1. On 30 July 2025 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 Clayton Smith, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 3 July 2025.
2. The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
   • the assessment was made on the basis of incorrect criteria, and
   • the MAC contains a demonstrable error.
3. The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
4. Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
5. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed

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

1. Diane Uzunovska (the respondent worker) sustained a primary psychological injury deemed to have occurred on 13 October 2021 in her employment as a primary school teacher with the appellant.
2. The respondent worker lodged an Application to Resolve a Dispute (ARD) in the Personal Injury Commission (Commission) dated 7 May 2025 in which she claimed lump sum compensation in respect the psychological injury.
3. The matter was referred to Dr Clayton Smith, 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 13 October 2021.
4. The Medical Assessor examined the respondent worker on 11 June 2025 via video link and assessed 19% WPI in respect of the psychological injury deemed to have occurred on

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 there was an error in the MAC and that the respondent worker should undergo a further medical examination because there was insufficient 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. Dr Graham Blom of the Appeal Panel conducted an examination of the worker on

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) Ground one - s 323 deduction - the Medical Assessor made no deduction in relation to the respondent worker's psychological conditions which pre-dated the injury on 13 October 2021;

(b) the Medical Assessor acknowledged the respondent worker's previous workers compensation claim in 2009 which related to an incident of alleged intimidation and harassment by a relieving deputy principal. The Medical Assessor noted that the respondent worker was diagnosed with post-traumatic stress disorder by her general practitioner and she was provided counselling during the three weeks she was off work;

(c) the Medical Assessor has failed to accurately appreciate the severity of the respondent worker's pre-existing injury which led to a diagnosis of post-traumatic stress disorder by Dr Mark Toomey on 12 November 2009 due to symptoms including distress, chest discomfort, emotional distress, and heavy breathing. This was confirmed by Dr Toomey in the certificate of capacity dated 6 November 2009 which indicated the respondent worker was unfit to work due to her condition;

(d) the Medical Assessor opined that the "brief stress-related symptoms experienced earlier in her teaching career did not warrant a deduction for pre-existing condition". The Medical Assessor was provided sufficient evidence for the consideration of a deduction for pre-existing conditions as required by s 323.

(e) the consideration of a pre-existing psychological condition, even if it was "brief" as described by the Medical Assessor, is relevant to an assessment of impairment and is not to be disregarded only due to a reported absence of symptoms at the time of injury or the brevity of the condition.

(f) there be a deduction applied under s 323 of the 1998 Act, of at least 10% in reference to the medical evidence which indicates the respondent worker's predilection for psychological injury in the workplace environment.

(g) this deduction was applied correctly by Dr D'Abrera in his report dated 8 January 2025, in which he noted that Dr Rastogi had not applied a deduction as she had not been provided with a history of the respondent worker's past psychiatric conditions. Dr D'Abrera opined a one tenth deduction was appropriate in light of "episodes of stress and anxiety in the past which required at the bare minimum a period of counselling by her GP and the lodging of a Workers' Compensation claim".

(h) in Wentworth Community Housing Ltd v Brennan [2019] NSWSC 152 it was held that a Medical Assessor would fall into error if they rely only on a worker's subjective reporting of symptoms during the examination. The Medical Assessor's overreliance on the respondent worker's subjective reporting of symptoms and her prior history, even after Dr D'Abrera drew attention to the respondent worker having been difficult to elicit a clear history from, has caused him to fall into error.

(i) the Medical Assessor's failure to apply a deduction under s 323 of the 1998 Act amounts to a demonstrable error and the application of incorrect criteria within the meaning of ss 327(3)(c) and (d) of the 1998 Act as the Medical Assessor failed to properly consider the application of any deduction under s 323 of the 1998 Act in the context of the respondent worker's pre-existing psychological condition and workers compensation claim.

(j) Ground two - social and recreational activities - the Medical Assessor in assessing Class 3 for the Psychiatric Impairment Rating Scale (PIRS) category of social and recreational activities failed to have regard to the totality of the medical and lay evidence before him.

(k) the following evidence is in direct contrast to the finding that the respondent worker has a moderate impairment in social and recreational activities:

(i) the report of Dr Juan D'Abrera dated 8 January 2025 recorded the respondent worker was able to socialise and travel with a support friend to the Blue Mountains for a "forest healing" retreat. The same report recorded the respondent worker was able to socialise regularly with her friend who also drives her in the greater Sydney region to visit family in Port Kembla;

(ii) the clinical records of Dr Romeo, the respondent worker's general practitioner, who recorded she had travelled to Macedonia in July to August 2024. He detailed the respondent worker had "facial fillers in Macedonia. Not happy with result";

(l) the Medical Assessor failed to have proper regard to the objective evidence including the prior clinical history indicating an ability to engage in activities for recreational purposes, whether under the guise of medical procedures or wellness retreats. The Medical Assessor simply states that Dr D'Abrera's assessment of social and recreational activities "was at odds with the available evidence" without giving reasoning as to why;

(m) the role of the Medical Assessor in preparing the MAC is to explain the actual path of reasoning in sufficient detail to enable a court or an appeal panel to determine whether there is error in its finding: Wingfoot Australia Partners Pty Limited v Kocak [2013] HCA 43; (2013) 252 CLR 480; El Masri v Woolworths Ltd [2014] NSWSC 1344. A failure to do so has been held as an error of law on the face of the record;

(n) the Court of Appeal in Campbelltown City Council v Vegan [2006[ NSWCA 284 held that the Medical Appeal Panel is obligated to give reasons and where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. This applies to a Medical Assessor;

(o) given the respondent worker's history and information about her international travel, it was contrary to the evidence for the Medical Assessor to consider the respondent worker moderately impaired in the scale of social and recreational activities. She is at most, mildly impaired (Class 2). This amounts to a demonstrable error contained in the MAC and/or the application of incorrect criteria as the Medical Assessor applied the wrong PIRS category;

(p) Ground three - travel - the failure of the respondent worker to report her international travel plans and subsequent trip to Dr Rastogi, Dr D'Abrera or the Medical Assessor hindered their ability to properly assess her level of impairment in respect of travel. This further demonstrated ability to travel went beyond the capacity of an individual mildly impaired in accordance with the Guidelines;

(q) the Medical Assessor recorded that the respondent worker "had not undertaken any overseas or interstate travel since leaving teaching". The Medical Assessor had sufficient clinical evidence to turn his mind to the international travel. This has led to a demonstrable error and use of incorrect criteria. There is no new evidence that needs to be considered by the Medical Assessor for the purposes of s 327(3)(b) as all evidence related to international trip was provided and the Medical Assessor has failed to appreciate it;

(r) further, the respondent worker has capacity to travel within the Greater Sydney area with trips reported to the Medical Assessor and other treating practitioners to the Blue Mountains for a "forest healing" with her support friend and travel to the Wollongong region to visit her family;

(s) it was contrary to the evidence before the Medical Assessor to consider the respondent worker was mildly impaired with respect to travel having regard to her ability to travel internationally and her capacity to travel throughout the Greater Sydney region even with her support friend;

(t) by assessing Class 2 for the PIRS category of travel, the Medical Assessor failed to have regard to the totality of the medical evidence and lay evidence as well as the evidence before him from his assessment which demonstrates the respondent worker has an ability to travel internationally, travel long-distances for retreats and family visits;

(u) given the respondent worker's history, it was contrary to the evidence before the Medical Assessor to consider the respondent worker is mildly impaired in travel and the evidence supports the finding she is not impaired (Class 1). The respondent worker is able to travel to new environments including overseas and for cosmetic procedures. The Medical Assessor's failure to review the available evidence such as the clinical records of Dr Romeo, constitutes a demonstrable error contained in the MAC and/or the application of incorrect criteria as the Medical Assessor applied the wrong PIRS category, and

(v) it would be appropriate for the respondent worker to be re-examined by a Member of the Appeal Panel in light of the inconsistencies identified above with the respondent worker's reported history and available evidence.

1. The respondent worker's submissions include the following:

(a) Ground 1 - s 323 deduction - the claim for permanent impairment compensation for a psychological injury sustained at work was supported by a report from Dr Rastogi;

(b) the ARD pleaded that the respondent worker suffered psychiatric injury during the course of her employment with the appellant, diagnosed with Major Depressive Disorder with panic attacks. The ARD establishes that the claim was in respect of an injury occasioned by her employment in general. The claim did not limit the period of the employment that was relevant. There is no issue that the injury is a disease to which s 15 applies;

(c) the respondent worker commenced employment with the appellant in about 2005. In the case of a disease injury there can only be a s 323 deduction if the pre-existing condition existed prior to the date on which the respondent worker commenced employment to the nature of which the injury was due. In this case that must be a date before commencing work with the appellant in 2005;

(d) the circumstances of the prior episode in 2009 fall within the descriptor in the ARD and the report of Dr Rastogi being bullying and harassment within the course of employment. As such the episode in 2009 is not a prior injury or preexisting condition or abnormality for the purposes of s 323. It follows that the Medical Assessor was correct to not make a deduction. Regardless of whether the prior episode contributed to the current impairment it would have been an error to make such a deduction;

(e) the evidence shows that in 2009 the respondent worker saw a GP and had five days under workers compensation. She saw a psychologist arranged by the appellant in order to get a clearance to return to work. The psychologist concluded that the respondent was in good condition. The appellant would have all of the records and could have filed the psychologist's report if there was any issue that the respondent had made a full recovery. Thereafter the respondent worker returned to work and forgot about the incident until remined by Dr D'Abera who had the 2009 claim file which has not been made available in these proceedings;

(f) the Medical Assessor expressly considered the prior incident. He said that "the brief stress related symptoms experienced earlier in her teaching career did not warrant a deduction for a pre-existing condition". That is a correct conclusion;

(g) the respondent worker had experienced some stress at that time in 2009.She only had three weeks off work. She had thereafter continued to function without restriction for over 10 years without any symptoms referrable to the prior condition. There is no evidence that the prior condition had persisted or in any way contributed to the current condition. At most the prior incident may have demonstrated a vulnerability to bullying and harassment behaviour. A mere vulnerability does not give rise to a deduction;

(h) in his report of 8 January 2025 Dr D'Abrera made a deduction. He did not give any reasons for making the deduction. At most he identified a condition that existed in 2009. He did not find that the condition was persisting and did not point to any evidence that it was. He did not give any reasons that disclosed whether he considered whether the condition in 2009 contributed to the current impairment and did not identify any such mechanism. The approach adopted by Dr D'Abrera was that because there had been an episode in 2009 there should be a deduction. This approach is contrary to authority (Ryder v Sundance Bakehouse [2015] NSWSC 526(Ryder));

(i) there is no evidence that the 2009 episode was other than a discrete incident with no continuing effect. In the circumstances there should not be any deduction;

(j) Ground 2 - social and recreational activities - the placement of a worker in a particular class within a scale is a matter of clinical judgement and there is no bright line between the classes. In order to find that there has been a demonstrable error it is not sufficient to say that an Appeal Panel would have reached a different conclusion. It is necessary to find that the Medical Assessor was wrong. In a matter of clinical judgement this is often described as asking whether the conclusion was open to the Medical Assessor;

(k) The appellant argues that the Medical Assessor's conclusion is in contradiction of other evidence. The history taken by Dr D'Abrera that when seen by him in January 2025 that the respondent worker is able to go out with her friend and last socialised with her last week. Has managed to travel to the Blue Mountains for a holiday, is not attending the gym like she used to but is able to go on walks. It is otherwise put that the doctor was told that she has a close friend who visits regularly and with whom she socialises (presumably at the respondent worker's premises when the friend visits). Last year they went for trip to the Blue Mountains and that she drives her longer distances e.g. to see her family in Port Kembla. Otherwise, the appellant points to evidence that suggests that the respondent worker made a trip to Macedonia;

(l) while there is no bright line between classes there is a strict division between the scales. This is because they measure different things. Evidence that the respondent worker is able to travel to the Blue Mountains on one occasion when driven by a close friend and is able to visit her family when again driven by the close friend is of no relevance to an assessment of social and recreational activities. Those matters are relevant to an assessment of travel;

(m) similarly, it is of no consequence whether the respondent worker travelled to Macedonia as that also relates solely to travel. There is no evidence of the circumstances in which the respondent worker may have travelled to Macedonia or what she may have done there other than to have face fillers. There is no evidence of socialising or engaging in other recreational activities in the company of others. The evidence that the respondent worker travelled to the Blue Mountains to spend some days relaxing there amongst nature is not inconsistent with the history relied upon by the Medical Assessor or his assessment of Class 3. The activity described is a solitary activity that does not involve engagement with other people. It is not a large scale social event. The respondent worker explained that the trip was part of her medical treatment. It was not a social or recreational event;

(n) there is nothing in the evidence that the respondent worker travelled to the Blue Mountains with her close friend to be amongst nature, is driven by the close friend to visit family or travelling to Macedonia that is inconsistent with that descriptor. The evidence that she travels with her close friend supports the assessment as Class 3;

(o) the evidence is inconsistent with Class 2. There is no evidence that she attends social and recreational events without a support person or becomes actively involved. The evidence is that she has attended solitary events in the company of her close friend who is a support person;

(p) the Medical Assessor gave full reasons for assessing as Class 3. No further explanation as needed for his assessment and there was no obligation to explain why his opinion differed from Dr D'Abrera other than to show that he had considered it. His reasons for differing from Dr D'Abrera when read in their entirety explain why he reached the assessment that he did. The Medical Assessor is only required to give brief reasons to explain how he reached his assessment. On a reading of the reasons as a whole it is clear that he found that the activities of the respondent worker limited as described justify an assessment of Class 3;

(q) there is no error in the assessment of social and recreational activities;

(r) travel - the medical assessor assessed travel as Class 2 which is consistent with the assessments of Dr Rastogi and Dr D'Abrera. In fact, Dr Rastogi had assessed travel as Class 3. The Class 2 descriptor is satisfied if the respondent worker is able to travel without a support person in familiar areas but needs a support person if travelling outside a familiar area. So long as there is a support person the descriptor does not limit the distance that can be travelled in order to fit within the class;

(s) the evidence is that her close friend drove her to the Blue Mountains and drives her to Port Kembla. She does not drive herself. Evidence that she only travels away from her residence with a support person would satisfy the criteria for Class 3. The evidence relied upon to support a conclusion that the respondent worker travelled to Macedonia is found in two references in clinical notes.;

(t) the case put by the appellant was that travel should be assessed as Class 2. At no time prior to the appeal did the appellant contend or argue that travel should be Class 1. As the appellant had not raised the existence of the specific clinical note or relied upon the note in support of its case, it is not a surprise that the Medical Assessor did not refer to it. In those circumstances it cannot be said that there is a demonstrable error because the Medical Assessor did not consider an argument that not been made. The evidence before the Medical Assessor was that the appellant considered and argued that travel should be assessed as Class 2;

(u) it is not actually known from the clinical notes referred to whether the respondent worker ultimately did travel to Macedonia in August 2024. The note of 29 June 2024 is only evidence of an intention to travel to an unknown destination. The note of 29 August 2024 does not say when the respondent worker had the facial fillers in Macedonia. If the travel did occur the evidence does not disclose the circumstances in which the travel occurred. The evidence does not say that she travelled without a support person being either her friend or family or what the purpose of the trip was;

(v) because of the unknown factors in the evidence it does not establish that there is a demonstrable error. All of the other evidence supports the assessment of Class 2 and is capable of supporting Class 3 if that had been the clinical judgement of the Medical Assessor. Even if there has been a single overseas trip it does not change the assessment;

(w) Class 1 is inconsistent with the evidence that the respondent worker no longer drives due to anxiety and travels with her close friend driving when leaving her immediate environs. The assessment of Class 2 for travel was the correct assessment;

(x) if contrary to these submissions a finding is made that there was an error in the assessment, it is necessary to have the respondent worker re-examined. It is only by re-examination that the Appeal Panel will be able to inform itself firstly, whether the respondent worker did travel to Macedonia in August 2024, secondly the circumstances in which she travelled including the purpose of the trip and who she travelled with and thirdly what symptoms she suffered whilst undergoing the trip and following, and

(y) in any event the appellant has not identified any error and the MAC should be confirmed 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 Appeal Panel reviewed the MAC and the evidence in this matter.

1. The appellant submits that the Medical Assessor failed to apply a deduction pursuant to

s 323 of the 1998 Act when such a deduction was appropriate to account for pre-existing psychological injuries. 2. Section 323 of the 1998 Act provides that in assessing the degree of permanent impairment, there is to be a deduction for any proportion of the impairment that is due to any previous injury, pre-existing condition or abnormality. 3. Further, cl 11.10 of the Guidelines provides:

"To measure the impairment caused by a work-related injury or incident, the psychiatrist must measure the proportion of WPI due to a pre-existing condition. Pre-existing impairment is calculated using the same method for calculating current impairment level. The assessing psychiatrist uses all available information to rate the injured worker's pre-injury level of functioning in each of the areas of function. The percentage impairment is calculated using the aggregate score and median class score using the conversion table below. The injured worker's current level of WPI% is then assessed, and the pre-existing WPI% is subtracted from their current level, to obtain the percentage of permanent impairment directly attributable to the work-related injury. If the percentage of pre-existing impairment cannot be assessed, the deduction is 1/10th of the assessed WPI".

1. In Cole v Wenaline Pty Limited [2010] NSWSC 78 Justice Schmidt held at [29-30]:

"29 ...The section is directed to a situation where there is a pre-existing injury, pre-existing condition or abnormality. For a deduction to be made from what has been assessed to have been the level of impairment which resulted from the later injury in question, a conclusion is required, on the evidence, that the pre- existing injury, pre-existing condition or abnormality caused or contributed to that impairment.

30. Section 323 does not permit that assessment to be made on the basis of an assumption or hypothesis, that once a particular injury has occurred, it will always, 'irrespective of outcome', contribute to the impairment flowing from any subsequent injury. The assessment must have regard to the evidence as to the actual consequences of the earlier injury, pre-existing condition or abnormality. The extent that the later impairment was due to the earlier injury, pre-existing condition or abnormality must be determined. The only exception is that provided for in s 323(2), where the required deduction 'will be difficult or costly to determine (because, for example, of the absence of medical evidence)'. In that case, an assumption is provided for, namely that the deduction 'is 10% of the impairment'. Even then, that assumption is displaced, if it is at odds with the available evidence."

"The reason for this statutory approach can readily be seen...an earlier injury which was asymptomatic, may or may not contribute to the impairment which results from a second injury. That is a matter of fact to be assessed on the evidence led in each case."

"Section 323 requires that a conclusion be reached as to whether or not any proportion of permanent impairment assessed resulted from an earlier injury, pre-existing condition or abnormality. In a case such as this, that conclusion must be reached on the evidence led as to the actual consequences of the earlier and later injuries, unless the assumption provided in s 323(2) applies."

1. The above was further affirmed in Ryder, whereby at [32], Campbell J stated:

"But it is necessary that the pre-existing condition was a contributing factor causing the loss. And, of course, it is necessary that there was a pre-existing condition."

"In Smart (at [33]) Giles JA emphasised that the questions of whether there is a pre-existing condition, and whether it is a contributing factor to the post-injury permanent impairment, are questions of fact. In Cole Schmidt J emphasised that it is inappropriate to assume that if a pre-existing condition, or injury, is made out on the evidence then it must contribute to the impairment ([28-30])."

1. At [45] Campbell J set out what was necessary to determine whether there was to be a deduction. He said:

"What s 323 requires is an inquiry into whether there are other causes, (previous injury, or pre-existing abnormality), of an impairment caused by a work injury. A proportion of the impairment would be due to the preexisting abnormality (even if that proportion cannot be precisely identified without difficulty or expense) only if it can be said that the pre-existing abnormality made a difference to the outcome in terms of the degree of impairment resulting from the work injury. If there is no difference in outcome, that is to say, if the degree of impairment is not greater than it would otherwise have been as a result of the injury, it is impossible to say that a proportion of it is due to the pre-existing abnormality. To put it another way, the Panel must be satisfied that but for the pre-existing abnormality, the degree of impairment resulting from the work injury would not have been as great."

1. Basten JA in Vitaz v Westform (NSW) Pty Ltd [2011] NSWCA 254 referred to the approach adopted by the Court in, for example, D'Aleo v Ambulance Service of New South Wales (NSWCA, 12 December 1996, unrep) (quoted by Giles JA, Mason P and Powell JA agreeing, in Matthew Hall Pty Ltd v Smart [2000] NSWCA 284; 21 NSWCCR 34 at [30]- [32] and, more recently, by Schmidt J in Cole. His Honour said:

"The resulting principle is that if a pre-existing condition is a contributing factor causing permanent impairment, a deduction is required even though the pre-existing condition had been asymptomatic prior to the injury."

1. The Medical Assessor noted on page 3 of the MAC:

"In 2009, Ms Uzunovska had a workers' compensation claim related to an incident of intimidation and harassment by a relieving deputy principal. Her general practitioner diagnosed post-traumatic stress disorder and provided counselling with approximately three weeks off work. She denied treatment from a psychologist or psychiatrist at that time and reportedly recovered within a few weeks. She denied any psychiatric hospital admissions or history of suicidal behaviour."

1. At [8 d] and [8 e] of the MAC (page 6) the Medical Assessor wrote:

"d. Is any proportion of loss of efficient use or impairment or whole person impairment, due to a previous injury, pre-existing condition or abnormality?

No. The brief stress-related symptoms experienced earlier in her teaching career did not warrant a deduction for a pre-existing condition.

e. If so, please indicate which body part/system is affected by the previous injury, pre-existing condition or abnormality. N/A."

1. At Part 11 of the MAC, the Medical Assessor wrote:

"11. DEDUCTION (IF ANY) FOR THE PROPORTION OF THE IMPAIRMENT THAT IS DUE TO PREVIOUS INJURY OR PRE-EXISTING CONDITION OR ABNORMALITY

a. In my opinion the worker suffers from the following relevant previous injuries, pre-existing conditions or abnormalities:

1. The appellant submits that the Medical Assessor has failed to accurately appreciate the severity of the respondent worker's pre-existing injury which led to a diagnosis of

post-traumatic stress disorder by Dr Mark Toomey on 12 November 2009 due to symptoms including distress, chest discomfort, emotional distress, and heavy breathing and confirmed by Dr Toomey in the certificate of capacity dated 6 November 2009. 2. In her statement dated 5 May 2025, the respondent worker wrote:

"48. Throughout my teaching career, I had been a fully functioning, permanent fulltime primary school teacher.

49. In 2009, while hosting a Stage 3 school assembly at Carlton Public School, I became entangled in the microphone cord, causing me to lose my balance and fall from the stage stairs onto my left arm, wrist, and hand. As a result, I sustained bruising and injuries to these areas. This incident occurred during the critical period of annual school report writing.

50. Following the fall, I consulted with a doctor and was advised to rest at home. I promptly informed the Department of Education's Incident Reporting Line and my assistant principal about my workplace injury and notified her that I would be taking some time off. Despite my injury, I attempted to complete the student report writing for my class while on sick leave. However, it quickly became evident that due to the pain and limitations caused by my injury, I was unable to comfortably finish typing the reports.

51. Upon returning to work, I handed over my incomplete student reports to my assistant principal. While in the staffroom that same day, I witnessed her reviewing my draft school reports. Her demeanour showed she viewed my injury as a significant inconvenience. I distinctly recall her rolling her eyes as she examined them, showing them to other Stage 3 teachers nearby, and audibly sighing in frustration. Her conduct made me feel humiliated and unappreciated as I had attempted to complete the reports whilst on sick leave recovering from my fall.

52. Following my return to work, I also noticed the relieving school principal at the time, was treating me differently to how she had normally treated me. She seemed annoyed at me; she spoke to me in a loud and irritated tone and was short with me. She repeatedly did this in front of students and parents without any clear justification. This left me feeling confused and distressed because I couldn't understand why I was being treated this way.

53. As a result, I sought guidance from the NSW Teachers Federation, expressing the distress caused by all this unacceptable treatment of me. They advised me the behaviours of the relieving principal were not professional and confirmed they were unacceptable according to the Department of Education's standards from a leadership perspective and to seek medical consultation, if I needed to do so, which I proceeded to do.

54. I saw a GP Dr Toomey in Kingsgrove, and I took approximately five working days of leave under workers' compensation, providing certificates of capacity. I then returned to work avoiding one-on-one communication with the relieving principal and ensuring a support person was present if interaction was necessary, as per the doctor's recommendations.

55. Upon my return to work, a Stage 3 Deputy Principal arranged for a psychologist from the workers compensation insurer to interview me inside my classroom. The psychologist concluded that I was in good condition.

56. Following my return to work, my interactions with the relieving principal were greatly minimised and subsequently she left the school shortly thereafter.

57. I did not need treatment from a psychologist or psychiatrist, nor did I need to take any medication because of the incidents with the relieving school principal.

58. I fully recovered from this incident and resumed my full-time teaching duties. I had forgotten it had occurred until it was mentioned by Dr D'Abrera and in the insurer's s 78 notice. It did not cause any lasting impact on me. It was 16 years ago and I had fully recovered within a few weeks."

1. Dr Mark Toomey, in a reply to questionnaire from the insurer dated 12 November 2009, noted that the respondent worker's symptoms included distress, chest discomfort, emotional distress, and heavy breathing. In a WorkCover NSW medical certificate dated 6 November 2009, Dr Toomey certified the respondent worker as unfit for work on 6 November 2009 and fit for suitable duties from 9 November 2009 to 13 November 2009. In the WorkCover NSW medical certificate of capacity dated 9 November 2009, Dr Toomey made a diagnosis of post-traumatic stress and certified the respondent worker as unfit for work from 9 November 2009 to 13 November 2009. Dr Toomey continued to certify the respondent worker as unfit for work from 18 November 2009 to 7 December 2009 and the fit for suitable duties from

8 December 2009 to 21 January 2010. 2. Dr Juan Carlos D'Abrera, consultant psychiatrist, in a report dated 8 January 2025 wrote:

"I could not identify any pre-existing or non-work-related factors which might have caused or contributed to the claimant's current condition other than a possible preexisting anxiety disorder as evidenced by her Workers' Compensation claim from 2009. She was somewhat evasive about other pre-existing psychological conditions but when pressed, denied that she had seen a psychologist, counsellor or psychiatrist prior to the current injury."

1. Dr D'Abrera made a one-tenth deduction for a pre-existing injury. He noted that Dr Rastogi's opinion and wrote:

"I note that she does not mention any past psychiatric history, although it is clear that Ms Uzunovska has had episodes of stress and anxiety in the past which required at the bare minimum a period of counselling by her GP and the lodging of a Workers' Compensation claim."

1. The appellant submits that the Medical Assessor has failed to accurately appreciate the severity of the respondent worker's pre-existing injury which led to a diagnosis of

post-traumatic stress disorder by Dr Mark Toomey on 12 November 2009 due to symptoms including distress, chest discomfort, emotional distress, and heavy breathing. 2. The Appeal Panel considers that the Medical Assessor did accurately appreciate what had occurred in 2009. He was of the view that the respondent worker had brief stress-related symptoms in 2009, which did not warrant a deduction for pre-existing condition. The evidence referred to by the appellant does not identify that the respondent had any further stress related symptoms or psychological problems after her return to work. The respondent worker required no treatment from a psychologist or psychiatrist, nor did she take any medication. She stated that she fully recovered from the incident and resumed her fulltime teaching duties. 3. The Appeal Panel is satisfied that the Medical Assessor was not only aware of the 2009 incident, but he considered whether a deduction for a pre-existing condition should be made as required by s 323. In determining that a deduction should not be made, the Medical Assessor properly took into account that the symptoms relating to the 2009 condition were "brief", she denied having treatment from a psychologist or psychiatrist at that time and reportedly recovered within a few weeks. 4. The appellant relies on the report of Dr D'Abrera in which he applied a s 323 deduction. However, Dr D'Abrera merely identified a condition that existed in 2009. He did not find that the condition was persisting and did not point to any evidence that it was. He did not provide any reasons that disclosed whether he considered that the condition in 2009 contributed to the current impairment. The approach adopted by Dr D'Abrera was that because there had been an episode in 2009, there should be a deduction, which is contrary to authority (Ryder). 5. The appellant did not identify any evidence to indicate that the prior condition had persisted or in any way contributed to the current condition. At most, the evidence concerning the prior incident demonstrated a vulnerability on the part of the respondent worker to bullying and harassment behaviour. In Cullen v Woodbrae Holdings Pty Ltd [2015] NSWSC 1416,

Beech-Jones J reiterated the need for evidence of an actual pre-existing condition rather than a predisposition or susceptibility. A mere vulnerability does not give rise to a deduction. 6. The Appeal Panel does not accept that the Medical Assessor's determination not to make an s 323 deduction was at odds with the available evidence or that he failed to consider relevant information demonstrating the existence of a pre-existing psychological condition. 7. This ground of appeal is not made out.

Ground two - PIRS in respect of social and recreational activities

1. The appellant submits that the Medical Assessor erred in his assessment of the PIRS category of social and recreational activities.
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."

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

"Social and recreational activities - Class 3 Moderate Impairment

She rarely attends large-scale social events. She lacks motivation for recreational activities. She has lost interest in previously enjoyed activities. Her social and recreational activities are limited to solitary home-based activities or socialising with her immediate family. She rarely socialises outside the home and does so reluctantly. She socialises infrequently."

1. At page 3 of the MAC, the Medical Assessor takes to the following history under "Social Activities/ADL":

"Her social circle has contracted to her parents and one support friend, having lost contact with other friends due to declining invitations to socialise. She no longer attends restaurants or cafes, although she noted she has never been "a café person". She has ceased all previous recreational activities, including gym attendance, walking and hiking. She is not a member of any clubs, groups or associations. She does not attend family celebrations or birthdays except rarely. Her only regular social contact occurs during medical appointments or when her support friend visits.... She may occasionally take a brief walk with her support friend but quickly returns home."

1. In commenting on the other medical opinions at [10 c] of the MAC, the Medical Assessor wrote:

"In his report dated 8 January 2025, Dr Juan Carlos D'Abrera detailed the circumstances of the injury. He diagnosed a major depressive disorder and alcohol use disorder. The veracity of her self-reported alcohol use was questioned. He assessed whole person impairment at 9% assessing self-care and personal hygiene at Class 2, social and recreational activities at Class 2, travel at Class 2, social functioning at Class 2, concentration, persistence and pace at Class 3 and employability at Class 5. Dr D'Abrera's assessment of social and recreational activities was at odds with the available evidence.

.... I note in the psychologist's notes references to salsa dancing, aqua aerobics and exercise physiology, although these activities were some years ago."

1. In her statement dated 7 May 2025, the respondent worker wrote:

"21. My ability to engage socially in public with large groups has become nonexistent. I no longer engage in social activities with friends. I avoid social gatherings.

22. I have ceased participating in hobbies and personal interests. "

1. In a report dated 28 June 2024, Dr Richa Rastogi assessed the respondent worker as Class 3 for social and recreational activities and provided the following reasons:

"Moderate Impairment as socially she avoids going out and isolated. She does not enjoy travelling so much and in high stimulus environment, does not participate in social events, prefers her own company."

1. In his report dated 8 January 2025, Dr D'Abrera assessed the respondent worker as Class 2 for social and recreational activities and provided the following reasons:

"Mild impairment. States that she is able to go out with her friend and last socialised with her last week. Has managed to travel to the Blue Mountains for a holiday; is not attending the gym like she used to but is able to go for walks".

1. The appellant submits that the Medical Assessor in assessing Class 3 for the PIRS category of social and recreational activities failed to have regard to the totality of the medical and lay evidence before him. The appellant argues that the report of Dr D'Abrera and the clinical notes of Dr Romeo are in direct contrast to the finding that the respondent worker has a moderate impairment in social and recreational activities.
2. The Appeal Panel notes that Dr D'Abrera in his report dated 8 January 2025 recorded the following:

"Ms Uzunovska told me that she has a close female friend who visits regularly and with whom she socialises. She reported that last year the two of them went for a trip to the Blue Mountains and spent some days relaxing there amongst nature. She stated that her friend also drives her longer distances e.g. to see her family in Port Kembla".

1. Dr Romeo, in his clinical records, recorded she had travelled to Macedonia in July to August 2024. He noted that the respondent worker had "facial fillers in Macedonia. Not happy with result". On 31 August 2024 Dr Romeo wrote: "S/B RPA yest. For facial swelling.? filler migration." On 12 September 2024, Dr Romeo noted: "S/B Dr Patel. Inflammation sec. to filler." Dr Romeo prescribed Keflex.
2. On balance, the Appeal Panel is satisfied that the Medical Assessor failed to have proper regard to the evidence including the prior clinical history which indicating an ability to engage in activities for recreational purposes including overseas travel and travel to the Blue Mountains. Although the respondent worker submits that these activities are part of her "medical treatment", the Appeal Panel considers such activities as recreational and there is no evidence that these activities were part of a treatment plan recommended by her treating medical professionals. The failure to have a proper regard to the evidence amounts to a demonstrable error contained in the MAC and/or the application of incorrect criteria as the Medical Assessor applied the wrong PIRS category
3. This ground of appeal is made out.

1. The appellant submits that the Medical Assessor erred in his assessment of the PIRS category of travel.
2. The examples under Table 11.3 for "Travel" in the Guidelines are:

"Class 1 No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision.

Class 2 Mild impairment: Can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.

Class 3 Moderate impairment: Cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment".

1. The Medical Assessor assessed Class 2 for travel. In the PIRS Rating Form, the Medical Assessor wrote:

She can take a trip to her local pharmacy or a familiar area unaccompanied. She relies on her supportive friend for any travel further afield. She said she has stopped driving due to excessive anxiety and concerns about her concentration."

1. Under the heading of 'Social activities/ADL', the Medical Assessor recorded the following:

"She claimed to have ceased driving despite maintaining a valid licence and owning a car, citing severe anxiety in traffic and concerns about her concentration. She requires assistance from her support friend for all transportation, including medical appointments and family visits to Port Kembla. Her friend will drive Ms Uzunovska's car as required. She has not undertaken any overseas or interstate travel since leaving teaching. Her only trips outside Sydney have been a day trip to the Blue Mountains with her friend for "forest healing" some time ago, and visits to her parents in Wollongong, always accompanied by her support friend who drives her car."

1. In commenting on the other medical opinions at page 7 of the MAC, the Medical Assessor wrote:

"In her report dated 28 June 2024, Dr Richa Rastogi detailed the circumstances of the injury noting a history of alcohol use of two to three standard drinks a few times a week. She noted a major depressive disorder with panic attacks, avoidance, excessive fears, worthlessness, a sense of failure and poor stress coping. She assessed whole person impairment at 22% with self-care and personal hygiene at Class 2, social and recreational activities at Class 3, travel at Class 3, social functioning at Class 2, concentration, persistence and pace at Class 3 and employability at Class 5. Her assessment of travel was at odds with the available evidence."

1. The appellant again refers to the clinical records of Dr Romeo, who recorded the respondent worker had travelled to Macedonia in July to August 2024. He detailed the respondent worker had "facial fillers in Macedonia. Not happy with result".
2. The appellant refers to an entry in the clinical records by Dr K.P Shanmugam on 29 June 2024, which noted the respondent worker "is going away in July/August 2024, request for a two months certificate". The respondent worker was certified as having no capacity for work for the following two months period. The Appeal Panel noted that this consultation was one day after Dr Rastogi issued her report dated 28 June 2024, in which the respondent worker reported to Dr Rastogi that she was "home bound and does not socialise anymore...she has episodes of anxiety when she has to leave the house and is extremely stress intolerant".
3. In her statement dated 5 May 2025, the appellant wrote:

"67. I have a female friend with whom I have maintained a long-standing friendship. She is the person I have referred to as my support friend. Since my injury she regularly visits to assist me with domestic tasks, such as cleaning, laundry, cooking, grocery shopping, and short walks along my street. She also drives me outside of my local area, when necessary, for example, at times to visit my parents or when attending appointments as I no longer feel comfortable doing so independently, due to feelings of severe anxiety and panic attacks.

68. I shared with Dr D'Abrera that my support friend had driven me to the Blue Mountains last year to assist with my mental health, allowing me to spend time in nature as part of my healing process using Shinrin-Yoku also known as forest healing. It was not a camping trip as asserted by the doctor. It was part of my medical treatment."

1. In a report dated 28 June 2024, Dr Rastogi assessed the appellant as Class 3 for travel and provided the following reasons: "Moderate impairment as does drive with caution, avoids going out, drives rarely and feels overwhelmed with anxiety and cognitive deficits"
2. In his report dated 8 January 2025, Dr D'Abrera assessed the respondent worker as Class 2 for travel and provided the following reasons:

"States that she is able to drive short distances. Drives longer distances in the company of her friend. Has not undertaken any interstate travel but visited the Blue Mountains."

1. The Appeal Panel accepts that the failure of the respondent worker to report her international travel plans and subsequent trip to Dr Rastogi, Dr D'Abrera or the Medical Assessor significantly limited their ability to properly assess the level of impairment in respect of travel.
2. The Medical Assessor was provided with the clinical notes and records of the respondent worker's general practitioner which indicated that she had travelled overseas in July and August 2024. The Appeal Panel considers that the overseas travel by the respondent worker is a factor which needed to be taken into account in the assessment made in respect of travel. The Medical Assessor failed to consider this evidence relating to overseas travel, or confirm with the respondent worker that she did travel to Macedonia in August 2024, and take a history relating to the circumstances in which she travelled, including the purpose of the trip and who she travelled with and whether, she had any symptoms whilst undergoing the trip and what she did once she was in Macedonia.
3. As noted above, the respondent worker did not disclose to the Medical Assessor that she had travelled overseas in July and August 2024. The Medical Assessor proceeded to make an assessment on the basis that the respondent worker had not undertaken any overseas or interstate travel since leaving teaching. Reference to the clinical records of Dr Romeo, shows that this assumption was incorrect.
4. The Appeal Panel is satisfied that the failure to take into account the evidence relating to overseas travel amounted to a demonstrable error and use of incorrect criteria.
5. This ground of appeal is made out.
6. As noted above, the Appeal Panel considered that it was necessary for the respondent worker to undergo a further medical examination because there was insufficient evidence on which to make a determination in relation to the PIRS scales of social and recreational activities and travel.
7. As noted above, Medical Assessor Blom of the Appeal Panel examined the appellant on

11 November 2025. Medical Assessor Blom provided the following report:

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

I confirmed with Ms Uzunovska that she had read the medical certificate issued by Dr Clayton - Smith. She said she had, although clarified that she was unable to read it herself and had her "support person" read to her. She said that she had generally agreed with Dr Clayton - Smith's history of the injury and subsequent events.

I clarified the nature of her symptomatology soon after finishing work - that is in late 2021 through to early 2022. She said that her symptoms overall have not changed very much over the entire four years - they have neither improve nor worsened. She said that at the time she was constantly anxious and frequently had panicky feelings. She said her mood was depressed and she felt sad most of the time. She said that she ruminated constantly about what had happened and how she had been treated by the school and its management. She was often tearful and distressed she said, describing herself as being "emotional" all the time. She said she experienced disturbed sleep with both initial and interval insomnia and frequently had nightmares. She said that these symptoms were reasonably consistent over time.

She consulted her general practitioner and was initiated on the antidepressant medication desvenlafaxine, at a dose initially of 50 mg/day but this has been gradually stepped up to a final dose of 150 mg/day. She also was referred to a psychologist, Ms Joanna Atkins and began seeing her, she thought, around early 2022. She has continued to see her up until recently, consulting her usually between every two or four weeks. Initially, sometime in early 2022, she was referred to a psychiatrist, Dr Hong although she only consulted him on one or two occasions. Subsequently her general practitioner, Dr Romeo, referred her to another psychiatrist Dr Rastogi, whom she began consulting in mid-2023. She consulted Dr Rastogi every two or three months. As far as I can gather there has been no significant change in her overall treatment, however.

I then inquired about the nature of her relationship with her "support person". Ms Uzunovska said that her" support person" was a friend, Fiona, whom she had known since childhood and that they had been friends throughout her life. She said that beside taking her to the shops and appointments her "support person" also took her to the beach or to other areas where they could go for walks. She denied having any Social or Recreational activities that didn't involve either her support person or her family. She also said that she now did not leave the house without the assistance of her support person.

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

I then attempted to address issues specifically raised in the Appeal, that had not been adequately addressed in the original MAC.

I initially asked about some of the reports in her psychologist's handwritten notes, specifically that the appointment of 15 April 24, which starts with "At the beach". It appeared from the documentation that the review had been performed via teleconference and that Ms Uzunovska had been at the beach at the time of the conference. She essentially confirmed this although stated that her friend Fiona (her support person) had driven her to the beach, that they occasionally did this and that she had been walking at time of her appointment. She again confirmed that she had been there with a support person describing it as for her 'well-being'.

I then asked about several references to a man that it would appear that Ms Uzunovska expressed some interest in. In an entry in her psychologist's written notes dated 28 May 2024, I noted that her psychologist had written, regarding Ms Uzunovska -" saw the guy again -" what on earth is wrong with me" .... saw him a few times at Salsa place - mostly ignored him. About a month ago - saw him and he came up to her, chatted and apologised." She then further wrote "dating for a month he was narcissistic and wouldn't compromise on anything. Saw each other every day." I read this entry to her and asked how she reconciled this with her apparent incapacity to leave the house alone. She said that she had seen a man whom she had found attractive although denied that there was any relationship between them. She said that she had seen him in front of a Salsa dance studio which she and her "support person" used to sometimes walk by. I asked specifically about the entry stating that she had dated the man over a period of a month on a very regular basis. She denied that this happened. She said she had never dated anyone during the period of her illness. I asked if she had previously dated the man and she was somewhat equivocal about this, saying she could not remember, that she may have a long time ago but certainly not since her injury.

I then asked her about her trip to Macedonia initially questioning as to why she had not actually mentioned this to the Medical Assessor. She said that she had not mentioned it because she did not think it was very important as it was just part of her "healing" rather than a vacation or recreational event. She said that her friend and support person, Fiona had planned to travel to Macedonia where she had family and friends. She said that her psychiatrist Dr Rastogi had encouraged her to undertake the trip and although she had been very hesitant, she eventually decided to go. She said that she managed the plane journey using a variety of relaxation techniques including having a weighted blanket, spraying Lavender spray and undertaking guided meditation with headphones. The flight was not direct, they initially flew to Istanbul and then switched flights for Skopje, in Macedonia. They then travelled to their final destination, Ohrid, which I gather is a seaside resort about 170 km from Skopje. Ms Uzunovska said that she and Fiona shared an apartment, each having their own level in the apartment. Fiona visited friends and went sightseeing, but Ms Uzunovska said that she never left the apartment complex. She said that there was a pool in the complex in which she swam and that she had massages from a masseur that came to the premises. She also said that she had regular facials. I asked specifically about the notation in her GPs notes in which he stated that she had had "fillers" injected. She denied this but said that she had had some form of injection into her face, although she was unable to be clear about what exactly it was - she said it was natural and intended to make her skin smoother and more natural. She said that she had subsequently developed an infection in her face and that perhaps this is what the GP was referring to. She said that she was treated for this in Macedonia with antibiotics. During her time in Macedonia, which she said lasted about four or five weeks, she denied going outside the complex, going to restaurants or involving herself in any activity that was not part of her "healing". She said that any food that she ate was bought to the house by her support person, Fiona. She and Fiona flew back to Australia in August again travelling via Istanbul. She said that she did not notice any particular improvement or deterioration in her condition as a result of her trip overseas.

I also enquired about the reference by Dr Abrera to her having gone on a retreat in the Blue Mountains. She denied that it was a formal retreat but said that she and her friend Fiona were interested in natural healing and had gone there to spend the day immersed in nature, essentially walking in the forest and attempting to commune with the natural environment. She said that this only occurred on one occasion and she has not repeated it.

She acknowledged that she visits her parents in Port Kembla usually one or two times/month. She said that she never drives there but that her support person, Fiona drives her there. I was struck by how much time her friend was providing to her for support over a period of four years and asked her how she was able to do this. Her answer was that Fiona has her own business which gives her a great deal of flexibility in her time and thus is able to be very supportive of Ms Uzunovska.

Overall Ms Uzunovska stated that her condition was unchanged over her four years of illness.

Ms Uzunovska said that there has been no overall change in her symptomatology. She said that she remains anxious and constantly ruminates about what happened to her at school. She is easily distracted and sometimes irritable. She is sad, depressed and often tearful. She experiences regular headaches. She has difficulty sleeping with both initial and interval insomnia and as a result sleeps till late in the morning, often not arising before midday. She is usually fatigued during the day she said because of her poor sleep. She also feels that she has lost all motivation. Overall, she described herself as having lost her sense of herself. She denied any deliberate self-harm and denied suicidal ideation. I asked about alcohol intake, she acknowledged that in the initial period after her injury she had been drinking more heavily although denied that it was ever at a problematic level. Currently she said that she drinks about three classes of wine/month. She denied using tobacco or other illicit medications.

She continues to take desvenlafaxine, 150 mg/day. She said that Dr Rastogi had suggested in the past that she Increase the dose of medication, but she was unwilling to do this as she preferred minimal medication treatment. She had continued to consult her psychologist Ms Atkins up until about three or four months ago when her insurer refused further treatment. She has not initiated any further treatment with her but intends to see Dr Rastogi more regularly perhaps every two months.

She has been consulting Dr Rastogi off and on since July 2023 usually about every two or three months depending on need.

She continues to consult her general practitioner on a regular basis.

Ms Uzunovska was seen via the teleconferencing application Teams. She had some difficulty initially with the application as her computer camera would not turn on. This was distressing for her and eventually she undertook the assessment using her portable phone. She became distressed initially during this process but quickly regained her composure and was able to engage with the interview without any great difficulties. She persisted through an interview that lasted in total about one hour and 20 minutes, although 10-15 minutes of this was consumed in attempting to resolve the camera difficulty. She was dressed in her pyjamas which were quite neat and fashionable and in fact I was unaware they were pyjamas until she pointed this out to me. She was able to respond in detail to the broad number of questions that I raised. She had no difficulty in answering these questions and certainly had no great problems with persistence or focus throughout the interview.

Whilst she sometimes became distressed, on one or two occasions primarily referring to her injury and following the difficulties with the camera, she nevertheless was able to quickly manage this and return appropriately to the interview. She had a range of affect and was able to smile appropriately on occasions as well as be thoughtful. She seemed more distressed than depressed at interview. She was not suicidal.

There was no evidence of any formal thought disorder, delusions or hallucinations.

Using the DSM - 5 classificatory system currently Ms Uzunovska meets the criteria for the diagnosis of:

1. Persistent Depressive Disorder - it is likely that in the past she has previously suffered from Major Depressive Disorder but did not meet the criteria for this disorder, at the time of this interview. The diagnosis was made because of the presence over several years of persistently low mood, with insomnia, fatigue and low energy and difficulties with concentration. This is associated with feelings of hopelessness and helplessness; however, the symptoms are currently not severe enough to warrant the diagnosis of MDD.
2. Generalised Anxiety Disorder. This diagnosis is made because of the presence of persistent feelings of anxiety associated with feelings such as restlessness, tension, headache, insomnia and difficulties with concentration. The symptoms have been present persistently for several years.

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

1. The Appeal Panel adopts the report and findings of Medical Assessor Blom.
2. Medical Assessor Blom noted that the respondent worker answered the questions in his examination with poise and even certainty. He noted that the respondent worker referred to her friend Fiona, throughout the interview as "my support person" and was very clear and unwavering in stating that she never left the house without her "support person". Medical Assessor Blom also noted that the respondent worker denied having dated since her injury and was unwavering in this and appeared genuinely perplexed when questioned about this.
3. The first scale which required assessment by the Appeal Panel is social and recreational activities.
4. Stern JA in Botha v Secretary, NSW Department of Customer Service [2024] NSWSC 781 at [68] considered the aim of Table 11.2 and said: "Rather, the intention in table 11.2 is to provide a tool for assessing the worker's ability to engage in activities that are properly characterised as social or recreational".
5. The Appeal Panel is satisfied that the trip to the Blue Mountains involved some kind of recreational nature trip. During the trip to Macedonia, the respondent worker engaged in activities such as swimming, and having massages, facials and "natural injections". The respondent worker visits her parents once or twice a month with her friend and support person, Fiona. The respondent worker goes on walks and to the beach with Fiona.
6. The Appeal Panel, after considering the evidence and the report of Medical Assessor Blom, accepts that the respondent worker does not leave her home without a support person and if she goes for a walk or to the beach, she is accompanied by her support person. The respondent worker no longer engages in social activities with her friends. The fact that she requires a support person in order to leave her home is consistent with Class 3 rating for social and recreational activities.
7. The second scale which requires assessment is travel. The respondent worker was very clear in the examination with Medical Assessor Blom that she never leaves the house unsupported. However, during the trip to Macedonia, her support person would visit friends and go sightseeing leaving the respondent worker alone in the apartment complex where she would swim in the pool. In short, the respondent worker was away from her home, and at times by herself in the apartment building and its grounds in Macedonia.
8. The Appeal Panel does not accept the appellant's submission that the respondent worker has no deficit or a minor deficit attributable to the normal variation in the general population. The respondent worker cannot travel to new environments without supervision. The Medical Assessor noted that the respondent worker could take a trip to her local pharmacy or a familiar area unaccompanied although she told Medical Assessor Blom that she now did not leave the house without the assistance of her support person.
9. Taking into account the details of the actual trip to Macedonia, which involved two flights and a trip by car, the Appeal Panel considers that although the respondent worker was accompanied by a support person, the ability to undertake such a long and complicated trip without any deterioration in her condition, indicates that her functioning in this scale is mild and an assessment of Class 2 for travel is appropriate.
10. The Appeal Panel having re-examined the respondent worker arrives at an assessment of Class 3 for social and recreational activities and Class 2 for travel. These assessments are the same as made by the Medical Assessor.
11. In summary, the assessment of total WPI by the Appeal Panel was the same as that made by the Medical Assessor. In those circumstances the Appeal Panel will confirm the MAC as the review has not led to a different result and should not be interfered with (Robinson v Riley [1971] 1 NSWLR 403).
12. For these reasons, the Appeal Panel has determined that the MAC issued on 3 July 2025 should be confirmed.