1. On 14 July 2025 Cindy Santoso, 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 18 June 2025.
2. The appellant relies on the following grounds for 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 commenced employment with Alcon Laboratories Australia Pty Ltd, the respondent, in 2017, working as a detainee services officer. Her last day of work for the respondent was on 15 July 2022. Due to several incidents that occurred from 2021 in her employment she suffered a psychological injury.
2. The appellant claimed compensation for a permanent impairment from her injury. She relied on a report her solicitor's received from psychiatrist Dr Assad Saboor dated 21 November 2023, who assessed the degree of the appellant's permanent impairment from her injury is 16% whole person impairment (WPI).
3. Dr Saboor advised that he made his assessment by reference to the Psychiatric Impairment Rating Scale (PIRS), which the Appeal Panel notes is detailed in the Guidelines at paragraphs 11.11 and 11.12. Dr Saboor rated the appellant had a Class 2 impairment in self-care and personal hygiene, a Class 3 impairment in social and recreational activities, a Class 2 impairment in travel, a Class 3 impairment in social functioning, a Class 3 impairment in concentration, persistence and pace (CPP), and a Class 4 impairment in employability. Those ratings converted to 17% WPI, but Dr Saboor made a deduction of 10% for a proportion of the appellant's permanent impairment he considered was due to a per-existing condition, specifically post traumatic stress disorder that she developed as a consequence of domestic violence in a previous relationship. That deduction reduced her permanent impairment to 15% WPI but Dr Saboor also added 1% WPI for "the effect of treatments". It is apparent he made that adjustment in accordance with paragraph 1.32 of the Guidelines that allows an assessor to increase the percentage of WPI where effective long-term treatment has resulted in apparent substantial or total elimination of a worker's permanent impairment but the worker is likely to revert to the original degree of impairment if treatment is withdrawn. When that adjustment was made the net result is Dr Saboor assessed the appellant's permanent impairment from her injury is 16% WPI.
4. The respondent's insurer did not accept the appellant's claim for compensation because it considered the degree of her permanent impairment from her injury is less than 15% WPI. The insurer relied on a report of psychiatrist Dr Ian Sherman dated 25 November 2024. He advised that after examining the appellant on 7 November 2024 he assessed she had a degree of permanent impairment 7% WPI. Dr Sherman rated the appellant's impairment in self-care and personal hygiene as Class 1, in social and recreational activities as Class 3, in travel as Class 2, in social functioning as Class 2, in CPP as Class 2, and in employability as Class 3. That correlated with a degree of permanent impairment of 6% WPI. Dr Sherman also made a deduction of ten percent for a contribution he considered a pre-existing condition made to the appellant's permanent impairment, namely a co-morbid personality disorder, reducing the appellant's impairment to 5% WPI, but he too added a percentage WPI for "treatment effect", with the percentage WPI he added being 2% WPI, and hence his assessment that the degree of the appellant's permanent impairment from her injury is 7% WPI.
5. On 12 March 2025 the appellant initiated proceedings in the Personal Injury Commission (Commission), seeking the Commission determine her disputed claim for compensation for permanent impairment. The matter was referred by the Commission to one of its members, namely Ms Kathryn Camp, to deal with some preliminary issues. On 17 April 2025 the Commission issued a Certificate of Determination recording several determinations Member Camp made with the consent of the parties, including that the matter be remitted to the President of the Commission to refer it pursuant to s 321 of the 1998 Act to a Medical Assessor to assess the degree of the appellant's permanent impairment from her injury.
6. The Medical Assessor examined the appellant on 5 June 2025 and, as said, issued the MAC on 18 June 2025 in which he certified he assessed the degree of the appellant's permanent impairment is 4% WPI. His assessment was done by reference to the PIRS. He rated the appellant has a Class 2 impairment in self-care and personal hygiene, a Class 1 impairment in social and recreational activities, a Class 1 impairment in travel, a Class 1 impairment in social functioning, a Class 2 impairment CPP, and a Class 2 impairment in employability.
7. In her appeal against the medical assessment, the appellant has challenged the Medical Assessor's ratings of her impairment in self-care and personal hygiene, social and recreational activities, CPP, and employability.
8. In the PIRS rating form attached to the MAC the Medical Assessor provided the following reasons for rating the appellant's impairment as Class 2 in self-care and personal hygiene:

"As described in the main body of the report, there is mild impairment. She cleans her teeth and showers most days, although not everyday. She only managed to get her hair cut after two years. She tries to keep her room clean."

1. Within the MAC the Medical Assessor also noted that the appellant had reported her appetite fluctuates and that sometimes she can binge on food and in a typical binge she will eat a burger, a plate of chips and milkshake bought from her local takeaway. The Medical Assessor noted that this occurs once a week. The Medical Assessor noted that the appellant also reported that she has a day a week where she just grazes all day.
2. The Medical Assessor recorded that the appellant said that before her injury she drank recreationally but since her injury has been drinking daily and had increased her drinking to two bottles a night but has since reduced that to between a couple of glasses to half a bottle of wine each night.
3. The Medical Assessor recorded in the MAC the appellant said "she gets her nails done". He also recorded whilst she keeps her room clean her mother otherwise manages household cleaning. The Medical Assessor recorded that the appellant wears clean clothes and is presentable at her workplace.
4. The Medical Assessor provided the following reasons in the PIRS rating form for rating the appellant's impairment in social and recreational activities as Class 3:

"As described in the main body of the report, there is no impairment. She attended a Christmas dinner on 24 December with her work colleagues. She socialises with her family and attends family dinners. She can go to the shops and for groceries as needed. She enjoys playing games on her phone."

1. Within the MAC the Medical Assessor noted that the family dinners at which the appellant attends once a week occur at either at her family's home or at a restaurant. The Medical Assessor also recorded that the appellant reported that she does not socialise outside of work. He recorded that she is liked at her workplace. He recorded that she can play games on her phone "for a while". He recorded that the appellant reported being anxious when at new places. He recorded that before her injury she enjoyed weight training but now lacks the motivation to do that.
2. The Medical Assessor provided the following reasons in the PIRS rating form for rating the appellant's impairment in CPP as Class 2:

"As described in the main body of the report, there is mild impairment. She describes reduced concentration at the workplace and taking longer to learn new processes. However, her work performance is maintained, and she can manage the workload and routine associated with her workplace. She can play games on her phone 'for a while'."

1. Within the MAC the Medical Assessor recorded that the appellant had reported that she struggles to retain information on matters on which she is working in her employment and also struggled with her concentration at her work.
2. The Medical Assessor provided the following reasons in the PIRS rating form for rating the appellant's impairment in employability as Class 2:

"She used to work 30 hours per week before her injury and is currently working in an equivalent role and averaging 26.25 hours per week. Her work performance is maintained, and she has been able to keep that job for a reasonable period. She is unable to return to work in her pre-injury role. She has mild impairment in this domain."

1. Within the MAC the Medical Assessor recorded that the appellant's work with the respondent was in its customer service team, where she served business customers. The Medical Assessor recorded that the appellant had reported that for most of her career she worked in managerial positions. The Medical Assessor recorded that the appellant's current position is as an administrative officer and that she struggles with "personalities and egos" at her current workplace and is looking for a new job. The Medical Assessor noted that the appellant can manage her workload and the routine.

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 information before the Appeal Panel is sufficient for it 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 failed to take into account a relevant consideration, specifically her poor drinking habits, and thereby made an error. The appellant further submitted that the Medical Assessor failed to take into account her evidence in statement she signed on 4 March 2025 wherein she said that she had eaten inconsistently since her injury and gained 8kg of weight. The appellant also referred to the report of Dr Saboor in which he noted that her weight was uncontrollable and fluctuating. The appellant submitted that this evidence was a relevant consideration for the Medical Assessor and submitted that he failed to take this evidence into account which is an error.
3. The appellant noted that both Dr Saboor and Dr Sherman had rated her impairment in social and recreational activities is Class 3. The appellant further noted that the Medical Assessor did not within the MAC comment on the ratings that Dr Sherman and Dr Saboor had made of her impairment in social and recreational activities and the appellant submitted that by not doing so the Medical Assessor denied her "a fair procedure".
4. The appellant submitted that the reasons the Medical Assessor provided for rating her impairment in CPP as Class 2 were inadequate. The appellant submitted that, "no attempt is made [by the Medical Assessor] to define the words 'for a while' such that it is difficult to reconcile which PIRS Class the appellant may fall under". The appellant referred to evidence in her statement in which she said that she finds it difficult to keep her attention and focus on a task for more than a few minutes and that she can only read for 10 minutes before losing concentration. The appellant submitted that the Medical Assessor did not make any explicit reference to her statement and as a consequence it is "difficult to appreciate how the Medical Assessor engaged in an active intellectual process directed at the information".
5. The appellant referred to the certificates of capacity that her general practitioner had issued that consistently certified that she had a limited capacity for work for three hours a day on two days a week. The appellant said that the Medical Assessor did not acknowledge these certificates and submitted that it is "difficult to appreciate how or whether they were considered at all". The appellant noted that Dr Saboor had rated her impairment in employability is Class 4 and that Dr Sherman had rated her impairment in employability is Class 3. The appellant also noted that the Medical Assessor within the MAC had referred to her treating psychologist providing a letter on 13 January 2021 advising she is unfit to work. The appellant contended that the Medical Assessor did not grapple with that evidence or justify adequately finding her impairment in employability is Class 2.
6. In reply, the respondent submitted that the Medical Assessor was entitled to allocate a Class 2 impairment in respect to the appellant's self-care and personal hygiene based the history he obtained at the time of his examination. The respondent noted that Dr Saboor, who rated the appellant's impairment in self-care and personal hygiene as Class 2, obtained a history more than 18 months prior to the Medical Assessor's examination of the appellant. The respondent also noted that the history Dr Sherman obtained, who rated the appellant's impairment is Class 1 in self-care and personal hygiene, obtained a history more recent to the Medical Assessor's examination than the history Dr Saboor obtained.
7. The respondent made no submissions regarding the Medical Assessor's rating of the appellant's impairment in social and recreational activities.
8. The respondent submitted that the Medical Assessor's rating of the appellant's impairment in CPP as Class 2 is entirely consistent with the history he obtained at the examination.
9. The respondent submitted that the Medical Assessor obtained a history from the appellant that revealed she had a significant increase in her work capacity since the time that both Dr Saboor had examined her and the appellant's psychologist had opined that the appellant was unfit to work. The respondent submitted that the Medical Assessor's rating of the appellant's impairment in employability did not involve error.

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.
3. The examples provided for a Class 2 rating in Table 11.1 of the Guidelines, which relates to 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 rating 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. The Appeal Panel considers when the MAC is read as a whole it is apparent that the Medical Assessor has composed the history he detailed in the MAC by reference to both the information he elicited from the appellant during his examination of her and the information within documentary evidence that the Commission provided to him, which included the appellant's statement. The Medical Assessor has composed a history that has detailed what he considered is clinically relevant to rate the appellant's impairment in the several PIRS domains. Because he had regard to her statement, he was aware of her issues with weight gain. He had read and was aware of the reasons that both Dr Saboor and Dr Sherman provided for their respective assessments, noting that the Medical Assessor made specific reference to their respective reports. The Medical Assessor was aware of the appellant's drinking both before and subsequent to her injury and noted that it had increased from recreational drinking to two bottles a night subsequent to her injury and was up to half a bottle a night at the time he examined her.
2. The Medical Assessor was aware of the appellant's eating habits, including that she engaged in binge eating once a week.
3. In the Appeal Panel's view there is no error in the history the Medical Assessor obtained to enable him to rate the appellant's impairment in self-care and personal hygiene. As said, the Appeal Panel considers that the Medical Assessor composed the history he detailed in the MAC by having regard to all the documentation before him and the information he elicited from the appellant during the examination. The history he detailed in the MAC was sufficient for him to evaluate the appellant's impairment in self-care and personal hygiene. The Guidelines require that the Medical Assessor evaluate a worker's impairment based on findings the Medical Assessor makes on examination of the worker and the history the Medical Assessor obtains.[1]
4. The Appeal Panel considers that the history the Medical Assessor obtained relevant to the appellant's function in self-care and personal hygiene accords with a severity of impairment described by the examples for a Class 2 impairment in Table 11.1. They do not meet a severity of impairment described by the examples for a Class 3 impairment.
5. The history the Medical Assessor obtained revealed the appellant is able to live independently and looks after herself adequately but may rely occasionally on takeaway food. The history the Medical Assessor obtained does not indicate that the appellant is unable to live independently without regular support or needs prompting to attend to her self-care. The history indicates that she is not dependent upon takeaway meals or people providing her meals or that she requires the assistance of other to ensure a minimum of hygiene or nutrition.
6. The history that the Medical Assessor detailed does not indicate that the appellant drinking half a bottle of wine a day is affecting her hygiene or nutrition or her ability to maintain her self-care and personal hygiene.
7. Consequently, the Appeal Panel considers that the Medical Assessor made no error in his evaluation of the appellant's impairment in self-care and personal hygiene and that when evaluating the appellant's impairment he took into account all relevant matters.
8. The examples provided in Table 11.2 of the Guidelines for a Class 1, Class 2 and Class 3 impairment in social and recreational activities are:

No deficit, or minor deficit attributable to the normal variation in the general population: regularly participates in social activities that are age, sex and culturally appropriate. May belong to clubs or associations and is actively involved with these.

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).

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.

1. As the Appeal Panel noted earlier, both Dr Saboor and Dr Sherman rated the appellant's impairment in social and recreational activities as Class 3. The appellant has contended that the Medical Assessor by making no comment on the reasons each of those clinicians provided for their respective ratings meant that the Medical Assessor did not provide her a fair procedure when rating her permanent impairment.
2. The reasons Dr Saboor provided for his rating were:

"She reported she has not been going to any recreational activities. She was not

going to movies. She was attending family dinners once a week, and was going to the gym 4-5 days a week."

"Moderate impairment: She used to be very social and wanted to go out with friends. Now, enjoying alone time - would rather stay home and make dinner and not leave the house. Rarely go out now. She does "hang out" a bit with flatmates - talking and meals together and watching TV."

1. The obligation of the Medical Assessor under s 325(2)(c) of the 1998 Act to set out the reasons for an assessment requires the Medical Assessor to expose his or her path of reasoning such that a Medical Appeal Panel can determine whether there is error in the reasoning.[2] That obligation does not require a Medical Assessor to "opine on the correctness of other opinions"[3], but rather to articulate his or her reasons for the degree of permanent impairment she or he assessed a worker has from an injury.
2. Hence in this case the Medical Assessor was not required to explain why his opinion differed from the opinion Dr Sherman or the opinion of Dr Saboor. He was not required to explain why he considered his opinion correct, and the opinions of Dr Saboor and Dr Sherman incorrect. In any event, insofar as the Medical Assessor has detailed his reasons for his assessment, it is apparent why his assessment differs from the assessments Dr Saboor and Dr Sherman made.
3. Having regard to the reasons that the Medical Assessor provided for his rating and the reasons that each of Dr Saboor and Dr Sherman provided for their respective ratings, it is apparent that each clinician obtained a different history at their respective examinations of the appellant.
4. The Medical Assessor was entitled to rely upon the history he obtained, rather than the history that either Dr Sherman or Dr Saboor obtained.
5. That said however, the Appeal Panel considers that the Medical Assessor erred by rating the appellant's impairment in social and recreational activities as Class 1.
6. The history the Medical Assessor detailed included that the appellant no longer has the motivation to participate in weight training. The history he obtained details she has no social activity outside of attending weekly dinners with her family and socialising with her work colleagues. His reasoning for rating the appellant's impairment as Class 1 included that the appellant can go to the shops for her groceries as needed. That is an irrelevant consideration to rate her impairment in social and recreational activities.
7. The Medical Assessor was wrong to evaluate that the appellant has no deficit in her social and recreational activities or a minor deficit attributable to the normal variation of the general population. That is evidently not the case noting that she no longer has motivation to participate in weight training and is limited in her social activities to events that involve her workplace friends and her family. The history the Medical Assessor composed revealed a severity of impairment that accords with the examples for a Class 2 impairment. That is the appellant is able to go to social events with her work colleagues without the need of support person and has a family dinner weekly either at her home or at a restaurant. She is able to enjoy playing games on her phone. The history the Medical Assessor detailed is not such that her impairment can be elevated to Class 3 impairment given that she socialises with her work colleagues and she regularly attends a family dinner.
8. The Medical Assessor consequently erred by not rating the appellant's impairment in social and recreational activities is Class 2.
9. The examples provided in Table 11.5 of the Guidelines for a Class 2, Class 3 and Class 4 impairment in CPP 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 also has erred by rating the appellant's impairment in CPP as Class 2 and the correct rating he should have made is that the appellant's impairment is Class 3. Whilst the appellant is employed as an administrative officer, she nevertheless has difficulty with her concentration and takes longer to learn work processes than what otherwise would be the case if she was uninjured. Her evidence in her statement is that she was able to maintain a high level of concentration prior to her injury but now has difficulty focusing on task at hand for more than a few minutes and only reads for 10 minutes before losing her concentration. In the Appeal Panel's view that reveals that she would have difficulty following complex instructions. In the Appeal Panel's view her capacity in CPP now reveals a severity of impairment that best accords with the examples provided for a Class 3 impairment, rather than a Class 2 impairment.
2. The examples provided in Table 11.6 of the Guidelines for a Class 2, Class 3 and Class 4 impairment in employability are:

Mild impairment. Able to work full time but in a different environment from that of the pre-injury job. The duties require comparable skill and intellect as those of the pre-injury job. Can work in the same position, but no more than 20 hours per week (eg no longer happy to work with specific persons, or work in a specific location due to travel required).

Moderate impairment: cannot work at all in same position. Can perform less than 20 hours per week in a different position, which requires less skill or is qualitatively different (eg less stressful).

Severe impairment: cannot work more than 1 or 2 days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic ss 4

1. The Appeal Panel also considers that the Medical Assessor erred by rating the appellant's impairment in employability as Class 2 and that the correct rating is Class 3 based on the history he detailed in the MAC relevant to the appellant's capacity in employability. That said however, the Appeal Panel does not accept the appellant's submission relating to the Medical Assessor's evaluation of her impairment in employability insofar as the appellant contended that the Medical Assessor did not regard to the certificates of capacity that were in evidence or the reasoning of Drs Saboor and Sherman for their respective ratings of her ability in employability, or the letter that her treating psychologist wrote in 2021. The history that the Medical Assessor obtained clearly reveals that the appellant is working beyond the limit her general practitioner certified in the certificates of capacity and also her working more than that described within history Dr Saboor obtained. The treating psychologist's opinion was that the appellant was unfit for employment in 2021. She is working at the moment and hence the severity of her impairment has eased since then.
2. In any event, as the Appeal Panel said it is satisfied that the Medical Assessor has had regard to all the documents that were forwarded to him in the process of his composing the history that he deemed relevant to assess the degree of the appellant's permanent impairment.
3. Notwithstanding that, and as indicated just above, the Appeal Panel considers that the Medical Assessor's evaluation of the appellant's impairment in employability is wrong. Prior to her injury the appellant's career was based in management and at the time of her injury she was working a position where she had to serve business customers. Whilst she was only engaged in her employment for 30 hours a week, the evidence does not indicate that she unable to work more than that.
4. Currently the appellant is working as an administrative officer which is less demanding than work as a customer services officer attending to the needs of business customers. She is working now in a position that is qualitatively different and requires less skill. She has difficulty concentrating at her work and takes longer to learn work processes than what would have been the case if she was uninjured. She can however work 7.5 hours in that position.
5. The situation of the appellant currently is that she does not match any of the examples provided in Table 11.6 for a Class 2 impairment. Further, she does not match any of the examples provided for a Class 4 impairment in that she is able to work more that one or two days at a time and able to work more than 20 hours a fortnight. Her impairment in employability is of a severity that best accord with the examples provided for Class 3 impairment and, hence, that is how the Medical Assessor ought to have rated her impairment.
6. The Appeal Panel must correct the errors the Medical Assessor made which it does so by rating the appellant's impairment in social and recreational activities as Class 2 and her impairment in CPP and employability as Class 3. The aggregate of her scores is therefore 12, noting that the Appeal Panel found no error in the Medical Assessor's rating of her impairment as Class 2 in self-care and personal hygiene and no issue was raised with the Medical Assessor rating of the appellant's impairment in travel and social functioning as Class 1. Her median Class score is therefore 2. Her aggregate score and median score convert to 6% WPI, and that is how the Appeal Panel rates the appellant's impairment from her injury.
7. For these reasons, the Appeal Panel has determined that the MAC issued on 18 June 2025 should be revoked, and a new MAC should be 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 Panel 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:

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] Tradieh v LM Hayter & Sons Pty Ltd [2025] NSWSC 840

[2] Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA43; Tradieh v LM Hayter & Sons Pty Ltd [2025] NSWSC840 at [33] - [42]