1. On 5 July 2025, Lisa Ryan (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Douglas Andrews, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 12 June 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 MAC contains a demonstrable error. 3. The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made. 4. Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules. 5. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).

1. The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
2. As a result of that preliminary review, the Appeal Panel determined that the worker should undergo a further medical examination because we considered that the Medical Assessor erred in his assessment in the psychiatric impairment rating scale (PIRS), in the category of Travel.

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 submits that the Medical Assessor erred as follows:

(a) the Medical Assessor failed to correctly apply the PIRS;

(b) the Medical Assessor failed to engage with the evidence of Dr Goodison in respect of the category of travel, and

(c) the Medical Assessor denied the appellant procedural fairness.

1. Specifically, the appellant submits that the Medical Assessor erred in respect of his whole person impairment (WPI) assessment in the PIRS, in the categories of self-care and personal hygiene and travel.
2. The respondent in reply submits that no errors were made.

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 appellant was referred to the Medical Assessor for assessment of WPI in respect of a primary psychological injury on a date of injury of 1 December 2022.
4. The Medical Assessor obtained a history of the circumstances leading to the injury as follows:

"Ms Ryan started work with TBE in June 2022. She successfully completed a three month probation and was rewarded with a $15,000 pay rise. Among her duties, she had been asked to update the company website, but this request was abruptly rescinded. Ms Ryan experienced role uncertainty and alleged poor communication with her employer. Issues regarding her employment remained unresolved. In late November 2022, an allegation of bullying was made against her, a claim which she asserts was unfounded. She left her role on 1 December 2022, taking leave under workers' compensation provisions.

Ms Ryan's mental health deteriorated during the latter part of 2022, and she increased her alcohol intake.

She sought support from her general practitioner and was referred to a psychologist.

In October 2023, she attended a three-week alcohol detoxification and rehabilitation program at the Brisbane Waters Private Hospital.

She is currently casually employed by Scholastic Australia, nominally for 26.5 hours weekly."

"Treating clinicians: General practitioner Dr David Daoud. Psychologist Ms Michela Verwey

Ms Ryan sees her general practitioner monthly. She also regularly saw her psychologist until the end of 2024, when the insurer withdrew funding.

During her three-week stay at Brisbane Waters Private Hospital, she was under the care of a psychiatrist, Dr Sujatha Kalava, whom she saw 2 or 3 times in the weeks following her discharge. Dr Kalava briefly trialled several medications such as topiramate, clonidine, aripiprazole, olanzapine, mirtazapine and acamprosate. Ms Ryan found Dr Kalava's approach unhelpful and has not seen her since February 2024."

1. The Medical Assessor then noted present symptoms as follows:

"Ms Ryan's mood is often low but varies significantly with circumstances. She enjoys contact with her daughters.

She is anxious and concerned about her current circumstances and future. She has lost confidence and worries that she cannot trust others.

She feels injustice and is bothered by intrusive thoughts about her treatment in the workplace. She says, 'I feel wronged,' and comments on the unfairness of the lack of consequences for the alleged perpetrators of her problems.

She has low motivation to be active and is often tired.

She denied irritability or outwardly expressed anger. Instead, she said, 'I go inwards.'

She has subjective problems with concentration and memory. She said, 'I live in a fog, my memory is shot; it is hard to focus and complete tasks.'

She has not recently had thoughts of self-harm or suicide.

She is in bed by 10 PM and suffers from initial and middle insomnia.

Her appetite is reduced, but this can be attributed to using semaglutide, an appetite suppressant."

1. The Medical Assessor then set out details of previous injuries and conditions, and said:

"Ms Ryan had depression in her 20s and had two suicidal gestures. On both occasions, she cut her wrists but was not taken to the hospital because her injuries were superficial. She now believes these were "not serious attempts, a cry for help." She was prescribed sertraline, an antidepressant that she didn't tolerate, and then a second antidepressant, the name of which she can't remember. This medication was effective.

She sought counselling when she was 29 and she had a relationship breakup.

She suffered postnatal depression, lasting about 2 years, following the birth of her youngest daughter. At that time, she was commenced on duloxetine, a drug which she continued and was still on at the time of her workplace injury.

Ms Ryan was well during 2021 and 2022, until the problems at TBE. Her alcohol use was minimal. I discuss her alcohol consumption more fully under the heading of general health."

"During her 20s and 30s, Ms Ryan worked in hospitality and the advertising industry, both of which have cultures of excessive alcohol use. She believes she probably drank to excess during those years. During 2021, she consumed 3 or 4 standard drinks of alcohol in the form of wine daily. She reduced this in 2022, when she started working for TBE. She was enthusiastic about her new job, wanted to make a good impression and felt her "happiest in years."

She increased her alcohol intake when she felt more pressured in her work at TBE.

Following her three-week stay at Brisbane Waters Private Hospital, she had a brief period of abstinence before recommencing her drinking.

Currently, she drinks about six full-strength stubbies of beer and half a bottle of wine daily, approximately 12 standard drinks. She usually starts drinking at 5 PM when preparing the evening meal. She doesn't have a hangover, tremors or other physical problems the following day. Her alcohol intake has not caused legal issues for her. She is aware of the negative impact of her alcohol intake on her family and her health, but has been unable to cut back further."

1. The Medical Assessor then set out details of the impact of her injury on her social activities and activities of daily living (ADL's) as follows:

"Ms Ryan lives in her freestanding home at Niagara Park on the Central Coast with her two daughters, ages 8 and 10.

On work days, she rises at 5:30 AM, makes coffee, and readies her girls for school. She then drops them off at before-school care before continuing to her workplace, within 4 km of her home.

Her work packing books in a warehouse ends at 2 PM. She enjoys the company of the other women at work, whom she describes as 'so supportive.'

Returning home, she sleeps for an hour before picking up her girls from the bus.

At 5 PM, she prepares the evening meal and lunches for the next day. Recently, she has been preparing basic meals and heating pre-prepared meals that her mother has dropped off and left in the freezer.

She does minimal housework, neglecting cleaning and allowing clothes to pile up. She has a cat and three birds, which she feeds.

She showers only two or three times a week and brushes her teeth infrequently. Because of her poor dental hygiene, she has developed dental caries.

She watches television, streaming series (for example, Sirens) or documentaries in the evening.

On days that she doesn't work, she stays in bed for much of the day. Her daughters stay with their father every second weekend and part of each school holiday. They also spend time with Ms Ryan's mother during school holidays.

Her father occasionally visits to do outside work, such as mowing lawns and gardening. His partner helps with some housework. Her mother, stepfather, and sister also sometimes assist.

Before becoming unwell, Ms Ryan had five close friends. She enjoyed walking, going to the beach and occasionally attending the gym. She described herself as a 'foodie' and enjoyed going to cafés and restaurants with friends. She relocated to the Central Coast in 2019 to be near family and had fewer opportunities to socialise with friends. However, the family got together for dinners, barbecues, and outdoor activities such as boating and jet skiing.

She attends occasional family get-togethers for celebrations such as birthdays or Christmas. For Christmas in 2024, she went to her father's house at Maitland, a gathering of about 10 people. She travelled by train with her daughters, a trip of about 2 hours each way, stayed for a few hours, and then went home. She usually has a small celebration at home with close family for her daughters' birthdays.

Ms Ryan is independent with driving but feels unsafe. She said, 'I'm scared I'm going to hurt my girls because I'm not focused.' Due to a lack of attention, she has had three speeding tickets in the last year in the same spot. She recently drove to Forster, a two-hour and 45-minute drive, to celebrate her daughter's birthday with her mother and stepfather. They stayed three nights.

She took her daughters camping at Shoal Bay (1 hour and 45 minutes) in January, but unfortunately, she developed adult chickenpox and her mother had to come and bring them home.

Ms Ryan is close to her daughters, parents, stepparents, and siblings. Because of the distance, she has less contact with her sisters in Newcastle and New Zealand. She has lost contact with her friends because of her social disengagement. She doesn't use social media or other methods to communicate with them. She had maintained a friendship with a gay man in Sydney, but he recently ended the relationship, saying, 'For the last couple of years, it's not fun anymore.'

Ms Ryan has stopped reading because she struggles with concentration. When she watches television shows, she does so in short bursts and often needs to rewind. She had a hobby of doing art with alcohol ink, but gave it up in 2018 before starting work with TBE. She has no ongoing projects or hobbies. Recently, she fixed a leak in her carport after taking advice from her brother-in-law on how to waterproof the roof."

1. Findings on examination were reported as follows:

"I assessed Ms Ryan in her home via an audiovisual link for 80 minutes. The connection quality was adequate to do a comprehensive assessment

She presented as an overweight woman, casually attired and well-groomed.

She said that she was anxious. Her affect was reactive, consistent with her mood, and congruent with the interview's contents. She maintained composure.

There is no evidence of any disorder of thought-form or perception.

She denied any recent thoughts of self-harm or suicide.

When asked at the end of the interview if she had anything else to add, she said, 'I just want this to be over. I do want to deal with the insurance company. It is beyond devastating.' She again repeated her disappointment that there are no consequences for her employer."

1. The Medical Assessor then summarised the injuries and diagnoses as follows:

"My diagnoses rely on the Diagnostic and Statistical Manual - Fifth Edition (DSM-5), published by the American Psychiatric Association.

Alcohol use disorder: Persistent depressive disorder with a major depressive episode and anxious distress

Ms Ryan is drinking at an unsafe level. She has made unsuccessful attempts to reduce her intake. She is aware of the negative impact this has on her health.

She has had mood symptoms for more than 2 years, warranting a diagnosis of persistent depression.

She has a frequent low mood with a loss of interest in previously enjoyed activities. She suffers from insomnia, loss of energy, and diminished ability to concentrate. Her weight loss is not attributable to her mental health symptoms. She has five of the nine symptoms described for a major depressive episode, just meeting a threshold for this condition."

1. The Medical Assessor assessed 13% WPI (wrongly referred to earlier in the MAC as 15%).
2. He then set out a summary of the material he had before him.
3. Relevant to the issues in dispute, he said:

"Psychiatrist Dr Sujatha Kalava, 13 October 2023, refers to Ms Ryan using 30 standard drinks of alcohol daily, noting "heavy use on and off 30 years - recent trigger work stress... 2 suicide attempts in past." Dr Kalava refers to using topiramate, olanzapine, aripiprazole, clonidine and duloxetine, although not altogether. She states, 'will benefit from dialectical therapy.' Dr Kalava has diagnosed an adjustment disorder and alcohol use disorder.

Ms Ryan briefly associated with Dr Kalava but has not seen her since early 2024.

IME psychiatrist Dr Kristy Morris, 28 August 2024, described the circumstances of Ms Ryan's workplace experience, including her successful three-month probation period, which gave rise to the injury. Dr Morris diagnosed Ms Ryan with a major depressive episode and comorbid alcohol use disorder, remarking that both had improved with treatment. At the time of the assessment, Ms Ryan worked 26.5 hours per week, packing boxes for Scholastic Australia. Dr Morris determined a 15% WPI (classes 2, 3, 2, 2, 3 and 3). Because the earlier psychiatric problems had resolved by the time Ms Ryan started work with TBE, Dr Morris did not make a deduction for the pre-existing conditions.

My impairment assessment concurs with Dr Morris's, except in the travel category.

Dr Morris determined mild impairment, whereas I considered that Ms Ryan functioned within the normal variation in the general population. I agree with her decision not to make a deduction for any pre-existing condition. Dr Morris stated: 'Can drive without a support person. Avoids a certain area of Gosford due to worry about seeing ex-colleagues.'

Dr Morris appears to be unaware of Ms Ryan's other travel. Ms Ryan travels freely in the local area. Avoiding a specific area she does not need to visit does not constitute an impairment. She can travel further afield, such as on her trips to Maitland, Shoal Bay, and Forster. These are outside of her familiar areas. er trips to Maitland, Shoal Bay, and Forster. These are outside of her familiar areas. She has increased concern when driving because of her perceived inattentiveness. This is a symptom and has not limited her ability to travel. She has no need to travel elsewhere.

IME psychiatrist Dr Suzanna Goodison, 10 April 2025, noted that Ms Ryan continued to work for Scholastic Australia at 26.5 hours per week. Regarding treatment,

Dr Goodison noted that Ms Ryan had not seen a psychologist during 2025, her last appointment being in late 2024, and stated: 'Ms Ryan has seen a psychiatrist once when she was admitted to a rehab facility in Brisbane was for alcohol detoxification and at that stage, she discussed that her medications were reviewed.... She has not been referred for any other drug and alcohol support after the detoxification.... She describes symptoms of withdrawal such as shaking and also cravings in the context of starting to drink. She describes that outpatient detoxification has been discussed but allegedly the insurer will not cover this.'

Dr Goodison said that Ms Ryan 'has always drunk alcohol' and that currently she was consuming 10 to 15 standard drinks daily with no alcohol free days. Dr Goodison diagnosed an 'alcohol use disorder with secondary mood changes', with a differential diagnosis of an alcohol use disorder with additional major depressive episode.

Dr Goodison stated, 'Ms Ryan has reached a level of maximum medical improvement at this stage; without further intervention, she is unlikely to improve.' She then clarifies that she considered that Ms Ryan had not reached maximum medical improvement.

Dr Goodison considered that Ms Ryan needed to reengage with treatment and have therapy for her alcohol use disorder before a final determination could be made.

Ms Ryan's alcohol consumption is marginally better than when she saw Dr Goodison. While I agree that it would be beneficial for Ms Ryan to reengage with therapy, especially around her alcohol consumption, I have given my reasons above why I consider that she has reached maximum medical improvement."

1. The Medical Assessor assessed a Class 2 rating and said:

"Ms Ryan is a single mother with two daughters. She purchases food and prepares meals. She showers 2 or 3 times weekly without prompting. She neglects dental hygiene and has developed caries. She maintains a lower standard of home care. She often neglects house cleaning and laundry. She has some support from her parents and sister for housework, meal preparation and gardening. She presents herself adequately to attend work several days a week. She presented adequately groomed for today's assessment. She has taken positive steps to reduce her weight, including the use of medication, semaglutide. Although she has support, she can live independently and attend to her hygiene, albeit at a lower standard than before, without prompting."

(a) the PIRS activities are examples only, and the appellant's drinking habits clearly impact her self-care and personal hygiene;

(b) despite the Medical Assessor's acknowledgement of this in the history of his report, in addition to diagnosing the appellant with Alcohol use disorder, the Medical Assessor proceeded to assess the appellant as a class 2 in respect of the category 'self-care and personal hygiene';

(c) the appellant submits that the Medical Assessor erred by assessing the appellant as a class 2 in circumstances where a class 3 rating was warranted, and

(d) the Medical Assessor's assessment simply does not acknowledge or ignores the impact of the appellant's alcohol intake on her self-care, which the Medical Assessor conceded was at an unsafe level. It is difficult to appreciate how drinking at an unsafe level does not impact on an individual's self-care and personal hygiene.

1. The descriptor for a Class 2 reads: "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."
2. For a Class 3 it reads:

"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. Although as the Medical Assessor acknowledged, Ms Ryan gets some support from family members for "housework, meal preparation and gardening," she is able to live independently and care for her two children.
2. She is able to "present herself adequately to attend work several days a week" notwithstanding any alcohol issues and as the Medical Assessor noted: "She presented adequately groomed for today's assessment."
3. The Medical Assessor acknowledged that "Although she has support, she can live independently and attend to her hygiene, albeit at a lower standard than before, without prompting."
4. In short, she certainly has some limitations in this category as the Medical Assessor accepted, noting that her standards in this category are "lower" than previously, but she is certainly able to live independently'
5. The fact that she "purchases food and prepares meals" is inconsistent with a Class 3 rating.
6. Similarly "she showers 2 or 3 times weekly without prompting," an indicator of a mild impairment in this category.
7. In our view, the Medical Assessor's assessment in this category was consistent with his findings on examination.
8. It must be remembered that cl 1.6 of the Guidelines provides:

"Assessing permanent impairment involves clinical assessment of the claimant as they present on the day of assessment (our emphasis) taking account the claimant's relevant medical history and all available relevant medical information..." (our emphasis).

1. The Medical Assessor assessed a Class 1 rating and said:

"She drives independently in the local area. Because of her inattentiveness, she is anxious about driving and worries about safety. In the last year, she has travelled by train to Maitland and driven to Forster and Shoal Bay. These are trips along familiar routes to visit family members. She functions within the normal variation in the general population."

(a) Dr Goodison noted: "She is independent of driving locally, she only goes and drives when she absolutely needs to or to an appointment with her local gp", and

(b) there is a clear failure to engage in an active intellectual process with

Dr Goodison's evidence.

1. The Panel agreed with the appellant's submissions in this category such that we considered that a re-examination of Ms Ryan was appropriate.
2. Medical Assessor Michael Hong of the Panel re-examined Ms Ryan on 5 November 2025 and reported to us as follows:

Ms Ryan was seen by Dr Morris in August 2024 with a 15% WPI, by Dr Goodison in April 2025, who advised she was not stabilised yet, and by Medical assessor Andrews in June 2025, who assessed 13% (with typos of 15% in one section). She relapsed in her Alcohol use disorder after detoxification in October 2023. The doctors noted her alcohol intake fluctuated over time, and remained consistently high.

She confirmed a history of bullying at work at TBE between June 2022 and

1 December 2022. She said the bully has moved to Queensland but still owns the business, and comes back to NSW once a month.

After assessment by Dr Andrews, her symptoms have not resolved.

Ms Ryan is taking Duloxetine 120 mg. She had consulted Michela Verway, psychologist and not since February 2025. She has not consulted a psychiatrist in 2025. She commenced Ozempic (Semaglutide) early in 2025. She said she had tonsil surgery in July 2025, and her ENT surgeon recommended weight loss before that operation, and Ozempic was started by her GP. She said her alcohol intake has reduced since the operation. She said she still drinks when stressed or overwhelmed, and knows it is not good. Recently, she drinks a couple of beers to a couple of bottles of wine in a day, with 2 alcohol-free days in a week. There was no other substance history reported. She said after the 2023 admission for detox, she gained 'a new lens' or perspective about her alcohol consumption.

In the past few months Ms Ryan said her mental health is not great due to the ongoing assessment process. She said she feels like she is 'continuingly against the past' and cannot see a future about her work or her finances. Currently, the main psychological' problems are her depression, because she constantly 'look back and not forwards'. She said suicide is a 'safety blanket' and 'there is always that', and does not think she would do it as she has children. With Ozempic, she lost 6kg overall. She does not think she is losing more weight now, she said due to her high alcohol intake. She skips meals, especially dinner. She eats two meals a day and has a snack, and eats without prompting. Her anxiety symptoms are triggered by 'thinking about getting a new job, thinking about him (the bully)'. No other triggers have been identified. She described being easily frustrated. She said apart from the bullying, all other workers at TBE were nice to her and she has no problem with anyone else there. She said her concentration and memory are 'non-existent' due to her workplace bullying. I asked about ADHD diagnosed by her psychologist, as recorded by her GP Dr Daoud in mid-2024. She said it was raised, but she has not been tested and she has not been formally diagnosed with ADHD.

Ms Ryan is 48 and living with her two daughters, who are 10 and 8.

Ms Ryan has one point left on her driver's licence, and said she was caught in the same school zone, 4 times, as she forgot it was a school zone. The last time she lost points was in mid-2025. She lost her Learner driver's licence as a teenager and lost her licence again in her 30s from accumulation of demerit points. She has not had an interlock and never had alcohol-related offences.

She said she is anxious driving as she only has one point left, and cannot afford to be without a licence. She drives in the local area, and drives her daughters 2 hours to Shoal Bay yearly for camping each January. She goes with her mother and children to Forster, as her mother lives there, and this is 2.5 hours drive with breaks. She drives on highways and said it is 'nerve-wrecking', nevertheless, she can drive long distances and to unfamiliar places.

She said she does not go to Gosford and there is no need to go there. The local shops are only 4km away. Tuggerah is the nearest large shopping centre and not Gosford. She uses K-mart and other shops in Tuggerah. She said there is no problem for her to go to Gosford, but she has no reason to go. She said she has no problem to go to Queensland but has no reason to go there, and does not know where the bully is in Queensland. She has not been on a plane for a long time and does not use public transportations, but there is no problem if she needs to use them.

She showers every 2-3 days, or 3 times per week without prompting. Her dental hygiene has deteriorated, she said due to a loss of motivation.

She still works casually packing books, and wants to look for other jobs as she is not using her full potential.

Ms Ryan was assessed by video. She was at home during the assessment. She engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. There was no apparent distress during the assessment. She was moderately restricted in her affect range and did not smile or laugh. She spoke spontaneously in a soft tone. She was not thought disordered.

Before I completed the assessment, I asked her for additional information that she wanted to add and she said her life has shifted fundamentally as a result of work, in a negative way, and she has not recovered from it."

1. The Panel noted Ms Ryan's driving history and that she had lost her driver's licence previously, and not since her work injury. She had lost demerit points after her work injury, and said she is more careful with driving now, and that she had lost points in the same location four times, because she had forgotten it was a school zone. Even though she drove at low speed, it was above the speed limit. Apart from that, there is no other concern with her driving, she can drive long distances despite having anxiety and does not avoid any place and drives independently, and goes to unfamiliar places independently.
2. The Panel noted that Dr Morris rated 2 in travel impairment and said "She can drive without a support person but avoids the area of Gosford due to worry about seeing her ex-colleague". On clarification, the only person she worries about is the bully who owns the business, and he lives in Queensland now but might go to Gosford every three months. She said she has no reason to go to Gosford, but if she has to, she can see no problem going there.
3. In these circumstances, and based on the history obtained by Medical Assessor Hong, her impairment overall would be consistent with what Dr Andrews had assessed, there is only a minor deficit, attributable to the normal variation in the general population, consistent with 1.
4. For these reasons, the Appeal Panel has determined that the MAC issued on