Rice v ACT Steelworks Administration Pty Ltd

[2025] NSWPICMP 637

DETERMINATION OF APPEAL PANEL
CITATION:	Rice v ACT Steelworks Administration Pty Ltd [2025] NSWPICMP 637
APPELLANT:	Cheryl Rice
RESPONDENT:	ACT Steelworks Administration Pty Ltd
APPEAL PANEL
MEMBER:	Jane Peacock
MEDICAL ASSESSOR:	Douglas Andrews
MEDICAL ASSESSOR:	Professor Nicholas Glozier
DATE OF DECISION:	25 August 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under four of the psychiatric impairment rating scale (PIRS) categories namely self-care and personal hygiene, social functioning, concentration, persistence and pace, and employability; Held – Appeal Panel found error in two domains namely social functioning and concentration, persistence and pace; a re-examination was not considered necessary as there was sufficient material before the Appeal Panel to enable a determination to be made; Medical Assessment Certificate revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

1. On 30 April 2025 the worker Cherly Rice (the appellant), lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by
   Dr Himanshu Singh, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 3 April 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):

   ·        availability of additional relevant information (being additional information that was not available to, and that could not reasonably have been obtained by, the appellant before the medical assessment appealed against);

   ·        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, 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 did not request that she undergo a re-examination. 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

Fresh evidence

1. Section 328(3) of the 1998 Act provides that evidence that is fresh evidence or evidence in additional to or in substitution for the evidence received in relation to a medical assessment appealed against may not be given on an appeal by a party unless the evidence was not available to the party before the medical assessment and could not reasonably have been obtained by the party before that medical assessment.

2. The appellant seeks to admit the following evidence:

   (a)    statement of the appellant dated 30 April 2025.

3. The appellant submits that the evidence was not available and could not reasonably have been obtained because it concerns the medical assessment by the Medical Assessor.

4. The respondent opposes the admission of the additional evidence.

5. The Appeal Panel determines that the evidence should not be received on the appeal because the appellant has had the opportunity to present statement evidence as annexed to her Application to Resolve a Dispute and to provide a history to the Medical Assessor.

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):

   o   the degree of permanent impairment of the worker as a result of an injury (s 319(c));

   o   whether any proportion of permanent impairment is due to any previous injury or pre-existing condition or abnormality, and the extent of that proportion (s 319(d));

   o   whether impairment is permanent (s 319(f)), and

   o   whether the degree of permanent impairment of the injured worker is fully ascertainable (s 319(g))

   ·      Date of injury: 14 July 2021 – deemed.

   ·      Body parts/systems referred: Psychiatric / psychological disorder

   ·      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)
1. Psychological Injury	14 July 2021 – deemed	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	8 %	0 %	8 %
2.
3.
4.
5.
6.
Total % WPI (the Combined Table values of all sub-totals)					8 %

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	Cheryl Jeanette Rice	Claim reference number (if known)	W822/25
DOB	xxxx	Age at time of injury	53
Date of Injury	14 July 2021 – deemed	Occupation at time of injury	Business Manager
Date of Assessment	11 March 2025	Marital Status before injury	Partner

Psychiatric diagnoses	1.Major depressive disorder		2.
3.		4.
Psychiatric treatment	Treatment " the care of GP, Psychologist and Psychiatrist.		Treatment with antidepressant medication and psychological intervention.
Is impairment permanent?	Yes
PIRS Category			Class		Reason for Decision
Self Care and personal hygiene			2		Ms Rice would wake up in the morning and have breakfast.  Her partner leaves early for work.  She will then stay at home.  She would shower most days before bed at nighttime and wash her hair once a week.  She sweats a lot.  She will do a load of washing every day and will vacuum.  She will do only few rooms at a time in a day and her partner does steam mop.  Doing vacuum increases the pain in her body and they load the dishwasher product together and put it on.
Social and recreational activities			3		Ms Rice has been isolating. She does enjoy swimming on occasions but if she does too much then she is in pain. She had not done swimming for the last few months as she is in Queensland and the water in the pool gets very hot in summer which makes her hard for her to never swim. Occasionally, she will walk the dog with her partner Michael.  She tried doing jigsaw puzzle, but it is difficult to do.  She can do the edges but finds it difficult to do the middle bit. She would watch home recreation show on the TV. She does not go out for meals, mostly go out only once or twice in a year for birthdays. She would text her siblings or speak to mum or talk to her daughters on phone. She would talk to her neighbours if she would see them. She is not into any events or clubs or parties. She would go out with a partner for buying groceries. She does not like meeting new people as she finds it hard to explain things to others.
Travel			2		Ms Rice has lost her confidence to drive, and her partner Michael will drive when they go together.  She may drive locally to the chemist which is few minutes away or may drive to the beach to have a walk in the sand or go for a walk in the ocean.
Social functioning			1		Ms Rice reported that her relationship is not good.  She feels guilty about her partner who works for long hours and gets tired after a long day of manual work.  They do not have arguments, but they may just disagree on things and may not talk for a day.  She stated he is very understanding and has been very supportive and good in their relationship.  The relationship with her children is good as well.  He will talk to them once a week.  She denied any periods of separation or domestic violence.
Concentration, persistence and pace			2		Ms Rice used to do a lot of reading.  She has struggled to concentrate and focus.  She has to go back few pages in Kindle when she tries to read, and she may get stuck and leave it.  She tried to do Xero certification course and had to read a topic and do three questions.  However, she could not get the question right. She has only been able to do 3-4 topics and took a long time and has not gone back to it.  She does not mind watching TV.  She cannot sit all day in front of the TV as she gets distracted and then she will get up to put the washing or make tea and then again watch TV or do puzzles in between.  She will catch up or video call her family.  She was able to hold her attention and concentration through the assessment.  In my opinion, she would be slow to do training or a course and would classify in mild impairment.
Employability			4		Ms Rice stated that she wishes that she could work. She is not getting her Super as well and is struggling with her finances. She may try some volunteer work as she spoke to her psychologist to begin with or start some part-time work.  She stated that she needs to work and get earning and Super.  Her pain affects her work as well.  She stated that a job which involves work from home may suit her as and then she can work on her own pace and can move around in the house or may change her posture and position when she is in pain.  She cannot work at all in same position.  She can perform less than 20 hours per week in a different position.
Score										Median Class
1	2	2		2		3	4		2
Aggregate Score Impairment								Total			%
+	+	+		+		+	14			7

Pre-existing impairment = 0 %

Treatment effects = 1 %

Final WPI = 8 %”

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 he made under four 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;

   (c)    in assessing class 2 for concentration, persistence and pace when he should have assessed a class 3, and

   (d)    in assessing class 4 for employability when he should have assessed a class 5.

3. In summary, the respondent employer ACT Steelworks Administration Pty Ltd (the respondent) submitted that the Medical Assessor did not make assessments on the basis of incorrect criteria and did not err 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 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.

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. The appellant alleged that the reasons given were inadequate in the domains challenged on Appeal. The respondent submitted that the Medical Assessor exercised his clinical judgment on the day of examination applying correct criteria to the assessments in each of the challenged domains and the reasons were adequately expressed and no error has been demonstrated.

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 Rice stated that she joined her employer in 2019, and she worked up until the date of injury which is in July 2021.

   I have noted the statement of Ms Rice where she has written about her injury that she sustained during her employment. I have noted the statement dated 16 August 2021 and another statement dated 1 May 2024. I have noted salient details from her two statements.

   Ms Rice noted in her statement;

   I started working as a business manager at ACT Steelworks in about December 2019.  The job was intensive and demanding, requiring BaaS reconciliation, daily bank reconciliations and attending to payroll for 60 employees across ACT and New South Wales payroll tax and employee entitlements. I would have to ensure that the staff reimbursement codes were correct and reconcile credit card expenses. We will account invoices, statements, we will text rebates, customer invoicing, retentions and bank guarantees. When I first commenced the role, almost all the available services in the office were piled with documents that had not been scanned or filed. As such, I had to work through a significant backlog of paper documents while monitoring two email inboxes and completing the reconciliation duties as required.

   I sustained a psychological injury following extensive bullying and harassment from my employers at ACT Steelworks.

   Incident 1: On 8 July 2020, Michael Barry yelled at me because I made one tiny little error in the new MYOB file setup.  He then left the room and slammed the door so hard, the exit light fell down from above the door. I was shocked and scared. I was worried for my job and wondered what else he was capable of.

   Incident 2: On 4 February 2021 and 5 March 2021, Michael Barry and I attended meetings with TSC Insurance Brokers in Michael's office. Michael said that the actual wages I had calculated must have been incorrect. I attempted to reply to his statement, however he cut me off as was usual practice. I was very embarrassed that he cut me off and questioned my numbers in front of others. He appeared annoyed.  I felt that I did not have an opinion.

   Incident 3: In a fortnightly meeting in or after March 2021, Michael Barry said in front of the project managers and estimators, I'm going to make this Cheryl’s problem in regard to updating the subcontractor's spreadsheet. Everyone looked at me, I felt embarrassed, I felt less important than the other staff. Michael knew the project managers and estimators did not take much notice of the spreadsheet. I felt that Michael was setting me up to fail.

   Incident 4: In a fortnightly meeting in or after March 2021, Michael Barry said ‘that is enough from you’ which I took as meaning to not bring up any more matters concerning administration.  He then said I could leave the meeting, and the meeting could continue about the jobs. I felt that as the business manager, I should have been in attendance for the whole meeting. I felt unimportant and devalued.

   Incident 5: On 23 March 2021, Michael Barry blamed me for Aria Shelton's departure and said ‘what are you doing about finding another job.’ I felt threatened for my job and felt hurt that he blamed me for Aria leaving. He then left the room and slammed the door after I told him that my doctor told me that my headaches were due to workplace stress. He returned and soon after left and slammed the door again. Then I heard glass being smashed.  I felt threatened.  Michael yelled at me when he spoke throughout his conversation.

   Incident 6: In a meeting with Michael and Danny Barry on 24 March 2021, Michael said ‘it is your job to serve the boys’ to which Danny told Michael that was not a nice way to put it. I felt sexually discriminated against.

   Incident 7: I told Michael Barry on 1 July 2021, that I had sacked my daughter for not turning up to work and I asked if he could advertise for a part-time replacement.  However, said he would look around first and that the girl at Wellcraft does everything on her own and their turnover was higher than ours. I believe that Michael just made up that Wellcraft was bigger than the insured as I believe Wellcraft to be a smaller company. I felt that Michael expected me to do everything on my own.

   Incident 8: On 13 July 2021, I told Michael Barry that I could not work downstairs due to Kurt's mess as he was moving him upstairs. He told me I had issues with Kurt. I told him Kurt does not do any work to which Michael yelled back at me that Kurt did. He said “he is not going anywhere accept it and move on. The more you bitch and complain and whinge about him, the less I hear. He is not going anywhere.” I told Michael ‘I am feeling unappreciated, busting my gut, cleaning up everyone else's mess.’ I felt as though I was being moved downstairs as a punishment, as I would be interrupted all the time downstairs and not able to keep up with my duties

   Incident 9: On 14 July 2021, Danny Berry accused me of being rude to his wife as she apparently parked in my car spot. I explained that was not the case. I told him there was no appreciation for the extra work I did. Danny asked me when I was going to find another job. We discussed that Michael Barry told me that the girl at Wellcraft does everything on her own. My last day at work was 14 July 2021.

   Ms Rice, following these incidents, developed headaches and saw her GP and was told by her GP that it was due to the stress of her work. However, when she told her boss about this, he yelled at her. She was not able to sleep and was waking up early in the morning. She had been worrying about everything and about her job. The headaches continued and got worse. She was excessively worried. She was not depressed in the beginning. However, the worries continued about her financial matters and mortgage.  She reported low energy and feeling tired. Her appetite was okay. She enjoyed daily walks and taking her dogs for walks. Her self-care was good. She was cooking and cleaning without any problems and was able to attend shopping. Her concentration was good.  She planned to find a job.  She could not work in a full-time capacity. She did not want to go back to her previous job and did not want to be checked it to being bullied, abused and harassed by the bosses.

   Ms Rice started to take treatment. She saw her General Practitioner. She had an MRI scan which showed osteoarthritis of her spine, and on a few spots, it was more severe than others. She had cortisone injection, and she was put on pain relief medication Panadol, and when the pain was getting worse, she was using some codeine. Her symptoms kept fluctuating.  She felt stressed and depressed and had sleep problems. She was having trouble falling asleep and was waking up early in the morning. She then saw an osteopath and massage therapist for pain management. She saw a psychologist and had a few sessions with her. She started EMDR; however, she was told after two sessions that it was not working. She saw a psychiatrist as well. Her symptoms continued and gradually worsened over time.

   ·        Present Treatment: Ms Rice continues to see a psychologist every few weeks. They started around six to twelve months following her injury at work. She does telehealth appointments and has done various psychological interventions such as grounding, mindfulness and did a mindfulness course in Canberra. She is working with a psychologist and trying to have a routine in her day.

   Ms Rice saw a psychiatrist for a while, and she stopped seeing her around six months ago. She stated that the psychiatrist took her off her duloxetine and wanted to try some other medication which flared up her fibromyalgia due to which she stopped seeing the psychiatrist and has restarted her duloxetine. She denied any admissions to mental health units in public or private setting.

   Ms Rice continues to take the following medications: duloxetine 90 mg daily, Mersyndol prn for pain, Catapres 100 mcg for sleep at nighttime, and Ditropan she takes prn half tablet three times a day.

   ·        Present symptoms: Ms Rice stated that she is not working currently. Her mental health is not great. She lives with her partner, who has been together for 9 years. She stated that she continues to have sleep problems. She has moved from Canberra to Queensland. She is okay to go to sleep but then she would wake up in the night and then finds it hard to fall back asleep. She also has indigestion when she goes to bed and has been prescribed pantoprazole. 40 mg. She may wake up at 5:00 am and has a cat and a kitten and would feed her animals.

   Her partner goes to work then she may go to bed to get some more sleep if she is feeling tired.  Food does not interest her. She may have porridge and yogurt in morning. Her lunch varies. She may drink more water and have apples and crackers and cheese. She does not feel hungry. She would plan dinner for the night, before her partner comes back. She will get veggies ready and make some effort to get things ready for the dinner. She may get the veggies prepared and her partner will do the meat barbecue. She does barbecues on the weekends and tries new recipes, but she would stay inside and not much interested.

   Ms Rice stated that she sweats all the time even when she is in air conditioner. She is worried and keeps thinking all the time. She gets these thoughts in her head such as ‘why I am here, why I can't work.’ She said ‘I don't work, I am always tired and have nothing else to do, I may go out with Michael when he walks the dog.’

   Ms Rice stated that she is in pain all the time which affects her ability to work. She has soreness in her back and most days she is in pain with back aches and headaches. She feels flat in herself and keeps thinking and ruminating about what happened at work.  She does not have motivation to leave her bed and may spend whole day lying around in bed.

   Ms Rice stated that she has struggled to work and hold a job. After she finished with ACT Steelworks Private Limited, she got a job in September 2021. It was a work from home with an accounting firm. It was COVID time so she could work from home. However, things fell apart when she had to work in the office. It was an open-plan office in which she would have to sit with all the people around, and later, it became all day in the office when she could not cope and left work. The previous girl who had left the job left things in mess and she was fixing things. She felt she could not fix someone else's error, and it was very difficult. A year later she had other jobs where she was working 20 to 25 hours in a week in 2022, but she could not cope there as well. She tried 6 to 7 jobs. She would start it but then soon to realise that she is not able to manage it. In one of the jobs, one female employer yelled at her and she packed and left. She had struggled to concentrate in the job and could not get her head around. In most of the jobs, she just lasted one week. However, in the last jobs, she only lasted for a day in late 2022.

   Ms Rice’s stated that in around November 2023, they moved from ACT to Queensland, and she had not applied for jobs since then. She cannot think of it. The reason they moved was because Canberra is a small town and the 7-8 jobs that she had, she came to know that her previous employer found out about her various jobs and caused problems. She told me that she is aware that her employer, ACT Steelworks has made people to leave the town in the past and have bullied others as well. However, no one else has put in a complaint.

   Ms Rice stated that she has good days and bad days. She has been unable to return to employment due to her ongoing symptoms. On a good day, she may manage to go out and spend time gardening or watching a good show. On a bad day, she cannot manage to get out of bed and may end up staying in bed all day. She has lost interest in reading, watching TV, or talking to anyone.

   ·        Details of any previous or subsequent accidents, injuries or condition: Ms Rice stated that she had a stillborn baby in 1996 on the day of Christmas. That was her son. She told that her doctors believed that she had a delayed grief. She delayed her grief and later when she gave birth to her elder daughter, she had bad postnatal depression which continued, and for 12 months she started anti-depressants. She stated that the first 5 years were hard. She would get upset over Christmas every year, which continues to be the case. However, she is better in the rest of the year, and she has been on anti-depressants ever since.  She has tried all different types of medication. She also had postnatal depression when she had her youngest daughter. She tried coming off the medication, but then the symptoms would relapse, and she had continued her medication.

   ·        General Health: Ms Rice stated that she has seen a rheumatologist and has fibromyalgia, which was diagnosed somewhere around 2021. Following the subject incident at work, her pain symptoms have flared up significantly.

   ·        Work history, including previous work history if relevant: Ms Rice worked in Bowral for 7 years in an accounting firm.  She then moved to Canberra as her ex-husband moved there and she wanted her daughters to be close to their dad and able to see him, so she moved to Canberra as well as she thought that Canberra had more to offer to her and her daughters. She stated that when she was working in Canberra, she had a job where one of the boss's sons was very nasty. It was a full-time job, and she left and got out of that job.  She got another work later on. Her GP did a Certificate of Capacity for her and she had a few weeks of work until she got the new job.

   Ms Rice stated that when she was working at ACT Steelworks Private Limited, she developed pain, and it would hurt to climb stairs. She stated this was because of fibromyalgia and the pain started two months before she left work. Her Achilles tendon would feel like a hard rock, and she has pain and aches all over her body. She also gets headaches, fatigue and excessive sweating. She was having physio for the same as she struggled to climb stairs and struggled to walk on the hill.

   ·        Social Activities/ADL: Ms Rice stated that before the injury, she had no issues in going out and socialising. She would regularly catch up with friends and family. She would often go to Southern Highlands when she was in Canberra to see her family and attend family events and used to enjoy driving and had no issues. However, things have changed a lot now when she does not want to go out and prefers to stay home.

   ·        Personal History: Ms Rice was born in Sydney and her family moved close to Bowral.  She grew up in Southern Highlands in Bundanoon. She grew up on 2 acres of land, farm, lot of animals, had milking cows, chooks, eggs and a veggie garden.  She went to the local primary school, played lot of sports. She did coaching for softball as well. She had three siblings growing up. She left school in Year 11 and then did TAFE courses when she started in real estate. She later moved to Canberra. She has two daughters, one lives in Canberra who is 27, the other one lives in Brisbane who is 24. She currently lives with her partner, and they have been together for 9 years and her partner does not have any children. She was married to their daughter's father and got divorced around 18 to 19 years ago.

   Ms Rice denied any drug use. She denied excessive use of alcohol and would mostly drink alcohol in social situations. She denied any family history of mental illness.”

1. The Medical Assessor conducted a mental state examination and recorded his findings as follows:

   “Ms Rice was seen over a video conference over Teams meeting on 11 March 2025.  Ms Rice appeared clean and dressed appropriately. We maintained good eye-to-eye contact and rapport was established. She did not appear agitated or retarded. There were no signs of psychomotor agitation or retardation. She had a spontaneous speech with normal rate, tone and volume. She described her mood as low and flat and her affect was restricted and was teary at times. She had a spontaneous speech with normal rate, tone and volume.

   She described her sleep as disturbed and her appetite has been low as well. She described no pleasure in any activity and nothing makes her happy. She reported some joy with her cats. They give her company, and it makes her feel responsible and she likes to spend time with them. She reported that she may have self-harm or suicide thoughts, but she does not plan anything.  She is aware that her family will be devastated, and her family stops her from doing it.

   She has done her will and her power of attorney and her daughters are aware of it, but she has no plans or intents of self-harm or of suicide. She denied any attempts.  She stated that her case manager had to call the police a few times for welfare check.  She described low levels of self-esteem and confidence. She did not describe any grandiosity, racing thoughts or increased energy levels. There was no evidence of any formal thought disorder, no delusional pattern of thinking and no perceptual abnormalities.  She had an intact judgment and had reasonable insight into her issues and was help-seeking.”

2. The Medical Assessor summarised the injury and diagnosis as follows:

   “●    Summary of injuries and diagnoses: In my opinion, Ms Rice has sustained a psychological/psychiatric injury because of her employment with ACT Steelworks Private Limited as a business manager. She continues to struggle with psychiatric/psychological symptoms and her symptoms are ongoing. She currently meets the DSM-5 criteria for a diagnosis of persistent depressive disorder. Ms Rice has following ongoing symptoms; Depressed mood most of the day or most days or at least two years along with disturbed appetite, insomnia, low energy or fatigue, low self-esteem, poor concentration and feelings of hopelessness. Her symptoms are not explained by any other major mental illness or physiological effects of a substance or another medical condition. Her symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.

   ·        consistency of presentation

   Her presentation was consistent with the history given during the clinical interview, documentation received and mental state examination.”

3. The Medical Assessor explained the basis on which his assessment was made as follows:

   “The facts on which I have based my assessment of whole person impairment (WPI) are:

   -Clinical Interview

   -Mental Status Examination

   -Documentation received including previous IME”

4. The Medical Assessor made an assessment of WPI in accordance with his assessment under the six PIRS categories as set out in Table 11.8 quoted above.

5. The Medical Assessor made comment on the other evidence before him as follows:

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

   ·        I have noted the independent medical examination report by Dr Assad Saboor, Consultant Psychiatrist dated 3 September 2021. Dr Saboor made an opinion-based on the provided history, I am of the opinion that Ms Rice suffers with adjustment disorder with depressed and anxious mood as per DSM-5 diagnostic criteria. Based on the provided history, I am of the opinion that she sustained a psychiatric disorder as a result of workplace bullying and harassment.

   ·        I have noted the independent medical examination report by Dr Assad Saboor, Consultant Psychiatrist dated 18 July 2022. The report stated the diagnosis is major depressive disorder with anxiety features as per DSM-5 diagnostic criteria. I am of the opinion that her current condition is as a result of her work-related injury. Other non-work related factor is her ongoing chronic pain which is interfering with her current presentation causing her distress and affecting her recovery.

   ·        I have noted the independent medical examination report by Dr Assad Saboor, Consultant Psychiatrist dated 13 November 2023. The diagnosis is of the opinion that her condition meets the diagnosis of generalised anxiety disorder as per DSM-5 diagnostic criteria.  Her psychological injury is continuing and has not been resolved.  She has reached maximum medical improvement. The final whole person impairment is 10%.

   ·        I have noted the supplementary report by Dr Assad Saboor, consultant psychiatrist dated 22 January 2024 with amended impairment assessment. There is a deduction for secondary psychological injury of 10%. The final whole person impairment is 9%.

   I have considered the history provided by Ms Rice that she suffered with physical pain in multiple areas of her body, and she was diagnosed with fibromyalgia as a result of work-related injury. The pain due to her fibromyalgia affected her emotionally as well. Therefore, I allow 10% deduction for the effect of secondary psychological injury. It appears that the stress at work precipitated her fibromyalgia as per her reported history. In addition, the pain affected her emotionally. Therefore, it could be interpreted as a secondary psychological injury.

   ·        I have noted the independent medical examination report by Dr Ben Teoh, Psychiatrist and Physician in addiction medicine dated 29 September 2023. The report stated Ms Rice's presentation is consistent with a diagnosis of chronic adjustment disorder with mixed anxious and depressed mood, DSM-5 diagnostic criteria. Her condition has resulted in permanent impairment. She has reached maximum medical improvement. The final whole person impairment is 19%.

   ·        I have noted the supplementary report dated 6 January 2025 by Dr Ben Teoh, Psychiatrist and Physician in Addiction Medicine. The report stated, it is my opinion that fibromyalgia is not considered a psychological condition. Reports are indicating that psychological stress may exacerbate fibromyalgia. The stress exacerbating her fibromyalgia is as a result of her primary psychological condition of her chronic adjustment disorder with mixed anxious and depressed mood caused by her employment. It is my opinion that her fibromyalgia has not materially contributed to her psychological condition. It is more likely that her psychological condition has aggravated her fibromyalgia. It is my opinion that her fibromyalgia pain would have occurred regardless of her work injury. Fibromyalgia has not contributed to the level of an impairment requiring any deduction. Therefore, it is my opinion that deduction of a pre-existing psychiatric condition is not appropriate. 

   ·        I have noted the letter by Dr Samuel Primrose at your General Practitioner Centre dated 23 August 2022. The letter noted her current medications as Amitriptyline, 25 mg tablet, total dose of 75 mg, Brintellix 10 mg one daily, CBD oil 1 ml twice a day, and referred for opinion and management regarding chronic depression and anxiety which has been long-standing on and off. Cheryl has seen regular psychology over the past 10 months. She has tried antidepressants, escitalopram from 2018 until mid-2021, then vortioxetine (currently 20 mg once a day) with amitriptyline being used as a treatment for fibromyalgia (75 mg nocte). She continues to struggle with low mood and physical pain.  This has been complicated getting back and remaining in work.

   ·        I have noted the letter by Dr Romil Jain Interventional pain specialist, dated 25 July 2022. The letter stated, Cheryl has a history of multiple chronic pain problems due to fibromyalgia, chronic widespread pain problems on background of fibromyalgia and psychosocial distress. Psychological distress is contributed to and worsened the pain. Pain impacts her function, mood and sleep, lacking in exercises. She would like to explore medicinal cannabis for her pain management. I have assessed her, and she is eligible for medicinal cannabis.

   ·        I have noted the letter by Dr Amy Kelly, Consultant Rheumatologist dated 31 August 2022. Certainly, Cheryl has symptoms that could be consistent with both mechanical and inflammatory joint pain. I have taken the liberty of prescribing her an anti-inflammatory, that is 50 mg of Mobic per day.

   ·        I have noted the letter by Dr Sujatha Kalava, Consultant Psychiatrist dated 10 January 2024.  The letter stated, Impression: Adjustment disorder on background of work stress, fibromyalgia. Plan to maintain duloxetine at 60 mg. Request more sessions for further treatment.

   My comments:

   In my opinion, Ms Rice has sustained a psychological/psychiatric injury because of her employment with ACT Steelworks Private Limited as a business manager. She continues to struggle with psychiatric/psychological symptoms and her symptoms are ongoing. She currently meets the DSM-5 criteria for a diagnosis of persistent depressive disorder.

   Ms Rice has reached maximum medical improvement as her impairment has become stable.  In my opinion, her impairment is permanent and is unlikely to change substantially by more than 3% in the next 12 months with or without treatment. There is no deduction for pre-existing conditions, and I have added 1 % to the WPI for the effects of treatment. The final WPI is 8%.”

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

   “Ms Rice would wake up in the morning and have breakfast. Her partner leaves early for work.  She will then stay at home. She would shower most days before bed at nighttime and wash her hair once a week. She sweats a lot. She will do a load of washing every day and will vacuum. She will do only few rooms at a time in a day and her partner does steam mop. Doing vacuum increases the pain in her body and they load the dishwasher product together and put it on.”

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 is able to prepare meals, care for herself adequately, showering most days, while some household tasks are shared with her partner she is also able to perform daily household tasks such as a load washing every day and vacuum. The Medical Assessor has taken a detailed history in this regard and has applied the correct criteria in assessing a mild impairment. A rating of class 2, mild impairment, accords with the correct criteria and the Appeal Panel can discern no error in this domain.

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 (e.g. lost partner, close friends). Unable to care for dependants (e.g. 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:

   “Ms Rice reported that her relationship is not good. She feels guilty about her partner who works for long hours and gets tired after a long day of manual work. They do not have arguments, but they may just disagree on things and may not talk for a day. She stated he is very understanding and has been very supportive and good in their relationship. The relationship with her children is good as well. He will talk to them once a week. She denied any periods of separation or domestic violence.”

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 no longer sees her friends. She is also, irritable and angry within her relationship. Although her partner is supportive and there have not been any periods of separation, the Appeal Panel notes that this degree of tension has been consistently described over a long period of time in the other medical evidence that was before the Medical Assessor. These impacts from her psychiatric condition on the quality of the appellant’s relationships represent more than “a minor deficit attributable to the normal variation in the general population”. A class 2 or mild impairment rating is consistent with the correct criteria.

3. In respect of Concentration, Persistence and Pace, Table 11.5 of the Guides provides as follows:

Class 1	No deficit, or minor deficit attributable to the normal variation in the general population. Able to pass a TAFE or university course within normal time frame.
Class 2	Mild impairment: can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.
Class 3	Moderate impairment: unable to read more than newspaper articles. Finds it difficult to follow  complex instructions (eg operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.
Class 4	Severe impairment: can only read a few lines before losing concentration. Difficulties following simple instructions. Concentration deficits obvious even during brief conversation. Unable to live alone, or needs regular assistance from relatives or community services.
Class 5	Totally impaired: needs constant supervision and assistance within institutional setting.

Table 11.5: Psychiatric impairment rating scale – concentration, persistence and pace

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

   “Ms Rice used to do a lot of reading. She has struggled to concentrate and focus. She has to go back few pages in Kindle when she tries to read, and she may get stuck and leave it. She tried to do Xero certification course and had to read a topic and do three questions. However, she could not get the question right. She has only been able to do 3-4 topics and took a long time and has not gone back to it. She does not mind watching TV. She cannot sit all day in front of the TV as she gets distracted and then she will get up to put the washing or make tea and then again watch TV or do puzzles in between. She will catch up or video call her family. She was able to hold her attention and concentration through the assessment. In my opinion, she would be slow to do training or a course and would classify in mild impairment.”

2. The appellant submitted that a moderate impairment or class 3 should have been assessed. The respondent submitted that the Medical Assessor’s rating should be confirmed noting he has exercised his clinical judgment on the day of examination.

3. The Appeal Panel considers that an error has been made. What the Medical Assessor has described in his reasoning accords closely with the criteria for a moderate impairment, and the Medical Assessor did not identify any of her current function that represented a mild impairment, but a hypothetical scenario. The Medical Assessor recorded that the appellant struggles to concentrate when reading, gets distracted such that she doesn’t persists with the undemanding activity of watching TV, can’t follow complex instructions and hypothetically would struggle to do a training course. The assessment of a mild impairment is inconsistent with what the Medical Assessor has described which correctly accords with the criteria for a moderate impairment. The appellant is moderately impaired according to the Medical Assessor’s own description and the evidence before him. Class 3 is the appropriate assessment in the domain of concentration, persistence and pace.

4. 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 (e.g. 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 a severe impairment (class 4) with the following explanation:

   “Ms Rice stated that she wishes that she could work. She is not getting her Super as well and is struggling with her finances. She may try some volunteer work as she spoke to her psychologist to begin with or start some part-time work. She stated that she needs to work and get earning and Super. Her pain affects her work as well. She stated that a job which involves work from home may suit her as and then she can work on her own pace and can move around in the house or may change her posture and position when she is in pain. She cannot work at all in same position. She can perform less than 20 hours per week in a different position.”

1. The appellant submitted that the Medical Assessor should have found the appellant to be totally impaired at class 5. The respondent submitted that the Medical Assessor did not err in the assessment at class 4. The Appeal Panel considers that the assessment of class 4 was correct although incorrectly reasoned. The Appeal Panel considers that a moderate impairment is correct. The appellant has taken several short-term jobs since leaving her employment with the respondent. These include six weeks for MGI Accountants in 2021, immediately followed by a further six weeks with Martin Donnelly, a few days as a bookkeeper with DJAS in April 2022, one month with Kowalski Recruitment from June 2022, a few hours with Alchin Long Group in September 2022 in administration and six hours as a finance manager with Hot Water Hotline in November 2022.

2. In each of these cases, the appellant took roles with significant responsibility and hours and found herself unable to continue.

3. The appellant noted that she suffered from “physical pain and symptoms, which came to be diagnosed as fibromyalgia”, further limiting her ability to work. The Medical Assessor noted that “Ms Rice stated that she is in pain all the time which affects her ability to work.” Impairment related to physical limitations and pain must be ignored in this assessment.

4. According to the MAC, the appellant now has “good days and bad days.” There is nothing to suggest that her condition or impairment has worsened since 2022.

5. The appellant had tried to work in a role similar to that which she left, working full hours and taking on significant responsibility. She was unable to manage. However, from a psychiatric perspective, her efforts provide evidence that she could take on some role. The impairment arising solely from her psychiatric disorder would limit her to one of less responsibility for limited hours (less than 20 hours a fortnight) and her symptoms would lead to erratic attendance. This is a severe impairment rather than being unfit for any work at all due to her psychiatric impairment.

6. In summary, the classes of self-care and personal hygiene (class 2) and employability (class 4) 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 concentration, persistence and pace which was assessed as class 2 but should have been assessed as class 3.

7. This means the calculations become as follows:

Score								Median Class
2	2	2	3	3	4		=3
Aggregate Score Impairment						Total			%
+2	+4	+6	+9	+12	4	16			17

1. The Medical Assessor allowed 1% for the effects of treatment and neither party appealed this allowance. This means the overall impairment as a result of the referred injury becomes 18% WPI.

2. For these reasons, the Appeal Panel has determined that the MAC issued on
   3 April 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:	W822/25
Applicant:	Cheryl Rice
Respondent:	ACT Steelworks Administration Pty Ltd

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 Himanshu Singh 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	14 July 2021 – deemed	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	18 %	0 %	18 %
2.
3.
4.
5.
6.
Total % WPI (the Combined Table values of all sub-totals)					18 %

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.