Amcha v Roads and Maritime Services

[2025] NSWPICMP 696

DETERMINATION OF APPEAL PANEL
CITATION:	Amcha v Roads and Maritime Services [2025] NSWPICMP 696
APPELLANT:	Rebecca Amcha
RESPONDENT:	Roads and Maritime Services
APPEAL PANEL
MEMBER:	Jane Peacock
MEDICAL ASSESSOR:	Professor Nicholas Glozier
MEDICAL ASSESSOR:	Douglas Andrews
DATE OF DECISION:	11 September 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under four of the psychiatric impairment rating scale (PIRS) categories (self-care and personal hygiene, social and recreational activities, travel, concentration, persistence and pace, and employability); Held – Appeal Panel considered that the Medical Assessor’s (MA) path of reasoning was inadequate; it was not clearly discernible from the reasons given in the MAC that the assessments under the contested PIRS categories were based upon the correct criteria and whether the MA had discounted impairment on the basis of a physical disorder and/or medication side effects; re-examination was considered necessary in the circumstances of a finding of error; MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

1.On 28 March 2025 the worker Rebecca Amcha (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Michael Hong, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 28 February 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.The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the grounds of appeal on which the appeal is made.

4.Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.

5.The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 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).

PRELIMINARY REVIEW

6.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.

7.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.

EVIDENCE

Documentary evidence

8.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.

Further medical examination

9.Medical Assessor Nicholas Glozier of the Appeal Panel conducted an examination of the worker and reported to the Appeal Panel.

Medical Assessment Certificate

10.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

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

FINDINGS AND REASONS

12.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.

13.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.

14.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: 5 March 2022

·Body parts/systems referred: Psychological / Psychiatric disorder

·Method of assessment: whole person impairment.”

15.The Medical Assessor issued a MAC certifying 7% whole person impairment (WPI) as a result of the injury as follows:

Body Part or system	Date of Injury	Chapter, page and paragraph number in NSW workers compensation guidelines	Chapter, page, paragraph, figure and table numbers in AMA5 Guides	% WPI	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)
1. Psycho-logical	5 MARCH 2022	11 page 55-60	14	7	0	7
2.
3.
4.
5.
6.
Total % WPI (the Combined Table values of all sub-totals)					7%

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

“Table 11.8: PIRS Rating Form

Name	Rebecca Amcha	Claim reference number (if known)	W479/25
DOB	Xxxx	Age at time of injury	44-year-old
Date of Injury	5 MARCH 2022	Occupation at time of injury	Roads and Maritime Services
Date of Assessment	26/2/2025	Marital Status before injury	Never married

Psychiatric diagnoses	1. Post-traumatic stress disorder		2.
3.		4.
Psychiatric treatment	Psychologist
Is impairment permanent?	Yes
PIRS Category			Class		Reason for Decision
Self-care and personal hygiene			2		Ms Amcha's physical injuries and immunotherapy side effects, are not assessable in the PIRS. From a psychological perspective, she buys the groceries online and buys food, and showers daily without prompting, and is capable of independent living without regular support, and does not need prompting with self-care.
Social and recreational activities			2		She described having occasional (certainly not rare), social recreational activities. She enjoys social events, with her family and friends, at home or in the family owned function centre, involving all her family, parents, brothers, their partners and nieces and nephews. She enjoys fewer activities over time, and does not go to public venues for social events anymore.
Travel			2		Ms Amcha has anxiety and avoids being in public. She is independent in travel around familiar area.
Social functioning			2		She is anxious and socially avoidant, and ceased contact with some of her friends. She has maintained a few long-term friendships. The relationship with her general family is good and they are close.
Concentration, persistence and pace			2		Ms Amcha reported having reduced concentration. She has undertaken intellectually demanding tasks for a significant period of time, up to 30 minutes (e.g. taking notes in business meetings) and this is consistent with a rating of 2, and with her mental state examination.
Employability			3		She cannot perform full-time work. She can manage lower-stress employment at around 20 hours per week. She can no longer manage her pre-injury duties.
Score										Median Class
2	2	2		2		2	3		=2
Aggregate Score Impairment								Total			%
+	+	+		+		+	13			7

Treatment effects

I have assessed her functioning before and after treatment, and there were no apparent substantial or total elimination of her permanent impairment with treatment.

0

Pre-existing injury

0

Final WPI

7

17.The worker appealed.

18.In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments he made under four   of the six PIRS categories, namely self-care and personal hygiene, social and recreational activities, travel and concentration, persistence and pace causing him to make an error in the assessments in these domains as follows:

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

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

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

(d)    in assessing Class 2 for concentration, persistence and pace.

19.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 and it could not be discerned on a fair reading of the MAC whether the assessments had been made on the basis of correct criteria given the Medical Assessor has seemingly ignored aspects of the appellant’s impairment relating them to her psychical constraints.

20.In summary, the employer Roads and Maritime Services (the respondent) submitted that the Medical Assessor neither erred nor made an assessment on the basis of incorrect criteria and the MAC should be confirmed. It was submitted that the MAC was adequately reasoned when read as a whole and the findings were open to the Medical Assessor applying his clinical expertise to the assessment. The respondent submitted that the appellant’s submissions “are directed to issues which are within the discretion of the MA in assessing the appellant, The matters raised by the appellant are not demonstrable errors but rather, matters open to be determined by the MA by the use of his training, expertise and clinical judgment.”

21.The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS for mere difference of opinion but must be satisfied as to error.

22.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 and whether, and to what degree, the Medical Assessor had discounted the impairment ratings attributable to the primary psychiatric injury on the basis of a physical disorder, and/or medication side effects. Despite the diagnosis he made that the appellant was suffering from post-traumatic stress disorder as a result of her primary psychological injury, he considered that “most of her daily functioning impairment, are related to her physical condition and medication side effects, and these should be assessed by a physician and not a psychiatrist.” Additionally, “further secondary impairment” caused by side effects of medication used to treat the injury should be dealt with following paragraph 1.38 in the Guidelines.

23.The requirement is to determine the impairment arising from the primary psychiatric condition, post-traumatic stress disorder. If there is impairment arising solely from a physical injury that would not have existed otherwise (that is, it clearly does not arise from the, post-traumatic stress disorder), then it must be ignored. If the primary psychiatric condition causes the whole degree of impairment rated in each class, even if physical injury may have contributed, but either its effects cannot be disentangled, or it does not cause the impairment to be rated at a higher class, then the impairment should be attributed to the primary psychiatric injury. 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 Nicholas Glozier was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):

“APPEAL AGAINST MEDICAL ASSESSMENT

REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR

MEMBER OF THE APPEAL PANEL

Matter Number:	M1-W479/25
Appellant:	Rebecca Amcha
Respondent:	Roads and Maritime Services

Examination Conducted By:	Nicholas Glozier by MS TEAMS
Date of Examination:	13 August 2025

The examination was conducted via the Teams platform. There were no technical difficulties throughout the assessment which lasted for just over an hour.

1.    The worker’s medical history, where it differs from previous records

Today throughout the assessment, and specifically at the end when asked if there was anything further that we had not covered, Ms Amcha reiterated that although she has significant symptoms and some limitations from her physical health conditions, her life has in large part been changed by the development of her chronic psychiatric disorder. For instance she suggested that the physical condition’s sequelae are ‘fair enough’ and she manages these but the anger, resentment, anxiety, rumination and sleep disturbance centre around how she believes she was forced to have the initial vaccine against her preferences and the determination by some of her treating clinicians exacerbated over the subsequent months and how she was treated, culminating in her eventual dismissal in early 2023, having refused to have a second vaccination.

Current treating clinicians

i)GP Dr Buddy Maroun.

She has seen Dr Maroun for many years and he is supportive and is a very well-known

doctor in the Maronite community. Ms Amcha confirms that she sees him at the slightly-odd hours he is well-known for keeping.

ii)Immunologist Dr Ong at Five Dock.

She said that she was taking Xolair twice a month up until the beginning of this year but now takes this only once a month. This is because of its side effects where for 4-5 days afterwards she has significant nausea, vomiting, is unable to eat or if she does, unable to keep anything down. She said as a result she lost a lot of weight, falling from 55kg to a lowest of 37kg although she is now back up to 41kg with reduced injection frequency. In between the injections she says that her appetite is still somewhat diminished and that her family bring food for her, in large part to prompt her to eat.

She was on Ozempic for some time but stopped this because of the weight loss. She takes Claritin twice a day, Maltofer, Lukair Pariet and Tacidine. She has an oral iron replacement due to her inability to tolerate blood transfusions resulting from her immunological condition. She has intermittent courses of Prednisone, 25mg for three days, when her blood sugars are highly deranged or her face has become markedly swollen. She uses Ventolin and always carries an EpiPen. She also takes Montelukast for her asthma symptoms, and Metoclopramide and Ondansetron for the nausea and vomiting at the time she has her Xolair injections.

She reports taking no antidepressants, hypnotics or any other psychotropics.

She reports considerable help-seeking to try and alleviate her symptoms but great difficulty in finding clinicians who will either take her case, due to the complications of the Covid vaccine and workers' compensation-related issues, as well as her complexity. For instance she said she finally got to see a haematologist earlier this year due to her anaemia from her clotting condition. She could not recall whether he had a diagnosis but was told that he apparently could not help her and that she needed to see a further specialist which has not happened. She reports not having been able to find a psychiatrist to take her case for similar reasons and searching the internet regularly and using support groups to try and locate clinicians who have developed a clinical practice related to Covid vaccination sequelae, however she reports she has not been able to find one in Australia.

She was seeing an exercise physiologist up until early 2025 but says that this clinician’s employer stopped them from doing home visits. On exploration it turns out that they were using the gym at the family’s office complex. She also has been seeing a physiotherapist, Stephanie, on and off over the past year or so, also at the gym.

Her primary support is her psychologist, Mr Sorbello, whom she sees two-weekly. She describes driving to see him as almost the only travel that she does on her own and even this has been limited of late, such that most of the time she prefers to go with a member of her family.

Symptoms

She has a range of symptoms, both chronic and intermittent, arising from her immunological disorder.

From what I understand she has been diagnosed with a spontaneous chronic urticaria which has been exacerbated by the Covid vaccination. She reported spontaneous bleeding, leading to her having marked visible dark pigmentation in many areas of her body including her face, shoulders and hands that were obvious during the assessment today. She also reports bleeding rectally, at times losing black clots, and at other times fresh blood. She said that this leads to her being anaemic with associated lethargy and fatigue.

Every few weeks she wakes with episodes of swelling in her face, ankles, fingers, associated with some shortness of breath and nausea. She also becomes anxious around that time and highly vigilant in case these symptoms develop into a further anaphylactic reaction. She will take antihistamines, watch herself and use her Prednisone to manage these symptoms which may last from several hours to a couple of days. They can be associated with itching and tingling and she could not identify any specific trigger to these.

She reported today, as she has told other clinicians consistently, that her last anaphylactic reaction was in December 2023 when she was having coffee with her sister-in-law in the local shopping centre. I note an ambulance was called and she was administered adrenaline, and taken to the Emergency Department. There was a blood transfusion at the time which further complicated things with another allergic reaction.

She has had other less-severe allergic reactions. She is highly fearful of recurrences of these as she obviously sees these as potentially life-threatening. As a result she has limited her exposure outdoors because she believes she has been told she is allergic to many things in her environment and food.

She is also embarrassed about the way she looks, such that if she is out using caps and scarves etc to hide her bruising. She has tried numerous products, none of which work to mask the skin pigmentation.

She reported, again as she has told others including the assessing immunologists and physicians in 2022, that her dominant symptoms are psychological, particularly anger and resentment, directed to all those she sees as having effectively forced her to have the vaccination in 2022 and the subsequent treatment and experiences at work. She is also angry at herself for not having resisted this more and of late being unable to recover and move on. She described being ‘stuck,’ and fixated upon the vaccination and its sequelae, to an obsessive extent. She has joined online forums such as COVERSE although does little posting or interaction herself, rather ‘stalking them.’ She spends much of the day on the internet, researching her condition and looking for potential solutions, clinicians that might treat her, where such things might be available, potential causes and others with similar stories.

She can be irritable with her family who have remained supportive. She reports a low mood, although dominated by the anger and irritability. She is highly anxious, wary about any potential triggers of a further anaphylactic reaction. She at times can experience intrusive re-experiencing of the episode. She says that these can occur at night as nightmares, and during the day where she has memories of the ambulance, what happened to her there and in the hospital, with sensory re-experiencing.

She struggles with motivation with little interest in doing things for herself, has become withdrawn from her family and friends and her mood symptoms have compounded her fatigue, particularly via her significant sleep disturbance. She stays up late, often not going to sleep until around 3am. She says she cannot sleep in her bed for some unknown reason and tends to doze on the couch. She reported light sleep and that as she lives on a main road it is often broken by sirens and nightmares. She wakes 2-3 hours later but then lays in bed dozing until around 7am. She has a further nap later on in the day. As such she has a disturbed low sleep duration.

She reports spending much of her time ruminating both about the vaccination sequelae and how she sees herself as so damaged and impaired, reporting subjective problems with concentration. On exploration these appear to be more ones of reduced motivation for tasks that she finds demeaning such as those she does in her family’s business now, compared to the level of work she used to do in her employment.

She describes a degree of anxiety, which at times become anxiety attacks, particularly if she begins to experience allergic symptoms. She said the last time she had a very significant episode that possibly met the criteria for a panic attack, was when she received the Medical Assessment Certificate and how she felt aggrieved at how this had been conducted and reported.

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

(In large part confirmatory except to explore the matters raised in the Appeal found to be erroneous and delineate between the impairments arising solely from her physical conditions and those from her psychiatric condition).

She continues to live alone although very close to her mother and close to her brothers. She reported there is an office complex owned by the family business which apparently is also ‘just over the road.’ Her appetite is intermittently impaired by her Xolair and its side effects of nausea, vomiting. However she reports no motivation to undertake most other aspects of self-care including cooking, whereas previously she was an enthusiastic hostess. Although she reports that her immunologist had suggested she is allergic to ‘almost everything,’ this appears on exploration to really refer to foods with sauces, prepared takeaways and other more processed food. As a result she restricts herself to rice, light foods, soups. She has little interest in preparing food, looking after herself or cleaning her own home. As a result her mother has taken over cooking, bringing over food on an almost-daily basis, augmented by her siblings. She said her mother generally comes over around 7-7:30am, getting her up from ‘dozing,’ brings a coffee, has a quick chat, checks how she is and whether there is any swelling. She may be chased by her brothers to come into the office, who may at times even send one of their staff there to bring her over if she is more reluctant. She reports that a cleaner has been provided by the insurers because of her lack of motivation, fatigue and difficulty in completing even fairly basic tasks. She reports that her family do the shopping she does require and although she tried this online a couple of times, she did not find that she was getting what she wanted. She has now stopped looking for make-up and masking alternatives, again due to both the difficulty of this and a degree of hopelessness about these making any difference.

She has no motivation to go out now, does not want to interact with people and has not seen her friends physically since Christmas. She says they stay in contact via WhatsApp groups, as do some of her work colleagues. There have been family events which she has refused to attend. She will occasionally go to church but less frequently and only when accompanied by her family, not getting involved in any of the after-service activities. She went a few weekends ago to a Giant Steps function as her family are significant sponsors, but did not become involved and only went because she felt pressured to do so. Although there is some contribution arising from embarrassment over how she looks, her social activities are impaired over and above this by lack of motivation, anger, low mood and fatigue.

She reports almost never leaving the home unless accompanied. This is because she fears having another anaphylactic reaction and so would need a member of her family to be there in order to prevent potential serious injury or ensure that she has access to her EpiPen. As such this appears to be driven by an understandable response to her physical condition or alternatively a psychological component secondary to her physical disorder. She has little motivation to go anywhere, is anxious when out about further traumatic reactions and generally only goes to places with her family members. She was driving to her psychologist some 15 minutes away on her own but would not go anywhere else (in fact she apparently has little need to do so, given her lack of motivation, to undertake any social events, travelling, relationships or other activities outside of her home). After the last anaphylactic reaction she said she has stopped going out for coffee or seeing other family members in such circumstances.

As noted she spends some hours each week doing various administrative tasks for the family business including ordering, answering emails and other admin roles. She feels this is demeaning compared to her previous level of functioning and says she struggles with her energy and motivation. She spends much of her time at home online and on her computer. She says she ‘goes over and over’ her paperwork, the injury case notes, hospital notes, reports etc. She will review and examine these for up to an hour, often getting herself worked up or angry, then having to move away for a while because she is so agitated but then going back to them. She notes that she is ‘obsessed by this’ but feels she is unable to change and move on because of what has happened to her life. She is involved in online forums although does little actual online posting. She spends much of her time searching the internet for doctors, clinicians and others who she sees may help her. She noted that those she has found tend to be overseas e.g. via the Dr Phelps’ website. Despite having found some of these doctors, she says she is unable to travel overseas because she has been told that she is likely to have further clots which could potentially be life-threatening and as such has been medically recommended not to do so.

She is also continuing to search for clinicians in Australia who may understand her condition and also importantly be willing to take her case.

She will watch TV occasionally but mainly YouTube. She may watch some Canadian ice hockey games and has some interest in the English Premier League although has not watched any games for some months obviously. She reports having lost interest in these because of her focus on her condition and its context.

3.     Findings on clinical examination

Ms Amcha was prompt and attentive. There were obvious pigmentation marks on her face, upper body, which looked like long-term bruises. Throughout the assessment she would at times become agitated, upset, stopping just briefly but then returned, coming back straight to the points we were talking about, showing good focus. She was an engaged interlocutor in the complex assessment, particularly when trying to disentangle aspects of her condition. She showed no difficulty following the pace of this assessment. She reports a dysphoric, angry mood with marked sleep disturbance, fatigue, lack of motivation, withdrawal, ongoing anxiety, rare panics triggered by both immunological symptoms and at times coming out of the blue. She is embarrassed about how she looks and is fixated on her condition, its sequelae and impact, as well as the causes of this and her experiences over 2022. She acknowledges she is unable to move on, change, feels trapped, hopeless, helpless and also experiences intrusive re-experiencing phenomena of the post-vaccination reaction and takes great pains to avoid further episodes with associated behavioural sequelae.

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

Not applicable.

Summary

Ms Amcha has a chronic and complex presentation. I note the physician records and reports describe a seemingly less impaired clinical pattern than that she describes from her physical symptoms. As all physicians have noted, her condition is dominated by her psychological condition.

1.      She would meet the DSM 5 criteria both for a post-traumatic stress disorder and a Major Depressive Disorder. This is her primary psychiatric injury. She could also meet the criteria for a DSM5 “310.1 Personality change due to another medical condition’ as some aspects of her presentation e.g. the embarrassment and impact on some aspects of her personality in the social realm reflect the physical appearance/sequelae of her urticaria.

In attempting to ascertain the impairment arising from her PTSD/Major Depressive Disorder, I have also had to consider the symptoms and impairment that might solely arise from her recurrent urticaria and avoidance of triggers of further anaphylactic reactions e.g. the intermittent swelling, embarrassment about her appearance and some fatigue from her chronic anaemia.

The only domain of the PIRS in which I see these as resulting in an impairment over and above that attributable only to her psychiatric disorders is in that of Travel where it appears her avoidance of potential triggers to a further anaphylactic reaction and embarrassment about her appearance cause a greater impairment than that attributable to any anxiety, fear and PTSD-related avoidance, given that anyone with an anaphylactic reaction would likely have significant avoidance of potential triggers and thus this would be considered as part of a normal reaction rather than her PTSD. Even so there is still some impairment.

Self-Care and Personal Hygiene

Although she has some fatigue and soreness, she reports no longer being interested in cooking, cleaning or maintaining many aspects of her self-care, such that although she lives on her own she does not live independently, receiving daily support from many members of her family, particularly her mother, who cook and shop for her, and has cleaners provided. This is a moderate impairment.

I note that both IMEs came to the same conclusion for very similar reasons attributable to the symptoms arising from her psychiatric injury alone.

Social and Recreational Activities

In this category she reported having not had any social and recreational activities with friends since the beginning of the year although still maintains some social media contact with them. She only very occasionally goes to a more social event and then only when pushed by her family and accompanied by them. She goes to church more frequently but again only accompanied by her family and does not get involved in any of the social aspects of church. I could identify no regular solitary recreational activity. She has also lost interest in watching sport, e.g. showing little interest in recent football events when I asked her about her preferred EPL team and their recent transfers: a moderate impairment.

Travel

Although she only leaves home with social support most of the time, she has at times been able to go on her own e.g. to her psychologist and reported that this is through fear of a recurrence of her physical condition primarily. There is a mild impairment arising from her anxiety, mood, and irritability symptoms.

Concentration, persistence and pace

She continues to take on administrative duties within the family business although reports that these are somewhat less demanding than those previously. She spends many hours a day searching on the internet going over her case again and again with a level of obsession and described no significant difficulties focusing on this. She was also well engaged in the complex assessment, returning to focus quickly when she became distressed and showed no difficulties with the pace of the assessment: a mild impairment.

I note the other two classes have not been appealed.

The Medical Assessor described his reasoning for disagreeing with the PIRS categories of the appellant’s IME psychiatrist, Dr Anderson. I disagree with him in the two classes of Travel and Concentration, Persistence and Pace, for the reasons above.

The Medical Assessor commented on the first report by Dr Kumar of 30 March 2023 but not the second later report. My classes are very similar to those of Dr Kumar with the exception of Concentration, Persistence and Pace where the amount of time she spends focusing on her case, researching clinicians on the internet, combined with the lack of cognitive impairment and demonstration of good concentration, focus and persistence with the pace of the assessment today would indicate only a mild impairment. Dr Kumar relied solely upon her self-report of issues in these areas which are inconsistent with those observed within the assessment.

If the Panel agrees with the suggested confirmation of the errors in Self-Care and Personal Hygiene, and Social and Recreational Activities, this would result in PIRS classes of, in order: 3,3,2,2,2,3; with a median class of 3; and a total of 15% WPI arising from her primary psychiatric injury.”

2.     The Appeal Panel considers that the examination undertaken by Medical Assessor Nichaolas Glozier was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor Nicholas Glozier 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, travel, and concentration, persistence and pace. The Appeal Panel notes that Medical Assessor Nicholas Glozier 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 Nicholas Glozier’s findings on clinical examination of the appellant and his diagnosis made after clinical examination of the appellant, both Post-traumatic Stress Disorder and a Major Depressive Disorder and that she could also meet the criteria for a DSM5 ‘310.1 Personality change due to another medical condition’ as some aspects of her presentation e.g. the embarrassment and impact on some aspects of her personality in the social realm reflect the physical appearance/sequelae of her urticaria. The Appeal Panel agrees with and adopts the findings of Medical Assessor Nicholas Glozier.

3.     In respect of self-care and personal hygiene, Table 11.1 of the Guides provides as follows:

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

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.
Class 3	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) 2–3 times per week to ensure minimum level of hygiene and nutrition.
Class 4	Severe impairment: Needs supervised residential care. If unsupervised, may accidentally or purposefully hurt self.
Class 5	Totally impaired: Needs assistance with basic functions, such as feeding and toileting.

4.     The Appeal Panel adopts the findings of Medical Assessor Nicholas Glozier on
re-examination as follows:

“Although she has some fatigue and soreness, she reports no longer being interested in cooking, cleaning or maintaining many aspects of her self-care, such that although she lives on her own she does not live independently, receiving daily support from many members of her family, particularly her mother, who cook and shop for her, and has cleaners provided. This is a moderate impairment.”

5.     It is noted that both IMEs came to the same conclusion for very similar reasons attributable to the symptoms arising from her psychiatric injury as opposed to arising from her psychical injury.

6.     The Appeal Panel considers that based on these findings, the best fit is a moderate impairment or Class 3 for self-care and personal hygiene.

7.     In respect of social and recreation activities, Table 11.2 of the Guides provides as follows:

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

Class 1	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.
Class 2	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).
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.
Class 4	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.
Class 5	Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.

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

“She reported having not had any social and recreational activities with friends since the beginning of the year although still maintains some social media contact with them. She only very occasionally goes to a more social event and then only when pushed by her family and accompanied by them. She goes to church more frequently but again only accompanied by her family and does not get involved in any of the social aspects of church. I could identify no regular solitary recreational activity. She has also lost interest in watching sport, e.g. showing little interest in recent football events when I asked her about her preferred EPL team and their recent transfers: a moderate impairment.”

9.     The Appeal Panel agrees that based on the findings on re-examination, the best fit is a moderate impairment or Class 3 for social and recreational activities.

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

Table 11.3: Psychiatric impairment rating scale – travel

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision.
Class 2	Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.
Class 3	Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.
Class 4	Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person.
Class 5	Totally impaired: may require two or more persons to supervise when travelling.

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

“Although she only leaves home with social support most of the time, she has at times been able to go on her own e.g. to her psychologist and reported that this is through fear of a recurrence of her physical condition primarily. There is a mild impairment arising from her anxiety, mood, irritability symptoms.”

12.   The Appeal Panel considers that based on these findings, the best fit is a mild impairment or Class 2 for travel. It is noted that this is the same rating given by the Medical Assessor.

13.   In respect of concentration, persistence and pace, Table 11.5 of the Guides provides as follows:

Class 1	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.
Class 2	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.
Class 3	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.
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.
Class 5	Totally impaired: needs constant supervision and assistance within institutional setting.

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

“She continues to take on administrative duties within the family business although reports that these are somewhat less demanding than those previously. She spends many hours a day searching on the internet going over her case again and again with a level of obsession and described no significant difficulties focusing on this. She was also well engaged in the complex assessment, returning to focus quickly when she became distressed and showed no difficulties with the pace of the assessment: a mild impairment.”

24.The Appeal Panel agrees that based on these findings, the best fit is a mild impairment or Class 2 for concentration, persistence and pace. This is the same impairment rating accorded by the Medical Assessor.

25. What this means is that the classes assessed by the Appeal Panel are in accordance with the classes assessed by the Medical Assessor for the contested PIRS categories of travel  and concentration, persistence and pace at Class 2 mild impairment. In respect of the classes of self-care and personal hygiene and social and recreational activities there are moderate impairments at Class 3.  

26.This means the calculations become as follows:

Score								Median Class
2	2	2	3	3	3		=3
Aggregate Score Impairment						Total			%
+2	+4	+6	+9	+12	15	15			15

27.For these reasons, the Appeal Panel has determined that the MAC issued on
28 February 2025 should be revoked and a new MAC issued. The new certificate is attached to this statement of reasons.

WORKERS COMPENSATION DIVISION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter number:	W479/25
Applicant:	Rebecca Amcha
Respondent:	Roads and Maritime Services

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.

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

Table - whole person impairment (WPI)

Body Part or system	Date of Injury	Chapter, page and paragraph number in NSW workers compensation guidelines	Chapter, page, paragraph, figure and table numbers in AMA5 Guides	% WPI	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)
1. Psychological Injury	5 March 2022	Chapter 11 Guidelines 11.1-11.3 11.4-11.6	Guidelines 11.11,11.12 Table :11.1,11.2,11.3,11. 5,11.5,11.6	15%	0%	15%
Total % WPI (the Combined Table values of all sub-totals)					15%

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.