Alder-Blackmore v Kurri Kurri Community Services Ltd

DETERMINATION OF APPEAL PANEL
CITATION:	Alder-Blackmore v Kurri Kurri Community Services Ltd [2025] NSWPICMP 718
APPELLANT:	Vanessa Lee Alder-Blackmore
RESPONDENT:	Kurri Kurri Community Services Limited
APPEAL PANEL
MEMBER:	Carolyn Rimmer
MEDICAL ASSESSOR:	Douglas Andrews
MEDICAL ASSESSOR:	Graham Blom
DATE OF DECISION:	17 September 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment by Medical Assessor (MA) of 7% whole person impairment (WPI) for primary psychiatric condition; appeal under sections 327(3)(c) and (d) for failure to comply with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed 1 March 2021 (the Guidelines) in respect of the history of suicidal ideation and alcohol use disorder; Appeal Panel satisfied that the MA complied with the Guidelines; Appeal Panel satisfied that grounds of appeal in relation to the assessments in the psychiatric impairment rating scale (PIRS) categories (self-care and personal hygiene, social and recreational activities, social functioning, and concentration, persistence and pace) were not made out; Held – MAC confirmed.

BACKGROUND TO THE APPLICATION TO APPEAL

On 14 July 2025 Vanessa Lee Alder-Blackmore (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Alan Doris, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 16 June 2025.
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.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
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.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

RELEVANT FACTUAL BACKGROUND

The appellant suffered a primary psychological injury deemed to have occurred on
20 May 2022 in her employment as a support worker with Kurri Kurri Community Services Limited (the respondent).
The appellant lodged an Application to Resolve a Dispute (ARD) in the Personal Injury Commission (Commission) dated 24 February 2025 in which she claimed lump sum compensation in respect the injury to her lumbar spine.
The matter was referred to Dr Alan Doris, Medical Assessor, for assessment of whole person impairment (WPI) of a psychiatric/psychological disorder as a result of the injury deemed to have occurred on 20 May 2022.
The Medical Assessor examined the appellant on 12 June 2025 and assessed 7% WPI in respect of the psychiatric/psychological disorder as a result of the injury deemed to have occurred on 20 May 2022.

PRELIMINARY REVIEW

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.
As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because there was sufficient information on which to make a determination.

EVIDENCE

Documentary evidence

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.

Medical Assessment Certificate

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.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full but have been considered by the Appeal Panel.
The appellant’s submissions include the following:
(a)    the assessment was made on the basis of incorrect criteria for failing to comply with the Guidelines at clause 1.6 a. particularly " ... taking account the claimant's relevant medical history and all available relevant medical information to determine ... " in two particular respects, suicidal ideation and alcohol use disorder;
(b)    suicidal ideation - in the appellant's statement of 17 March 2025 she records: "I have recently contacted my Super fund to check that my death cover insurance will pay out if I commit suicide". More than 12 months prior to the above-noted statement, in her statement of 7 February 2024 she wrote: "I became really depressed and in fact suicidal ... As I have said, I was suicidal before Christmas and needed to seek assistance, both from my GP and Psychologist and also from the Suicide Prevention Hotline";
(c)    Dr Ben Teoh in reports dated 18 April 2024 observed: "She was preoccupied with negative thoughts, including fleeting suicidal ideation. She has been worrying about her future and employment. She reported acute anxiety attacks and avoidant behaviour. She has insomnia and nightmares. She has lost her confidence, and she has been irritable". Further, Dr Teoh records " ... negative thoughts, including fleeting suicidal ideation" in his reasons for decision for assessing Class 3 in the PIRS Category of concentration, persistence and pace;
(d)    the MAC does not reveal any reference to the worker's repeated statements of suicidal ideation. The MAC does present consideration of the reporting of
Dr Teoh but does not refer to Dr Teoh reporting the worker's suicidal ideation. That absence of reference to a salient feature of the reporting of Dr Teoh appears erroneous;
(e)    the Guidelines oblige the medical assessment to take account of all available relevant medical information. The available medical information has repeated references to the appellant's suicidal ideation which is a relevant consideration in a psychiatric injury assessment. The absence of any expressed regard to the appellant's suicidal ideation does not meet the Guidelines standard;
(f)    further, those references are absent the MAC without explanation when explanation is reasonably required to understand the assessment process: Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43 at [55];
(g)    alcohol use disorder - the medical assessment has had insufficient regard to the implications of the alcoholism of the appellant disclosed in the statement of the worker dated 17 March 2025;
(h)    the worker's alcohol intake is addressed in the MAC but that reference is sanguine, understated in its terms. The medical assessment, conducted remotely, has not satisfactorily considered alcohol use disorder as a consequence of the workplace injury and finding of psychiatric injury diagnosis of "major depressive disorder, recurrent, moderate with anxious distress”. The medical assessment has proceeded without the diagnostic inquiry beckoned by DSM-5;
(i)    it is reasonable to apprehend the appellant may have been presenting a "brave face" when assessed remotely by the Medical Assessor on 12 June 2025;
(j)    in DSM-5 two pertinent alcohol use disorder diagnostic criteria are specified as, having occurred within a 12-month period, "Alcohol is often taken in larger amounts or over a longer period of time than was intended" and "Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school or home". DSM-5 iterates nine further criteria. These criteria are not considered in the instant medical assessment, nor their absence satisfactorily rationalised;
(k)    there should have been further and testing inquiry to the confessed alcoholism of the appellant and its causes, and effects on behaviours and the validity of the presentation of the appellant in the remote assessment clinic in context of her alcohol intake;
(l)    the availability of the alcohol use disorder diagnosis bears directly on the medical assessment. This is a psychiatric injury WPI assessment where engagement of Guidelines Chapter 11 and the PIRS Table 11.1 through 11.6 is for consideration;
(m)     the passing reference in the MAC is stated as "excessive alcohol consumption" for a period commencing at least six months before the statement of
17 March 2025, and continuing thereafter, is a failure to satisfy the Guidelines, and therefore an incorrect application of the specified Guidelines provision. With respect to the s 327(3)(d) "demonstrable error" ground, the unreasonably benign reference to the excessive alcohol consumption of the appellant may be seen to constitute demonstrable error;
(n)    PIRS categories - the Medical Assessor appears to have been unaware of significant factual matters, as above, such the suicidal ideations and likely diagnosis of alcohol use disorder. There is demonstrated a clear misunderstanding, or unsupportable reasoning processes;
(o)    the diagnosis is the MAC is of major depressive disorder and at page 9 is qualified as" ... recurrent, moderate, with anxious distress" and holding the impairment permanent;
(p)    the appellant's GP, Dr Hafssa Al-Khalil, in a psychiatrist specialist referral dated 13 August 2024 notes:
"Despite her commitment to treatment, Vanessa is observed to struggle with acute ongoing symptoms. Symptoms include fatigue, lethargy, low mood, reduced concentration, and sense of hopeless were observed and reported. Symptoms are observed to be having a significant impact on her function and requires consideration in terms of assessment of work capacity";
(q)    Treating psychologist Ms Kate Maher, notes on 26 September 2024: "Persistent low mood, avoidance behaviours. Withdrawal, disrupted capacity for self-care and AD Ls, persistent sense of hopelessness";
(r)    PIRS assessment Table 11.1 self-care and personal hygiene - the Medical Assessor allocates Class 1 which does not appear to accommodate the history under "Present symptoms" at page 3.2 of the MAC: "Her sleep pattern is variable and there were times since the workplace injury when she would spend days in bed". Also referrable in this respect is the history recorded by Ms Maher of “…disrupted capacity for self-care and ADLs." The Class 1 assessment seems glaringly improbable. An Appeal Panel would likely assess Class 2;
(s)    Table 11.2 social and recreational activities - the MAC records: "She struggles with physiological symptoms of anxiety such as breathing difficulties when in public situations ... her mood is generally low, and she is tearful at times. Ms Alder-Blackmore is forgetful and uses lists to remember to do daily tasks." That seems strikingly inapt the MAC Class 2 assessment and an Appeal Panel would likely assess Class 3;
(t)    Table 11.4 social functioning - the MAC assessment of Class 2 appears unsupportable, if not improbable, particularly compared to the diagnosis at MAC page 4.7 and the suicidal ideation and alcohol use disorder. This should likely warrant Class 3 assessment, and
(u)    Table 11.5 concentration, persistence and pace - the MAC assesses Class 3. In whole context, if an Appeal Panel were to assess Class 4, such would be consonant all the circumstances.
The respondent’s submissions include the following:
(a)    the Medical Assessor did not fail to comply with cl 1.6 of the Guidelines, and that the Medical Assessor has appropriately formed opinions based on the medical and factual evidence, the appellant worker’s presentation and history given at consult, and his own qualified expertise. The Medical Assessor has correctly applied the Chapter 11 of the Guidelines and the PIRS to assess the appellant’s psychological injury;
(b)    the appellant has not established how the Medical Assessor incorrectly applied the Guidelines in assessing the appellant’s psychological injury and when conducting an assessment of permanent impairment using the PIRS method under Chapter 11 of the Guidelines. The appellant has also not established that the MAC contains a “readily apparent error”. The appellant’s submissions simply cavil with the difference in clinical opinion of the Medical Assessor as compared to the competing evidence in relation to the assessment;
(c)    the appellant’s submissions mainly refer to the Medical Assessor’s apparent failure to consider all of the available evidence, particularly with respect to the appellant’s suicidal ideation and alcohol intake;
(d)    the available evidence considered by the Medical Assessor: a number of statements dated 6 December 2023, 7 February 2024, and 17 March 2025. In the appellant’s statement dated 6 December 2023, there is no reference to suicidal ideation and/or increased consumption of alcohol. In the appellant’s statement dated 7 February 2024, it is noted that in late-2023 that she suffered a ‘significant relapse’ in her condition and became really depressed and suicidal resulting in her consulting with her treating general practitioner, psychologist, and the suicide prevention hotline. There is no reference to increased alcohol consumption in this statement. In the appellant’s statement dated 17 March 2025. It is recorded that she did not feel that a job as a “cellar door assistant” at Tyrrell’s Winery was appropriate as any role where she would be working with alcohol would pose a risk as she had developed an issue with excessive alcohol consumption in the past six months as a result of her depressive mental state. In this statement there is no reference to suicidal ideation;
(e)    the appellant’s statements only make passing comments in respect to suicidal ideation in late 2023 and allege some “excessive alcohol use” in the six-month period prior to the statement of 17 March 2025;
(f)    the Medical Assessor was open to review the statement evidence to inform his assessment of the appellant worker, to use that evidence in conjunction with the treating and qualified reports and the history given at consult, to form his qualified opinion as expressed in the MAC;
(g)    Dr Teoh did not make any observations of any significant suicidal ideation or intent, describing only a “fleeting’ ideation” nor did he make any mention of any alcohol intake concerns. Associate Professor Davies made no reference to any suicidal ideation or excessive alcohol intake in his reports and only noted that the appellant “drinks little alcohol”. At no point does he make any mention of suicidal ideation or excessive alcohol use;
(h)    Dr Hafassa Al-Khalil in his report dated 13 August 2024 makes no reference to any symptoms of suicidal ideation or increased alcohol intake. Ms Kate Maher, in a report dated 27 June 2024 noted that the appellant worker was experiencing ongoing and significant symptoms but makes no reference to suicidal ideation or increased alcohol intake. A certificate of capacity dated 31 January 2024 from
Dr Gursimran Sandhu, provided comment that ‘mental health exacerbated over Christmas period; passing TOSH (‘thoughts of self-harm’) but nil active plans; protective factors family’. A certificate of capacity dated 25 February 2025 from Dr Al-Khalil notes that the appellant worker was suffering a “mental health crisis” with respect to her weekly benefits being “cut off” and that this had been led to suicidal ideation and thoughts, noting that the appellant worker felt “that she is more worthy dead than alive”;
(i)    the allegations of suicidal ideation are mentioned on only two occasions in the treating medical evidence, with there being some thoughts of self harm in or around early 2024, this was described as “passing” by Dr Sandhu and then referenced as “fleeting” by Dr Teoh;
(j)    there is no mention of any concerns regarding the appellant worker’s alcohol intake or any suggestion of an alcohol use disorder in the treating evidence before the Commission;
(k)    at page 2 of the MAC, the Medical Assessor makes a comprehensive note of the appellant worker’s present symptoms in which there is no mention of any suicidal ideation. With regard to alcohol consumption, the Medical Assessor notes “she was drinking alcohol to excess for several months earlier this year. Her children expressed their concerns about this and so she reduced. She now drinks modest amounts of alcohol every few weeks.” The Medical Assessor’s comments on alcohol consumption, whilst acknowledging a high intake prior, evidence that the appellant was able to (on her own volition and without professional intervention) reduce her consumption of alcohol and continue to consume alcoholic beverages in a modest fashion;
(l)    further, the Medical Assessor provides clear references to and opinions on the treating and qualified medical evidence, which evidences clearly that he did not fail to consider the totality of the evidence before him and has complied with cl 1.6 of the Guidelines;
(m)     whilst the Medical Assessor makes no outright reference to the appellant worker’s alleged suicidal ideation, it is clear on the evidence that he has reviewed all of the clinical and qualified evidence which was provided by the Commission. It would appear that whilst assessing the appellant worker, the Medical Assessor was not able to ascertain any comments of clinical significance from the appellant worker that would raise concerns or give rise to comments regarding suicidal ideation or alcohol use. The Medical Assessor took a comprehensive history of the injury and the appellant worker’s presenting symptoms;
(n)    the Medical Assessor did not err in awarding a Class 1 impairment for self-care and personal hygiene under Table 11.1 of the Guidelines. Under Table 11.1, a Class 1 impairment suggests no deficit or minor deficit attributable to normal variation in the general population. The Medical Assessor provided a clear reasoning for the awarding of a Class 1 impairment, noting that the appellant lives with her two adolescent children and attends to both their needs and her own, he also notes that the appellant showers daily (though washes her hair less often), takes prescribed medications and attends appointments, which would be a minor deficit attributable to normal variation in the population. Dr Teoh assessed a Class 1 impairment under Table 11.1 of the Guidelines;
(o)    the Medical Assessor did not err in awarding a Class 2 impairment for social and recreational activities under Table 11.2 of the Guidelines. Under Table 11.2, a Class 2 impairment suggests that the worker occasionally goes out to events without needing a support person but does not become actively involved. The Medical Assessor has provided a clear reasoning, noting that the appellant was able to undertake recreational activities such as walking her dog and gardening. He also noted that she was able to go out to entertainment events such as a comedy show which was attended two weeks prior to the assessment, or coffee with a friend which she had done the day before the assessment. The Medical Assessor makes clear note of the appellant experiencing anxiety in public situations, having clearly factored this into his awarding of a Class 2 impairment. There is no evidence to suggest that the appellant would satisfy the Class 3 criteria under Table 11.2 of the Guidelines;
(p)    the Medical Assessor did not err in awarding a Class 2 impairment for social functioning under Table 11.4 of the Guidelines. Under Table 11.4, a Class 2 impairment suggests strain in existing relationships, tension or arguments with partner or close family and loss of some friendships. The Medical Assessor provided clear reasoning for the awarding of a Class 2 impairment, noting that the appellant maintains positive relationships with her children who she actively parents, and her mother who she supports to live independently. The Medical Assessor also noted that the appellant maintains contact with friends, though has lost some friendships. There is no evidence that the appellant worker would satisfy the criteria for a Class 3 impairment under Table 11.4 of the Guidelines;
(q)    the Medical Assessor did not err in awarding a Class 3 impairment for concentration, persistence and pace under Table 11.5 of the Guidelines. Under Table 11.5, a Class 3 impairment suggests that an injured worker is unable to read more than newspaper articles and finds it difficult to follow complex instructions. The Medical Assessor has provided clear reasoning and examples to justify the awarding of a Class 3 impairment under Table 11.5 noting that the appellant is able to concentrate on text such as novels or proofreading her son’s schoolwork for around 10 minutes before losing concentration, is able to read news online, and completed a Responsible Service of Alcohol (‘RSA’) course in 2024. He noted that the appellant was impaired in this category, with concentration issues when driving, and increased reliance on lists and reminders to avoid forgetting things. There is no evidence that the appellant worker would satisfy the criteria for a Class 4 impairment under Table 11.5 of the Guidelines. The evidence suggests that the appellant is able to read more than a few lines, is able to maintain conversations, and is able to live independently (or with dependents) and without community assistance. Dr Teoh assessed a class 3 impairment under Table 11.5 of the Guidelines;
(r)    in Ferguson v State of New South Wales [2017] NSWSC 887 at [24], Campbell J held that in relation to classes of PIRS: “there has to be more than a difference of opinion on a subject about which reasonable minds may differ to establish error in the statutory sense”;
(s)    paragraph 1.6 of the Guidelines also confirms that ‘assessing permanent impairment involves clinical assessment of the claimant as they present on the day of assessment taking account the claimant’s relevant medical history and all available medical information…”;
(t)    the Medical Assessor did not err in his assessment of the appellant’s WPI and has correctly applied and explained his reasoning for the awarding of PIRS impairment categories;
(u)    the Medical Assessor assessed the appellant as she presented on the day of the assessment, also taking into account the material before him as required by the Guidelines. Accordingly, the assessment was not determined on the basis of incorrect criteria and the MAC does not contain a demonstrable error, and
(v)    the MAC dated 16 June 2025 ought to be confirmed.

FINDINGS AND REASONS

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.
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.

Ground 1 - Failing to comply with the Guidelines at clause 1.6 a.

The appellant submits that the Medical Assessor failed to comply with the Guidelines at cl 1.6 a. particularly " ... taking account the claimant's relevant medical history and all available relevant medical information to determine ... ", in two particular respects, suicidal ideation, and alcohol use disorder.

Suicidal ideation

The Medical Assessor at Part 10 a. of the MAC noted that in making the assessment he had taken into account the history provided to him by the appellant, information from documents provided and a mental state examination interview. In Part 5 of the MAC, the Medical Assessor noted that the appellant’s thought content “revealed self-critical and anxious cognitions and some guilt and shame at being unwell and not currently working”. There was no reference to any suicidal ideation.
In the appellant’s statement of 17 March 2025, she wrote: "I have recently contacted my Super fund to check that my death cover insurance will pay out if I commit suicide". In her statement of 7 February 2024, she wrote: “I suffered a significant relapse in my psychological condition over December 2023 and January 2025. I became really depressed and in fact suicidal and had to see my GP and also my psychologist, Kate Maher, again.” She also stated that she had sought assistance from the Suicide Prevention HotLine.
Dr Ben Teoh, consultant psychiatrist, in his reports dated 18 April 2024, observed:
"She was preoccupied with negative thoughts, including fleeting suicidal ideation. She has been worrying about her future and employment. She reported acute anxiety attacks and avoidant behaviour. She has insomnia and nightmares. She has lost her confidence, and she has been irritable."
Further, Dr Teoh recorded " ... negative thoughts, including fleeting suicidal\ ideation" in his reasons for decision for assessing Class 3 in the PIRS Category of concentration, persistence and pace.
The MAC does not refer to the appellant’s repeated statements of suicidal ideation. However, the MAC does refer to consideration of the report of Dr Teoh, although it does not refer to
Dr Teoh reporting the appellant's suicidal ideation.
The Appeal Panel accepts that in commenting on the appellant worker’s mental state,
Dr Teoh noted a preoccupation with negative thoughts, including ‘fleeting suicidal ideation’. Dr Teoh’s inclusion of comment regarding ‘fleeting suicidal ideation’ under the PIRS category of ‘concentration, persistence, and pace’ is not, in the view of the Appeal Panel, a relevant consideration under the criteria of Table 11.5 of the Guidelines for the awarding of a Class 3 impairment. The Appeal Panel does not accept that the failure by the Medical Assessor to the comments about a fleeting suicidal ideation is an error. The Medical Assessor read
Dr Teoh’s reports and considered the opinion expressed by Dr Teoh.
In his initial report dated 6 January 2023, Associate Professor Davies made no reference to any suicidal ideation and this is consistent with what was reported in later report dated
15 August 2023 and 18 November 2024. Associate Professor Davies had examined the appellant on three occasions throughout the course of the claim, and that at no point does he make any mention of suicidal ideation.
A report from general practitioner, Dr Hafassa Al-Khalil, dated 13 August 2024 makes no reference to any symptoms of suicidal ideation or increased alcohol intake. A report from psychologist, Ms Kate Maher, dated 27 June 2024 noted that the appellant was experiencing ongoing and significant symptoms, however, she makes no reference to suicidal ideation. In a questionnaire response to the insurer dated 26 September 2024, Ms Maher makes no reference to suicidal ideation.
In a certificate of capacity dated 31 January 2024 from general practitioner, Dr Gursimran Sandhu, commented that ‘mental health exacerbated over Christmas period; passing TOSH (‘thoughts of self-harm’) but nil active plans; protective factors family’. A certificate of capacity dated 25 February 2025 from Dr Al-Khalil notes that the appellant was suffering a ‘mental health crisis’ with respect to her weekly benefits being “cut off” and that this had been led to suicidal ideation and thoughts, noting that the appellant felt “that she is more worthy dead than alive”.
The allegations of suicidal ideation are mentioned on only two occasions in the treating medical evidence, with there being some thoughts of self harm in or around early 2024 which this was described as ‘passing’ by Dr Sandhu and then referenced as ‘fleeting’ by Dr Teoh.
The Appeal Panel considers that the two occasions when suicidal ideation was reported occurred during relapses in the appellant’s condition and do not reflect the improvement after such relapses and her presentation on 12 June 2025 when the appellant was examined and assessed by the Medical Assessor.
The Appeal Panel considers that any suicidal ideation is a symptom of the appellant’s condition. There was no clear argument made by the appellant as to why these fleeting symptoms had resulted in an increase in the level of impairment assessed in the PIRS. The Appeal Panel is satisfied that the Medical Assessor has complied with the Guidelines. This ground of appeal is not made out.

Alcohol use disorder

The appellant submits that the Medical Assessor had insufficient regard to the implications of the alcoholism disclosed in the statement of the appellant dated 17 March 2025.
In the appellant’s statement dated 17 March 2025 she stated that she did not feel that engagement with vocational rehabilitation and job-seeking in a ‘cellar door assistant’ at Tyrrell’s Winery was appropriate as any role where she would be working with alcohol would pose a risk as she had developed an issue with excessive alcohol consumption in the past six months as a result of her depressive mental state.
The appellant's alcohol intake is addressed in the MAC under “General Health”. The Medical Assessor wrote:
“She was drinking alcohol to excess for several months earlier this year. Her children expressed their concerns about this and so she reduced. She now drinks modest amounts of alcohol every few weeks."
The appellant submits that this reference is sanguine and understated in its terms. The Appeal Panel rejects that submissions and is satisfied that this reference accurately reflected the history obtained by the Medical Assessor in the examination.
The appellant submits that the medical assessment, conducted remotely, did not satisfactorily considered alcohol use disorder as a consequence of the workplace injury finding of psychiatric injury diagnosis of "major depressive disorder, recurrent, moderate with anxious distress”. The appellant submits that the medical assessment has proceeded without the diagnostic inquiry “beckoned by DSM-5”.
Any alleged limitations posed by the telehealth component of the examination is in the view of the Appeal Panel irrelevant, as the Medical Assessor is experienced in conducting assessments via audiovisual link and this would not have impaired the ability to conduct a comprehensive and accurate assessment of the appellant. The Appeal Panel also noted that in the Certificate of Determination dated 5 May 2025, the applicant consented to the assessment taking place by audiovisual link and no complaint was made by the appellant before the appeal about this method of carrying out assessment. Further, the examination by Dr Teoh on 11 April 2024 was conducted ‘via Telehealth” as were the assessments by Associate Professor Davies on 6 January 2023 and 18 November 2024.
The Appeal Panel also rejects the submission that the medical assessment, conducted remotely, did not satisfactorily consider alcohol use disorder as a consequence of the workplace injury diagnosis of "major depressive disorder, recurrent, moderate with anxious distress” and proceeded without the diagnostic inquiry “beckoned by DSM-5”. It was clear from the history obtained by the Medical Assessor and from the medical reports and detailed notes in the certificates of capacity that there was no history of an alcohol use disorder.
Dr Teoh did not make any mention of any alcohol intake concerns. In fact, Dr Teoh wrote: “There is no history of drug or alcohol abuse.” Dr Teoh did not make a diagnosis of alcohol use disorder.
In his initial report dated 6 January 2023, Associate Professor Davies noted that the appellant “drinks little alcohol”. In his second report dated 15 August 2023 Associate Professor Davies noted “She drinks little alcohol.” In his third report dated 18 November 2024, Associate Professor Davies again noted “She drinks little alcohol.” Associate Professor Davies had examined the appellant on three occasions throughout the course of the claim, and that at no point did he make any mention of excessive alcohol use.
In a referral to Dr Pavan Bhandari dated 13 August 2024, the general practitioner,
Dr Hafassa Al-Khalil, makes no reference to increased alcohol intake. A report from the treating psychologist, Ms Kate Maher, dated 27 June 2024 makes no reference to increased alcohol intake. In a questionnaire response to the insurer dated 26 September 2024,
Ms Maher makes no reference to alcohol use.
The appellant submits that it is reasonable to apprehend she may have been presenting a "brave face" when assessed by the Medical Assessor on 12 June 2025. The Appeal Panel does not consider that this is a relevant concern, as the Medical Assessor applied his qualified and expert judgment when assessing the appellant, who had an opportunity to note or raise any concerns during the examination.
The Appel Panel considers that, in the absence of any history of excessive and continuing alcohol use, it was not necessary for the Medical Assessor to conduct an inquiry into whether the appellant satisfied the diagnostic criteria for alcohol use disorder in DSM - 5. It was clear from the examination, the history and the medical evidence that the applicant did not have an alcohol use disorder when she was examined by the Medical Assessor. The Medical Assessor’s comments on alcohol consumption, whilst acknowledging a high intake prior, noted that the appellant was able to (on her own volition and without professional intervention) reduce her consumption of alcohol and continue to consume alcoholic beverages in a modest fashion.
The Appeal Panel rejects the submission that the Medical Assessor should have conducted “further and testing inquiry to the confessed alcoholism” of the appellant and its causes, and effects on behaviours and the validity of her “presentation in the remote assessment clinic in context of her alcohol intake”. The Appeal Panel finds that there was no failure by the Medical Assessor to comply with the Guidelines.
It follows that any impairment on the appellant’s ability to function in day-to-day or work-related activities is attributable to her work-related psychological injury and not excessive alcohol use.
The Appeal Panel agree with the respondent’s submission that the Medical Assessor provided clear references to and opinions on the treating and qualified medical evidence, which evidences clearly that the Medical Assessor did not fail to consider the totality of the evidence before him and has been and had complied with cl 1.6 of the Guidelines. The Appeal Panel agrees that while the Medical Assessor made no outright reference to the appellant s suicidal ideation, it is clear on the evidence that he had reviewed all of the clinical and qualified evidence which was provided by the Commission. Further, the Appeal Panel does not accept that the lack of any specific reference to the suicidal ideation resulted in a material error.
This ground of appeal is not made out.

PIRS Categories
Self care and personal hygiene

The appellant submits that the assessment of Class 1 by the Medical Assessor did not accommodate the history under "Present symptoms" in MAC of variable sleep pattern and times since the injury when she would spend days in bed. The appellant referred to the history recorded by Ms Maher of “... disrupted capacity for self-care and ADLs". The appellant submits that the Class 1 assessment seems glaringly improbable.
The examples under Table 11.1 for “self care and personal hygiene” in the Guidelines are:
“Class 1: No deficit, or minor deficit attributable to the normal variation in the general population.
Class 2 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.”
The Medical Assessor assessed the appellant as Class 1 for self care and personal hygiene. In the PIRS Rating Form, the Medical Assessor wrote:
“Self care and personal hygiene - Class 1
Ms Alder-Blackmore lives with her two adolescent children and attends to their needs as well as her own including doing cooking, shopping and housework. She showers daily though washes her hair less often than before the workplace injury. She no longer tints her eyebrows. She takes medication as prescribed and attends health appointments. This indicates a minor deficit in this area attributable to normal variation in the population.”
Under “Present symptoms”, the Medical Assessor noted: “She eats adequately….Her sleep pattern is variable and there were times since the workplace injury when she would spend days in bed”.
Under “Social activities/ADL”, the Medical Assessor wrote:
“Ms Alder-Blackmore has good and important relationships with her
children and her mother who lives nearby and she is a support to each of them. On a typical day she will get out of bed to make breakfast for her son, and as he is now driving himself, she will drive her daughter school. Ms Alder-Blackmore makes her own breakfast and takes her medication. She showers each day and washes her hair every few days. Most of the time she spends at home doing household tasks or gardening. She may help her mother who is visually impaired with tasks at her home or take her to appointments in the local area… She does the shopping and cooking for the family and continues to enjoy looking after the household which she sees as her duty as a parent.”
Under Findings on Physical Examination on page 4 of the MAC, the Medical Assessor noted that the appellant showed reasonable self-care.
In her statement dated 7 February 2024, the appellant stated that before Christmas her daughter had to take her shopping so that they could buy some food for Christmas and the help her prepare this. She stated that she had little interest in domestic duties and the children did most of this now. She wrote: “I don’t change my sheet for weeks on end and although I have a shower each morning this is more routine than anything.”
Dr Teoh, in a report dated 18 April 2024, assessed a Class 1 for self care and personal hygiene providing the following reasons: “She has been lacking motivation to care for herself.”
Ms Maher in a questionnaire from the insurer dated 26 September 2024 noted “current symptoms” included “disrupted capacity for self-care and ADLs”.
The Appeal Panel considers that the appellant’s condition has improved since that examination by Dr Teoh and her relapse in December 2023 - January 2024, and February 2025.
The Appeal Panel considered that the Medical Assessor provided a clear reasoning for the assessing Class 1 in this scale. The Medical Assessor noted that the appellant lives with her two adolescent children and attends to both their needs and her own, showers daily (though washes her hair less often), takes prescribed medications and attends appointments. The Appeal Panel considers that these reasons amount to a minor deficit attributable to normal variation in the population. Further, Dr Teoh assessed a Class 1 impairment under Table 11.1 of the Guidelines
The Medical Assessor did not err in awarding a Class 1 impairment for self-care and personal hygiene under Table 11.1 of the Guidelines and the assessment was not made on the basis of incorrect criteria. This ground of appeal is not made out.

Social and recreational activities

The applicant submits the assessment of Class 2 was “strikingly inept” as the Medical Assessor had recorded that she struggles with “physiological symptoms of anxiety such as breathing difficulties when in public situations ... her mood is generally low, and she is tearful at times. Ms Alder-Blackmore is forgetful and uses lists to remember to do daily tasks."
The examples under Table 11.2 for “Social and recreational activities” in the Guidelines are:
“Class 2: Mild impairment: occasionally goes out to such events e.g. without needing a support person, but does not become actively involved (e.g. dancing, cheering favourite team).
Class 3: Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.”
The Medical Assessor assessed the appellant as Class 2 for social and recreational activities. In the PIRS Rating Form, the Medical Assessor wrote:
“Social and recreational activities - Class 2
Ms Alder-Blackmore takes her dog for a walk usually four nights per week. She enjoys gardening. She occasionally goes to entertainment events with her family and gave the example of going with her mother and children to a comedy show two weeks before our interview. She experiences anxiety in public situations and feels embarrassed that she is not working and so avoids some contact with old friends due to this. She has been invited to a meeting with old friends this weekend, though is unsure whether she will attend or not. She occasionally meets for a coffee with a friend and did so the day before our meeting."
Under “Present symptoms” the Medical Assessor noted that the appellant was able to get pleasure from spending time with her family, her dog, and gardening.
Under “Social activities/ADL”, the Medical Assessor wrote:
“She has recently developed her garden with citrus trees and flowers to help her feel more positive and productive…
Ms Alder-Blackmore maintains contact with her brother and his family and they visit
occasionally. She participates in family events such as birthday celebrations. She maintains contact with some old friends though does not see them often partly due to her embarrassment at being out of work. She socialises with her family and described going with them to a comedy show two weeks ago which she enjoyed. She had a coffee yesterday with the mother of a pupil at her son’s school, and is considering whether to join some of her old friends for a reunion in the coming weeks.”
In her statement dated 16 December 2024, the appellant stated that she had cut out all her social activity.
Dr Teoh, in a report dated 18 April 2024, assessed Class 3 for social and recreational activities providing the following reasons:
“She has been socially isolated, and she has lost motivation and interest in her usual activities. She said: “I can’t be bothered”. She has no joy. She has not been able to do things that she used to enjoy like going to the beach or for a drive.”

The Appeal Panel notes that Dr Teoh examined the appellant on 11 April 2024, not long after her relapse in December 2023 and January 2024. The Appeal Panel considers that the appellant’s condition has improved since that examination by Dr Teoh.
Stern JA in Botha v Secretary, NSW Department of Customer Service [2024] NSWSC 781 at [68] considered the aim of Table 11.2 and said: “Rather, the intention in table 11.2 is to provide a tool for assessing the worker’s ability to engage in activities that are properly characterised as social or recreational”.
The Appeal Panel notes that the Medical Assessor reported that the appellant walks her dog, gardens, goes out with family on occasions including a recent outing to see a comedy show and occasionally meets a friend for coffee. She does not require a support person.
The Medical Assessor did not err in awarding a Class 2 impairment for social and recreational activities. The Medical Assessor has provided a clear reasoning for the awarding of a Class 2 impairment The Medical Assessor made a clear note of the appellant worker experiencing anxiety in public situations and clearly factored this into his awarding of a Class 2 impairment. The Appeal Panel considers that there is no evidence, apart from Dr Teoh’s report, to suggest that the appellant would satisfy the Class 3 criteria under Table 11.2.
The Medical Assessor did not err in awarding a Class 2 impairment for social and recreational activities under Table 11.2 and the assessment was not made on the basis of incorrect criteria. This ground of appeal is not made out.

Social functioning

The appellant submits that the assessment of Class 2 appears unsupportable, if not improbable, particularly in view of the diagnosis in the MAC and the suicidal ideation and alcohol use disorder.
The examples under Table 11.4 for “Social functioning” in the Guidelines are:
“Class 2: Mild impairment: Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
Class 3: Moderate impairment: Previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.”
The Medical Assessor assessed Class 2 in relation to social functioning and provided the following reasons:
“Ms Alder-Blackmore has positive relationships with her children who she actively parents, and her mother who she supports to live independently. She maintains contact with friends, though has lost some, and meets them less frequently due to her current mental health problems.”
Under “Social activities/ADL”, the Medical Assessor noted:
“Ms Alder-Blackmore has good and important relationships with her
children and her mother who lives nearby and she is a support to each of them. …”
Ms Alder-Blackmore maintains contact with her brother and his family and they visit
occasionally. She participates in family events such as birthday celebrations. She maintains contact with some old friends though does not see them often partly due to her embarrassment at being out of work.”
In her statement dated 30 October 2023, the appellant stated: “I felt very bad over the Christmas holidays that I could not do much with my children. That caused friction with both of them.”
Dr Teoh, in his report dated 8 November 2023, assessed a class 3 for social functioning providing the following reasons:
“She admitted that she has been irritable and argumentative.”
The Appeal Panel notes that Dr Teoh examined the appellant on 11 April 2024, not long after her relapse in December 2023 and January 2024. The Appeal Panel considers that the appellant’s condition has improved since that examination by Dr Teoh. Further, Dr Teoh’s does not actually describe the quality of the appellant’s relationships with her family and friends in his assessment. Irritabilty and argument would more readily fall into Class 2 rather than 3 within the Guidelines.
The Appeal Panel notes that the Medical Assessor provided clear reasoning for the awarding of a Class 2 impairment, noting that the appellant maintains positive relationships with her children who she actively parents, and her mother who she supports to live independently. The Medical Assessor also noted that the appellant maintains contact with friends, though has lost some friendships.
Under Table 11.4, a Class 3 impairment would require there to be evidence of severely strained established relationships evidenced by periods of separation or domestic violence, and that spouse, relatives or community services were looking after any children. There is no evidence, apart from Dr Teoh’s report, to suggest that the appellant would satisfy the criteria for a Class 3 impairment under Table 11.4. Indeed, the appellant is actively parenting and caring for her mother.
The Medical Assessor did not err in awarding a Class 2 impairment for social and recreational activities under Table 11.4 and the assessment was not made on the basis of incorrect criteria. This ground of appeal is not made out.

Concentration, persistence and pace

The appellant submits that an assessment of Class 4 would be consonant all the circumstances.
The examples under Table 11.5 for “Concentration, persistence and pace” in the Guidelines are:
“Class 3: 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.
Class 4: 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.”
The Medical Assessor assessed the appellant as Class 3 for concentration, persistence and pace. In the PIRS Rating Form, the Medical Assessor wrote:
“Concentration, persistence and pace - Class 3.
Ms Alder-Blackmore is able to concentrate on text such as a novel or proofreading her son’s schoolwork. for approximately 10 minutes before losing concentration. She reads news online. She feels that her concentration when driving is reduced and she increasingly uses lists and reminders to avoid forgetting things. She successfully completed a responsible serving of alcohol course last year.”
Under “Present symptoms” the Medical Assessor noted:
“Ms Alder-Blackmore is forgetful and uses lists to remember to do daily tasks. She eats adequately.
Ms Alder-Blackmore finds that her concentration and memory are reduced and notices this when reading text such as novels. She estimated that she can read approximately 5 pages of a novel before losing concentration.”
Under “Findings on physical examination” the Medical Assessor wrote:
“Ms Alder-Blackmore joined the telehealth consultation from her home. She showed
reasonable self-care and managed the interview situation adequately. There were no abnormal movements or behaviours. Her speech was normal and she gave a good history. Her affect was appropriately reactive and showed have good range of emotion depending on the material under discussion. Her mood was objectively and subjectively mildly low with increased anxiety. Her thought form was normal. Her thought content revealed self-critical and anxious cognitions and some guilt and shame at being unwell and not currently working. Ms Alder-Blackmore was fully alert and orientated at interview. She attended adequately for the purposes of our meeting. She complained subjectively of forgetfulness. I did not carry out a formal cognitive assessment.”
In her statement dated 7 February 2024 the appellant wrote:
“I get regular panic attacks which interrupt what I am doing, sometimes even conversations on the phone. I have trouble with my memory and often lose track of what I am talking about. I find it hard to concentrate.”
Dr Teoh, in his report dated 8 November 2023, assessed a class 3 for concentration, persistence and pace providing the following reasons:
“She was preoccupied with negative thoughts, including fleeting suicidal ideation. She has been worrying about her future and employment. She reported acute anxiety attacks and avoidant behaviour. She has insomnia and nightmares. She has lost her confidence, and she has been irritable.”
The Appeal Panel notes that the Medical Assessor provided clear reasoning for the awarding of a Class 3 impairment, noting that the appellant can read about five pages of a novel before losing concentration, can proofread her son’s schoolwork, for approximately 10 minutes before losing concentration and reads news online. He noted that the appellant feels that her concentration when driving is reduced and she increasingly uses lists and reminders to avoid forgetting things. The Medical Assessor noted that the appellant successfully completed a responsible serving of alcohol course in 2024.
There is no evidence to suggest that the appellant would satisfy the criteria for a Class 4 impairment under Table 11.5 which would require her only being able to read a few lines (of text) before losing concentration, difficulties following simple instructions, have concentration deficits obvious in brief conversation, be unable to live alone or requiring regular assistance from relatives or community services. The evidence is that that the appellant can read more than a few lines, can maintain conversations, and is able to live independently (or with dependents) and without community assistance. Dr Teoh assessed a Class 3 impairment under Table 11.5 of the Guidelines.
The Medical Assessor did not err in awarding a Class 3 impairment for concentration, persistence and pace under Table 11.5 and the assessment was not made on the basis of incorrect criteria. This ground of appeal is not made out.
For these reasons, the Appeal Panel has determined that the MAC issued on 16 June 2025 should be confirmed.

[2025] NSWPICMP 718

17 September 2025