Carter v Kids Academy Springfield

[2025] NSWPICMP 411

DETERMINATION OF APPEAL PANEL
CITATION:	Carter v Kids Academy Springfield [2025] NSWPICMP 411
APPELLANT:	Meriam Carter
RESPONDENT:	Kids Academy Springfield
APPEAL PANEL
MEMBER:	Jane Peacock
MEDICAL ASSESSOR:	Michael Hong
MEDICAL ASSESSOR:	John Lam Po Tang
DATE OF DECISION:	10 June 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 three of the psychiatric impairment rating scale (PIRS) categories namely self care and personal hygiene, social and recreational activities, and social functioning; Held – Appeal Panel found error in the category of self care and personal hygiene; MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

1. On 14 March 2025 the worker Meriam Carter (the appellant), lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by
   Dr Douglas Andrews, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 20 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

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):

   ·        the degree of permanent impairment of the worker as a result of an injury (s319(c))

   ·        whether any proportion of permanent impairment is due to any previous injury or pre-existing condition or abnormality, and the extent of that proportion (s319(d))

   ·        whether impairment is permanent (s319(f))

   ·        whether the degree of permanent impairment of the injured worker is fully ascertainable (s319(g))

   ·        Date of injury: 16 September 2021 (deemed)

   ·        Body parts/systems referred: Psychiatric/psychological

   ·        Method of assessment: Whole Person Impairment”

4. 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)
Psychiatric	16 September 2021 (deemed)	Chap 11, p 54-60	n/a	15%	Nil	15%
Total % WPI (the Combined Table values of all sub-totals)					15%

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	Meriam Carter	Claim reference number	W30152/24
DOB	xxxx	Age at time of injury	40
Date of Injury	16 September 2021 (deemed)	Occupation at time of injury	Early childhood educator
Date of Assessment	19 February 2025	Marital Status before injury	Married

Psychiatric diagnoses	Separation anxiety disorder; generalised anxiety disorder
Psychiatric treatment
Is impairment permanent?	Yes

PIRS Category			Class		Reason for Decision
Self-care and personal hygiene			1		Ms Carter is independent in all aspects of self-care and personal hygiene. She presents well-groomed, wears clean clothing, and showers daily. She is careful about her health, regularly exercising and eating a good diet. Her weight is stable. She does housework and cooks most meals without prompting from her husband.
Social and recreational activities			2		She goes out to lunch at a café with her husband frequently. She visits close friends every one to 2 months, taking walks and going out to cafés. She attends church every Saturday morning and socialises with a close group. She has had holidays in the Philippines and Tasmania. She had been attending a gym regularly until the insurer withdrew funding. She usually has her husband present as a support person, but when she visits her friends or goes to the gym, her husband drops her off, and she goes out without him.
Travel			3		Ms Carter regularly travels between her two homes, attends medical and other appointments, and goes shopping. She has travelled to Tasmania and the Philippines. She will not travel away from her house without her husband accompanying her because of her excessive anxiety.
Social functioning			1		She has maintained close and caring relationships with her husband, in-laws, two close friends, and her family in the Philippines. Although her illness has been stressful for her husband, there has not been apparent damage to the relationship. There have been no separations and no domestic violence. Ms Carter is functioning within the normal variation in the general population.
Concentration, persistence and pace			3		Ms Carter can read, watch television, and play the piano for at least 20 minutes. During my assessment, she had periods of losing focus, but this did not occur until after the evaluation progressed for an hour. She can focus well enough to play the piano at her church.
Employability			Ms Carter has significant anxiety and struggles to be away from her husband. She is limited in her ability to sustain concentration and focus. For these reasons, I consider her unfit to work.
Score										Median Class
1	1	2		3		3	5		= 3
Aggregate Score Impairment     15								Total			15 %

1. The worker appealed.

2. In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and/or made demonstrable errors in the assessments she made under five of the PIRS categories, as follows:

   (a)    in assessing class 1 for self-care and personal hygiene when he should have assessed a class 3;

   (b)    in assessing class 2 for social and recreational activities when he should have assessed a class 3, and

   (c)    in assessing class 1 for social functioning when he should have assessed a class 3.

3. In summary, the respondent employer Kids Academy Springfield (the respondent) submitted that the Medical Assessor did not err or make an assessment on the basis of incorrect criteria and the MAC should be confirmed.

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

5. The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self- report can be properly evaluated in the context of other evidence before the Medical Assessor.

6. 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:

   Ms Carter started working for Kids Academy in February 2021. She had concerns about how the preschool was managed and how the manager treated staff.

   Ms Carter had been working with a painful right shoulder since December 2020, which had caused trouble and limited her ability to do some aspects of her job. She applied for workers' compensation in July 2021. Her employer asked for a doctor’s certificate and was unsupportive. She was asked to resign in November 2021.

   Ms Carter said, ‘I was in a bad situation. I feared for my life and thought [my manager] would do something bad to me.’ I asked Ms Carter if she still had this fear, and she confirmed. She explained that in the Phillippines, if you had a dispute with someone, they might kill you.

   She sought support from her general practitioner and was referred to a psychologist.

   ·    Present treatment:

   Treating clinicians:

   o   general practitioner Dr Danny Tang

   o   psychologist Sharon (Ms Carter couldn’t recall her last name); previously Mr Robert Karandrews

   Psychiatric medication:

   o   Nil

   Ms Carter takes Chinese herbs but does not take psychiatric medication. She has a strong preference in this regard.

   She sees her psychologist every three weeks, who has worked on dearousal strategies and encouraged her to be less dependent on her husband.

   Ms Carter has not made meaningful progress.

   ·    Present symptoms:

   Ms Carter is anxious about any separation from her husband. She never goes out without him and accompanies him to his workplace. While he is at work, she sits in the car from a vantage where she can see him. If she needs to go to the toilet, she calls him, and he comes and takes her. They eat lunch together in the car or a café.

   About every one or two months, Mr Carter drops off at a friend’s house, and she can spend time in the company of her friend without him. They may go for a walk or out to lunch.

   She is often irritable and grumpy, often without provocation. She worries about the effect this will have on her husband.

   Her mood is often low, reactive to her anxiety.

   She panics when she is alone, experiencing tachycardia and worries that she is going to have a heart attack. Her psychologist has been encouraging her to take short walks away from the car, no more than 20 metres, and this is sufficient to provoke a panic attack.

   Ms Carter has significant anxiety related to concerns about her safety or the potential of harm from others. I queried her closely about possible psychotic symptoms, but these were not present.

   She has subjective problems with concentration, attention and memory.

   She has no thoughts of self-harm or suicide.

   She has initial insomnia with a two-hour latency. She has middle insomnia, waking up 2 or 3 times during the night.

   Her appetite is intact, and her weight is stable.

   Her libido is reduced but still present.

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

   Ms Carter denied having any mental health problems before commencing work with Kids Academy. There have been no subsequent accidents, injuries or conditions.

   ·    General health:

   Ms Carter's frozen right shoulder first troubled her in December 2020. It still causes pain in her neck and shoulder and restricts her activities. She said, “I can take care of myself, but I have to be careful when doing household chores.

   She has a history of hyperthyroidism that was treated medically. Regular checks have demonstrated euthyroidism.

   She eats a healthy diet and maintains her weight within a narrow band.

   She should not smoke or drink alcohol.

   ·    Work history, including previous work history if relevant:

   Ms Carter was raised in a Seventh-day Adventist family in the Philippines with two sisters. She recalls a happy and caring childhood. Her mother is now deceased, but her father and sisters remain in the Philippines.

   She finished high school and earned a bachelor's degree in pharmacy in the Philippines.

   When she was 21, she travelled to South Korea for missionary work. She met her husband there, and they migrated to Australia in 2008.

   She has earned a Certificate III and diploma qualifications in early childhood education.

   ·    Social activities/ADL:

   Ms Carter and her husband stay at her mother-in-law’s house in Gosford every weekend, and during the work week, they travel to Wahroonga and stay in a rented granny flat.

   She has been married for 16 years. Her husband is a manager who does social media ministry in the evening.

   She rises at 7 AM and does devotional exercises before preparing breakfast. She then showers, dresses, and attends to personal care. Because of her shoulder injury, she does housework at a slower pace.

   She accompanies her husband to work, spending the day in the car. While waiting for him, she reads devotional material, communicates with her family in the Philippines, scrolls through social media and watches videos on YouTube.

   Her husband leaves work to have lunch with her or take her to appointments.

   Her husband used to drop her off at a gym several times a week, but she stopped going in October 2024 when the insurance company stopped paying for it. She would take an exercise class with a friend while he waited in the car.

   She has maintained an exercise regimen using videos on television.

   She and John shop together, and she prepares the evening meal.

   On Saturday, she attends church from 9:30 AM until 2 PM. She plays the piano for the church once a month and practices at home on those occasions. She participates in the church service, including singing and a communal lunch. She has close friends in the church community.

   She used to do community visits with a friend on behalf of the church but stopped doing so when she lost motivation.

   Ms Carter has 2 close girlfriends, and her husband drops her off at one of their homes about once every month or every second month. They go out to lunch together and have a walk.

   She visited the Philippines with John for 2 weeks in 2023. They spent their time visiting family and going to the beach.

   In December 2024, she travelled to Tasmania with John, her mother-in-law and brother-in-law. They went on drives, visited the beach, got out in nature, and visited Mount Wellington.

   Last year, she travelled with her husband, John, to Queensland for his work.

   She drives a car accompanied by her husband and will do so while he works. She said, ‘I never go without my husband except when he drops me off at my friend every one to two months.’

   She has a very close and dependent relationship with John, whom she described as a wonderful husband. She is close to her mother-in-law, brother-in-law, two friends, her father, and sisters in the Philippines. She has a circle of church-related friends whom she doesn’t see outside of that venue. She hasn’t lost any friends, although she is getting out less often. She said, “We still communicate with each other.

   She can read, watch television, or play the piano for at least 20 minutes. When reading, she sometimes has to reread passages because she loses focus. She used to paint but did so only once last year and has no other hobbies or projects.

   When asked by the IME, Dr Verma, what she might do to help her husband, she offered that she might start a home business. She has made no moves to do so and has no idea what sort of business she might be capable of starting.”

7. The Appeal Panel is satisfied that an adequately detailed history was taken, which is broadly consistent with the other evidence before the Medical Assessor. Medical Assessors have to obtain a focussed history and undertake a mental state assessment within a finite appointment time.

8. The Medical Assessor undertook a mental state examination of which he recorded:

   “I assessed Ms Carter via an audiovisual link while she sat in her car. The connection quality was adequate to do a comprehensive assessment lasting 70 minutes.

   She presented casually attired and well groomed, wearing a knitted top.

   She said she was anxious during the interview, but this was not readily apparent. She was cooperative.

   She denied any thoughts of self-harm or suicide.

   She paused and stared into space a few times late in the interview. She would then ask me to repeat my question. When asked about this, she said that her mind wandered off as she focused on her worries.

   There was no evidence of any disorder of thought form or perception. There were no other psychotic phenomena.

   When asked at the end of the interview if she had anything else to add, she agreed that we had covered everything necessary.”

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

   “● summary of injuries and diagnoses:

   My diagnoses rely on the Diagnostic and Statistical Manual – Fifth Edition (DSM-5), published by the American Psychiatric Association.

   o   Separation anxiety disorder

   o   Generalised anxiety disorder

   Ms Carter experiences profound anxiety about separation from her husband, who is her most important attachment figure. She worries about losing him and frets that something dire will happen to her if she has left on her own. She refuses to go out without her husband except when he drops her off for time with one of her close friends. The symptoms have been present for more than 6 months, confirming a diagnosis of separation anxiety disorder.

   Additionally, she is restless and feels keyed up or on edge, has difficulty concentrating, is irritable and suffers sleep disturbance. This supports a diagnosis of generalised anxiety disorder.

   This need not be conceived of as two separate conditions but rather manifestations of a single complex anxiety disorder arising out of her work injury.

   ·    consistency of presentation

   I found no inconsistencies in Ms Carter’s presentation.”

1. The Medical Assessor made an assessment of WPI in accordance with his assessment under the six PIRS categories as set out above.

2. The Medical Assessor made brief comment on the other opinions as follows (emphasis in original):

   “My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reasons why my opinion differs

   Ms Carter provided a statement dated 12 December 2024 in which she endorsed the findings of IME Dr Agnes Chan and criticised those of IME Dr Surabhi Verma. She provided information on her level of functioning using the PIRS categories. Notably, she emphasised her dependence on her husband and that she had travelled to the Philippines in 2023.

   Previous treating psychologist, Mr Rob Karandrews, on 17 June 2022, noted that
   Ms Carter met the symptoms for an adjustment disorder with anxiety and described using CBT and ‘gradual exposure therapy.’

   General practice records note that Dr Danny Tang had diagnosed Ms Carter with a major depressive disorder and used a small dose of amitriptyline, 10 mg daily. On
   5 January 2023, Dr Tang wrote, ‘Her mental health is progressively getting worse despite psychological cognitive behavioural therapy.’ In July 2023, he noted that her mental health was ‘capricious’ [sic] and that she had requested to use herbal medicines.

   IME Dr Agnes Chan, 23 July 2023, interviewed Ms Carter for 80 minutes. Dr Chan described an injury to Ms Carter’s shoulder in December 2020 that, by April 2021, had worsened to the point that Ms Carter was unable to move her arm sideways. Eventually, a frozen shoulder was diagnosed. Dr Chan diagnosed a generalised anxiety disorder (GAD) that had been present since August 2021. Dr Chan noted:

   ‘Of note was the right shoulder pathology in the impairment that resulted from
   Ms Carter. She was able to link the association between the limited shoulder movement and the restrictions upon certain domestic and occupational tasks. Her inability to return to any form of childcare work has been attributed to her shoulder pathology. This is further eroded into her confidence in an already anxious state.’

   Dr Chan recommended engagement with a psychiatrist and possible commencement of medication. She opined, ‘Ms Carter’s prognosis is guarded as she has declined pharmacological treatment.’

   Dr Chan determined a 44% WPI (classes 2, 2, 5, 3, 4 and 5).

   IME psychiatrist Dr Surabhi Verma, 17 September 2024, quoted Ms Carter saying her ‘main difficulty is staying on her own.’ Dr Verma also diagnosed GAD and determined a 6% WPI (1, 2, 3, 1, 2 and 4) before adjusting by 1% WPI for the effect of treatment, arriving at a final 7% WPI.

   Assessing Ms Carter’s impairment is challenging given the severity of her attachment disorder leading to her dependence on her husband.

   Regarding self-care and personal hygiene, Dr Chan found a mild impairment. In contrast, Dr Verma and I thought that Ms Carter was functioning within the normal variation in the general population. Dr Chan stated:

   ‘Does not require her husband to attend to her actual self-care or personal hygiene, but requires either him or her friends to be in company. Appeared well groomed in the interview.’

   Comment: Ms Carter presented very well groomed at the interview. She attends to self-care, including grooming and showering daily without prompting. She does housework, including cleaning, laundry and cooking, without supervision or direction from her husband. In line with her condition, it is sufficient that he is around. Her ability to care for herself or manage her household shows no impairment.

   Dr Chan found Ms Carter unfit to travel, whereas Dr Verma and I considered the impairment moderate. Dr Chan argued:

   ‘Unable to travel on her own on any form of transport due to fear of being alone and concentration difficulties.’

   Comment: For a class 5 rating for travel, the guidelines state, ‘Totally impaired: may require two or more persons to supervise when travelling.’ This does not describe
   Ms Carter. She travels extensively between her two homes, on holidays to Tasmania and overseas to the Philippines. She cannot travel independently and always has her husband accompany her when she travels. This warrants a moderate impairment rating.

   Dr Chan found a moderate impairment in social functioning, whereas Dr Verma and I found Ms Carter unimpaired. Dr Chan stated:

   ‘Marriage is severely strained as Ms Carter is aware of her not accommodating her husband’s time on his own. Able to maintain a sexual relationship but quality has deteriorated. Able to confide in friends and maintain friendships.’

   Comment: There is no evidence that Ms Carter’s marriage is severely strained. She stated that her husband found her condition stressful but is doting and attentive; she described him as a wonderful husband. There has been no domestic violence and no suggestion of separation. She has maintained all other meaningful relationships in her life. She is functioning within the normal variation in the general population.

   Dr Chan found a severe impairment in concentration, persistence and pace, whereas Dr Verma found the impairment mild, and I considered it moderate. Dr Chan stated:

   ‘Ms Carter has not been able to sustain her attention in playing musical instruments. She has not been able to attend to any complex tasks beyond basic activities of daily living. She has constantly been needing the company of another person. She has poor concentration and was quickly and easily overwhelmed.’

   And Dr Verma:

   ‘Her attention and concentration is ‘not so good’ and she keeps on forgetting things. She added that she cannot concentrate like before and she has to reread books ‘until she absorbs the information.’

   Comment: Ms Carter told me that she could read, watch television or play the piano for up to 20 minutes. She reads devotional and self-help books and sometimes needs to reread passages. She gave a detailed history during my interview but on a a few occasions appeared to lose focus briefly.

   Dr Verma found a severe employment in employability, whereas Dr Chan I considered Ms Carter unable to work. Dr Verma stated:

   ‘Ms Carter reported that ‘I really want to work and want to have a normal life but find it difficult to be without my husband.’ She is now planning to start a business so that she could work from home.’

   Comment: Ms Carter said that she speculated about having a home business when asked how she might be able to help her husband. She has no plans to start a business. Her anxiety is of such severity that she would find it challenging to do so.”

3. 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 and recreational activities, and social functioning.

4. 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.

5. 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 no deficit or minor deficit consistent with normal variation in the population at class 1 with the following reasoning (emphasis in original):

   “Ms Carter is independent in all aspects of self-care and personal hygiene. She presents well-groomed, wears clean clothing, and showers daily. She is careful about her health, regularly exercising and eating a good diet. Her weight is stable. She does housework and cooks most meals without prompting from her husband.”

2. The appellant submitted that a class 3 should have been assessed. The Appeal Pane notes that neither the IME qualified by the appellant who assessed a class or the IME qualified on behalf of the respondent assessed higher than a mild impairment.

3. The Appeal Panel is however satisfied that an error was made in the assessment of class 1, or a mild impairment. This is because the appellant depends on the presence of her husband at all times to function when out, in this domain. She cannot go to the toilet when out without her husband accompanying her, and this is consistent with separation anxiety disorder and generalized anxiety disorder as the Medical Assessor had identified. The appellant therefore cannot be considered as having no deficit or a minor deficit consistent with normal variation in the population. A rating of class 2, mild impairment, is the correct criteria.

4. In respect of Social and Recreational Activities, Table 11.2 of the Guides provides as follows:

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

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.

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

   “She goes out to lunch at a café with her husband frequently. She visits close friends every one to 2 months, taking walks and going out to cafés. She attends church every Saturday morning and socialises with a close group. She has had holidays in the Philippines and Tasmania. She had been attending a gym regularly until the insurer withdrew funding. She usually has her husband present as a support person, but when she visits her friends or goes to the gym, her husband drops her off, and she goes out without him.”

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

3. The Appeal Panel considers there is no error in the rating of a mild impairment. The appellant is undertaking both regular social activity and recreational activity. She has travelled for holidays overseas (Philippines). She goes to cafes and to church events as well as the gym. All of these are undertaken on a regular basis. The Appeal Panel considers that there has been no error in assessment on the basis of incorrect criteria and that assessment on the basis of correct criteria gives a class 2 or mild impairment rating for social and recreational activities.

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 with the following reasoning:

   “She has maintained close and caring relationships with her husband, in-laws, two close friends, and her family in the Philippines. Although her illness has been stressful for her husband, there has not been apparent damage to the relationship. There have been no separations and no domestic violence. Ms Carter is functioning within the normal variation in the general population.”

2. The appellant submitted a class 3 should have been assessed. Social functioning is concerned with the quality of relationships. There is no evidence of a severe strain in the appellant’s marriage, and her husband remains supportive. There has been no loss of friendships and she maintains lose relationships with her in-laws to the extent of visiting them in the Philippines and holidaying with them. There is no error in rating a class 1 which is a minor deficit consistent with normal variation in the population.

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

4. This means the calculations become as follows:

Score								Median Class
1	2	2	3	3	5		=3
Aggregate Score Impairment						Total			%
+1	+3	+5	+8	+11	5	16			17

1. For these reasons, the Appeal Panel has determined that the MAC issued on
   20 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:	W30152/24
Applicant:	Meriam Carter
Respondent:	Kids Academy Springfield

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 Douglas Andrews 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	23 March 2020	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	17%	0%	17%
Total % WPI (the Combined Table values of all sub-totals)					17%

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.