WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of an assessments under four of the psychiatric impairment rating scale (PIRS) categories (travel, social functioning, concentration, persistence and pace, and employability); Held - Appeal Panel found there to be no error in each of the challenged assessments; MAC confirmed.

1. On 27 May 2025 the worker Con Spyrou (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by

Dr Patrick Morris, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 29 April 2025. 2. The appellant relies on the following ground of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act): * the assessment was made on the basis of incorrect criteria, and * the MAC contains a demonstrable error. 3. It is noted that the appellant did not rely on the ground of availability of additional evidence in the formal part of the Application to Appeal but attached to the submissions additional evidence in the form of statement from the appellant. The respondent has had the opportunity to meet the submissions of the appellant and so there is no prejudice to the granting of leave to the appellant to rely on this further ground, and therefore to the extent that it is necessary, the Appeal Panel grants leave to the appellant to rely on the ground of appeal of assessment on the basis of the availability of additional evidence. The question of whether that additional evidence is admitted is dealt with separately below. 4. 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. 5. 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. 6. 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 he 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 not necessary for the worker to undergo a further medical examination because the Appeal Panel did not find error. Absent a finding of error, the Appeal Panel has no power to require the worker to undergo a re-examination: see New South Wales Police Force v Registrar of the Personal Injury Commission of New South Wales [2013] NSWSC 1792.

1. Section 328(3) of the 1998 Act provides that evidence that is fresh evidence or evidence in addition to or in substitution for the evidence received in relation to a medical assessment appealed against may not be given on an appeal by a party unless the evidence was not available to the party before the medical assessment and could not reasonably have been obtained by the party before that medical assessment.
2. The appellant seeks to admit his statement dated 27 May 2025 which essentially addresses where he considers the Medical Assessor has erred in the psychiatric impairment rating scale (PIRS) ratings given in the MAC.
3. The respondent opposes the admission of the additional evidence.
4. The Appeal Panel determines that the evidence should not be received on the appeal because it concerns the ratings given by the Medical Assessor in the contested PIRS categories and seeks to give evidence relevant those categories. The appellant has had the opportunity to provide a statement of evidence and an opportunity to provide a history to the Medical Assessor as well as histories to the various doctors including IMEs whose reports are in evidence. There is no basis for the admission of additional evidence from the appellant in the form of a further statement at this point in the proceedings.

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

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

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

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):

• 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))

Date of injury: 24 February 2022 (deemed) - disease

Body part/s referred: Psychiatric/Psychological Disorders

Method of assessment: Whole Person Impairment**"**

1. The Medical Assessor issued a MAC certifying 7% 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 PIRS as required by the Guidelines as follows:

Persistent Depressive Disorder with anxious distress

1. Takes medications Lexapro 10mg daily and Melatonin 5mg at night and sees his GP on a monthly basis.

Mild impairment. Mr Spyrou is able to live independently. His wife has always done all the household chores. He frequently skips meals and has lost 7kg in weight. He is less interested in his personal appearance and grooming than previously. He requires prompting from his wife to shower and change his clothes at times.

Moderate impairment. Mr Spyrou generally remains quiet and withdrawn at home. He has lost interest in coaching his son's football team. He will occasionally go out with his family at their prompting. He has lost interest in going camping with his family. He said occasionally friends will come and take him out for a coffee. He does not leave his home alone for any social and recreational activities.

No impairment. Mr Spyrou reports no problems driving his car or work truck. He is able to drive his work truck to new locations such as driving from his home near Wollongong to Nowra and to Mittagong for work.

Mild impairment. Mr Spyrou reports some strain in his relationship with his wife due to his psychological symptoms but there have been no episodes of separation or domestic violence. He reports a reasonably good relationship with his two teenage children. He has lost a number of friendships due to his social withdrawal but continues to have contact with two friends who occasionally come and take him out for a coffee.

Mild impairment. Mr Spyrou complains of poor concentration. He finds it more difficult to read complex documents but said he is able to focus on a task for 30 minutes to one hour. He is able to drive to new locations in his truck for work and can drive for 2 to 3 hours at a time without needing to take a break.

Moderate impairment. Mr Spyrou works up to 10 hours a week as a truck driver in his family business and is the company director of his family company. He reports that he only works a few hours a week in this role. I note that the company employs three people and he said that the company is successful. Therefore, I believe there is a significant degree of reliability in Mr Spyrou's work as a relief truck driver and company director in his family business.

1. The worker 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 four of the six PIRS categories, namely self-care and personal hygiene, social and recreational activities, travel and concentration, persistence and pace causing him to make an error in the assessments in these domains as follows:

(a) in assessing Class 1 for travel when he should have assessed Class 2;

(b) in assessing Class 2 for social functioning when he should have assessed Class 3;

(c) in assessing Class 2 for concentration, persistence and pace when he should have assessed Class 3, and

(d) in assessing Class 3 for employability when he should have assessed Class 4.

1. In summary it was submitted that these errors arose because the Medical Assessor did not provide an adequate path of reasoning for his findings in the contested domains which were decided on the basis of incorrect criteria.
2. In summary, the employer State of New South Wales (NSW Fire & Rescue) (the respondent) submitted that the Medical Assessor neither erred nor made an assessment on the basis of incorrect criteria and the MAC should be confirmed. It was submitted that the MAC was adequately reasoned when read as a whole and the findings were open to the Medical Assessor applying his clinical expertise to the assessment.
3. 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.
4. 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 MAC must be read as whole.
5. The Medical Assessor took a history which broadly accords with the other evidence as follows:

"● Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:

Mr Spyrou said he commenced working for Fire & Rescue NSW as a firefighter in 1998. He said that he had started having issues with another firefighter named Mark who was making complaints about him. He said that he had worked with Mark since 2006 and considered him a friend. He said that Mark had had personal issues and had been admitted on a number of occasions to psychiatric hospitals.

Mr Spyrou said in 2019 Mark made an official complaint against him including of Mr Spyrou putting a plastic bag over Mark's head. Mr Spyrou said he was investigated and threatened with dismissal. He said he was accused of "bullying and harassment". He said there was a lack of communication and lack of support from Fire & Rescue NSW at that time.

Mr Spyrou said he took some time off work as his mother had died suddenly. He said the other firefighter, Mark, was moved to a new Fire Station and Mr Spyrou had less contact with him.

In the period from 2019 to 2022, Mr Spyrou said there were further investigations into complaints Mark had made against him. He felt very stressed at the time. He said that another firefighter had told him that Mark had made a threat against Mr Spyrou's employment with Fire & Rescue NSW.

In February 2022, Mr Spyrou said an Inspector came into the Fire Station and said all the members of the team there would be investigated by Professional Standards and Mr Spyrou felt extremely anxious. He said the next day he had a meeting with the Superintendent and was given information that he was being investigated for bullying and harassment of Mark and other firefighters and he was told not to discuss this with anyone. He became extremely stressed and went off work and has been off work on medical certificates since then.

Mr Spyrou said his GP, Dr Loo, put him on Propranolol medication for anxiety. He changed to a new GP, Dr Buckingham, who ceased the Propranolol and commenced him on Lexapro 10mg daily and Melatonin 5mg at night.

Mr Spyrou said he saw a psychologist, Sarah Gomes, for five or six sessions in late 2024- early 2025. He said that he has never been referred to a psychiatrist.

Mr Spyrou said he was discharged from Fire & Rescue NSW at the end of March 2025.

Mr Spyrou said that he has continued to feel depressed and anxious.

Mr Spyrou takes the medication Lexapro 10mg in the morning and Melatonin 5mg at night. He sees his GP on a monthly basis.

Mr Spyrou reported that his mind "races" and he generally feels very anxious. He occasionally has symptoms of heart palpitations and chest tightness. He said that he is restless and edgy most of the time.

Mr Spyrou reports having less pleasure and enjoyment in his life now. He said that he is more tearful than previously. He reports problems with lethargy and lack of motivation. He reports having poor concentration. His appetite is poor and he has lost 8 to10kg in weight. His sleep is poor even when taking the Melatonin medication. He reports having a low energy level. He reports having very low self-esteem. He said that he tries to avoid social interactions. He has trouble making decisions. He feels hopeless at times but does not have suicidal ideation.

On a rating scale from zero to 10, where zero is the worst he could imagine feeling and 10 is how he was feeling before his work problems began, Mr Spyrou rated himself currently as 4-5 out of 10.

• Details of any previous or subsequent accidents, injuries or condition:

Mr Spyrou reported no psychiatric symptoms prior to his work problems beginning in 2019.

Mr Spyrou said his mother died suddenly in 2019 and his father died in 2024 after a long illness. He reported having a normal grief reaction to these losses.

Mr Spyrou said he drinks 3 to 4 standard drinks of alcohol per week. He said he smokes less than 10 cigarettes per day. He said he does not use illicit drugs.

Mr Spyrou takes medication for hypercholesterolaemia.

• Work history including previous work history if relevant:

Mr Spyrou was born in Wollongong. He completed Year 12 at school and the Higher School Certificate. He then completed an electrician's apprenticeship over a four year period and worked as an electrician for one or two years. He then worked in his father's transport business as a truck driver for three years before joining Fire & Rescue NSW as a firefighter in 1998.

Mr Spyrou said he owned a transport business whilst working for Fire & Rescue NSW and did some driving for it. Since stopping work for Fire & Rescue NSW in February 2022, he has continued to run his transport business. This involves having two trucks which are involved in providing material for road repairs. He is the director of the business. He employs two drivers and his wife in full-time administration. He said that he is certified to do 10 hours of driving per week. He is also involved in administration work as a director. He said that his company is successful.

Mr Spyrou has been married since 2006 and has two children aged 17 and 15.

Mr Spyrou lives in Wollongong in his own home with his wife and two children. He said his wife has always done all the shopping, cooking, house cleaning and clothes washing.

He said that he now needs prompting from his wife sometimes to shower and change his clothes. He said he does not shave regularly. He is less interested in his personal grooming than previously. He said that he frequently skips meals and has lost weight.

Mr Spyrou said he does not leave his home alone for any social or recreational activities. He said that occasionally friends will come and take him for a coffee at their prompting. He is no longer able to coach his son's soccer team. He is less interested in going camping with his family now. He reported being able to drive wherever he needs to go including driving trucks in his work."

1. The Medical Assessor conducted a mental state examination and recorded his findings as follows:

"Mr Spyrou was a casually dressed, bespectacled, unshaven man of stated age. He was cooperative but withdrawn in his manner. His speech was of normal rate and flow. His mood was depressed and anxious. His affect was appropriate to his mood with limited reactivity. There was no formal thought disorder and no psychotic symptoms.

Mr Spyrou was alert and oriented and able to answer questions appropriately during the course of the assessment."

1. The Medical Assessor summarised the injury and diagnosis as follows:

In my opinion, Mr Spyrou has the psychiatric condition of Persistent Depressive Disorder with anxious distress according to DSM-5 diagnostic criteria.

This condition emerged as a result of the work-related stressors he experienced working for Fire & Rescue NSW from 2019 until he left work in February 2022.

Mr Spyrou was consistent in the presentation of his symptoms and history. He did not appear to be exaggerating or minimising his clinical condition."

1. The Medical Assessor outlined the facts on which his assessment was based as follows:

"The facts on which I have based my assessment of whole person impairment are:

• my interview with Mr Spyrou on 16 April 2025;
• the Application and attached documents;
• the Reply and attached documents."

1. The Medical Assessor assessed a total of 7% WPI based on the scores in the PIRS Table as set out above.
2. The Medical Assessor made brief comment on the other medical evidence that was before him as follows:

"My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reasons why my opinion differs.

I note a report on Mr Spyrou by Dr Richa Rastogi, psychiatrist, dated 3 November 2023. Dr Rastogi gave Mr Spyrou the diagnosis of Adjustment Disorder with anxious distress.

I note a further report on Mr Spyrou by Dr Rastogi dated 18 September 2024. In that report Dr Rastogi gave Mr Spyrou the diagnosis of Chronic Adjustment Disorder with anxious distress, whereas I have given Mr Spyrou the diagnosis of Persistent Depressive Disorder with anxious distress as I believe that he has significant depressive and anxiety symptoms of long enough duration to warrant this diagnosis.

In her report dated 18 September 2024, Dr Rastogi gave Mr Spyrou a final whole person impairment rating of 15% whereas I have given him a final whole person impairment rating of 7%. Where Dr Rastogi differed from me in her ratings was for Self-care and personal hygiene where she rated Mr Spyrou a Class 1, whereas I have rated him a Class 2. I rated Mr Spyrou a Class 2 as he reports that he frequently skips meals and has lost 8-10kg in weight. He is less interested in his personal appearance now and often does not bother to shave. He was unshaven at the assessment. He said that sometimes he requires prompting from his wife to shower and change his clothes.

Dr Rastogi rated Mr Spyrou a Class 2 for Travel whereas I have rated him a Class 1 as he has reported no problems being able to drive himself either in his car or work truck. He said that in his truck he can drive to new locations without a problem, including driving from his home near Wollongong to Mittagong or Nowra.

Dr Rastogi rated Mr Spyrou a Class 3 for Concentration, persistence and pace whereas I have rated him a Class 2. I rated Mr Spyrou a Class 2 as he reports being able to focus on work tasks for 30 minutes to an hour before needing to take a break and being able to drive to new locations for up to two hours without needing to take a break.

Dr Rastogi rated Mr Spyrou a Class 4 for Employability/adaptation whereas I have rated him a Class 3. I rated Mr Spyrou a Class 3 as he reports being able to drive up to 10 hours per week as a truck driver in his own family business. He also has responsibilities as the sole director of the family business which employs three people, and which he said is operating successfully. I believe this best fits a Class 3 rather than Class 4 level of impairment for Employability as I believe there is a good degree of reliability in his work functioning in these roles.

I note a supplementary report by Dr Rastogi dated 18 September 2024 in which she focussed upon Mr Spyrou's employability. Dr Rastogi wrote, "...I am of the opinion given his ongoing symptoms of anxiety with poor coping threshold and vulnerabilities with treatment just commenced, he does not have capacity to work 20 hours a week."

I have given Mr Spyrou a Class 3 rating for Employability and note that this rating includes a reference to working less than 20 hours per week in a different position which requires less skill or is qualified as different, e.g. less stressful, than his previous work as a firefighter. I believe that Mr Spyrou's work in his family business best fits a Class 3 rather than Class 4 rating which involves working less than 20 hours per fortnight with reduced pace and erratic attendance. I took into consideration that Mr Spyrou's family business employs three people and he said it is operating successfully. Therefore, I believe there is a degree of reliability in Mr Spyrou's work performance in his family business which would fit him better into a Class 3 rating for Employability.

I note a report on Mr Spyrou by Dr Judith Clarke, psychiatrist, dated 4 December 2023. Dr Clarke had given Mr Spyrou the diagnosis of Adjustment Disorder with anxiety.

I note a further report on Mr Spyrou by Dr Clarke dated 11 December 2024. Dr Clarke gave Mr Spyrou the diagnosis of chronic Adjustment Disorder with anxiety, in partial remission whereas I have given Mr Spyrou the diagnosis of Persistent Depressive Disorder with anxious distress as I believe that he has sufficient current depressive and anxiety symptoms and a clinical history of longer than two years to fulfil this diagnosis.

In her report dated 11 December 2024, Dr Clarke gave Mr Spyrou a final whole person impairment rating of 7% which is the same as I have given Mr Spyrou. Where Dr Clarke differed from me were in her ratings for Self-care and personal hygiene where she rated Mr Spyrou a Class 1 whereas I have rated him a Class 2 for the reasons I have outlined above. Dr Clarke rated Mr Spyrou a Class 2 for Travel whereas I have rated Mr Spyrou a Class 1 for the reasons I have outlined above.

I note a report on Mr Spyrou by Ms Ellana Iverach, psychologist, dated 23 June 2022. Ms Iverach wrote, '...During our sessions you have reported pervasive symptoms of difficulty concentrating and making decisions, ruminating thoughts of worry, sleep disturbances and distressing dreams, fatigue, tightness in chest, and feeling on edge or restless.'

I note a report on Mr Spyrou by his GP, Dr Daniel Buckingham, dated 10 August 2023. Dr Buckingham wrote, '...Diagnosis - stress response / adjustment disorder with anxiety, low mood and panic symptoms.'

I note a letter from Ms Sarah Gomes, psychologist, regarding Mr Spyrou to his GP, Dr Buckingham, dated 9 September 2024. Ms Gomes wrote, '...During our initial session, Con reported symptoms consistent with anxiety and panic, reporting hypervigilance, feeling on edge, withdrawal from social life, loss of confidence, ruminating and over thinking of negative cognitions. Con also reported episodes of panic, where he feels heavy, heart racing and feels 'worked up'. In addition, Con reported loss of interest and pleasure in activities, poor sleep, low energy and motivation, and anhedonia.' Ms Gomes wrote, '...A DASS assessment indicated that Con had symptoms associated with moderate depression, mild anxiety and mild stress.' She recommended psychological therapy 'including CBT, ACT, DBT, Mindfulness and Psychotherapy'.

I note an earning capacity assessment written by Sophia Fitzgerald, Vocational Assessor & Labour Market Analysis Assessor and Senior Rehabilitation Consultant (registered psychologist), dated 19 August 2024. Ms Fitzgerald wrote, '...Based on the outcome of the assessment, he appears to have capacity to work up to full-time hours in truck driving or similar type of role ... In response to whether Mr Spyrou could work in a management role working 20 hours per week, at the time of the assessment, it is unlikely that Mr Spyrou would be able to effectively perform a management role on 20 hours per week unless there is further improvement in his symptoms as the psychological cognitive demands of a management role are likely to exceed his current coping abilities at the current time.'

I have given Mr Spyrou a Class 3 Moderate impairment rating for Employability for the reasons I have outlined above."

1. The appellant complained about four of the assessments in the categories of travel, social functioning, concentration, persistence and pace and employability. The Appeal Panel will now deal with each contested category in turn.

1. In respect of Travel, Table 11.3 of the Guides provides as follows:

Table 11.3: Psychiatric impairment rating scale - travel

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

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

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

Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person.

Totally impaired: may require two or more persons to supervise when travelling.

1. The Medical Assessor rated Class 1 (no deficit or consistent with normal variation in the population) with the following reasoning:

"No impairment. Mr Spyrou reports no problems driving his car or work truck. He is able to drive his work truck to new locations such as driving from his home near Wollongong to Nowra and to Mittagong for work."

1. The appellant submits that a Class 1 rating was given in error and a Class 2 or 3 should have been assessed. The appellant submitted that a higher Class should have been assessed because of "excessive anxiety".
2. The MAC must be read as whole. The Medical Assessor is clearly cognisant of the varying IME opinions. He notes Dr Clarke and Dr Rastogi's rating of Class 2. He comments specifically on Dr Rastogi's rating of Class 2 as follows:

"Dr Rastogi rated Mr Spyrou a Class 2 for Travel whereas I have rated him a Class 1 as he has reported no problems being able to drive himself either in his car or work truck. He said that in his truck he can drive to new locations without a problem, including driving from his home near Wollongong to Mittagong or Nowra."

1. Given the appellant is a professional driver who is able to drive without supervision to places beyond the local area, the Appeal Panel can discern no error in the rating of Class 1 for which adequate reasons were given.
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 Medical Assessor assessed Class 2 with the following reasoning:

"Mild impairment. Mr Spyrou reports some strain in his relationship with his wife due to his psychological symptoms but there have been no episodes of separation or domestic violence. He reports a reasonably good relationship with his two teenage children. He has lost a number of friendships due to his social withdrawal but continues to have contact with two friends who occasionally come and take him out for a coffee."

1. The appellant submitted that the Medical Assessor should have assessed a moderate impairment at Class 3. Both IMES Dr Rastogi and Dr Clarke rated Class 2 or mild impairment in this domain.
2. Social functioning is concerned with the quality of relationships. Whilst there has been tension in the marital relationship it is not characterised by separation or domestic violence which is necessary for a Class 3 rating. A good relationship with his teenage children is maintained by the appellant. While there has been some loss of friendships, this is consistent with the criteria for Class 2. The appeal panel can discern no error in the Class 2 rating.
3. In respect of concentration, persistence and pace, Table 11.5 of the Guides provides as follows:

No deficit, or minor deficit attributable to the normal variation in the general population. Able to pass a TAFE or university course within normal time frame.

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 (eg operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.

Severe impairment: can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.

Totally impaired: needs constant supervision and assistance within institutional setting.

1. The Medical Assessor rated Class 2 (mild impairment) with the following reasoning:

"Mild impairment. Mr Spyrou complains of poor concentration. He finds it more difficult to read complex documents but said he is able to focus on a task for 30 minutes to one hour. He is able to drive to new locations in his truck for work and can drive for 2 to 3 hours at a time without needing to take a break."

1. The appellant submitted that a Class 3 or moderate impairment should have been assessed in this domain. The appellant submitted:

"Assessor Morris has found mild impairment on the basis that the worker is able to drive his truck for work and can drive 2 to 3 hours without needing a break. These examples are not appropriate for this category and do not demonstrate that he can focus on intellectually demanding tasks as set out in the PIRS for rating 2."

1. The Appeal Panel notes that the appellant has interpreted the Medical Assessor's determination of mild impairment in this category in a limited manner. While professionally driving for his own company, the appellant must navigate, collect and make appropriate deliveries at the right time and deal with people on site. This is more extensive and demanding than merely travelling to an unfamiliar place. The appellant is certified to work 10 hours a week and does so in blocks longer than 30 to 60 minutes. During these times, he relies on sustained concentration, persistence and pace. Additionally, he assumes the role of company director, overseeing his successful company, directing other employees, and handling some administrative tasks.
2. The Medical Assessor was cognisant of the opinions of the IMEs. Dr Clarke also rated a Class 2. Dr Rastogi who rated a moderate impairment at Class 3 and the Medical Assessor clearly explained why his opinion differed as follows:

"Dr Rastogi rated Mr Spyrou a Class 3 for Concentration, persistence and pace whereas I have rated him a Class 2. I rated Mr Spyrou a Class 2 as he reports being able to focus on work tasks for 30 minutes to an hour before needing to take a break and being able to drive to new locations for up to two hours without needing to take a break."

1. The Medical Assessor must make his own independent assessment using his clinical expertise not based on self-report alone. This is what the Medical Assessor has done here. The Appeal Panel can discern no error in the rating of a mild impairment or Class 2 for concentration, persistence and pace for which rating the Medical Assessor has given adequate reasons that accord with the correct criteria in the Guidelines.
2. In respect of Employability, Table 11.6 of the Guides provides as follows:

No deficit, or minor deficit attributable to the normal variation in the general population. Able to work full time. Duties and performance are consistent with the injured worker's education and training.

The person is able to cope with the normal demands of the job.

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 one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic.

Table 11.6: Psychiatric impairment rating scale - employability

1. The Medical Assessor rated Class 3 with the following explanation:

"Moderate impairment. Mr Spyrou works up to 10 hours a week as a truck driver in his family business and is the company director of his family company. He reports that he only works a few hours a week in this role. I note that the company employs three people and he said that the company is successful. Therefore, I believe there is a significant degree of reliability in Mr Spyrou's work as a relief truck driver and company director in his family business."

1. What the Medical Assessor has done here is make his own independent assessment based on his clinical expertise having due regard to the appellants self-report as well as the other medical evidence before him including the other IME opinion. Dr Clarke rated a Class 2. Dr Rastogi rated a Class 3 and the Medical Assessor specifically addressed why his opinion differed as follows:

"Dr Rastogi rated Mr Spyrou a Class 4 for Employability/adaptation whereas I have rated him a Class 3. I rated Mr Spyrou a Class 3 as he reports being able to drive up to 10 hours per week as a truck driver in his own family business. He also has responsibilities as the sole director of the family business which employs three people, and which he said is operating successfully. I believe this best fits a Class 3 rather than Class 4 level of impairment for Employability as I believe there is a good degree of reliability in his work functioning in these roles.

I note a supplementary report by Dr Rastogi dated 18 September 2024 in which she focussed upon Mr Spyrou's employability. Dr Rastogi wrote, '...I am of the opinion given his ongoing symptoms of anxiety with poor coping threshold and vulnerabilities with treatment just commenced, he does not have capacity to work 20 hours a week.'

I have given Mr Spyrou a Class 3 rating for Employability and note that this rating includes a reference to working less than 20 hours per week in a different position which requires less skill or is qualified as different, e.g. less stressful, than his previous work as a firefighter. I believe that Mr Spyrou's work in his family business best fits a Class 3 rather than Class 4 rating which involves working less than 20 hours per fortnight with reduced pace and erratic attendance. I took into consideration that Mr Spyrou's family business employs three people and he said it is operating successfully. Therefore, I believe there is a degree of reliability in Mr Spyrou's work performance in his family business which would fit him better into a Class 3 rating for Employability."

1. The Appeal Panel can discern no error in the assessment of Class 3 as the Medical Assessor's findings accord with the criteria for that class and it is the best fit.
2. For these reasons, the Appeal Panel has determined that the MAC issued on 29 April 2025 should be confirmed.