1. On 20 December 2024 the employer the Secretary, Department of Education (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Aman Suman, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 26 November 2024.
2. The appellant relies on the following ground of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
   • the assessment was made on the basis of incorrect criteria, and
   • the MAC contains a demonstrable error.
3. The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the grounds of appeal on which the appeal is made.
4. Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
5. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed

1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).

1. The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
2. The appellant requested that the worker undergo a re-examination by a Medical Assessor who is also a member of the Appeal Panel. As a result of its preliminary review, the Appeal Panel determined that it was necessary for the worker to undergo a further medical examination because the Appeal Panel found error.

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

1. Medical Assessor Douglas Andrews of the Appeal Panel conducted an examination of the worker and reported to the Appeal Panel.

1. The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

1. The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
3. The matter was referred to the Medical Assessor for assessment as follows:

"The following matters have been referred for assessment (s 319 of the 1998 Act):

MEDICAL DISPUTE REFERRED FOR ASSESSMENT (s319 WIM Act)

• □ the degree of permanent impairment of the worker as a result of an injury (s319(c))
• □ whether any proportion of permanent impairment is due to any previous injury or pre-existing condition or abnormality, and the extent of that proportion (s319(d))
• □ whether impairment is permanent (s319(f))
• □ whether the degree of permanent impairment of the injured worker is fully ascertainable (s319(g))

Body part/s referred: Psychological/ Psychiatric disorder

1. The Medical Assessor issued a MAC certifying 22% whole person impairment (WPI) as a result of the injury as follows:

page and paragraph number in NSW workers compensation guidelines

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

WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)

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

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

1. The assessment was based on his assessment under psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows:

• Major depressive disorder.
• Panic disorder.
• Opioid use disorder (in remission).

He has received adequate treatment and psychological therapy input

Mr Hill told me that he is able to manage living independently with support from his family. He told me, "I take a shower once every three weeks". He told me he struggled with his energy and motivation. He told me that he relied on microwave meals or takeaways, "I don't cook much. I don't have an appetite". Mr Hill told me that he would experience severe abdominal discomfort if he were to consume more than two meals. He told me that he avoids certain foods. Mr Hill highlighted that it takes him significant effort to clean the bus or wash his clothes. He told me that his mum and brother visited him every two to four weeks "They encourage me to clean my place."

Mr Hill told me he has not attended social events over the last six months. He told me he missed three weddings "I don't want to attend a wedding and be trapped in anxiety". Mr Hill told me that he feels panic symptoms in any crowded situation. He told me he is unable to concentrate and wants to leave the social environment if he experiences panic. Mr Hill has given up activities he used to enjoy, including surfing, playing soccer, and camping.

Mr Hill told me that he is able to drive, although he prefers going out with his family. He told me that he has been to shops to buy groceries, although he prefers family do the shopping for him or get it delivered. He often went out with his landlady, who had been helping him.

Mr Hill told me that his relationship with his wife ended in early 2024. He said, "I have not felt like being in any other relationship with the female". Mr Hill told me he had lost contact with most of his friends. He told me that he receives much support from one of his brothers and his mum: "Most of my family members don't understand about my issues. My relationship with them is not the same".

Mr Hill told me his concentration has worsened over the last six months. He told me, "I cannot concentrate for more than 20 minutes. I have given up reading, which I used to enjoy". Mr Hill told me that he struggled with remembering details. He told me, "My mind gets distracted, and I struggle with anxiety and negative rumination if I were to attend to an email. I give it up". Mr Hill told me that he has been unable to take on tasks requiring sustained concentration or planning.

As per the review today, it is evident Mr Hill will struggle to take on any work commitment, considering his ongoing struggle with complex mental health issues.

1. The employer appealed.
2. In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments he made under one of the six PIRS categories, namely social functioning, causing him to make an error in assessing a class 3 for social functioning when he should have assessed a class 2.
3. In summary it was submitted that this error arose because the Medical Assessor did not properly take into account non-work related stressors when assessing social functioning. It was submitted that the worker had pre-existing marital issues unrelated to his psychological injury which was not properly considered by the Medical Assessor. It was further submitted that the separation from his wife did not arise as a result of his work injury. The finding of class 3 for social functioning was not open to the Medical Assessor on the available evidence particular the report of Dr Peter Young dated 1 June 2023.
4. In summary, the worker Mr Michael Hill (the respondent) submitted that the Medical Assessor did not err and nor did he make an assessment on the basis of incorrect criteria and the MAC should be confirmed.
5. The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS for mere difference of opinion but must be satisfied as to error.
6. The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self-report can be properly evaluated in the context of other evidence before the Medical Assessor. The Appeal Panel considered that the path of reasoning was inadequate, and it was not clearly discernible from the reasons given that the assessment under the contested PIRS category was based upon the correct criteria.
7. In these circumstances of the above finding of error, the Appeal Panel considered that a

re-examination by a Medical Assessor member of the Appeal Panel was necessary. Medical Assessor Douglas Andrews was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):

1. The workers medical history, where it differs from previous records

Mr Hill is a 38-year-old teacher who had worked for the Department of Education since 2005. In the last several years of his employment, he was a special education teacher. In early 2018, he developed anxiety related to the challenging behaviours of the children in his care and his perception of a lack of support from management. He had been threatened by students and believed they were emboldened when there were no consequences. He said, "The kids were ruling my classes." His anxiety progressed to frequent panic attacks.

Two months ago, Mr Hill moved into a freestanding house in Nowra. Previously, he had been living in a bus on a property. His parents and extended family assisted financially and practically with the move.

He has sought care from his general practitioner, Dr Luke van Rossum, psychologist Mr John Littleton, and psychiatrist Dr Charles Austin-Woods.

His current medication regimen is quetiapine XR 100 mg nocte, prazosin 2 mg nocte, propranolol 40 mg twice daily and diazepam 5 mg as needed (on average, he uses one or two tablets daily).

In early 2024, Mr Hill spent one month in the mental health unit of South Coast Private Hospital, where he had treatment with rTMS. Dr Austin-Woods has applied for funding from the insurance company for a second course of rTMS.

Mr Hill has marginally worsened since his assessment with the MA. He attributed this to stressors associated with moving home.

Since the onset of his condition, his condition has been up and down. It had been more manageable before the breakdown of his marriage because of the support offered by his wife.

Mr Hill met Lauren in 2010 and started a relationship. She had been working internationally as a model but returned home when her brother died. They have three daughters, ages 6, 5 and 2.

Mr Hill recalled a close and loving relationship before his work injury. After he became unwell at work, Lauren was his main support.

After he left work in 2019, the relationship experienced increased stress. He felt that Lauren "now had an extra child to deal with," referring to his increased dependency on her. Things became more challenging by late 2022, and the relationship failed in March 2023. They formally separated in June 2024.

Lauren accused Mr Hill of being a paedophile, accusations that were investigated by the Department of Community and Justice (DCJ) and dismissed. Further allegations were that Mr Hill had abused foster children that had been in the care of his parents. It is unclear where these allegations originated, and they were later dismissed. Mr Hill received an apology from DCJ; no further action is pending.

After the separation, together with the abuse allegations, Mr Hill's relationship became contentious. He has been denied access to his children, a matter before the court.

Mr Hill suffers stress-related abdominal migraine for which he takes medicinal cannabis. This condition started after the work-related anxiety. Initially, Mr Hill took oxycodone and oxycodone/naloxone. He developed opiate dependency and was treated with maintenance buprenorphine. He ceased this medication and has remained opiate free for the last 2 years.

He has no other medical conditions. He rarely drinks alcohol.

Earlier, his weight had fallen from 90 kg to 60 kg. This has substantially recovered, and he is now about 85 kg.

1. Additional history since the original Medical Assessment Certificate was performed

Mr Hill has marked anxiety associated with panic attacks and avoidant behaviours.

He has subjective problems with concentration, attention and memory.

He has frequent thoughts of suicide and has contemplated means such as jumping from height, hanging or an intentional motor vehicle accident. However, he has strong protective factors concerning his children and religious faith.

He has initial and middle insomnia, usually getting only a few hours of broken sleep.

Mr Hill lives alone in a freestanding house. He managed a move 2 months ago with support from family.

He rarely leaves his home. During the day, he has the television or music on for background noise. Occasionally, he engages with a television show and can watch it for up to 30 minutes before losing concentration. He can read for periods varying from 5 to 30 minutes. He reads the same positive religious tract daily.

He doesn't do housework. He has groceries delivered and eats takeaway or heat-and-eat prepared meals. He used disposable dishes where possible.

He may go up to 3 weeks before showering or brushing his teeth. Because of his poor dental hygiene, he has lost some teeth since leaving work.

Before becoming unwell, he was an active surfer and enjoyed team sports such as soccer and touch football. He had several close friends and was socially active. He has given up these activities. He doesn't go to restaurants or cafés.

He no longer has any friends. He said that he last saw his previous best friend six months ago, and it had been years before that.

Mr Hill has five brothers and five sisters. His parents and eight of his siblings live locally. His relationships are amicable, but he is only close to one brother, Luke. He sees Luke monthly when he comes to drive him to appointments. They don't otherwise socialise.

Mr Hill doesn't travel without support. He has lost his license because of unpaid fines, and his car is unregistered.

He has not worked in any capacity since leaving his teaching job.

Mr Hill had been diagnosed by the MA with major depressive disorder, panic disorder and an opioid use disorder in remission. His history today supports those diagnoses.

His condition is entrenched. It will not change significantly over the next 12 months, with or without further medical treatment. He has reached maximum medical improvement.

The employer had appealed the MA's finding on social functioning. The MA had determined a moderate impairment, Class 3.

Mr Hill has had a permanent and contentious separation from his wife. Although there was no domestic physical violence, they often argued, and his wife made serious and damaging allegations against him that were not sustained. They continue to argue about Mr Hill's parental access through the courts. The breakdown in their relationship happened because Mr Hill's wife struggled to deal with the changed circumstances following the deterioration in his mental health. She likely struggled with managing three children, and some aspects of her past may have contributed to this, such as alleged domestic violence in a previous relationship and developmental trauma. However, the deterioration in Mr Hill's mental health and his associated dependency on her played a substantial role in the decline of the relationship.

He has lost all his friends. He has a good relationship with one brother and a reasonable relationship with his parents and other siblings.

This history is consistent with a moderate impairment (Class 3) in social functioning, as determined by the MA.

I assessed Mr Hill in his home via an audiovisual link for 75 minutes. The connection quality was adequate to do a comprehensive assessment.

He presented casually attired with a long beard and wearing a grey hoodie jacket.

He described a low mood and anxiety. His anxiety was apparent on observation. His affect was reactive and congruent with the interview content.

There was no evidence of any disorder of thought-form or content.

He gave a detailed history without apparent cognitive challenges.

1. Results of any additional investigations since the original Medical Assessment Certificate

1. The Appeal Panel considers that the examination undertaken by Medical Assessor Douglas Andrews was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Douglas Andrews has provided in his report to the Appeal Panel, including the history as to the respondent worker's ability to function in the PIRS category that has been challenged on appeal, namely social functioning. The Appeal Panel notes Medical Assessor Douglas Andrews' findings on clinical examination of the respondent worker and his diagnosis made after clinical examination of the respondent worker, namely that the respondent worker's history supports the diagnosis of the Medical Assessor that Mr Hill suffers from major depressive disorder, panic disorder and an opioid use disorder in remission. The Appeal Panel agrees with and adopts the findings of Medical Assessor Douglas Andrews.
2. In respect of Social Functioning, Table 11.4 of the Guides provides as follows:

Table 11.4: Psychiatric impairment rating scale - social functioning

No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).

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

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

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

Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.

1. The Appeal Panel adopts the findings of Medical Assessor Douglas Andrews on re-examination as follows:

"Mr Hill has had a permanent and contentious separation from his wife. Although there was no domestic physical violence, they often argued, and his wife made serious and damaging allegations against him that were not sustained. They continue to argue about Mr Hill's parental access through the courts. The breakdown in their relationship happened because Mr Hill's wife struggled to deal with the changed circumstances following the deterioration in his mental health. She likely struggled with managing three children, and some aspects of her past may have contributed to this, such as alleged domestic violence in a previous relationship and developmental trauma. However, the deterioration in Mr Hill's mental health and his associated dependency on her played a substantial role in the decline of the relationship.

He has lost all his friends. He has a good relationship with one brother and a reasonable relationship with his parents and other siblings."

1. The Appeal Panel considers that based on these findings, the best fit is a moderate impairment or class 3 for social functioning. As this is the same as the assessment by the Medical Assessor, the MAC will be confirmed in this regard.
2. For these reasons, the Appeal Panel has determined that the MAC issued on