Lozare v Group Homes Australia Pty Ltd

[2025] NSWPICMP 803

DETERMINATION OF APPEAL PANEL
CITATION:	Lozare v Group Homes Australia Pty Ltd [2025] NSWPICMP 803
APPELLANT:	Mariel Jade Pan Lozare
RESPONDENT:	Group Homes Australia Pty Limited
APPEAL PANEL
MEMBER:	Catherine McDonald
MEDICAL ASSESSOR:	Douglas Andrews
MEDICAL ASSESSOR:	Professor Nicholas Glozier
DATE OF DECISION:	17 October 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of psychological injury under the psychiatric impairment rating scale (PIRS); appeal with respect to all tables except employability; re-examination; Coca-Cola Europacific Partners API Pty Ltd v Pombinho; Held – MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

1. On 6 May 2025 Mariel Jade Pan Lozare lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Medical Assessor Christopher Rikard-Bell who issued a Medical Assessment Certificate (MAC) on 10 April 2025.

2. Ms Lozare relies on the grounds of appeal under s 327(3)(c) and (d) 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 President’s delegate was satisfied that, on the face of the application, at least one ground of appeal was made out, being that in s 327(3)(d) . We conducted a review of the original medical assessment, 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).

RELEVANT FACTUAL BACKGROUND

1. Ms Lozare suffered a psychological injury on 16 November 2023 in the course of her employment with Group Homes Australia Pty Ltd (Group Homes) as a residential care officer. Ms Lozare suffered physical injuries and a primary psychological injury when she was punched by an elderly resident.

2. In respect of the primary psychological injury, the Medical Assessor assessed 5% whole person impairment (WPI) using the Psychological Impairment Rating Scale (PIRS) in the Guidelines. He assessed Ms Lozare in class 1 for self-care and personal hygiene and travel. He assessed her in class 2 for social and recreational activities, social functioning and concentration, persistence and pace. He assessed her in class 3 for employability. He did not make any deduction in respect of a previous injury or pre-existing condition and he did not adjust the assessment for the effects of treatment.

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. As a result of that preliminary review, we determined that the worker should undergo a further medical examination because the Medical Assessor did not provide a detailed explanation for his assessment and did not engage with the material in the file.

EVIDENCE

1. We have all the documents that were sent to the Medical Assessor for the original medical assessment and have taken them into account in making this determination.

2. Medical Assessor Glozier of the Appeal Panel conducted an examination of the worker on 10 October 2025 and reported to us. His report forms part of these reasons.

3. The parts of the MAC that are relevant to the appeal are set out below.

SUBMISSIONS

1. Both parties made written submissions. They are not repeated in full, but we have considered them.

2. In summary, Ms Lozare submitted that the Medical Assessor erred in his assessments under all of the tables of the PIRS except employability. Her submissions contrasted the Medical Assessor’s assessment with the evidence in the file and said that the Medical Assessor should have assessed 19% WPI. The thrust of the submissions is that the Medical Assessor applied incorrect criteria by not appropriately applying the PIRS. In the alternative, Ms Lozare argued that the Medical Assessor made a demonstrable error in failing to set out his actual path of reasoning.

3. The submissions also assert that Ms Lozare’s instructions are that the Medical Assessor failed to ask her questions to obtain information relevant to the PIRS assessment.

4. In reply, Group Homes submitted that the Medical Assessor was not in error to make his own assessment on a subject “about which reasonable minds may differ”, referring to Ferguson v State of New South Wales.[1] Group Homes said that the Medical Assessor did not need to provide extensive reasoning and that the MAC should not be construed “with an eye keenly attuned to the perception of error.”[2] Group Homes said that reference to Ms Lozare’s own statement and the report of Dr Chow, who examined her at the request of her solicitors, was not a sufficient basis to disturb the Medical Assessor’s assessment.

   [1] [2017] NSWSC 887.

   [2] Referring to Vitaz v Westform (New South Wales) Pty Ltd [2010] NSWSC 667.

FINDINGS AND REASONS

1. The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is 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[3] the Court of Appeal held that an 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] [2006] NSWCA 284.

3. In Queanbeyan Racing Club Ltd v Burton[4] the Court of Appeal held that an Appeal Panel is not limited to the ground held to have been made out by the delegate but may consider all grounds of appeal raised in the application. However, the panel is not permitted to look for errors which are not part of the grounds of appeal on which the appeal is made. We have only considered those grounds specifically raised by the appeal.

   [4] [2021] NSWCA 304 at [26].

The MAC

1. The Medical Assessor summarised the circumstances of the injury, noting that the resident who attacked Ms Lozare had broken a window on the day before the incident. He summarised her treatment with her psychologist. He set out her present symptoms, noting that she is worried about her visa status. Setting out Ms Lozare’s social activities and activities of daily living, the Medical Assessor said:

   “Currently, Ms Lozare is able to dress, feed and manage herself adequately. She is able to assist the children and help with their day-to-day needs. Therefore, there is no impairment of self-care and personal hygiene.

   In terms of social function, Ms Lozare is quite irritable and she finds it difficult to relax. She finds that she is unable to remain calm or relaxed when she should be caring for the children and she is irritable with her husband. Therefore, there is mild impairment of social functioning.

   In terms of concentration, Ms Lozare was able to focus well for the full hour long interview today, however, she feels a little less focused overall. She can forget her prayers at times and she finds her mind wandering and becomes distracted. However, she is able to follow prayers even though she re-centres on the task at hand. Therefore, there is mild impairment of concentration, persistence and pace.

   In terms of social and recreational activities, Ms Lozare enjoys taking the children out and interacting with extended family. Currently, there is a brother visiting from the Philippines and they will meet on weekends. Ms Lozare does not like to interact a great deal with friends outside of the family and last saw friends at Christmas time. Therefore, there is mild impairment of social and recreational activities.

   In terms of employability, Ms Lozare does not feel she would be capable of working currently and she has difficulty undertaking housework. She becomes stressed with chest pain and migraines and begins to feel overwhelmed. Ms Lozare has not worked since she ceased work with Group Homes. Therefore, there is moderate impairment of employability.

   In terms of travel, Ms Lozare is able to drive well with no restrictions, therefore, there is no impairment of travel.”

2. The Medical Assessor summarised the findings on his mental state examination:

   “Ms Lozare presented as a pleasant lady of stated age with thick, dark hair who was neatly attired and with a Filipino accent; however, her command of the English language was adequate for the purposes of the assessment and she was able to express herself well. There was a visible tattoo on her left shoulder. She engaged well with the interview process. Her speech was normal in tone and volume. There was no abnormality of perception. Ms Lozare’s affect was reactive, although he did seem anxious at times, particularly when talking about the incident. Her cognitive function appeared normal and her thoughts were logical.”

3. In setting out his summary of the injuries and his diagnosis, the Medical Assessor noted the diagnoses made by other examiners:

   “On 23 November 2023 Ms Lozare suffered a work injury when she was attacked by a resident who was irritable and aggravated. The Police were called and Ms Lozare has suffered with significant emotional difficulties since the incident. On 3 September 2024 Dr Chow, psychiatrist, diagnoses posttraumatic stress disorder and found 20% whole person impairment. She returned to work, 6 hours per day, 2 days per week in an administrative capacity Dr Chow. On 10 October 2024 Dr Andrew Porteous, occupational physician, noted exacerbation of soft tissue injury and degenerative changes. On 10 April 2024 Aimee Santos, psychologist, found there was posttraumatic stress disorder. On 18 March 2024 Dr Ron Haig found no ongoing injury following the subject incident. On 21 June 2024 and 22 November 2024 Dr Lucas Murphy, psychiatrist, found a whole person impairment of 8% with 3% added for treatment effect and recommended further psychological treatment.

   Following the subject incident, I formed the view, on balance, that Ms Lozare developed posttraumatic stress disorder (309.81, F43.10). The criteria according to DSM-5 are outlined below:

   A.     A traumatic event (the workplace incident on 23 November 2023)

   B.     Re-experiencing phenomena with flashbacks of breaking glass the day prior, nightmares and intrusive memories of the incident

   C.     Avoidance behaviours avoiding the elderly, avoidance of perceived danger or threat and avoidance of thinking about the incident as well as emotional distancing

   D.     Negative cognitions with anger, irritability and emotional numbing

   E.     Marked alterations in arousal with hypervigilance and panic attacks

   F.     Duration of more than one month

   G.     Significant impairment of functioning

   H.     Not due to substance use or other medical condition.”

4. The Medical Assessor summarised Ms Lozare’s statement and the reports in the file to which he referred in the quote immediately above. He did not set out why he agreed or disagreed with those opinions.

5. The Medical Assessor completed the PIRS Rating form with the information in [20] above.

Demonstrable error

1. A demonstrable error is an error which is readily apparent from the examination of the MAC.[5] The Medical Assessor has applied the correct criteria for his assessment because he assessed Ms Lozare using the PIRS. He made a number of demonstrable errors in doing so.

   [5] Merza v Registrar of the Workers Compensation Commission [2006] NSWSC 939 at [39].

2. The Medical Assessor is tasked with determining the degree of WPI by undertaking an examination and preparing a report, based on his observations on the day of the examination and using his own clinical judgement.[6] The Medical Assessor is therefore an administrative decision maker and the correct approach to review of his decision is described in the joint judgment in Minister for Immigration and Ethnic Affairs v Wu Shan Liang[7] where the High Court approved the statement of principle in a decision of the full Federal Court:

   “… a court should not be concerned with looseness in the language nor with unhappy phrasing of the reasons of an administrative decision-maker. … the reasons for the decision under review are not to be construed minutely and finely with an eye keenly attuned to the perception of error."

   [6] Guidelines paragraph 1.6.

   [7] [1996] HCA 6, 185 CLR 259, 272.

3. The Medical Assessor is required to set out the path of his or her reasoning. In State of New South Wales (NSW Department of Education) v Kaur[8] (Kaur) Campbell J said:

   “…In particular, it is obvious that approved medical specialists are required to decide disputes referred to them by the process of medical assessment. Even so, it is not necessary that approved medical specialists should sit as decision makers choosing between the competing medical opinions put forward by the parties. Essentially, the function is the same as that described by the High Court in Wingfoot Australia. That is to say, their function is in every case to form and give his or her own opinion on the medical question referred by applying his or her own medical experience and his or her own medical expertise. It is sufficient, as their Honours pointed out at [55], that:

   ‘The statement of reasons… explain the actual path of reasoning in sufficient detail to enable the Court to see whether the opinion does or does not involve any error of law’.”

   [8] [2016] NSWSC 346 at [26].

4. The Medical Assessor is directed by the standard MAP template to comment on other opinions. In Tradieh v LM Hayter & Sons Pty Limited,[9] Stern JA said that the medical dispute between the parties was not a dispute between the assessments made by their independent medical examiners. Her Honour said:[10]

   “Ultimately, as is clear from Wingfoot v Kocak and IAG v Keen, both of which arose in the context of (for this purpose) relevantly analogous legislative schemes, [the Medical Assessor] was required to make an assessment of the factual or evaluative question referred under s 319(c) of the 1998 Act, being the degree of the plaintiff’s permanent impairment as a result of the Injuries. Notwithstanding that s 321 of the 1998 Act provides for a medical dispute to be referred for assessment, the role of the medical assessor is not to adjudicate between or to resolve the competing positions of the parties. A medical assessor must plainly consider the material before him or her, and that material will likely include expert assessments of WPI relied upon by a claimant and an employer where the dispute is as to the degree of the claimant’s WPI, but no higher level of ‘engagement’ is required under the 1998 Act.”

   [9] [2025] NSWSC 840.

   [10] At [37].

5. A Medical Assessor is alerted by the template to provide the reasons why his or her opinion differs from other opinions in the file. That enables the parties understand how and why a different result was reached. The fact that another assessor made a different observation on a different day should not influence the Medical Assessor’s opinion but when the Medical Assessor’s assessment was so much lower than that of Dr Chow, it was necessary for him to explain why.

6. We are unable to consider Ms Lozare’s submission that the Medical Assessor failed to ask appropriate questions. Ms Lozare did not seek to rely on a statement about her experience at the examination and, if she had, it would not have been admissible. In Lukacevic v Coates Hire Operations Pty Limited,[11] Hodgson JA said:

   “A dispute by the worker as to the history set out in the certificate, or the observations made by the AMS, can readily be raised; and it could be raised honestly or dishonestly, on strong or flimsy grounds. Having regard to the matters I have set out, in my opinion it would be reasonable for an AP not to admit evidence raising such a dispute unless that evidence had substantial prima facie probative value, in terms of its particularity, plausibility and/or independent support. Otherwise, simply by raising such a dispute, going to a matter relevant to the correctness of the certificate, a worker could put the AP in a position where it had to have a further medical examination conducted by one of its members. I do not think this would be in accord with the policy of the WIM Act.”[12]

   [11] [2011] NSWCA 112.

   [12] At [78].

7. For that reason, we disregard the submission that the Medical Assessor did not ask appropriate questions. However, whether he asked appropriate questions to elicit a detailed history or not, the Medical Assessor did not set out adequate history in the MAC to properly disclose his path of reasoning.

Reassessment

1. Medical Assessor Glozier re-examined Ms Lozare on behalf of the Appeal Panel. We adopt his report and his assessment. There is no need or utility to repeat the matters set out in it, noting the statement Ward P with whom the other members of the Court of Appeal agreed, in Coca-Cola Europacific Partners API Pty Ltd v Pombinho:[13]

   “The statutory provisions assume power on the part of a medical member of the Appeal Panel to carry out a re-examination and assessment of the worker. It may be inferred that the Appeal Panel, in adopting the report and findings, was endorsing the reasoning in that report since that is where the reasons are to be found. I do not accept that the Appeal Panel was required to deliver separate or distinct reasons as to why the Appeal Panel (or two of the three members of it, perhaps) accepted [the Medical Assessor]’s assessment in preference to the assessment of, say, the Medical Assessor. In my opinion, it was sufficient for the Appeal Panel to adopt [the Medical Assessor]’s assessment (for the reasons contained therein).”

   [13] [2024] NSWCA 191 at [88].

2. We have re-assessed each of the PIRS tables based on the history Medical Assessor Glozier obtained. Because of the requirement to assess Ms Lozare on the day of the examination, there will inevitably be some differences in the assessments over time. Dr Chow assessed Ms Lozare in July 2024, only eight months after the injury and 15 months ago. Dr Murphy assessed her for Group Homes in November 2024.

3. It is relevant to observe that the important part of the description of each class is the level of impairment – e.g. no deficit, mild impairment, moderate impairment. The PIRS recognises that there is a range of conduct which can be described as normal. Assessment in class 1 is appropriate where there is “no deficit or minor deficit attributable to the normal variation in the general population”.

4. Rather than providing criteria for assessment, what follows the description of the level of impairment in each class are some examples of limitations on activities which are consistent with the level of impairment. In Jenkins[14] Garling J said:

   “I am satisfied that the descriptions of the activities which give rise to a conclusion by an AMS of the extent of a disability of an individual by reference to each table in the PIRS, are simply, in my view, examples of activities which would indicate an assessable level of disability. Those examples, on their face, are not necessary to be found in each case, but may, in any particular case, be sufficient to support a conclusion as to the level of disability.”

   [14] At [65].

Self care and personal hygiene

1. The Medical Assessor assessed Ms Lozare in class 1, on the basis that there was essentially no deficit. He gave generic reasons for the assessment without detailing the particular deficits.

2. Based on Medical Assessor Glozier’s recent assessment, we place Ms Lozare in Class 2. She reports some mild impairment with binge-eating, increasing weight and reduced hair-washing. She does all of the family chores although at times is distractible and may not complete these. She prepares her own meals, the meals of her children, shops and does other household activities.

3. The need for Ms Lozare’s husband to assist her with shopping is because she cannot carry heavy items as a result of her physical injury.

Social and recreational activities

1. The Medical Assessor assessed Ms Lozare in class 2. Based on Medical Assessor Glozier’s examination, we assess her in class 3.

2. Ms Lozare goes to church intermittently, less than before, and her social life revolves around her family, e.g. weekly visits with her cousins and family games. She takes her daughter to volleyball every Saturday but prefers not to become involved and avoids the other parents when watching the game. She can enjoy gardening on her own or being in nature but appears to have required prompting for this.

Travel

1. The Medical Assessor assessed Ms Lozare in class 1 on the basis that she is able to drive with no restrictions. The history that Medical Assessor Glozier obtained shows that there are some restrictions on her ability to drive in the city, but the table is not restricted to driving. As the examples in the PIRS show, the table measures a worker’s ability to leave their home and travel to unfamiliar areas. The examples also focus on the ability to travel, not whether a worker feels uncomfortable while travelling. It is important not to conflate the symptom of feeling uncomfortable with an impairment.

2. We assess Ms Lozare in class 1. She is able to drive as and where she needs locally. She has never been able to drive in the city so uses public transport. She travels from Whalan to Ultimo two days per week to attend her course. Although she may be symptomatic when on public transport, she is able to actually do this with no incapacity. She is unable to fly due to visa restrictions.

Social functioning

1. The Medical Assessor assessed Ms Lozare in class 2 because she is irritable with her family. He did not consider her ability to maintain other relationships.

2. Table 11.4 measures the impact of the injury on the existence and strength of a worker’s personal relationships.

3. Based on Medical Assessor Glozier’s examination, we also assess Ms Lozare in class 2. She is well supported by her family, has intermittent contact with an old friend. She has made some new friends and acquaintances at college but lost some of her other friends from when she used to work.

Concentration, persistence and pace

1. The Medical Assessor assessed Ms Lozare in class 2, essentially based on her ability to concentrate for the full, hour long interview. He did not consider the course that she has been undertaking since January 2025.

2. Table 11.5 assesses a worker’s ability to maintain concentration and to persist with cognitively demanding tasks. It also measures the pace of their cognitive processes. The assessment under this table differs from the other tables of the PIRS because the consultation allows the Medical Assessor to form their own opinion as to the worker’s ability to concentrate and respond during the examination, and their findings on the mental state examination are relevant. The examination will generally consist of open rather than closed questions. The consultation is, in itself, a cognitively demanding task. The medical examiner has an opportunity to observe the claimant’s ability to relate their story coherently, whether they have memory lapses or use memory aides, whether they can stay on topic or need questions restated or to be redirected. These elements form an important part of the mental state examination.

3. In the experience of the medical members of the Panel, a worker’s ability to engage in the interview process is a good reflection of their ability to concentrate and persist with tasks and of the pace of their cognition in other areas of their life. It is not sufficient by itself, but, taken with other aspects of the history provided by the claimant or in the Commission’s file, is an integral part of the assessment of concentration, persistence and pace.

4. We also assess Ms Lozare in class 2. Although she reports some subjective problems with concentration and persistence on an intermittent basis, she is completing a three-day-a-week diploma at the normal pace. Assisted by some prior knowledge, she described being able to catch up and complete the weekly tasks even when she has a day when she is unable to attend college because of anxiety.

Assessment

1. Ms Lozare did not appeal with respect to the Medical Assessor’s assessment of class 3 for employability.

2. For these reasons, we have determined that the MAC issued on 10 April 2025 should be revoked, and a new MAC should be issued.

3. The assessments are therefore class 2 for self care and personal hygiene, class 3 for social and recreational activities, class 1 for travel, class 2 for social functioning and for concentration, persistence and pace and class 3 for employability.

4. When those scores are arranged as required by paragraph 11.14 of the Guidelines, they are 1, 2, 2, 2, 3 and 3. The median score is 2, and the aggregate is 13. Under Table 11.7, that converts to 7% WPI.

5. The new certificate is attached to this statement of reasons.

PERSONAL INJURY COMMISSION

APPEAL AGAINST MEDICAL ASSESSMENT

REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR

MEMBER OF THE APPEAL PANEL

Matter Number:	M1-W793/25
Appellant:	Mariel Jade Pan Lozare
Respondent:	Group Homes Australia Pty Limited
Date of Determination:	8 October 2025

Examination Conducted By:	Nicholas Glozier
Date of Examination:	08 October 2025

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

Ms Lozare confirmed that she continues to see her psychologist, Matilda, on a two- to three-weekly basis. This appears currently focused on day-to-day strategies and managing her life stressors. She said the psychologist ‘wants me to focus on what happened’ through EMDR but she found it intolerable and so did not pursue. She continues to see the same general practitioner. She was referred to a psychiatrist many months ago but says that because of the gap between the request and approval, she has not followed up on this. She does not see any other specialists.

Current Medications:

Citalopram 20mg, Temazepam 10mg most nights (changed from her Circadin). She takes Meloxicam and Norgesic: if she overuses her shoulder it is painful and she also noted that she uses it when she is triggered by intrusive memories as this also causes her shoulder to hurt.

Other aspects of wellbeing and recovery:

She spent the last month trying to unpack and sort out the new home that the family has moved into but has still not completed this. Her husband and father have ‘made a garden’ and she does some gardening. Although enrolled in a gym, she says she has not been for a couple of months and despite thinking she will go on the way back from dropping the children at school, she does not do so. She continues to binge and comfort-eat at times, with an increased weight to 56kg. She will do breathing techniques & grounding, and listens to the rosary on a podcast to help her sleep.

Ms Lozare reported that her physical pain has improved a little, such that she no longer has to take her painkillers regularly. She also no longer has frank panic attacks but continues to experience a number of other symptoms as below.

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

A significant stressor over the past few months has been her visa requirements. Following her termination in January this year she only had 60 days to secure a new visa. She enrolled in a diploma in community services at a college in Ultimo. She has completed 6 or 7 months of this course, three days a week on a bridging visa. However this visa application has been rejected and they are currently in appeal. Her husband’s role was also impacted by the loss of visa and he has had to change job to being a delivery driver for DHL/Amazon. They moved to a new apartment in Whalan approximately a month ago due to their changed circumstances.

Ms Lozare reports she goes to bed around 10pm most nights and falls asleep listening to the rosary. This will take 30-60 minutes. She said she knows she is going to have a bad night if she remembers hearing the end of the rosary which occurs approximately half a week. She then wakes around 3am-4am, i.e. 5 or so hours later, about half of the week. She can be breathless with negative dreams, telling me today dreams about ‘her community underwater’ (I am unclear if this refers to the intense flooding recently in the Philippines), her being in a maze, or falling. She is often sweaty and aroused when awakes. She falls back to sleep generally, getting up at 7am. She will then prepare her and the children’s breakfast, make a coffee and their packed lunches, and take them to school.

On the weekdays she does not have college (two days a week), she will come back, lie down and then get on with the household chores. She says she is frustrated that although she does chores for much of the day, she does not complete them and is distractible such that at the end of the day she feels as though she has many unfinished tasks. She is responsible for all the cooking for the family, including dinners and making her own meals. She says she washes her hair less frequently because her hair is falling out, and takes less care of herself associated with some binge-eating. She also does the shopping although at times the heavier shopping is accompanied by her husband because she cannot carry heavy goods. She also finds encountering someone who looks like her assailant, anxiety-provoking.

One day a week she has to attend online seven hours, doing interactive assessments and tasks with her colleagues. Two days a week she has to attend a full day at college in Ultimo. She is allowed to turn up late because of her child duties. She has been able to attend throughout but says that at times the content can cause her to become frustrated or anxious and she may leave. She then has to make up this time and complete the tasks so has not fallen behind. She describes this as something that she enjoys and gives her confidence as she has prior experience in community and care services. She enjoys being able to share her experience and knowledge with others. She is completing the course in the standard pace although, as above, when anxious and aroused may at times leave.

She goes to church some Sundays. She has a close friend who lives in Australia whom she was at school with, but says she has not seen her for several months. She suggested this is in part due to their demands (her friend has young children) but also her own condition. She sees her cousins on a weekly basis, going to each other’s houses on a Friday evening as their daughters go to Hillsong Fellowship. She and her husband will at times go out e.g. they went to Empress Falls just recently for the day. Otherwise she is family-focused. In the afternoon she picks the kids up from school, makes dinner and then the family will have dinner together. In the evenings they will watch a movie or play games. She can at times play chess although can be distracted and her son recently found his Scrabble game in the move and the family will play Scrabble. If fatigued or distracted or overwhelmed, she will go and lie down. She describes reduced stress tolerance and intolerance of noise and being overly-demanded. She can drive her kids to school and locally. She said she has never liked being in the city as she used to get lost even before the incident, finding that the GPS made her ‘go round and round in circles.’ As such she has never driven into the city or to college. She takes public transport. She can do this without any incapacity although noted that at times she sees people who remind her of her assailant, causing arousal and anxiety but continues to actually manage this travel. She is not allowed to leave the country due to visa requirements.

She reports a close supportive relationship with her husband and her father (an Australian resident) who is currently visiting. She also has a supportive relationship with her cousins. Although she and her best friend don’t see each other much, they talk regularly. She has made two new friends at college, but has lost some of her previous acquaintances and workmates.

She reports a subjective sense of distraction, poor memory – particularly when she is anxious and aroused – although is completing a three-day-a-week diploma in a normal time with some issues over occasional lack of attendance or leaving when becoming overly distressed and aroused due to triggers. She is not allowed to work and had to relinquish her previous job as noted by others because of the visa restrictions as her role was a physical role.

Symptomatically she remains somewhat anxious/dysphoric with low stress tolerance, reduced confidence, and intrusive recollections of the assault. These occasionally affect her at night but can be more prominent during the day when she has full multimodal re-experiencing episodes. These recollections can also trigger recurrence of her bursitis pain. She does not have panic attacks anymore but has some symptoms of high levels of anxiety. She does not appear to be avoidant of any particular area but prefers the safety of home day-to-day and can manage to undertake external activities when required, fulfilling her social, college and family demands. She has some subjective issues with concentration and memory problems when overly aroused and anxious.

1. Findings on clinical examination

Ms Lozare was casually-dressed, not unkempt, and sitting on her bedroom floor. The bed was unmade behind her. She was somewhat anxious and apprehensive. She relaxed when I told her I did not have to go over the incident again as she was very fearful of this. She at times was slightly tearful. She was able to focus and attend well for the hour of the assessment. She was softly-spoken but showed no formal thought disorder. She described some dysphoric low depressive symptoms with associated lack of confidence although not anhedonia and being able to experience good self-confidence when in situations where she feels comfortable. She does not have panics or marked avoidance phenomena but intrusive re-experiencing, fairly common sleep disturbance of unusual dreams and arousal, but overall a normal sleep duration but with middle insomnia.

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

Not applicable.

Summary

Ms Lozare partially meets the criteria for a Posttraumatic Stress Disorder. Firstly it is quite unclear whether the traumatic event actually met the severity requirements of Criterion A. Secondly the level of avoidance that she reported today may well not meet Criterion C. She has marked intrusive recollections and a number of other phenomena in Criterion D and E. As such, her most parsimonious diagnosis is of a Posttraumatic Stress Disorder in a partial form or partially remitted given she has reported some mild improvement in some of the symptoms.

WORKERS COMPENSATION DIVISION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter number:	W793/25
Applicant:	Mariel Jade Pan Lozare
Respondent:	Group Homes Australia Pty Limited

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

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Christopher Rikard-Bell 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 AMA 5 Guides	% WPI	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total % WPI (after any deductions in column 6)
Psychiatric and psychological disorders	16.11.2023	Chapter 11	N/A	7	Nil	7%
Total % WPI (the Combined Table values of all sub-totals)					7%