Captanis v Swarovski Australia Pty Ltd

[2025] NSWPICMP 453

DETERMINATION OF APPEAL PANEL
CITATION:	Captanis v Swarovski Australia Pty Ltd [2025] NSWPICMP 453
Captanis
APPELLANT:
Swarovski Australia Pty Ltd
RESPONDENT:
APPEAL PANEL
MEMBER:	Jane Peacock
MEDICAL ASSESSOR:	Dr Michael Hong
MEDICAL ASSESSOR:	Dr Nicholas Glozier
DATE OF DECISION:	26 June 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; review of Medical Assessment Certificate (MAC); appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under three of the psychiatric impairment rating scale (PIRS) categories self-care and personal hygiene, social functioning and employability; Held – Appeal Panel found error in the categories of social function (which was assessed as Class 1 and should have been assessed as Class 2) and employability (which was assessed as Class 3 and should have been assessed as Class 5); MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

1. On 25 March 2025 the worker Sanaz Captanis (the appellant), lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by
   Dr Ankur Gupta, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 27 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 MAC contains a demonstrable error.

3. The Appeal Panel notes that the appellant, in the Application to Appeal form, ticked the box that the appellant was also relying on the availability of additional relevant information. However, she did not in fact file any additional evidence or make any submissions in support of this ground of appeal and accordingly the Appeal Panel considers that the grounds of appeal are limited to the ground of demonstrable error.

4. The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the grounds of appeal on which the appeal is made.

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

6. The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
   1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).

PRELIMINARY REVIEW

1. The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.

2. The appellant requested that she undergo a re-examination. However, as a result of its preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because although the Appeal Panel found error, there was sufficient material before the Appeal Panel to enable a determination to be made.

EVIDENCE

Documentary evidence

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

Medical Assessment Certificate

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

SUBMISSIONS

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

FINDINGS AND REASONS

1. The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.

2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.

3. The matter was referred to the Medical Assessor for assessment as follows:

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

   ·Date of injury: 16 January 2023

   ·Body parts/systems referred: Psychological/Psychiatric Disorder

   ·Method of assessment: Whole Person Impairment”

15. The Medical Assessor issued a MAC certifying 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. Psychological and Psychiatric Disorder	16 January 2023	Chapter 11 NSW workers compensation guidelines for the evaluation of permanent impairment 4th edition	Excluded	13%	Nil	13%
2.
3.
4.
5.
6.
Total % WPI (the Combined Table values of all sub-totals)					13%

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

“Table 11.8: PIRS Rating Form

Name	Sanaz Captanis	Claim reference number (if known)	W29662/24
DOB	xxxx	Age at time of injury	39 years
Date of Injury	16 January 2023	Occupation at time of injury	Store manager
Date of Assessment	12 February 2025	Marital Status before injury	Married

Psychiatric diagnoses	1. Major depressive disorder with anxious distress.		2.
3.		4.
Psychiatric treatment	Aripiprazole 5mg, Nortriptyline 50mg, Clonazepam 0.5mg, Olanzapine 2.5mg PRN		Psychotherapy, review by a psychiatrist
Is impairment permanent?	Yes
PIRS Category			Class		Reason for Decision
Self Care and personal hygiene			2		As described in the main body of the report, there is mild impairment. Her weight has been stable, and she eats healthily to manage Wilson's disease. She goes to the gym regularly and looks after her daughter well. She cleans her teeth daily but can go up to 3 days without showering. She has stopped looking after her appearance and does not go to the hairdresser or a nail salon.
Social and recreational activities			3		As described in the main body of the report, there is moderate impairment. She only speaks to her friends and has lost contact with others because she has stopped socialising. She does not go to the movies with her daughter. She has stopped playing tennis and swimming as well. She enjoys going to the gym. She had a holiday on the Gold Coast during school holidays but did not do much. She can go to the restaurants with her husband. She attends family events. She likes to listen to music and go for walks.
Travel			2		She can use public transport and can drive in her local area. She has to use her headphones and hat on public transport. Her inability to drive long distances is related to reduced concentration, which is rated separately in the psychiatric impairment rating scale. I consider her to have mild impairment in this domain.
Social functioning			1		As described in the main body of the report, there is no impairment. Her relationship with her husband is maintained. She is close with her parents and siblings as well. She looks after her daughter well.
Concentration, persistence and pace			3		As described in the main body of the report, there is moderate impairment. She burnt herself because of a lack of focus, but that was around two years ago. Her mental state has improved since. She describes ongoing problems with memory and concentration but was able to focus throughout the assessment. Her general practitioner has advised her against driving long distances because of lack of focus. Objectively, it is likely that she would struggle to read complex material and maintain focus for a long time.
Employability			3		Her case notes consistently document that she was considered capable of working as a manager or assistant manager for up to three days per week. In my opinion, Mrs Captanis has the capacity to work in a supportive environment with male colleagues. She can also work in her family business. On that basis, I consider her moderately impaired in this domain.
Score										Median Class
1	2	2		3		3	3		=3
Aggregate Score Impairment								Total			%
2+3	+2	+1		+3		+3	14			13”

1. The worker appealed.

2. In summary, the appellant submitted that the Medical Assessor made demonstrable errors in the assessments he made under three of the PIRS categories, as follows:

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

   (b)    in assessing class 1 for social functioning when he should have assessed a class 2, and

   (c)    in assessing class 3 for employability when he should have assessed a class 5.

3. The appellant also submitted that the Medical Assessor erred when he failed to properly consider whether the appellant had reached maximum medical improvement (MMI), he failed to make the assessment in accordance with the Guidelines and failed to provide adequate reasons.

4. In summary, the respondent employer Swarovski Australia Pty Ltd (the respondent) submitted that the Medical Assessor did not err and the MAC should be confirmed.

5. 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 scale for mere difference of opinion but must be satisfied as to error.

6. 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.

7. The Medical Assessor took a history which he recorded as follows (emphasis in original):

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

   Mrs Captanis was working as a store manager for the Swarovski store in Castlehill. She was employed on a full-time contract. She started on 18 October 21 and says an assistant manager had joined three months before her. She says that there were eleven staff under her. She alleges that seven of them got together and made false allegations about her to the head office. She says that the allegations include making threats, making a fraudulent transaction, being controlling and not doing any work. They used to speak in Mandarin on the shop floor to exclude her. She used to hear her name in their conversations but would not explain. They formed a WhatsApp group to communicate at work. She says they would ‘wait’ for her to make a mistake and report her. The regional manager started giving her warnings and did not support her. She says she was at a work conference in May 22, after which she went to the hotel, whereas others went out drinking. She says that at 3.30 AM someone opened her door and ‘jumped on her bed’. She says that it was a female manager from the Adelaide store who was drunk and fell on her, which traumatised her and she wet the bed in fear. She did not get any apology for that incident either. These types of incidents continued and it was becoming increasingly difficult for her emotionally. She says that she started getting ‘depression symptoms’ and anxiety from August 2022. She says that she went on leave on 31 December 2022 and before she was to return, she received a phone call from the regional manager saying that she should not return to the store but report to the head office and bring a support person along. No explanation was provided. She says that she was going with her husband to the head office when she had a panic attack and her husband took her to the doctor instead. She has not worked since.

   ·        Present treatment:

   Mrs Captanis takes zinc supplement for Wilson’s disease, Aripiprazole 5mg, Nortriptyline 50mg, Norspan patch for pain in her lower back, Pantoprazole 40mg, Carvediol 3.125mg BD for hypertension. Clonazepam 0.5mg, Olanzapine 2.5mg PRN, Spironolactone 25mg BD. Mrs Captanis says that she saw psychologist Ms Susan Gibson for six months but then switched to Ms Rhonda Nora for psychotherapy. She saw a psychiatrist in 2023 but switched to Dr Diana Wang on 19 November 24.

   ·        Present symptoms:

   Mrs Captanis says that her mood is ‘up and down’. She says that her mood is worse in the afternoons and sometimes when she wakes up. She says that her anxiety has been ‘on and off’ and she has had a few panic attacks in the last few weeks. She says that her sleep is also ‘up and down’. She has dreams but no nightmares. She has both initial and late insomnia. She says that she has not been to the Swarovski store but can go to the shops in the same shopping centre. She finds it difficult to manage with loud noises and wears headphones and a hat when she goes to the shops. She says that her head always feels ‘foggy’ and she suffers from ‘tension headaches’ and migraines. She says that her concentration and memory were ‘very very bad’ in 2023 and she was asked to stop driving. She says her memory is better but not as good as it used to be. She still forgets things and her mind races. She writes everything down. She describes hypervigilance but does not have an exaggerated startle response. She does not think that she could walk into the store. She has bumped into staff who bullied her on a few occasions, but did not describe flashbacks. She says that she felt uncomfortable and ‘hurt’ because of their comments. She says she has ‘trust issues’ and doubts her ability.

   She says that she wants to get well and regain her confidence.

   She says that she attempted suicide three times in 2023. She says that she still gets suicidal thoughts but there is no planning or intent.

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

   Mrs Captanis was born in Tehran, Iran, and her biological parents raised her. She says she had a very happy childhood, in New Zealand, where the family moved when she was one year old. She moved to Australia with her family in grade four or five and has been here since. She has a younger sister and a younger brother. She denies any history of abuse or trauma in her childhood. She denies any history of mental illness in her family.

   She denies any history of mental illness before the injury.

   She denies any subsequent trauma as well. However, she has been suffering from back pain on and off since the injury.

   ·        General health:

   Mrs Captanis says that she suffers from congenital Wilson’s Disease. She says that it is well controlled, but in 2016 she suffered cirrhosis. She says that she was diagnosed with hypertension and hypokalaemia in 2023.

   ·        Work history including previous work history if relevant:

   Mrs Captanis attended schools in New Zealand and Australia. She completed year twelve and then joined TAFE to study architecture. However, she left before completing the study and started working in the retail sector. She joined Swarovski in July 2021 but says her first day at work was on 18 October 21.

   ·        Social activities/ADL:

   Mrs Captanis says that she lost fifteen kilos while working at Swarovski and her Wilson’s disease worsened. She has managed to stabilise Wilson’s disease, but her appetite remains ‘up and down’. She says she has a healthy diet to manage her copper levels owing to underlying Wilson’s Disease. She says that she goes to the gym two to three times per week. She has an eight-year-old daughter whom she looks after well. She says that she does not shower daily due to lack of motivation but regularly cleans her teeth. She can go three days without showering. She has stopped going to the hairdresser and does not get her nails done. She says that she tries to maintain her house. She says that she does not cook after causing a fire in the kitchen because of a memory lapse. She says that she suffered some minor burn injuries. She says that she has not been cooking much since. She only cooks simple meals and buys takeaways. She gets on well with her husband. She is close with her parents and siblings. She meets them once a week. She says that her mother visits her in the evening, and she goes to their house, which is a ten-minute drive away. She says she has disconnected with her friends as she has not been sociable. She has not fallen out with any of her friends. She has one friend with whom she speaks. She says she takes her daughter to swimming classes, seven minutes away. She has stopped taking her to movies as she cannot handle noise. She has stopped playing tennis and swimming owing to lack of motivation. Mrs Captanis says that the gym is the only place that gives her pleasure. She says that she only drives within her local area. She says that she has been advised by her doctor to not drive further owing to lack of concentration and memory. She can travel with her husband as a passenger. She has occasionally used the metro, but with her headphones and hat on. She went on a holiday with a friend for three nights in Queensland over the school holidays. She says that she had ‘bad migraines’ throughout. She says that they flew to the Gold Coast for the holiday. She says she has been to restaurants with her husband a few times but only to quiet ones. She says that she has attended family birthdays as well. She says that she meditates in the morning and takes cold showers and ice baths for her mental health. She likes to listen to music and go for walks to manage her mental health. She sits in the park near her house sometimes. She says that she wants to work in the retail sector but has lost trust and fears that she would face the same if she returns. She feels that she could potentially work in her family’s business, which may be a safe place. She does not think she can work in a place where the workforce is predominantly female.”

8. The Medical Assessor summarised the injury and diagnosis as follows (emphasis in original):

   “●      summary of injuries and diagnoses:

   In my opinion, Mrs Captanis’ diagnosis is Major depressive disorder with anxious distress.

   ·        consistency of presentation

   No inconsistencies were noted”

9. In relation to MMI the Medical Assessor recorded as follows: (emphasis in original)

   “Have all body parts/systems stabilised/reached maximum medical improvement? Yes

   If not, please list those injuries not yet stable/at maximum medical improvement: None

   If stabilisation/maximum medical improvement, of any or all injuries has not been reached, when, in your opinion, will this occur? NA”

1. The Medical Assessor explained the basis on which his assessment was made as follows: (emphasis in original)

   “9.     THE FACTS ON WHICH THE ASSESSMENT IS BASED

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

   Clinical documentation and assessment findings

   10.   REASONS FOR ASSESSMENT

   a.My opinion and assessment of whole person impairment

   13%

   In making that assessment I have taken account of the following matters:-

   ·Psychiatrist Dr Diana Wang provided a letter dated 19 November 24. She noted that Mrs Captanis did not have any history of mental illness and had developed trauma symptoms along with major depression secondary to workplace bullying. She noted that Mrs Captanis could not tolerate transcranial magnetic stimulation and was being treated with a combination of nortriptyline, aripiprazole, clonazepam, olanzapine and pregabalin.

   ·Psychiatrist Dr Dulip Wettasinghe provided a letter in his capacity as a treating psychiatrist. He noted that Mrs Captanis had been started on mirtazapine by the treating general practitioner and had seen psychologist Susan Gibson on nine occasions. He advised that Mrs Captanis was suffering from major depressive disorder and generalised anxiety.

   ·Psychiatrist Dr Aman Suman provided an independent medical examination report dated 30 May 24. He noted that the medication included nortriptyline 75 mg and brexpiprazole 0.5 mg along with lorazepam. He advised that the diagnosis was major depressive disorder with panic attacks. He assessed Mrs Captanis to have a 23% impairment of the whole person, including a 1% uplift from the impact of treatment.

   ·Psychiatrist Dr Wettasinghe provided a letter dated 01 August 23 in which he advised that Mrs Captanis’ dose of nortriptyline was increased to 75 mg and that her psychotherapy would continue.

   ·Documentation from the Northern Sydney Local Health District was provided. According to the documentation, Mrs Captanis had been brought to the emergency department on 18 July 22 with burns at home. It was noted that a pot of hot oil, had caught fire. She had picked up the stove and rushed to the balcony when bubbling oil splashed her face.

   ·Documentation from the treating psychologist was provided. It contains consultation notes from 05 July 23 to 4 June 24. It appears that Mrs Captanis presented with symptoms of depression and anxiety throughout the sessions. Some symptoms of trauma were noted as well, but the overriding theme had been depression and anxiety. Significant weight loss and dietary changes were noted along with physical symptoms like cluster headaches and tightness in her shoulders at her most recent session, dated 04 June 24.

   ·Patient health summary from the treating general practitioner, Dr Jim Kafiris, was provided. It is printed on 07 August 24, and the following pertinent information is documented:

   ­She was seen on 17 January 23 when she reported traumatic incidents at her workplace. She was diagnosed with major depression, along with anxious distress, secondary headaches and insomnia. The general practitioner found her to be unfit for work and started her on temazepam for sleep.

   ­On 20 January 23, she was noted to have severe symptoms of depression on the MADRS scale for depression. She was prescribed melatonin 2 mg that day.

   ­On 27 January 23, temazepam and melatonin were stopped. She was prescribed amitriptyline instead.

   ­Not much improvement was noted at her next visit on 28 January 23.

   ­She reported improvement in mood on 03 February 23. She was prescribed clonazepam that day.

   ­On 07 February 23, it was noted that she had a panic attack. She was at her mother's place for an hour but then saw a staff member from Swarovski. That led to a panic attack.

   ­She reported ongoing depression at her presentation on 15 February 23.

   ­She was prescribed mirtazapine on 17 February 23.

   ­On 18 February 23, it was noted that because of the amitriptyline, her platelets had dropped into the severe range. It was further noted that her CT scan was normal. She had suffered right-sided neurological symptoms following a headache, and there was concern about intracranial bleeding.

   ­An MRI brain scan was requested for her on 23 February 23. It was further noted that her symptoms had normalised with mirtazapine 15 mg. The general practitioner noted that there was an alleged episode of postpartum depression, but according to the general practitioner, the symptoms at that time were related to stress rather than postpartum depression.

   ­Prominent anxiety, along with low mood, was noted on 28 February 23.

   ­The dose of mirtazapine was increased to 30 mg on 01 March 23.

   ­On 07 March 23, it was noted that she had passive suicidal ideation, and her distress increased because of financial problems. Clonazepam was stopped and was replaced with quetiapine.

   ­On 14 March 23, it was noted that she was agitated after her employer falsely accused her of her poor performance, but her store outperformed others on the national level. The dose of mirtazapine was increased to 45 mg.

   ­She was prescribed propranolol on 20 March 23.

   ­The dose of mirtazapine was reduced to 30 mg on 21 March 23.

   ­On 05 May 23, it was noted that her mood was worse in the morning. Propranolol and mirtazapine were increased to 45 mg again. Her mental state was noted to have improved at her visit on 13 April 23.

   ­She was prescribed olanzapine 2.5 mg on 22 April 23.

   ­On 26 April 23, it was noted that her mood was always worse in the morning but improved as the day went on. It was further noted that she felt ready to work but did not want to be alone at home.

   ­On 09 May 23, it was noted that she again forgot about the stove, which almost led to another fire. She was feeling anxious and not ready to return to work. The dose of mirtazapine was increased to 60 mg that day. She was prescribed melatonin as well.

   ­On 17 May 23, it was noted that she had lost 9 kg because of depression but had regained 4 kg.

   ­On 26 May 23, it was noted that her anxiety increased because of near accidents and the stress of her job.

   ­On 30 May 23, she reported side effects with mirtazapine and was advised to switch to nortriptyline. She was noted to be depressed on 13 June 23.

   ­On 20 June 23, it was noted that she was due to start transcranial magnetic stimulation the next day and was prescribed temazepam that day.

   ­On 28 July 23, it was noted that she was having vivid dreams and was suffering from anxiety.

   ­Passive suicidal ideation was noted on 11 August 23.

   ­On 04 September 23, it was noted that she had a panic attack.

   ­On 05 September 23, it was noted that her husband was not coping with financial stress and her illness.

   ­On 25 September 23, it was noted that she had been suffering from severe hypokalaemia for two weeks.

   ­Her mood was noted to be reasonably stable on 03 October 23.

   ­Ongoing nightmares were noted on 13 October 23.

   ­She was prescribed aripiprazole 5 mg on 19 October 23.

   ­On 14 December 23, it was noted that she was having a good result with aripiprazole, but her sleep was disturbed. She had also forgotten to take potassium.

   ­On 03 February 24, it was noted that her main issue was intolerance to interpersonal communication.

   ­On 21 March 24, it was noted that she was able and confident to act as a store manager or assistant store manager as part of a job-sharing environment. It was suggested that she could work three days during the week, including weekends. She was confident in her skills and knowledge of working in a men's store.

   ­On 10 May 24, it was noted that she had several stressors, including financial distress, feeling lost about her future, home repairs and her child. Passive suicidal ideation was noted as well. Her appetite was reduced. She was advised to take olanzapine twice a day.

   ­She was noted to be anxious on 12 May 24.

   ­On 18 May 24, it was noted that her depressive symptoms were worsening. She was started on vortioxetine that day.

   ­On 25 May 24, she was started on brexpiprazole 0.5 mg.

   ­Ongoing low mood was noted on 11 June 24.

   ·Dr Kafiris provided a letter dated 09 February 23 in which he stated that Mrs Captanis’ physical symptoms were related to the major depressive disorder.

   ·In a report dated 04 April 23, Dr Kafiris appeared to agree that Mrs Captanis had the capacity to work as a store manager.

   ·Psychiatrist Dr Yajuvendra Bisht, provided an independent medical examination report dated 05 November 24. He advised that the diagnosis was major depressive disorder with anxious distress. He had provided a report dated 18 July 24 with a similar opinion.

   ·Psychiatrist Dr Himanshu Singh provided an independent medical examination report dated 30 March 23. He noted that Mrs Captanis had suffered postpartum blues after the birth of her daughter and that her symptoms did not qualify for a diagnosis of postpartum depression. He advised that the diagnosis was adjustment disorder with mixed anxiety and depressed mood. He noted that Mrs Captanis was capable of working on suitable duties from 13 March 23 but could not participate in any disciplinary meeting, which her employer required.

   ·Dr Singh provided a supplementary report dated 21 June 23. He noted in this report that there were inconsistencies in information. The employer had strongly refuted Mrs Captanis’ allegations of bullying and harassment and had provided evidence that she had behaved in a bullying manner towards staff on numerous occasions. Furthermore, they had stated that Mrs Captanis had been under performance management throughout 2022. He stated that based on the information available, he considered Mrs Captanis to have suffered a psychological injury related to workplace events.”

2. The Medical Assessor made an assessment of whole person impairment (WPI) in accordance with his assessment under the six PIRS categories as set out in Table 11.8 quoted above.

3. He certified as to MMI having been reached as follows:

   “I certify that the impairment is permanent and that the degree of permanent impairment is fully ascertainable.”

4. In respect of commenting on other opinions before him, the Medical Assessor having made comment on the other evidence as set out above, simply stated: (emphasis in original)

   “My opinion is broadly consistent with other reports. “

5. The appellant complains that the medical assessor failed to properly consider whether the appellant had reached MMI and failed to adequately explain why she had reached MMI. It is noted that the respondent takes no issue with the certification by the medical assessor that MMI had been reached. The complaint on appeal by the appellant is made despite the appellant having brought a claim for lump sum compensation before the Personal Injury Commission (Commission), a process instigated by her and which relies on her having reached MMI as supported by the opinion of the independent medical expert (IME) qualified to provide an opinion on her behalf and upon which her claim for lump sum compensation is founded. The appellant asserts this strongly herself in paragraph 40 of her December 2024 statement The Medical Assessor assessed the appellant as MMI which accords with the opinion of the IME qualified on behalf of the appellant and in the circumstances was required to give no further explanation than what he gave.

6. The appellant complains that the Medical Assessor has erred in respect of three out of the six categories assessed, namely self-care and personal hygiene, social functioning and employability

7. The MAC must be read as a whole. The Appeal Panel cannot interfere with these ratings absent error by the Medical Assessor. The Appeal Panel cannot interfere with the rating because opinions might differ as to the best fit in each category. There must be error or assessment on the basis of incorrect criteria. The Appeal Panel will deal with each category complained about on appeal in turn.

8. 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.

1. The Medical Assessor rated mild impairment at class 2 with the following reasoning:

   “As described in the main body of the report, there is mild impairment. Her weight has been stable, and she eats healthily to manage Wilson's disease. She goes to the gym regularly and looks after her daughter well. She cleans her teeth daily but can go up to 3 days without showering. She has stopped looking after her appearance and does not go to the hairdresser or a nail salon.”

2. The appellant submitted that a class 3 should have been assessed.

3. The Appeal Panel considers that no error was made in the assessment of class 2, or a mild impairment. The assessment has been made on the basis of correct criteria which is that the appellant is able to live independently – she eats well and cares for herself adequately. She does not need the assistance of a support person. She meditates and takes regular ice baths as part of care for her mental health and goes to the gym several times per week and maintains a healthy diet as part of her physical self-care. A rating of class 2, mild impairment, accords with the correct criteria.

4. In respect of Social Functioning, Table 11.4 of the Guides provides as follows:

   Table 11.4: Psychiatric impairment rating scale – social functioning

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).
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.
Class 4	Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (eg lost partner, close friends). Unable to care for dependants (eg own children, elderly parent).
Class 5	Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.

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

   “As described in the main body of the report, there is no impairment. Her relationship with her husband is maintained. She is close with her parents and siblings as well. She looks after her daughter well.”

2. The appellant submitted a class 2 should have been assessed. Social functioning is concerned with the quality of relationships. The rating of a Class 1 is inconsistent with the history recorded in the MAC that the appellant has disconnected from friendship and that she has only one surviving friendship. This loss of friendships due to her psychiatric condition is more than “a minor deficit attributable to the normal variation in the general population”. A class 2 or mild impairment rating is consistent with correct criteria.

3. In respect of Employability, Table 11.6 of the Guides provides as follows:

Class 1

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

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

Class 2

Mild impairment. Able to work full time but in a different environment from that of the pre-injury job. The duties require comparable skill and intellect as those of the pre-injury job. Can work in the same position, but no more than 20 hours per week (eg no longer happy to work with specific persons, or work in a specific location due to travel required).

Class 3

Moderate impairment: cannot work at all in same position. Can perform less than 20 hours per week in a different position, which requires less skill or is qualitatively different (eg less stressful).

Class 4

Severe impairment: cannot work more than one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic.

Class 5

Totally impaired: Cannot work at all.

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

   “Her case notes consistently document that she was considered capable of working as a manager or assistant manager for up to three days per week. In my opinion, Mrs Captanis has the capacity to work in a supportive environment with male colleagues. She can also work in her family business. On that basis, I consider her moderately impaired in this domain.”

2. The appellant points out that, contrary to the assertion that she can work three days a week, her general practitioner in fact certifies her as having no current capacity for employment.

3. The Appeal Panel notes the appellant has not returned to any paid or voluntary role since the injury, despite the financial distress recorded in her notes. The Medical Assessor records her condition worsened after the suggestions in March 2024 she might be fit to return to part time work. He notes she has not apparently even worked within the supportive family business, she cannot tolerate the noise of movies, has frequent panics and is socially intolerant. The Medical Assessor has not identified how this description of her symptoms and impairment matches the descriptors of a class 3 when these in fact accord with her not even being to work for one or two days a week. She is totally impaired according to the Medical Assessor’s own description and the evidence before him. Class 5 is the appropriate assessment in the domain of employability.

4. In summary, the class of self care and personal hygiene (class 2) as assessed by the Medical Assessor has been confirmed on appeal. However there was error in the assessment for social functioning which was assessed as class 1, and should have been assessed as class 2 and an error in the assessment of employability which was assessed as class 3 but should have been assessed as class 5.

5. This means the calculations become as follows:

Score								Median Class
2	2	2	3	3	5		=3
Aggregate Score Impairment						Total			%
+2	+4	+6	+9	+12	5	17			19

1. For these reasons, the Appeal Panel has determined that the MAC issued on
   27 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:	W29662/24
Applicant:	Sanaz Captanis
Respondent:	Swarovski Australia Pty Ltd

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 Ankur Gupta 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	26/01/2023	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	19%	0%	19%
Total % WPI (the Combined Table values of all sub-totals)					19%

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.