1. On 12 November 2025 Adele Rye (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Christopher Canaris, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on

27 October 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 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 appellant sustained a psychological injury deemed to have occurred on

4 September 2019 in her employment as a mental health support worker employed by Third Sector Australia Limited (the respondent). 2. The appellant lodged an Application to Resolve a Dispute (ARD) in the Personal Injury Commission (Commission) dated 1 September 2025 in which she claimed lump sum compensation in respect the psychological injury. 3. The matter was referred to Dr Christopher Canaris, Medical Assessor, for assessment of whole person impairment (WPI) of a psychiatric/psychological disorder as a result of the injury deemed to have occurred on 4 September 2019. 4. The Medical Assessor examined the appellant on 13 October 2025 and assessed 17% WPI as a result of the injury deemed to have occurred on 4 September 2019.

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 because there was sufficient information on which to make a determination.

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. 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.
2. The appellant's submissions include the following:

(a) The appeal is brought on the basis that the Medical Assessor:

(i) misapplied the psychiatric impairment rating scale (PIRS) Class tables under Chapter 11 of the Guidelines;

(ii) failed to give adequate weight to the longitudinal pattern of severe functional incapacity and frequent hospitalisation, and

(iii) did not properly reconcile his findings with the consistent medical evidence from Dr Lim and treating clinicians.

(b) Ground 1 - Self-care and personal hygiene - the Medical Assessor rated this category as Class 2, relying on limited periods when the appellant was "reasonably OK with cooking and cleaning". However, this finding fails to reflect the sustained incapacity evidenced by frequent episodes where she does not eat or shower for days, severe appetite loss and periods of hospitalisation averaging three to four times per year for suicidal ideation and functional collapse.

(c) Under the Guidelines, Class 3 is appropriate where a person requires regular assistance or fails to maintain personal hygiene for several days at a time. The above evidence clearly meets this threshold.

(d) Dr Lim appropriately rated Ms Rye at Class 3 for self-care, noting she "misses meals on a regular basis, has lost weight, and alcohol use is problematic when living alone".

(e) Ground 2 - Social and recreational activities - the Medical Assessor rated this at Class 3, yet both the appellant's statement and Dr Lim's observations show total social withdrawal.

(f) The appellant reports that her friendship group and social life are non-existent, and she can go weeks without speaking to anyone, unable to attend family gatherings due to severe anxiety. Dr Lim recorded that the appellant is "very socially isolated, has lost all her friends and does not have any social contact", correctly placing her in Class 4.

(g) Under Table 11.2, Class 4 applies where there is marked restriction of social and recreational activities with almost completely withdrawn, which is indicative of the appellant's situation.

(h) Ground 3 - Social functioning - the Medical Assessor assessed Class 2, stating she maintains limited contact with family. The evidence, however, demonstrates that the appellant's inability to form or maintain relationships beyond minimal family contact. She avoids interaction for weeks, driven by guilt, shame, and fear of burdening others.

(i) Dr Lim rated this domain Class 4, describing her as "unable to form new relationships or sustain current ones", which aligns with the Guidelines definition of serious and persistent social impairment.

(j) Ground 4 - the Guidelines require that when fluctuating symptoms include prolonged or recurrent episodes of marked impairment, the assessor must rate according to the predominant level of functioning over time, not occasional good periods.

(k) The Medical Assessor appears to have given disproportionate weight to intermittent periods of relative functioning and discounted the sustained episodes of incapacity evidenced by multiple hospitalisations each year.

(l) The MAC be revoked and re-determined in accordance with Dr Lim's assessment of no less than 40% WPI or alternatively not below 20% WPI to reflect the true extent of permanent psychiatric impairment.

1. The respondent's submissions include the following:

(a) Ground 1 - Self-care and personal hygiene, the Medical Assessor assessed a Class 2 and recorded: "While her level of impairment may fluctuate, she has significant period in which there is evidence of at least Class II impairment."

(b) The appellant is able to live independently for the predominant portion of her life. This inherently evidences a capacity to perform self-care and personal hygiene functions. She reported she is able to make two meals per day for herself, "... go to the gym or to do yoga, do some painting, and look after her house and garden_"._

(c) The appellant did report that in bad periods of elevated or acute symptoms she stops answering the phone, loses touch with children, stop showering, and delays cleaning. She reported over the last five years she has lost around 7kg as in bad periods she might eat less. However, even during bad periods she is able to prepare her own meals, stating she "might just make a salad".

(d) This reported function does not evidence a severe appetite loss, or frequent restriction of eating or showering for days. She reported undergoing hospital admission three times this year for acute symptoms and bad periods. In the circumstances, it was open to the Medical Assessor to assess a Class 2 impairment.

(e) The Appeal Panel would not be satisfied that there is any demonstrable error.

(f) Ground 2 - Social and recreational activities - the Medical Assessor assessed the applicant as Class 3 impairment. The appellant gave the Medical Assessor a history that she is able to go out socially with one of her sons, or at other times can go out to see her son on her own. She stated she has to limit time when her sons come to see her, or she goes to see them. On the appellant's own reporting, she does leave her home on her own.

(g) The appellant also reported to the Medical Assessor that she is able to attend the gym or yoga when she is feeling better. She did not give any evidence that she requires a support person for same. This is not consistent with a Class 3 impairment but rather a Class 2 impairment.

(h) On 15 May 2025 Dr Goldstein reported the appellant "...has been busy with family commitments and a wedding over the past two weeks, involving constant excursions and get togethers". The appellant is able to attend social gatherings.

(i) On 9 June 2025, Dr Goldstein reported that the appellant had "...shown significant progress in her recovery... " She reported a positive experience of Art Day Program, noting a marked improvement in her distress tolerance and overall mental wellbeing. Dr Goldstein reported _"_She presents as well as I have seen her, and I am confident that this program will further support her recovery." She reported to the Medical Assessor she enjoys making art or tending to her garden at home. This evidence indicates some level of functioning in this category.

(j) The Medical Assessor made no error in his assessment of Class 3 impairment in line with his findings and the evidence. The Appeal Panel would not be satisfied that there is any demonstrable error.

(k) Ground 3 - Social functioning - the Medical Assessor assessed a Class 2 impairment.

(l) The appellant was single at the time of her injury after going through a divorce. The appellant reported she has "cut off most friends" as she feels she has nothing to contribute. She remains in touch with her two sons and her daughter. She sees her sons regularly and sees her daughter, who lives in Melbourne, two times per year.

(m) On 15 May 2025 Dr Goldstein reported the appellant "...has been busy with family commitments and a wedding over the past two weeks, involving constant excursions and get togethers".

(n) The evidence indicates that the appellant is able to function socially, even if only with family members. She has not given evidence of strained relationships, conflicts, or domestic violence. Therefore it was open for the Medical Assessor to assess a Class 2 impairment.

(o) The appellant has failed to demonstrate that the MAC contains any demonstrable error. The MAC contains an accurate assessment of the appellant's impairment in line with the Guidelines. The MAC ought to be confirmed.

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 Appeal Panel reviewed the MAC and the evidence in this matter.

1. The appellant notes that the Medical Assessor rated this category as Class 2, relying on limited periods when the appellant was "reasonably OK with cooking and cleaning".
2. The appellant submits that Class 3 is appropriate where a person requires regular assistance or fails to maintain personal hygiene for several days at a time. The above evidence clearly meets this threshold.
3. The examples under Table 11.1 for "Self-care and personal hygiene" in the Guidelines are:

"Class 2 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.

Class 3 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. The Medical Assessor assessed the appellant as Class 2 for self-care and personal hygiene. In the PIRS Rating Form, the Medical Assessor wrote:

She lives on her own. When she is feeling better, she will go to gym or to do yoga or gym, do some painting, and look after her house and garden 'but when I'm unwell, that all falls aside and I stop going to appointments, just doing them by telehealth, not answering the phone, not staying in touch with the children'. She is 'reasonably OK' with cooking and cleaning 'but when I start sinking into depression and I stop showering and the cleaning just has to wait'. She would "normally eat just twice a day ... but in bad periods less - probably over the last 5 years, I've dropped about 7 kilos' and on bad days 'I might just make salad'.

Comment: While her level of impairment may fluctuate, she has significant period in which there is evidence of at least Class II impairment."

1. Under "present symptoms", the Medical Assessor noted (page 3, MAC): "Her appetite has been poor, and she has to make herself eat 2 meals a day, and she has not had any weight changes."
2. Under "social activities/ADL" (page 4 MAC) the Medical Assessor wrote:

"She is "reasonably OK" with cooking and cleaning 'but when I start sinking into depression and I stop showering and the cleaning just has to wait'. She would 'normally just eat twice a day ... but in bad periods less - probably over the last 5 years, I've dropped about 7 kilos...' and on bad days 'I might just make salad.'

1. Under "Findings on Physical examination" the Medical Assessor noted that the appellant presented as a casually dressed and reasonably groomed woman.
2. In her statement dated 15 July 2025, the appellant wrote:

"In or around 2024, I got a support dog, her name is Molly. Molly gives me purpose and I feel as though she has saved me on many occasions.

I eat very little, and often I will skip meals, I try to make sure I eat two (2) meals a day but this is difficult. This has caused me to loose [sic] weight....

I have a hard time upkeeping self-care habits. I do make sure to shower before I go out."

1. Dr Terrence Lim, consultant psychiatrist, in a report dated 3 September 2024, assessed Class 3 for self-care and personal hygiene, and provided the following reasons:

"Currently lives alone but significant evidence that she is not attending to self-care adequately, misses meals on a regular basis, has lost weight, and alcohol use is problematic when living alone."

1. Dr Lim, on page 4 of his report, wrote: "She often skips meals, and eats very little. She has lost several kilograms of weight. Her self-care is poor".
2. In a report dated 17 February 2025, Dr Nabil Malik, consultant psychiatrist, noted:

"Her appetite has also been affected; she tells me that she is not eating well, either skipping meals or eating irregularly, and has noticed fluctuations in her weight as a result."

1. The appellant submits that the Medical Assessor in rating this scale as Class 2, was relying on limited periods when the appellant was "reasonably OK with cooking and cleaning" but this fails to reflect the sustained incapacity evidenced by frequent episodes where she does not eat or shower for days, severe appetite loss leading to 10 kg weight loss over five years and periods of hospitalisation averaging three to four times per year for suicidal ideation and functional collapse.
2. The Appeal Panel notes that the appellant lives by herself and there is no evidence that she requires regular support from family members or a community nurse in order to live independently. The Appeal Panel accepts that the appellant has had regular periods of hospitalisation for several years when she is unwell and requires treatment. However, the appellant is more often well, than she is unwell, and spends most of the year at home rather than in hospital.
3. The Medical Assessor obtained a history of the appellant being able to look after her house and garden and being reasonably "OK" with cooking and cleaning. The Medical Assessor noted that during bad periods of depression she would eat less and showering and cleaning would wait. The appellant, in her statement, said that she would shower before she went out and there is no suggestion that she had to be prompted to shower on those occasions.
4. The Appeal Panel accepts that there are periods where the appellant does not function as well as at other times. However, the Medical Assessor was aware of this and referred to these periods, her level of functioning during those periods, as well as the admissions to hospital. Further, the Appeal Panel notes that a particular level of functioning cannot be inferred because the claimant has been admitted to the hospital. Psychiatric hospitalisations occur for many reasons, including crisis admissions because of deterioration or suicidality, medication monitoring or changes, use of special therapies such as ketamine, or to allow participation in inpatient programs. Patients' functional status may vary considerably during their hospital stay. The claimant had symptomatic improvement during her hospital stay attributable to ketamine therapy.
5. The appellant submits that the Medical Assessor did not properly reconcile his findings with the consistent medical evidence from Dr Lim and treating clinicians. The Appeal Panel notes that apart from Dr Lim, no specific reference is made in the submissions to any other doctor or health professional. In relation to Dr Lim's report, this was dated 3 September 2024 and he did not, in our view, provide detailed reasons for the ratings in this and the other scales.
6. In Tradieh v LM Hayter & Sons Pty Limited, [2025] NSWSC 840 Stern J said that the medical dispute between the parties was not a dispute between the assessments made by their independent medical examiners. Her Honour said at [37]-[39]:

"...Ultimately, as is clear from Wingfoot v Kocak and IAG v Keen, both of which arose in the context of (for this purpose) relevantly analogous legislative schemes, [the Medical Assessor] was required to make an assessment of the factual or evaluative question referred under s 319(c) of the 1998 Act, being the degree of the plaintiff's permanent impairment as a result of the Injuries. Notwithstanding that s 321 of the 1998 Act provides for a medical dispute to be referred for assessment, the role of the medical assessor is not to adjudicate between or to resolve the competing positions of the parties. A medical assessor must plainly consider the material before him or her, and that material will likely include expert assessments of WPI relied upon by a claimant and an employer where the dispute is as to the degree of the claimant's WPI, but no higher level of 'engagement' is required under the 1998 Act."

1. The Appeal Panel accepts that it is not the role of the Medical Assessor to reconcile his findings with those of Dr Lim. The role of the Medical Assessor is to arrive at his own conclusions, having considered the material before him and his examination findings. It is clear that the Medical Assessor did consider the material before him.
2. Considering the evidence as a whole, the Appeal Panel agrees that the appellant fits a Class 2, not a Class 3 rating in this scale. As noted above the Medical Assessor was aware of the fluctuations in her condition and an assessment in such circumstances involves clinical judgment taking into account the findings of the day of examination as well the appellant's history.
3. The Appeal Panel considers that the evidence supports the finding that the appellant can live independently and the assessment of Class 2 for self-care and personal hygiene was consistent with the evidence.
4. The Appeal Panel is not persuaded that there has been a demonstrable error in the assessment of this scale.
5. This ground of appeal is not made out.

1. The appellant submits that both the appellant's statement and Dr Lim's observations show total social withdrawal. The appellant submits that Class 4 applies where there is marked restriction of social and recreational activities with almost completely withdrawn, which is indicative of the appellant's situation.
2. The examples under Table 11.2 for "social and recreational activities" in the Guidelines are:

"Class 2: Mild impairment: occasionally goes out to such events e.g. without needing a support person, but does not become actively involved (e.g. dancing, cheering favourite team).

Class 3: Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.

Class 4: Severe impairment: never leaves place of residence. Tolerates the company of a family member or close friend, but will go to a different room or garden when others come to visit family or flat mate."

1. The Medical Assessor assessed the appellant as Class 3 for social and recreational activities. In the PIRS Rating Form, the Medical Assessor wrote:

She does not go out socially, "unless it's with my sons" and might have breakfast with one son "every 2 or 3 weeks" most usually picked up by him. At other times, she will go down to see her other son which might be once a month. She has not been out with anyone but her sons for a long time. When feeling better, she might go out to see her son on her own "but even then having them come over or going to see them, it's gotta be for a limited amount of time - I can't keep the façade up."

1. Under "social activities/ADL" (page 4 MAC) the Medical Assessor wrote:

"When she is feeling better, she will go to gym or to do yoga, do some painting, and look after her house and garden: But when I'm unwell, all that falls aside ..."

1. In his statement dated 15 July 2025, the appellant wrote:

"I don't like leaving the house and only leave if I need to. I will sometimes get my groceries delivered or if I have to go to the shops, I will go around thirty (30) minutes before they close. I will go out for appointments that I have to attend".

1. Dr Terrence Lim, consultant psychiatrist, in a report dated 3 September 2024, assessed the appellant as Class 4 for social and recreational activities and provided the following reasons:

"Currently very socially isolated, has lost all her friends and does not

"Her days are spent mostly at home. She has lost all of her friendships. She will leave the house to attend appointments, the local shops or to pick up medication. Prior to an epigastric hernia operation she was going to the gym daily. She reads a wide variety of books often forgetting what she has read. Her concentration is very poor, and she has to re-read things."

1. Dr James Goldstein, treating psychiatrist, in a report dated 15 May 2025 wrote:

"Adele has been busy with family commitments and a wedding over the past two weeks, involving constant excursions and get-togethers. She reports having relapsed with alcohol over approximately 10 days, with her last drink being last Wednesday. She has managed to get herself back on track, but we are concerned that without intervention, her condition may worsen."

1. The appellant submits that her statement and Dr Lim's observations show total social withdrawal. The Appeal Panel noted, however, that Dr Lim does not refer to the appellant's regular social contact with her children.
2. The Appeal Panel accepts that there may be some weeks where the appellant does not speak to anyone or attend family gatherings, but this is not indicative of her functioning during all other periods. Although the appellant may have some limited periods where she has total social withdrawal, it is inappropriate to assess her on the basis that she is socially withdrawn all the time. The Medical Assessor was clearly aware that the appellant's condition fluctuated.
3. The Appeal Panel accepts that the appellant visits and goes out with her sons regularly (not rarely). The appellant sees her daughter and daughter's family, who live in Melbourne, twice a year. The appellant reported that she is able to go to the gym or to do yoga, do some painting when she is feeling "better".
4. The appellant submits that Class 4 applies where there is marked restriction of social and recreational activities with almost completely withdrawn. However, Class 4 is to be assessed where the claimant never leaves the place of residence, and that is not the case in this matter.
5. The Appeal Panel notes that Dr Goldstein, in relatively recent report dated 15 May 2025, noted that the appellant had been busy with family commitments and a wedding over the past two weeks, involving constant excursions and get-togethers. This indicates that the appellant was able to engage in social activities outside her home.
6. The Appeal Panel considers that the history taken by the Medical Assessor was consistent with a Class 3 assessment in respect of the PIRS scale of social and recreational activities and the appellant could not be assessed as Class 4 as she does leave her place of residence.
7. The Appeal Panel is not persuaded that there has been a demonstrable error in the assessment of this scale.
8. This ground of appeal is not made out.

1. The appellant notes that the Medical Assessor assessed the appellant as a Class 2 in respect of the PIRS category of social functioning, stating she maintains limited contact with family.
2. The appellant submits that the evidence, however, demonstrates that the appellant's inability to form or maintain relationships beyond minimal family contact and avoids interaction for weeks. The appellant argues that Dr Lim rated this scale as Class 4, describing her as "unable to form new relationships or sustain current ones", which aligns with the Guidelines' definition of serious and persistent social impairment.
3. The examples under Table 11.4 for "social functioning" in the Guidelines are:

"Class 2: Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.

Class 3: Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children

Class 4: Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (eg lost partner, close friends). Unable to care for dependents (eg own children, elderly parent)."

1. The Medical Assessor assessed Class 2 in relation to social functioning noting:

"She is many years divorced. She has "cut off most of my friends because I couldn't face them" saying she feels with her depression that I've got nothing to contribute" she remains in touch with her children she has a daughter in Melbourne whom she sees twice a year and 2 sons who live locally whom she sees more often. She says in relation to this, "I just don't think I'm a good person anymore".

1. Dr Terrence Lim, consultant psychiatrist, in a report dated 3 September 2024, assessed the appellant as class 4 for social functioning and relationships, and provided the following reasons:

"Has lost all of her pre-existing friendships and unable to form new

ones or sustain current ones. Unable to care for anyone else."

1. The Appeal Panel noted above that Dr Goldstein in his report dated 15 May 2025 noted that the appellant had been busy with family commitments and a wedding over the past two weeks, involving constant excursions and get-togethers. This indicates that the appellant was not socially withdrawn.
2. The appellant maintains her relationships with her sons and daughter. Dr Lim described the appellant's 31-year-old son as very supportive. The Appeal Panel accepts that the appellant has lost friendships, however, she has maintained her primary relationships with her three children and grandchildren.
3. A rating of Class 3 requires that previously established relationships are severely strained, evidenced by periods of separation or domestic violence. There is no evidence that any relationship with her children was severely strained or evidenced by periods of separation or domestic violence.
4. The Appeal Panel considers that the evidence including the history obtained by the Medical Assessor is consistent with a Class 2 rating for social functioning.
5. The Appeal Panel is not persuaded that there has been a demonstrable error in the assessment of this scale.
6. This ground of appeal is not made out.

Ground 4 - The Guidelines require that the assessor must rate according to the predominant level of functioning over time, not occasional good periods

1. The appellant submits that the Guidelines require that when fluctuating symptoms include prolonged or recurrent episodes of marked impairment, the assessor must rate according to the predominant level of functioning over time, not occasional good periods.
2. The Guidelines at 1.6 provide for assessment of the claimant "as they present on the day of assessment taking into account the claimant's relevant medical history and all available relevant medical information".
3. The Guidelines at 11.6 provide:

"It is expected that the psychiatrist will provide a rationale for the rating based on the injured worker's psychiatric symptoms. The diagnosis is among the factors to be considered in assessing the severity and possible duration of the impairment, but is not the sole criterion to be used. Clinical assessment of the person may include information from the injured worker's own description of his or her functioning and limitations, and from family members and others who may have knowledge of the person. Medical reports, feedback from treating professionals and the results of standardised tests - including appropriate psychometric testing performed by a qualified clinical psychologist and work evaluations - may provide useful information to assist with the assessment. Evaluation of impairment will need to take into account variations in the level of functioning over time. Percentage impairment refers to whole person impairment (WPI)."

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

1. The Medical Assessor at Part 8 b. of the MAC wrote:

"Yes. I am with respectful disagreement with Dr Malik who has declined to assess whole person impairment on the grounds that she has not reached maximum medical impairment.

The worker's overall history is one of repeated hospitalisations because of exacerbations of her symptoms. Her recent hospitalisations have more of the character of crisis management in the face of repeated flareups of her symptoms with depressed, high anxiety, and escalating alcohol use. Her condition has become one of stable instability and it is unlikely that the present hospitalisation or any further periods in hospital or biological interventions will substantially alter her level of impairment".

1. In her statement dated 15 July 2025, the appellant wrote:

"I have participated in the following inpatient stays:

(a) 4 May 2020 to 1 June 2020;

(b) 5 June 2020 to 6 July 2020;

(c) 9 July 2020 to 11 July 2020;

(d) 16 April 2022 to 11 June 2022;

(e) 27 June 2022 to 28 June 2022;

(f) 3 July 2022 to 28 July 2022;

(g) 23 September 2022 to 30 October 2022;

(h) 27 March 2023 to 14 May 2023;

(i) 16 August 2023 to 20 September 2023; and

(j) 25 January 2024 to 15 February 2024."

(k) 3 July 2022 to 28 July 2022;

(l) 23 September 2022 to 30 Octo

1. The Appeal Panel notes that the appellant had further admissions as an inpatient in 2024 and 2025. The Medical Assessor noted that she has had three or four hospitalisations each year always at Currumbin Clinic usually with suicidal ideations/attempts. The Medical Assessor wrote: "She may have been in hospital three times this year and would be in for 'usually around a month - the last time was 9 weeks' which was 'probably about a month ago'."

2. The appellant submits that the Medical Assessor appears to have given disproportionate weight to intermittent periods of relative functioning and discounted the sustained episodes of incapacity evidenced by multiple hospitalisations each year.

3. The Guidelines require that evaluation of impairment will need to take into account variations in the level of functioning over time. As noted above, the Medical Assessor was aware of the fluctuations in the appellant's condition and the pattern of hospitalisations. The Medical Assessor was aware and referred to the fluctuations in the appellant's condition and the hospitalisations. However, in the years since the work injury, the appellant has not spent a predominate amount of time in each year in hospital and she has never received domiciliary support.

4. This ground of appeal is not made out.

5. In summary, the Appeal Panel finds no error in the assessments of self-care and personal hygiene, social and recreational activities and social functioning.

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

   27 October 2025 should be confirmed.