's ability to concentrate on reading a book is not the only indicator for how to rate the appellant's impairment in CPP. The respondent highlighted that the Medical Assessor found that the appellant could sustain concentration for the duration of the assessment and that the Medical Assessor could not find make any objective findings of impairment. The respondent submitted that the Medical Assessor's rating of the appellant's impairment as Class 2 in CPP should be maintained.

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.

1. The examples provided in Table 11.1 of the Guidelines for a Class 2 impairment in self-care and personal hygiene are:

"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".

1. The examples provided for a Class 3 impairment are:

"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."

1. In accordance with paragraph 11.12 of the Guidelines these examples are just that: examples of the conduct of a worker that a Medical Assessor can consider in the process of exercising his or her clinical judgment to assess a worker's impairment in a particular PIRS category. They are not prescriptive, and act as guides only. The fact that a worker may exhibit conduct that accords with one or some of the examples provided for a particular class impairment does not compel a Medical Assessor to rate the worker's impairment within that class. A Medical Assessor must evaluate all the material before him or her, including the clinical history the Medical Assessor has elicited, to determine the level of impairment the worker has in a particular PIRS category. That is, the Medical Assessor must consider and weigh all conduct of a worker relevant to a particular PIRS category so as to evaluate the degree of impairment in the particular category.[1]
2. The Appeal Panel considers that the reasons the Medical Assessor has provided for rating the appellant's impairment in self-care and personal hygiene as Class 2 support that rating. The evidence on which the Medical Assessor relied does not indicate the appellant requires regular support to live independently or that he is unable to prepare his own meals or frequently misses meals or that he requires the support of family members or a community nurse to ensure a minimum level of hygiene and nutrition. The evidence does not reveal that he requires prompting to shower. The history the Medical Assessor obtained revealed that the appellant has reduced his showering from daily to every few days following his injury, and that a consequence of his injury, but that in the Appeal Panel's view is not such that it would warrant a finding that the appellant's impairment in his self-care and personal hygiene is moderate. The fact that he is now only showering every few days, rather than daily does, not indicate that he is unable to live independently.
3. Arguably, it could be inferred from the fact that the appellant now showers every few days that he requires prompting to shower (although the Appeal Panel hastens to add that is not the inference that the Appeal Panel draws). But even if that were the case, given that the appellant is not requiring outside support and he can maintain a minimum level of hygiene and nutrition and noting too that he attends to the outside tasks of his home, and is still able to shop, although less frequently than he did so before, and is able to make his breakfast, the Appeal Panel considers that a Class 2 rating is the correct rating. His showering every few days does not require a rating of a moderate impairment in the context of the other evidence.
4. The Appeal Panel consequently finds that the Medical Assessor did not err with respect to his rating of the appellant's impairment in self-care and personal hygiene. Further, the Appeal Panel finds that the Medical Assessor applied correct criteria to make his assessment, given that he applied the criteria detailed in Chapter 11 of the Guidelines.

1. The examples for a Class 2, Class 3 and Class 4 impairment provided in Table 11.4 of the Guidelines for social functioning are:

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).

1. The Appeal Panel considers that the Medical Assessor has not made any error with respect to his classification of the appellant's impairment in social functioning. In the Appeal Panel's view, for the reasons the Medical Assessor provided, the level of seriousness of the appellant's impairment in social functioning is clearly Class 2.
2. There is some strain in the appellant's relationship with his wife, and there would be some arguments between them, bearing in mind he is short tempered. Nevertheless, their relationship is strong and long-standing and there has been no physical violence or separation. The appellant maintains a good relationship with his children and with his grandchildren. Since his injury he has lost all but one of his friends, but he maintains a good relationship with that friend.
3. The evidence on which the Medical Assessor based his rating does not reveal that any of the relationships the appellant has with his family, including his children and grandchildren, are severely strained. Indeed, the appellant shares responsibility for looking after his grandchildren.
4. The level of impairment in social functioning is not such that it could be considered as meeting a level of impairment by the examples described for a Class 3 impairment or a Class 4 impairment.
5. Hence, the Appeal Panel finds that the Medical Assessor made no error with respect to his rating of the appellant's impairment in social functioning. The Appeal Panel also finds that the Medical Assessor applied the correct criteria in making his assessment given that he applied the criteria of Chapter 11 of the Guidelines.

1. The examples provided in Table 11.5 for a Class 2 impairment are:

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

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

1. The Appeal Panel considers that the Medical Assessor did err by rating the appellant's impairment in CPP as Class 2, rather than Class 3. The fact that the appellant is only able to read for 20 minutes reveals he has poor concentration and persistence. The appellant described to the Medical Assessor that before his injury he would read a book every week or so and could read for up to an hour and had good concentration. He described to the Medical Assessor that since his injury his concentration has been terrible.
2. That reveals the appellant would not have the concentration or the persistence to follow complex instructions or be able to read more than a newspaper article. The duration that he can persist with reading is less than 30 minutes. That squarely accords with a level of severity of impairment that is described by the examples provided for a Class 3 impairment.
3. The only reasons provided by the Medical Assessor that would contradict a moderate impairment are of observations of the worker being "alert" and "able to sustain his concentration" during the assessment. The Medical Assessor makes no connection between these and any of the descriptors in the PIRS. That error on the part of the Medical Assessor is such that the MAC contains a demonstrable error.
4. The Appeal Panel finds that the Medical Assessor applied the correct criteria to make his assessment, although he applied it incorrectly.
5. The MAC containing a demonstrable error, the Appeal Panel must correct that error. It does so by rating the appellant's impairment in CPP as Class 3.
6. For these reasons, the Appeal Panel has determined that the MAC issued on

22 August 2025 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

State of New South Wales (NSW Ambulance Service)

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

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Yu Tang Shen and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

Chapter, page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA 5 Guides

Proportion of permanent impairment due to pre-existing injury, abnormality or condition

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

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

[1] Rogers v Health Service Union NSW [2025] NSWSC 291 at [43] - [45].