WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; appellant worker alleged assessment on the basis of incorrect criteria; demonstrable error in the making of assessments under three of the psychiatric impairment rating scale (PIRS) categories for social and recreational activities, concentration, persistence and pace and employability; Held - Appeal Panel considered that the Medical Assessor's path of reasoning was inadequate; it was not clearly discernible from the reasons given in the Medical Assessment Certificate (MAC) that the assessments under the contested PIRS categories were based upon the correct criteria; re-examination was considered necessary in the circumstances of a finding of error; MAC revoked.

1. On 11 August 2025 the worker Paula Williams (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Surabhi Verma, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 14 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 grounds of appeal on which the appeal is made.
4. Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
5. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed

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

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

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

1. Medical Assessor Michael Hong of the Appeal Panel conducted an examination of the worker and reported to the Appeal Panel.

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

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

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

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

• Date of injury: 20 January 2023
• Body parts/systems referred: Psychiatric/Psychological disorder
• 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 AMA 5 Guides

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

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

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

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

1. Major Depressive Disorder with anxious distress.

Ms William Showers irregularly and mostly remain in her pyjamas. She said that she cannot be "bothered to shower." However, she is quite cognisant of her physical comorbidities and exercises, for that she uses a walking pad to "keep moving." She recently gained weight from 67 to 83 kg and underwent a bariatric surgery just seven weeks back.

She previously used to enjoy swimming, walking. However, she no longer goes for swimming as she finds it difficult to leave her house. She prefers to walk on her walking pad at home. She used to catch up with her friends every three to four weeks especially with her work friends. She also had another group of friends whom she used to work with and met them every four to six weeks. After the incident at work, people used to come over, but "their lifestyles have changed and they have children" and hence, they stopped coming. She said that she calls up "different friends at different times." She has attended 60 birthday party of her friend at Penrith League. She also attended other friends' birthday parties. She has been able to attend grandchildren's birthday, but at times she has to go out and get away from the noise. She talks to her sister every four to five weeks whom she finds quite supportive. Her son visits her on a weekly basis. She sees her grandchildren every Sunday. She finds "joy when she sees them but is also glad when they leave." Her grandchildren play basketball, tennis and do paintings when she babysits for them every Sunday.

She leaves her house to go for medical appointments on her own, she added that her husband accompanies her for grocery shopping at times. She took a holiday in April 2020 and travelled to Vietnam and Cambodia and stayed there for 20 days which she enjoyed doing.

Her husband has been quite supportive and understand that it is difficult for her to do things. He tries to encourage her to be engaged in day-to-day chores. Her sons too have been quite supportive.

Ms William reported that she is able to manage her finances on her own and has been able to budget depending on her income and has been able to focus on that. She, however, reported having overall "bad concentration." She is, however, able to play video games for "couple of hours every day and mostly spends time playing word games on her iPad which is a single player game." She has been gaining levels consistently in these games.

Ms William's ability to remain employed is impacted both by her physical and psychological symptoms. I believe that psychologically she cannot work for more than one or two days at a time, less than 20 hours per fortnight.

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 she made under three of the six PIRS categories, namely social and recreational activities, concentration, persistence and pace and employability causing her to make an error in the assessments in these domains as follows:

(a) in assessing Class 2 for social and recreational activities when she should have assessed Class 3;

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

(c) in assessing Class 4 for employability when she should have assessed Class 5.

1. In summary it was submitted that these errors arose because the Medical Assessor did not provide an adequate path of reasoning for her findings in the contested domains and it could not be discerned on a fair reading of the MAC whether the assessments had been made on the basis of correct criteria.
2. In summary, the employer Secretary, Department of Communities & Justice (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 her clinical expertise to bear and exercise her 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 Appeal Panel considered that the path of reasoning was inadequate, and it was not clearly discernible from the reasons given that the assessments under the contested PIRS categories were based upon the correct criteria.
5. In these circumstances of the above finding of error, the Appeal Panel considered that a

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

Ms Williams is 62 years old, and joined the Department of Communities and Justice in 2002 and ceased working in February 2023. She has no past psychiatric history and her anxiety and depressive symptoms commenced in January 2023.

After the MAC in July 2025, Ms Williams continues to have anxiety and depressive symptoms, and has not felt changed.

Ms Williams said her psychologist told her, she had sufficient treatment, including desensitisation and Cognitive behavioural therapy, therefore treatment ended in June 2025. She has never consulted a psychiatrist, due to a lack of psychiatrists locally. She continues to take Mirtazapine 45 mg and Desvenlafaxine 150mg. She has been on the same medications a long time.

She checked her phone and confirmed she is not on other psychotropic medications.

Ms Williams has chronic anxiety and depressive symptoms.

She reported chronically disrupted sleep despite Mirtazapine, and her psychologist referred her to an Insomnia course with mild benefit. She generally only sleeps 4-5 hours. She sleeps at 2am and generally watches TV aimlessly before that. She uses sleep hygiene and sleep management.

Ms Williams's anxiety symptoms are triggered by "everything", and said she struggles to leave home and has to force herself out. She only goes to her GP on her own, and generally goes to other places with her husband.

She reported having major problems with her concentration and memory, and said she read something, then rereads the same material as she cannot remember it. She uses a highlighter to help her remember important pieces of information. She said she read all the reports for the compensation claim this way. She asks her husband to read and explain things to her. She said she can only read and focus for 5-10 minutes, but it does not mean she can comprehend or understand the information. She said she cannot put things together based on step by step instructions, e.g. she bought a flatpack chest drawer a couple of months ago, but she could not put it together.

Ms Williams said she is a bit short and does not have major problems with her temper. She babysits her grandchildren every Sunday, but she is not as tolerant with them making noises. They are 8 and 4 years old, and her husband helps sometimes, but he is "not super great". She used to take them to the park but not now, they only do home-based activities, e.g. board games and she sets up computer games for them, indoor bowling and table tennis.

She drives in the local area, around 20-25km, to see doctors.

In terms of pre-injury hobbies, Ms Williams likes swimming and used to take walks, and socialise. She said she does not take walks now or socialise. I asked about the treadmill, she said she was using it when assessed by the other doctor, but not now.

She said she does not have any social activities or recreational activities.

She said she has no friends now. I asked seeing her friends, she said she only contact them by Facebook social media or texts, that is, she still has some friends. In terms of seeing her family, she said her son comes weekly with the grandchildren.

I asked about social functions and birthday parties. She went to a party at her girlfriend's house in March 2023 for 1 hour, she had panic attacks and left. She went to another party 2 years ago at the Penrith club, for only 1 hour and left.

She said she has grandchildren's birthday at her home, her children and daughter-in-law's family all come for a couple of hours, and she only had

2 parties this year, with around 15 people, all family members. She said she struggles with this too.

She has one sister and she moved back to NSW, and lives an hour away. Her sister visits her every 6 weeks, they chat and catch up.

I asked about holidays, she said it was in April 2023 to Vietnam and Cambodia, including a cruise, and it was organised in advance. Tt was a couple of months after she ceased work. She said it was stressful and ok, some parts were enjoyable, and she met people and went on daily tours.

I asked about daily activities. She said she plays video games on her computer, including matching games. She said she has been on the same level and not gained level as claimed by the MA, and she only plays 5 minutes, and it is incorrect she plays for hours, she plays daily, only 10-15 minutes. She plays word games too. She does not play with anyone.

She has osteoporosis, lupus and arthritis and said on medications, these are managed.

On weekends, she goes shopping with her husband. He retired in December 2024.

Ms Williams was assessed by video. She was at home on her own during the assessment. She was neatly attired and wore glasses. She had short greying hair and rocked throughout the assessment. She engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. She was moderately restricted in her affect range and reactivity. She spoke spontaneously. She was not thought disordered.

Before I completed the assessment, I asked her for additional information that she wanted to add and she discussed everyone said she is unwell, the likelihood she gets better is not good, but she is not crazy. She said her life has been taken away, she cannot do anything, cannot work or do anything. Her return to work chance is slim.

Ms Williams only attended 2 birthday parties in 2025. She only had one holiday with her husband, since her psychological injury at work, in April 2023 and felt stressed, and was able to enjoy parts of it.

She disputed some of the previously recorded history. She plays video games daily, but only for a limited time and not as much as the Medical Assessor had previously recorded. She initiates some recreational activities, including video games, and is actively engaged, and does not need prompting or a support person, and does on her own.

I also noted some recreational activities are social by nature.

I have not identified a need for a support person or incapacity to initiate activities, and also noted her recreational activities are not rare having considered her age, gender and culture. I noted the IMEs have not identified a need for prompting or a support person either.

She used to read books, and this has stopped because of concentration difficulties. She rereads the same material and generally only reads 10-15 minutes.

She does not have the capacity to focus on intellectually demanding tasks for 30 minutes.

Noting her anxieties, avoidant behaviour and specific mindset impact on her capacity to work and concluded, she has no work capacity.

1. The Appeal Panel considers that the examination undertaken by Medical Assessor Michael Hong was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Michael Hong has provided in his report to the Appeal Panel, including the history as to the appellant's ability to function in the PIRS categories that have been challenged on appeal, namely social and recreational activities, concentration, persistence and pace and employability. The Appeal Panel notes that Medical Assessor Michael Hong had clear regard to the other evidence before him, has not relied on self-report alone and has used his clinical expertise on the day of assessment to make recommendations to the Appeal Panel about the assessments of the contested PIRS categories. The Appeal Panel notes Medical Assessor Michael Hong's findings on clinical examination of the appellant. The Appeal Panel agrees with and adopts the findings of Medical Assessor Michael Hong.
2. In respect of social and recreational activities, Table 11.2 of the Guides provides as follows:

Table 11.2: Psychiatric impairment rating scale - social and recreational activities

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

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

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

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

Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.

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

"Ms Williams only attended 2 birthday parties in 2025. She only had one holiday with her husband, since her psychological injury at work, in April 2023 and felt stressed, and was able to enjoy parts of it.

She disputed some of the previously recorded history. She plays video games daily, but only for a limited time and not as much as the Medical Assessor had previously recorded. She initiates some recreational activities, including video games, and is actively engaged, and does not need prompting or a support person, and does on her own.

I also noted some recreational activities are social by nature.

I have not identified a need for a support person or incapacity to initiate activities, and also noted her recreational activities are not rare having considered her age, gender and culture. I noted the IMEs have not identified a need for prompting or a support person either."

1. The Appeal Panel considers that based on the findings on re-examination, the best fit is a mild impairment or Class 2 for social and recreational activities. The Panel notes the Medical Assessor on re-examination did not identify a need for a support person or incapacity to initiate activities, and also noted her recreational activities are not rare. In accordance with the correct criteria the best fit is Class 2 or mild impairment. It is noted that this is the same rating given by the Medical Assessor.
2. 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 (e.g. 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 Appeal Panel adopts the findings of Medical Assessor Hong on re-examination as follows:

"She used to read books, and this has stopped because of concentration difficulties. She rereads the same material and generally only reads 10-15 minutes.

She does not have the capacity to focus on intellectually demanding tasks for 30 minutes."

1. The Appeal Panel agrees that based on these findings, the best fit is a moderate impairment or Class 3 for concentration, persistence and pace, noting that she does not have the capacity to focus on intellectually demanding tasks for 30 minutes. This is the greater than the impairment rating accorded by the Medical Assessor.
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.

1. Medical Assessor Hong reported his findings on re-examination to the Appeal Panel as follows:

Noting her anxieties, avoidant behaviour and specific mindset impact on her capacity to work and concluded, she has no work capacity."

1. The Appeal Panel agrees that based on these findings, the best fit is total impairment or Class 5 for employability. This is greater than the impairment rating accorded by the Medical Assessor.
2. What this means is that the class assessed by the Appeal Panel is in accordance with the class assessed by the Medical Assessor for the contested PIRS categories of social and recreational activities at Class 2 or mild impairment. In respect of the class of concentration, persistence and pace the assessment of the Appeal Panel differs from that of the Medical Assessor and is assessed at a moderate impairment or Class 3. In respect of employability the assessment of the Appeal Panel differs from that of the Medical Assessor and is assessed at Class 5 or severe impairment.
3. This means the calculations become as follows:

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

14 July 2025 be revoked and a new MAC issued. The new certificate is attached to this statement of reasons.

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act 1998.

The Appeal Pane revokes the Medical Assessment Certificate of Medical Assessor Surabhi Verma and issues this new Medical Assessment Certificate as to the matters set out in the table below:

The above assessment is made in accordance with the Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA 5 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)