1. On 7 May 2025 the worker Karen Cormie (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 9 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 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. 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 further evidence as follows:

(a) Report from Ms Natalie Wong, psychologist, dated 16 April 2025, and

(b) Report from Dr Nick Dutton, GP, dated 28 April 2025.

1. The respondent opposes the admission of the additional evidence.
2. 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 psychiatric impairment rating scale (PIRS) categories and seeks to give evidence relevant those categories. The appellant has had the opportunity the medical evidence upon which she relies prior to the medical assessment taking place. There is no basis for the admission of additional evidence from the appellant in the form of further medical reports 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. Medical Assessor Ash Takyar 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: 1 April 2023 to 30 January 2024
• Body parts/systems referred: Psychiatric / Psychological Disorder
• Method of assessment: Whole person impairment."

1. The Medical Assessor issued a MAC certifying 6% whole person impairment (WPI) as a result of the injury as follows:

page and paragraph number in NSW workers compensation guidelines

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

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

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

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

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

Ms Woodcraft reported that she does not showers as 'as often she should and showers only every second or third day.' She brushes her teeth most days and changes into clothes every second day. She procrastinates doing her household chores and relies on microwave meals. She was at one point skipping meals and only had two meals instead of three to address her pre-diabetic status. She tries to microwave meals so that she does not have food regularly. She has lost about 9 kg both because of keto diet and skipping meals to address the pre-diabetic status.

Ms Woodcraft earlier enjoyed attending choir sports on Monday nights, did roller skating on weekends, crocheting, catching up with friends. She said that she continues to attend the sports activity and choir every alternate week instead of doing it on a weekly basis. She reported that her friends have been quite supportive and she was lucky to have them. They invite her to events. She said that she went out with them last Sunday afternoon but did not attend the dinner with them.

She is able to socialise with her friends on weekends and also communicate regularly with them via chatting in messenger. She met up with her family members after Christmas. Her housemates are very supportive and also check up on her. She continues to enjoy crocheting, sewing, rollerblading and skating and gardening. However, does not engage in these activities as frequently as before.

She takes her dog to the dog park and goes for a walk every day. She is able to drive to the local shops. She drives to the sports centre which is about 15 minutes' drive and choir, which is about 20 minutes' drive. She does not drive long distances as she feels she might have 'road rage.' She feels anxious when she drives and hence occasionally has to smoke.

Ms Woodcraft reported that she has good relationship with her siblings but does not meet up with them often as they work. She has been single for more than six years. She has not lost any friendships.

Ms Woodcraft reported that her attention and concentration is 'short.' She is unable to make complex crocheting patterns as before, but continues to make granny squares. She watches movie but at times is unable to follow the storyline. She is able to manage her finances and is staying on top of paying the bills.

She reported that she feels quite fatigued and exhausted when she does any activities and has to sleep to recover from that. Objectively, Ms Woodcraft scored 3/3 on 3-word repeat and 3/3 on 3-word recall. She was able to see 100 - 7 up to five steps without any mistakes. She was also able to focus and pay attention during the appointment.

Ms Woodcraft reported that she has been thinking about working again and believes that she would not be able to go to marketing but was not sure what she would be able to do. She said that her plan often changes and she feels very ambivalent about one particular role. Ms Woodcraft's current mental health symptoms will preclude her from engaging in any form of employment currently.

Deduction for the existing impairment = 1/10 of 7% = 0.7.

1. The worker appealed.
2. In summary, the appellant submitted that the Medical Assessor erred in failing to allow for the effects of treatment and in making a deduction of one-tenth when it should have been 2%. The Appeal Panel notes that if the rest of the MAC was confirmed the deduction of 2% would give a 5% WPI as opposed to the 6% WPI certified by the Medical Assessor if the appellant's submissions were accepted.
3. In summary, in addition, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments she made under four of the six PIRS categories, namely self-care and personal hygiene, social and recreational activities, social functioning and concentration, persistence and pace, causing her to make an error in the assessments in these domains as follows:

(a) in assessing Class 2 for self-care and personal hygiene when she should have assessed Class 3;

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

(c) in assessing Class 1 for social functioning when she should have assessed Class 2.

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.
2. It was also submitted that the rating of Class 5 for employability or a severe impairment is so at odds with the lower ratings in other categories, that there must be error. There is no weight to this submission, the domains in each of the PIRS categories are rated separately and a severe impairment in one category cannot and does not mean that lower ratings accorded to other domains are erroneous as the criteria for each category is category specific.
3. In summary, the employer CBHS Health Fund Limited (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. Essentially it was submitted that the MAC was adequately reasoned when read as a whole and the findings were open to the Medical Assessor applying her clinical expertise to the assessment.
4. 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 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.
5. 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.
6. 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 Ash Takyar was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):

1. WORKER'S DETAILS INCLUDING
   • Date of examination: 1 October 2025
   • Date of birth and age at examination: 21 September 1986, 39 years
   • Hand dominance: Right-handed
   • Details of who attended the examination: Daniel Jones, support person
   • Date of injury: 1 April 2023 to 30 January 2024
   • Employer and occupation: Marketing Manager - CBHS Health Fund
2. HISTORY RELATING TO THE INJURY

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

Ms Woodcraft confirmed the history of her injury at CBHS, which was discussed with her. With respect to paragraph three of this section within the MAC, she commented, 'My role didn't change at that point, it was still the same position', with no change during her employment, she explained.

She currently sees Dr Nick Dunn at Harold Park Medical monthly for Certificates of capacity/fitness and to monitor her sertraline and anxiety levels. Of medications for the psychiatric injuries, she reported, 'He provided me with, I call them panic drugs, just to help with my anxiety' - she is prescribed propranolol 10mg, commencing 'a couple of months ago'. She uses it selectively: 'if I am in a situation where I am starting to panic... I tend to avoid those kinds of situations'. More recently, she has used it 'once every three weeks - mostly I forget that I have them, but when I take them they are good. Like today, I forgot to take one'. Sertraline, an SSRI, was commenced 'probably seven years ago, I was leaving my long term partner, I was moving from Queensland to NSW, there were a lot of life things at that time'. She has been on the current dose for 'Probably six months', and prior to that she took150mg from August 2024, which she felt was increased from 100mg in January 2024.

Psychologist, Natalie Wong sees her fortnightly to weekly (weekly in the last six weeks). Treatment began in late November 2024 and she described supportive therapy. Sessions are via Zoom or phone due the degree of anxiety - but for this, attending in person would be more often than she can manage, as she finds those sessions quite helpful.

Ms Woodcraft said she has been attending an exercise physiologist every fortnight but due to anxiety, she has had difficulty attending (missing every two sessions)

This history was obtained with respect to a period of the last two months, as an average, unless otherwise stated.

Before the injury, she slept 'seven to eight' hours a night solidly, and she noted, 'I've always been pretty good at sleeping', with no initial insomnia. Nowadays, she sleeps around nine hours of actual sleep cumulatively and due to fatigue she falls asleep quickly 'but I always wake up still tired'. In the last two months, she has been waking two or three times a night for 'not long at all - generally I've woken up from a nightmare and I'm sweaty and my heart's racing and I pat my dog next to me and it calms down, and I'm able to fall asleep pretty quickly', within 'ten minutes, 15 minutes'.

Moderate deficit was apparent during the one-hour and 43 minute examination via Teams, with loss of focus observed at times, variably. She reported that compared to before her injury, it is now 'terrible... I now get overwhelmed, I have a stack of books I want to read but I can't, I just rewatch Bob's Burgers instead of watching anything new, because it's safe and familiar and dumb'.

If she watches something like this that she has seen before, the duration of her continuous focus is around '10 minutes', but with new episodes she has to rewind it during the show to keep up with the plot, realising some time into having lapsed in focus. Ms Woodcraft has to rewind it two or three times 'or I will just give up and come back to it later'. Pre-injury, she read recreationally for 30 minutes without difficulty - these days, she is limited to re-reading books she has already read (for 20-30 with reasonably solid focus), though with new reading material she feels fatigued due to the amount of energy needed to be able to progress through the material with adequate focus - Ms Woodcraft reported that she has to skim-read for six pages and she loses focus through this process but she becomes aware of this by the sixth page. There is little retention and awareness of the plot.

Deficits were observed, particularly with dates and times. Ms Woodcraft said she now forgets to buy items at the supermarket 'all the time', though her memory had been 'phenomenal' before it - 'I had my whole calendar, I had appointments and things I needed to do for that day, I had groceries and things, everything was easily there, it was just in my mind and I knew it'. She noted, 'I forget appointments all the time, it's really frustrating - I miss doctor's appointments and psych appointments all the time', monthly, she noted on enquiring. To counter this, she has a phone calendar and a wall calendar and she double-checks times usually. Ms Woodcraft said she loses and misplaces items at least weekly, particularly her keys - they now store a spare set external to the house because of this.

Ms Woodcraft said she used to be 'optimistic and happy, I was a really bubbly and cheerful person. Now I can recount one, maybe two occasions where I have felt happy in the last two months, because it is just such a dramatic shift'. She described one instance as being due to anxious cocooning but on a detailed exploration it was ascertained that she felt safer and less anxious but her actual mood remained 'flat', with ongoing depression described. She rated her mood in the last two months at 3/10 (where 1-2 reflect severe depression, 3-4 moderate depression, 5-6 mild depression, 7-8 normal mood and 9-10 elated mood) and she reported crying more often and easily than before her injury.

She described feeling 'just exhausted', with low energy, rated at 10-20% of her pre-injury full baseline, and she finds herself needing a lot longer to recover from activities and tasks that take energy. As a result, Ms Woodcraft has to nap for 'an hour to an hour and a half' most days. Enjoyment has reduced to 30-40% of her previous full level, and she remarked, 'There's just no point', stating that she no longer has hope that things will improve, also feeling worthless and helpless 'most of the time'. Amotivation was described. Ms Woodcraft described passive suicidality which her treatment

Where Ms Woodcraft ate three meals a day pre-injury, she has been eating one or two meals a day since the last year, and these are normally-sized but she no longer enjoys meals - weight had reduced 'for a while... I lost about 9 kilos... the last few months, it's going back up', she estimated that she has since gained 4-5kg since losing weight. She is not comfort eating as that would require more frequent grocery shopping and she tends not to order food in for snacks as she sees that as wasteful.

This is pervasive, rated in the last two months as severe, rated at 9/10 (where 1-3 are low-grade, 4-6 are moderate, 7-8 high-grade, and 9-10 are severe), and along with contributing to fatigue, sleep and concentration problems, she described lowered frustration tolerance and irritability - 'I get frustrated really easily... I used to be a really patient easy-going person and now I get irritated all the time'. Anxious muscle tension occurs with jaw clenching overnight and pain the morning, 'and I've needed to go and get massages because my neck and shoulders lock up', with some tension headaches. Restlessness was described, and she showed a piece of string that she had been knotting and unknotting during the consultation, congruent with her description of fidgeting with anxiety. Physiologic anxious changes occur of nausea, trembling, loss of vision from the peripheries in, dizziness and shortness of breath, elevated heartrate, palpitations and throat tightness. Four or more of these changes occur at once (around twice in the last two months, more often earlier post-injury, though these symptoms occur in isolation as well).

She noted dreams with themes of being 'trapped most of the time, and I am trying to help people and they are mad at me. It's always different situations, sometimes I am back in Queensland... people are always mad at me, and there's no way I can fix it'.

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

Ms Woodcraft was not aware of any history of mental illness in her family.

In the month or two before the work injury, she was prescribed a low dose of sertraline (50mg, 200mg is the usual maximal dose) and was well psychologically on this, with no active anxiety or depression or other active mental illness. She reported that both anxiety and depression went into remission around four months after sertraline commenced. She had not required treatment under a psychiatrist but she saw a psychologist 'maybe three or four times, that was helpful, she gave some tools. Once I made the life changes, she didn't need to see me anymore'.

Ms Woodcraft did not smoke prior to the injury but she reported that she took this up during the injury as a means to cope with the stress, though she now vapes 'every day', rather than using cigarettes (she estimated that her vape pod may contain 1200 puffs); it is a nicotine containing vape.

Before her injury, she would consume alcohol socially - at Trivia on a Wednesday or if she went out with friends on the weekend, estimating that pre-injury she consumed 'Seven or eight a week'. These days, while not socialising as much as prior to the injury, her alcohol, consumption has increased to 'four or five a day... it's just increased... it's fluctuated from the injury but it's definitely trending up'. Ms Woodcraft described using alcohol to quell anxiety, particularly if she socialises - if she isolates, she uses it less.

Ms Woodcraft does not use substances, gamble or have forensic history.

• Work history including previous work history if relevant:

She said she had completed Year 12 in around 2003, and after this she completed a massage course for a year, working as a masseuse 'for a couple years'. She then spent a year doing an event management course (from what she recalls) then working in organising music festivals 'for maybe seven or eight years... it's hard to say because it's a lot of contract work in festivals'. Following this, 'I had a café for a few years and then I was studying my Bachelor of Business and then I sold the café and started working in marketing'. The degree took four and a half to five years part time, she noted, finishing around 2002, or so.

Her marketing career began via an agency in Queensland 'for a couple of years, then I worked for a tourism organisation doing marketing, then I had my own agency with a partner for a couple of years', for three years before she sold it and moved to NSW six years ago - she noted here that memory difficulties meant she was not certain of the time periods. Daniel added that she had worked in a pub her partner owned 'for a couple of years'.

On moving to NSW, she worked for a marketing agency as their Head Account Manager for two years, followed by working for CBHS after that.

Ms Woodcraft has lived at her current rental home for three years and has two housemates (one for a year, one since moving in - Daniel is not living at the same address). She has a dog.

A history was obtained of her typical daily routine over the last two months - Ms Woodcraft said she wakes around 8:30 to 9am, needing half an hour to exit bed due to depressive symptoms including substantial fatigue. She noted that once she is up her flatmates have already left for work, and she lets her dog out into the backyard, she goes to the bathroom and she will 'throw on whatever clothes I have on the floor'. For around 20 minutes, she walks her dog each morning ' she winges at me', and she spoke how she would rather remain in bed. On returning, she feeds her dog, 'and then, most recently I've just been on X-box for hours a day... four hours a day, I'm getting really good at it'. On week days, she spends 15-20 hours in total now - she had no console pre-injury. Asked what else she might do, she stated, 'I spend a lot of time lying on the floor, watching TikTok or playing stupid games on my phone - Connect Four or Tetris-style games are really comforting', occupying her mind from the injury and its impacts, and she commented, 'it's a lot of distraction activities'. She heats up a pie, or nuggets or a microwave meal around midday, then naps from 3:30 to 5pm, before returning to the park with her dog for half an hour so she is away when they arrive - she explained that this is to avoid being asked about her day. Ms Woodcraft eats dinner around 4:30 to 5pm before going to the park or at 8pm. She retires to bed 'by around 9:30pm'.

Where Ms Woodcraft ate three meals a day pre-injury, she has been eating one or two meals a day since the last year, and these are normally-sized but she no longer enjoys meals - weight had reduced 'for a while... I lost about 9 kilos... the last few months, it's going back up', she estimated that she has since gained 4-5kg since losing weight. She is not comfort eating as that would require more frequent grocery shopping and she tends not to order food in for snacks as she sees that as wasteful. Showering has reduced in the last 'year and a half' from once or twice a day to two or three times a week due to amotivation, low mood and other depressive symptoms. Toothbrushing has reduced to once-daily 'most days' now (usually twice-daily pre-injury, she noted) and she wears clothing for up to three days before changing. Daniel (her support person) and her flatmates - or her psychologist - tend to prompt her to shower weekly each, and she is prompted to eat by her psychologist and Daniel once a week each, while her flatmates pre-empt her not cooking by making extra food for her.

Cooking was done 'every night', described at various points as something she used to enjoy. She now does this once or twice a month, mostly relying on microwave meals and Uber Eats. 'Mostly, it's a lot of pies'. Ms Woodcraft could grocery shop 'two or three times a week, cos I liked to have fresh ingredients to cook with', which has reduced to three-weekly, and she gets her flatmates or neighbours to go weekly. She only goes 'when I absolutely have to - when I've run out of things... in the lead-up, I eat less. The times I only absolutely have to go is when I run out of dog food. The times I do have to go, I'll try and buy as much as I can so I don't have to go as often'. She is more anxious while there - on her return she struggles from a depressive standpoint to transfer items to the fridge and freezer, and her share of the chores has reduced because of her depression. 'The housemates have started doing my washing up, because it sits there for so long'.

Before her injury, Ms Woodcraft saw friends 'Most days, at least every second day', which has reduced. 'I'll see them most weekends, but I am always really relieved when Monday rolls around and they will leave me alone', seeing them once in a week. Her social circle has reduced in size, not due to conflict but her withdrawal over time.

She was in a choir pre-injury (once or twice weekly, ceasing 'about six months ago', reducing in frequency over six months before that), and she went roller-skating with friends twice a week and she commented, 'but I haven't done that for months and months'. Ms Woodcraft did multisport 'twice a week', but this has reduced to fortnightly due to her anxiety and depression (a 10-minute drive away) - she has been in the same team for 'a couple of years, and I know they're all really supportive and lovely'. She could not go to a party alone now and Ms Woodcraft said she has not been to something like this or a major event by herself 'for probably a year, year and a half'.

She reported not being as close to her siblings since the injury - before the injury, she saw her weekly (at trivia), and she said she has not seen her 'for a couple of months', having seen her four times in the last 12 months. Her other family are in Brisbane but she spoke to her brother weekly before the injury but now ('hardly ever, like my birthday was a week a half ago and I didn't hear from any of them', with her speaking to him around six-monthly now) and to her parents 'every couple of weeks', which has also declined to 'months', around every 'three months, maybe'. She described a reduction in her social circle via anxious isolation and cocooning and depressive withdrawal, not conflict. She was not in a relationship at the time of the injury.

Where Ms Woodcraft ate three meals a day pre-injury, she has been eating one or two meals a day since the last year, and these are normally-sized but she no longer enjoys meals - weight had reduced 'for a while... I lost about 9 kilos... the last few months, it's going back up', she estimated that she has since gained 4-5kg since losing weight. She is not comfort eating as that would require more frequent grocery shopping and she tends not to order food in for snacks as she sees that as wasteful. Showering has reduced in the last 'year and a half' from once or twice a day to two or three times a week due to amotivation, low mood and other depressive symptoms. Toothbrushing has reduced to once-daily 'most days' now (usually twice-daily pre-injury, she noted) and she wears clothing for up to three days before changing. Daniel (her support person) and her flatmates - or her psychologist - tend to prompt her to shower weekly each, and she is prompted to eat by her psychologist and Daniel once a week each, while her flatmates pre-empt her not cooking by making extra food for her.

Cooking was done 'every night', described at various points as something she used to enjoy. She now does this once or twice a month, mostly relying on microwave meals and Uber Eats. 'Mostly, it's a lot of pies'. Ms Woodcraft could grocery shop 'two or three times a week, cos I liked to have fresh ingredients to cook with', which has reduced to three-weekly, and she gets her flatmates or neighbours to go weekly. She only goes 'when I absolutely have to - when I've run out of things... in the lead-up, I eat less. The times I only absolutely have to go is when I run out of dog food. The times I do have to go, I'll try and buy as much as I can so I don't have to go as often'. She is more anxious while there - on her return she struggles from a depressive standpoint to transfer items to the fridge and freezer, and her share of the chores has reduced because of her depression. 'The housemates have started doing my washing up, because it sits there for so long'.

Before her injury, Ms Woodcraft saw friends 'Most days, at least every second day', which has reduced. 'I'll see them most weekends, but I am always really relieved when Monday rolls around and they will leave me alone', seeing them once in a week. Her social circle has reduced in size, not due to conflict but her withdrawal over time.

She was in a choir pre-injury (once or twice weekly, ceasing 'about six months ago', reducing in frequency over six months before that), and she went roller-skating with friends twice a week and she commented, 'but I haven't done that for months and months'. Ms Woodcraft did multisport 'twice a week', but this has reduced to fortnightly due to her anxiety and depression (a 10-minute drive away) - she has been in the same team for 'a couple of years, and I know they're all really supportive and lovely'. She could not go to a party alone now and Ms Woodcraft said she has not been to something like this or a major event by herself 'for probably a year, year and a half.'

In the morning, Ms Woodcraft walks her dog ('otherwise she winges at me'- she said she would rather remain in bed) for 20 minutes, and she takes it to the park for half an hour - which allows her to be away from home when he partner returns home so she can avoid discussions about how her day was.

On returning from the morning walk, she feeds her dog. She added, 'And then, most recently I've just been on X-box for hours a day... four hours a day, I'm getting really good at it'. On weekdays, she spends 15-20 hours in total now - she had no console pre-injury. She described occupying her mind by other things to keep her mind from ruminating about the injury: 'I spend a lot of time lying on the floor, watching TikTok or playing stupid games on my phone - Connect Four or Tetris-style games are really comforting', occupying her mind from the injury and its impacts, and she commented, 'it's a lot of distraction activities'.

She reported not being as close to her siblings since the injury - before the injury, she saw her weekly (at trivia), and she said she has not seen her 'for a couple of months', having seen her four times in the last 12 months. Her other family are in Brisbane but she spoke to her brother weekly before the injury but now ('hardly ever, like my birthday was a week a half ago and I didn't hear from any of them', with her speaking to him around six-monthly now) and to her parents 'every couple of weeks', which has also declined to 'months', around every "three months, maybe'. She described a reduction in her social circle via anxious isolation and cocooning and depressive withdrawal, not conflict. She was not in a relationship at the time of the injury.'

'Ms Woodcraft presented as a 39 year old female of an average build, casually dressed in a light top, seated during the examination of an hour and 43 minutes with a support person, Daniel, present. She described restlessness and prior to her showing the string she had been knotting and unknotting during the assessment it had popped into the videoframe several times. She was not agitated, rapport was easily formed and was maintained; eye contact was fair. Speech was of a normal rate and volume, with no abnormality of thought stream or form. Mood was low, affect was restricted in range, anxious in quality and consistent with what she described, appropriate to context. Thought content revealed anxious and depressive themes. Concentration and memory disturbance was observed through the assessment. Ms Woodcraft reported having some passive suicidal thoughts that her treaters are aware of, and she denied any active self-harm or suicidal ideation, intent or plans, including on examination. Insight and judgement were intact.'

Ms Heather Woodcraft is a 39 year old female who was examined with respect to an accepted psychological injury occurring in the course of her employment with CBHS Health Fund Limited as a Marketing Manager.

She presents with symptoms consistent with diagnoses under DSM-5-TR of major depressive disorder and generalised anxiety disorder. On the basis of the material before me and my examination, and in my clinical assessment, I prefer my diagnosis to those of A/Prof Sankaranarayanan and Dr Teoh, who diagnosed a chronic adjustment disorder with mixed anxiety and depressed mood, or similar.

I note that while she had experienced a previous episode of anxiety and depression around seven years ago in the context of a constellation of life stressors, she was treated with low-dose sertraline (50mg, the usual maximal dose is 200mg) and three to four sessions of psychological therapy, with symptoms ceasing after four months of treatment. Ms Woodcraft was then free of any anxiety or depression until the work injury - though she required ongoing medication prior and up until to injury in the form of this low dose of sertraline. She is now prescribed 200mg; the dose increased to 100mg in January 2024, then to 150mg around August 2024. The final increase to 200mg occurred six months ago. She intermittently takes propranolol for symptomatic management of physical symptoms of anxiety, though often forgets to take it when intended, such as on the day of re-examination.

Ms Woodcraft sees her psychologist weekly and her GP monthly at current.

Her treatment is reasonable, and her condition is stabilised - that is, it is not likely to change by more than 3% in the next year, with or without treatment.

In terms of impairment, my findings concur with those of Dr Teoh in the domains of Social and Recreational Activities and Concentration Pace and Persistence. I assessed that Self-Care and Personal Hygiene was of a higher grade than Dr Teoh's examination in October 2024 - a year ago - as prompting is needed with showering and to eat, regularly by her psychologist, her friend (Daniel) and her flatmates. While strain is present with loss of frequency of interaction with friends and family and a smaller social circle via depressive and anxious isolation, there has not been conflict with friends leading to cessation of friendships. The strain in relationships is reflective of class 2, differing from Dr Teoh's class 3 rating.

A/Prof Sankaranarayanan in December 2024 determined functioning at a normal (class 1) grade in all four domains, which was not in keeping with my findings on re-examination, based on all the material before it.

Her presentation in terms of mental state examination features was consistent with her history and the material in the brief from both parties'."

1. The Appeal Panel considers that the examination undertaken by Medical Assessor Ash Takyar was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Ash Takyar 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 has been challenged on appeal, namely self-care and personal hygiene, social and recreational activities, social functioning and concentration, persistence and pace. The Appeal Panel notes that Medical Assessor Ash Takyar 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 Takyar's findings on clinical examination of the appellant and his diagnosis made after clinical examination of the appellant, namely, that she continues to meet the diagnostic criteria "under DSM-5-TR of major depressive disorder and generalised anxiety disorder". The Appeal Panel agrees with and adopts the findings of Medical Assessor Takyar.
2. In respect of self-care and personal hygiene, Table 11.1 in the Guidelines provides as follows:

Table 11.1: Psychiatric impairment rating scale - self care and personal hygiene

No deficit, or minor deficit attributable to the normal variation in the general population

Mild impairment: able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.

Moderate impairment: Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) two to three times per week to ensure minimum level of hygiene and nutrition.

Severe impairment: Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.

Totally impaired: Needs assistance with basic functions, such as feeding and toileting.

1. Medical Assessor Takyar made findings on re-examination as follows:

"Where Ms Woodcraft ate three meals a day pre-injury, she has been eating one or two meals a day since the last year, and these are normally-sized but she no longer enjoys meals - weight had reduced 'for a while... I lost about 9 kilos... the last few months, it's going back up', she estimated that she has since gained 4-5kg since losing weight. She is not comfort eating as that would require more frequent grocery shopping and she tends not to order food in for snacks as she sees that as wasteful. Showering has reduced in the last 'year and a half' from once or twice a day to two or three times a week due to amotivation, low mood and other depressive symptoms. Toothbrushing has reduced to once-daily 'most days' now (usually twice-daily pre-injury, she noted) and she wears clothing for up to three days before changing. Daniel (her support person) and her flatmates - or her psychologist - tend to prompt her to shower weekly each, and she is prompted to eat by her psychologist and Daniel once a week each, while her flatmates pre-empt her not cooking by making extra food for her.

Cooking was done 'every night', described at various points as something she used to enjoy. She now does this once or twice a month, mostly relying on microwave meals and Uber Eats. 'Mostly, it's a lot of pies'. Ms Woodcraft could grocery shop 'two or three times a week, cos I liked to have fresh ingredients to cook with', which has reduced to three-weekly, and she gets her flatmates or neighbours to go weekly. She only goes 'when I absolutely have to - when I've run out of things... in the lead-up, I eat less. The times I only absolutely have to go is when I run out of dog food. The times I do have to go, I'll try and buy as much as I can so I don't have to go as often'. She is more anxious while there - on her return she struggles from a depressive standpoint to transfer items to the fridge and freezer, and her share of the chores has reduced because of her depression. 'The housemates have started doing my washing up, because it sits there for so long'."

1. The Appeal Panel accepts the findings on re-examination which are consistent with the rating of a Class 3 or moderate impairment. This is greater than the assessment by the Medical Assessor who assessed Class 2.
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 eg without needing a support person, but does not become actively involved (eg 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 Medical Assessor made findings on re-examination as follows:

"Before her injury, Ms Woodcraft saw friends 'Most days, at least every second day' which has reduced. 'I'll see them most weekends, but I am always really relieved when Monday rolls around and they will leave me alone', seeing them once in a week. Her social circle has reduced in size, not due to conflict but her withdrawal over time.

She was in a choir pre-injury (once or twice weekly, ceasing 'about six months ago', reducing in frequency over six months before that), and she went roller-skating with friends twice a week and she commented, 'but I haven't done that for months and months'. Ms Woodcraft did multisport 'twice a week', but this has reduced to fortnightly due to her anxiety and depression (a 10-minute drive away) - she has been in the same team for 'a couple of years, and I know they're all really supportive and lovely'. She could not go to a party alone now and Ms Woodcraft said she has not been to something like this or a major event by herself 'for probably a year, year and a half'.

In the morning, Ms Woodcraft walks her dog ('otherwise she winges at me' - she said she would rather remain in bed) for 20 minutes, and she takes it to the park for half an hour - which allows her to be away from home when he partner returns home so she can avoid discussions about how her day was.

On returning from the morning walk, she feeds her dog. She added, 'And then, most recently I've just been on X-box for hours a day... four hours a day, I'm getting really good at it'. On weekdays, she spends 15-20 hours in total now - she had no console pre-injury. She described occupying her mind by other things to keep her mind from ruminating about the injury: 'I spend a lot of time lying on the floor, watching TikTok or playing stupid games on my phone - Connect Four or Tetris-style games are really comforting', occupying her mind from the injury and its impacts, and she commented, 'it's a lot of distraction activities'."

1. The Appeal panel adopts the findings on re-examination which are consistent with the rating of a moderate impairment or Class 3. This is greater than the assessment by the Medical Assessor who assessed Class 2.
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. Medical Assessor Takyar found on re-examination and reported to the Appeal Panel as follows:

"She reported not being as close to her siblings since the injury - before the injury, she saw her weekly (at trivia), and she said she has not seen her 'for a couple of months', having seen her four times in the last 12 months. Her other family are in Brisbane but she spoke to her brother weekly before the injury but now ('hardly ever, like my birthday was a week a half ago and I didn't hear from any of them', with her speaking to him around six-monthly now) and to her parents 'every couple of weeks', which has also declined to 'months', around every 'three months, maybe'. She described a reduction in her social circle via anxious isolation and cocooning and depressive withdrawal, not conflict. She was not in a relationship at the time of the injury."

1. The Appeal Panel adopts the findings on re-examination and noting social functioning is concerned with the quality of relationships, adopts the recommendation of Medical Assessor Takyar as follows:

"While strain is present with loss of frequency of interaction with friends and family and a smaller social circle via depressive and anxious isolation, there has not been conflict with friends leading to cessation of friendships. The strain in relationships is reflective of class 2."

1. The Appeal Panel agrees that considers that the findings accord with the rating of a mild impairment or Class 2 for social functioning. This assessment is greater than that of the Medical Assessor who assessed Class 1.
2. In respect of concentration, persistence and pace, table 11.5 of the Guidelines 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. Medical Assessor Takyar conducted a thorough mental state examination on the day of assessment and summarised his findings on re-examination to the Appeal Panel as follows:

"Ms Woodcraft presented as a 39 year old female of an average build, casually dressed in a light top, seated during the examination of an hour and 43 minutes with a support person, Daniel, present. She described restlessness and prior to her showing the string she had been knotting and unknotting during the assessment it had popped into the videoframe several times. She was not agitated, rapport was easily formed and was maintained; eye contact was fair. Speech was of a normal rate and volume, with no abnormality of thought stream or form. Mood was low, affect was restricted in range, anxious in quality and consistent with what she described, appropriate to context. Thought content revealed anxious and depressive themes. Concentration and memory disturbance was observed through the assessment. Ms Woodcraft reported having some passive suicidal thoughts that her treaters are aware of, and she denied any active self-harm or suicidal ideation, intent or plans, including on examination. Insight and judgement were intact."

1. He found throughout his clinical assessment of the appellant as follows:

Moderate deficit was apparent during the one-hour and 43 minute examination via Teams, with loss of focus observed at times, variably. She reported that compared to before her injury, it is now 'terrible... I now get overwhelmed, I have a stack of books I want to read but I can't, I just rewatch Bob's Burgers instead of watching anything new, because it's safe and familiar and dumb'.

If she watches something like this that she has seen before, the duration of her continuous focus is around '10 minutes', but with new episodes she has to rewind it during the show to keep up with the plot, realising some time into having lapsed in focus. Ms Woodcraft has to rewind it two or three times 'or I will just give up and come back to it later'. Pre-injury, she read recreationally for 30 minutes without difficulty - these days, she is limited to re-reading books she has already read (for 20-30 with reasonably solid focus), though with new reading material she feels fatigued due to the amount of energy needed to be able to progress through the material with adequate focus - Ms Woodcraft reported that she has to skim-read for six pages and she loses focus through this process but she becomes aware of this by the sixth page. There is little retention and awareness of the plot.

Deficits were observed, particularly with dates and times. Ms Woodcraft said she now forgets to buy items at the supermarket 'all the time', though her memory had been 'phenomenal' before it - 'I had my whole calendar, I had appointments and things I needed to do for that day, I had groceries and things, everything was easily there, it was just in my mind and I knew it'. She noted, 'I forget appointments all the time, it's really frustrating - I miss doctor's appointments and psych appointments all the time', monthly, she noted on enquiring. To counter this, she has a phone calendar and a wall calendar and she double-checks times usually. Ms Woodcraft said she loses and misplaces items at least weekly, particularly her keys - they now store a spare set external to the house because of this."

1. The Appeal Panel considers that based on the findings on re-examination, the best fit is a moderate impairment or Class 3 for concentration, persistence and pace. The findings on

re-examination accord with the correct criteria for this class. 2. What this means is that the classes assessed by the Appeal Panel are greater than the classes assessed by the Medical Assessor for all of the contested PIRS categories of

self-care and personal hygiene (Class 3), social and recreational activities (Class 3), social functioning (Class 2) and concentration, persistence and pace (Class 3). This means the Medical Assessment Certificate will be revoked. 3. This means the calculations become as follows:

1. The Appeal Panel adopts the findings on re-examination that there is not allowance for treatment effect because there has been no amelioration of the condition, that is, on the basis of the application of the correct criteria in the Guidelines, there has been no effective long term treatment which has resulted in the substantial or total elimination of the appellant's permanent impairment. The Appeal Panel notes that such a finding is consistent with the medical opinion from Dr Teoh, the IME qualified to provide an opinion on behalf of the appellant, who also made no allowance for the effects of treatment.
2. In respect of the deduction, the Appeal Panel notes the findings on re-examination. Medical Assessor Takyar on re-examination has taken a history consistent with the other evidence, that the appellant was on a dose of 50mg Sertraline which her prior condition warranted right up to the date of injury (after which there was a significant increase in dosage) and there has been a clear contribution to the level of permanent impairment assessed because of her prior psychological condition which warranted, prior to injury, ongoing treatment. The Appeal Panel notes that the IME Dr Teoh qualified to provide an opinion on behalf of the appellant Dr Teoh made a deduction of 2% WPI. The Appeal Panel confirms the deduction of one-tenth made by the Medical Assessor.
3. This means the WPI assessed as a result of injury is 22% WPI less one-tenth (2.2) which gives 19.8% or 20% WPI after rounding.
4. For these reasons, the Appeal Panel has determined that the MAC issued on

9 April 2025 should be revoked. A new medical 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:

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)

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