Robertson v Secretary (Department of Communities and Justice)
[2025] NSWPICMP 585
•8 August 2025
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Robertson v Secretary (Department of Communities and Justice) [2025] NSWPICMP 585 |
| APPELLANT: | Tracey Lee Robertson |
| RESPONDENT: | Secretary, Department of Communities & Justice |
| APPEAL PANEL | |
| MEMBER: | Jane Peacock |
| MEDICAL ASSESSOR: | John Baker |
| MEDICAL ASSESSOR: | Douglas Andrews |
| DATE OF DECISION: | 8 August 2025 |
CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); psychological injury; appellant worker alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under four of the psychiatric impairment rating scale (PIRS) categories namely self-care and personal hygiene, travel, social functioning and employability; Held – Appeal Panel found error and a re-examination was considered necessary; MAC revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 12 March 2025 the worker Tracey Lee Robertson (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Ankur Gupta, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 7 March 2025.
The appellant relies on the following ground of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
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.
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.
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
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.
The appellant requested that she undergo a re-examination by a Medical Assessor who is also a member of the Appeal Panel. As a result of its preliminary review, the Appeal Panel determined that it was necessary for the worker to undergo a further medical examination because the Appeal Panel found error.
EVIDENCE
Documentary evidence
The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.
Further medical examination
Medical Assessor John Baker of the Appeal Panel conducted an examination of the worker and reported to the Appeal Panel.
Medical Assessment Certificate
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
Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
FINDINGS AND REASONS
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.
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.
The matter was referred to the Medical Assessor for assessment as follows:
“The following matters have been referred for assessment (s 319 of the 1998 Act):
· Date of injury: 6 March 2023 (deemed)
· Body parts/systems referred: Psychological / Psychiatric disorder
· Method of assessment: whole person impairment”
The Medical Assessor issued a MAC certifying 11% whole person impairment (WPI) as a result of the injury as follows:
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psychological / Psychiatric disorder | 6 March 2023 (deemed) | Chapter 11 NSW workers compensation guidelines for the evaluation of permanent impairment 4th edition | excluded | 11% | 0% | 11% |
| 2. | ||||||
| Total % WPI (the Combined Table values of all sub-totals) | 11% | |||||
The assessment was based on his assessment under psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows:
“Table 11.8: PIRS Rating Form
| Name | Tracey Lee Robertson | Claim reference number (if known) | TF2217482 |
| DOB | xxxx | Age at time of injury | 54 years |
| Date of Injury | 6 March 2023 (deemed) | Occupation at time of injury | Manager Caseworker |
| Date of Assessment | 20 February 2025 | Marital Status before injury | Single |
| Psychiatric diagnoses | 1. Persistent Depressive Disorder with anxious distress | 2. | |||||||||
| 3. | 4. | ||||||||||
| Psychiatric treatment | on Venlafaxine 150mg, Quetiapine 450mg | Psychotherapy | |||||||||
| Is impairment permanent? | Yes | ||||||||||
| PIRS Category | Class | Reason for Decision | |||||||||
| Self Care and personal hygiene | 1 | As described in the main body of the report, there is a minor deficit attributable to the normal variation in the general population. She looks after her house and pets adequately. She does not need any prompting to eat, and she has maintained her hygiene as well. | |||||||||
| Social and recreational activities | 3 | As described in the main body of the report, she has moderate impairment. She has declined invitations to social events and has missed family birthdays. She can go to the shops as needed and communicate with her friends on Facebook. She likes spending time on social media. She travels to Coffs Harbour for a meal with her daughter every fortnight. | |||||||||
| Travel | 1 | As described in the main body of the report, there is no impairment. She can drive into town to Coffs Harbour and can get to new places if needed. She goes to the shops to collect her groceries as well. | |||||||||
| Social functioning | 1 | As described in the main body of the report, there is no impairment. She gets on well with her daughter and has not fallen out with her friends or extended family. | |||||||||
| Concentration, persistence and pace | 3 | As described in the main body of the report, there is moderate impairment. She reported reduced concentration and being unable to retain things. However, she was able to focus throughout the assessment. She manages her finances independently and takes her medication regularly. In my opinion, she is likely to struggle to read complex material. | |||||||||
| Employability | 4 | Based on her symptom burden and presentation, it is my opinion that Tracy has severe impairment. She cannot return to her pre-injury role or any other position that requires her to work as a social worker. She can work up to 10 hours per week in a home-based role, over one or two days a week. Her attendance is likely to be erratic based on emotional symptoms. | |||||||||
| Score | Median Class | ||||||||||
| 1 | 1 | 1 | 3 | 3 | 4 | =3 | |||||
| Aggregate Score Impairment | Total | % | |||||||||
| 1+3 | +1 | +1 | +3 | +4 | 13 | 11% | |||||
The Appeal Panel notes that the Medical Assessor in fact made an error in his calculation of the median leading to an error in the final whole person impairment assessment. His assessment results in a WPI of 7% because the median is in fact 2 and not 3 as he incorrectly stated. Neither party drew the Appeal Panel’s attention to this error. It has not formed the basis on which the Appeal Panel has approached the Appeal.
The worker appealed.
In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and demonstrable errors in the assessments he made under four of the six PIRS categories, namely self care and personal hygiene, travel, social functioning, and employability causing him to make an error in the assessments in these domains as follows:
(a) in assessing Class 1 for self care and personal hygiene when he should have assessed Class 2;
(b) in assessing Class 1 for travel when he should have assessed Class 2;
(c) in assessing Class 1 for social functioning when he should have assessed Class 2, and
(d) in assessing Class 4 for employability when he should have assessed Class 5.
In summary it was submitted that principally this error arose because the Medical Assessor did not provide an adequately path of reasoning for his findings in the contested domains.
In summary, the employer Secretary, Department of Communities & Justice (the respondent) submitted that the Medical Assessor did not err and nor did he make an assessment on the basis of incorrect criteria and the MAC should be confirmed. It was submitted that the MAC was adequately reasoned when read as a whole and the findings were open to the Medical Assessor applying his clinical expertise to the assessment.
The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS for mere difference of opinion but must be satisfied as to error.
The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self-report can be properly evaluated in the context of other evidence before the Medical Assessor. The Appeal Panel considered that the path of reasoning was inadequate, and it was not clearly discernible from the reasons given that the assessments under the contested PIRS categories were based upon the correct criteria. The Appeal panel notes that the Medical Assessor does not provide an adequate record of his findings on mental state examination.
In these circumstances of the above finding of error, the Appeal Panel considered that a
re-examination by a Medical Assessor member of the Appeal Panel was necessary. Medical Assessor John Baker was appointed to conduct the re-examination, and he reported to the Appeal Panel as follows (emphasis in original):
“APPEAL AGAINST MEDICAL ASSESSMENT
REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR
MEMBER OF THE APPEAL PANEL
Matter Number: | M1-W30202/24 |
Appellant: | Tracey Lee Robertson |
Respondent: |
Examination Conducted By: | Dr John Baker |
Date of Examination: | 7 July 2025 |
NSW Workcover re-examination of Tracey Lee Robertson
Matter Number: M1-W30202/24
Appellant: Tracey Lee Robertson
Respondent: Secretary (Department of Communities and Justice)
Date of Injury: 14 June 2023 (deemed)
Method of assessment: Whole person impairment
Re-examination date: 7 July 2025
Re-examination
The claimant attended the re-examination by MS teams. She attended alone without a support person. Assessor John Baker performed the re-examination.
History relating to the injury.
The claimant reported the following:
The claimant said she was aged 57 years at the time of this assessment.
The claimant was the second daughter of a two-sibling family. She was born in Crown Street Woman’s Hospital (closed). She said her father had died at 70 years of age about 12 years ago. She said her mother died from breast cancer in 1997 aged about 52 years. The claimant had one elder sister aged 63 years who was self-employed in a small business.
The claimant said she lived alone in her own home with her two dogs and two cats. She reported that she attended Cartwright public school during her primary school years. She progressed to Hoston Park High School. She complete Year 10. Whilst at school she reported that she enjoyed playing basketball as a centre for her team. She was also a sprinter during the athletics season. She said whilst at high school she was told that she was ‘long-sighted.’ She used reading glasses.
The claimant reported that her childhood was enjoyable and she. She was never injury because of childhood trauma, abuse, or neglect. Whilst in primary school the claimant had her tonsils surgically removed. She recovered from this surgical treatment without impairment. The claimant reported that she was physically well during her early adulthood. She did not have diabetes, asthma, epilepsy, skin, or cardiac conditions. She stated she would suffer from mild seasonal hay fever.
The claimant reported that when she let school she was employed as a mural artist. She said that she worked in this capacity painting murals on public and private clients’ buildings. She reported that at about 17 years of age she completed an NSW TAFE course as a graphic artist. She reported that she was soon to cease work as an artist because of no new work.
The claimant said she then commenced work in various office roles for steel product manufacturers. She reported she worked in the office supporting sales, and incoming payments. She reported that the company manufactured steel guttering for the construction industry.
Whilst working within this industry the claimant said she travelled to various locations with Australia. She worked in Perth, W.A. After returning from Perth, she travelled internationally. She travelled to Nicaragua Cuba and Mexico for about one year. She said she visited various cultural sites of interest to her during her travel.
The claimant returned to Australia when she was aged about 30 years of age. She said she had a relationship with the father of her daughter. They separated after a brief time, and she reported that her daughter was now aged 23 years and working as a legal assistant. She said her daughter was born by caesarean section and she recovered from this surgical procedure without impairment. She stated she did not suffer from any psychiatric or psychological impairment in relation to her pregnancy or during the postnatal period.
The claimant said that she had an episode of hyperparathyroidism disease. She reported having her affected hyperparathyroidism glands removed surgically about 10 years ago. She reported that her condition settled and has remained in remission since surgical treatment. She did not have any impairment from this surgical treatment or condition.
The claimant reported that she had stopped drinking alcohol about 12 years before this re-examination. She reported that she stopped smoking tobacco about 24 years prior to this re-examination. She does not use illicit substances and does not gamble.
The claimant reported that in about 2008 she returned to university to study social work by distance education through Deakin University. She said that she would study modules by correspondence and attend block for her on-campus curriculum. She completed her Bachelor of Social work in 2012. She was employed at Coffs Harbour Base Hospital and then found employment with this employer in 2013.
The claimant reported that prior to this primary psychological injury she had never lodged a personal injury claimant either in relation to motor accidents, Workcover, or public liability. She said that this was her first psychological personal injury claim.
History of primary psychological injury
The claimant reported that she commenced her work as a social worker in the Grafton Office in 2013. She reported that she was employed by ‘FACS.’ The claimant’s role was as a case worker. She participated in child protection duties for her region.
The claimant reported that during the initial years of her employment the office where she was employed was well resourced and staffed. She reported that there were usually 6 to 7 case workers per manager. The claimant stated that as her employment progressed, she noticed that there were fewer case managers and less teams. She said she told what the plan moving forward for her regional office was and her role and responsibilities became increasingly more overwhelming.
The claimant reported that in 2017 she became an acting manager and by about 2018 she was promoted to manager. She said that there were only about three staff to assist her. The claimant reported that she had also begun working as a ‘triage’ manager. She said she would be responsible for answering calls received on the Helpline. The claimant reported that she began to become overwhelmed emotionally by her work duties. She reported that during 2022 until her leaving her work role in about May 2023 she closed two hundred cases of children been at risk. She reported that she did not have the necessary resources to manage the many children referred to the child protection service.
The claimant was responsible for all court matters within the regional office. She felt increased pressure to work harder and close more cases whilst the number of workers per case-management team deteriorated. The number of case-worker teams decreased from about six to three due to lack of resources.
The claimant stated she became very distressed as she feared that a child may be seriously injured and she would have been the person who closed the case worker file. She reported her emotional distress to her senior manager. The senior manager would not say anything more than, ‘Write a good closing rational and you will be alright.’ The claimant stated she became increasingly depressed in her mood. She reported that she felt excessive inappropriate guilt and she would have intrusive distressing depressive ruminations about how worthless and hopeless things were. She reported that she felt depressed in her mood on most days, for most of the day. She said her appetite decreased and she began to experience low energy and fatigue. She stated she began to have depressive ruminations about worthlessness. Her concentration became poor, and she was less able to concentrate and persist with the necessary pace of her work duties. She reported she felt as if she were making multiple errors and she would have to check to ensure she had not made errors before moving on to close the next case.
The claimant reported that she became increasingly focused on her worries about a 4-year-old girl. This girl returned to her mother’s care whilst the claimant worried for the safety of the girl. The claimant said she feared from the child’s safety, as she felt responsible for the child’s welfare after this child had been restored to her mother who was well known to the regional office where the claimant worked.
The claimant said that she felt her workplace, depressed overwhelmed and feeling worthless with poor sleep and low energy every day. She said since leaving her employment she had not returned to work in any capacity. She said that she continues to feel that she should have done more – however she was unable to identify in that capacity she should have improved. The claimant reported that she had not had any of her closed cases re-investigated.
Mental State Examination
The claimant presented as a distressed, dishevelled woman who looked older than her stated age. She had unwashed and uncombed hair. She reported she was not interested in attending her hairdresser. She stated that her daughter would attend and try and lift her depressed mood by washing her hair and cutting her hair when the claimant’s grooming became too poor for her daughter to tolerate.
The claimant spoke in a soft quiet voice. Her rate of speech was slow. She demonstrated difficulty at times with her checking herself as to the narrative she provided during the assessment. The claimant reported low energy and her clothes were unwashed. She reported that she would re-wear her clothes for many days before changing them.
The claimant’s concentration was slow and disrupted by intrusive distressing depressive ruminations she could not voluntarily supress. She became tearful and distress when talking about having to close cases on children she feared were at future risk. She described she felt worthless and that her self-esteem and self-confidence broke. The claimant became emotionally overwhelmed by the most severe cases that involved court attendance – as well as the overwhelming number of cases she had to close because of lack of resources in the office.
The claimant’s sensorium was normal, her orientated in time, place, and person were normal. She did not suffer from psychotic symptoms or delusional ideas. She was insightful into her condition. She did not report suicidal thoughts or plans.
DSM-5-TR F43.1 Persistent depressive disorder – complaint criteria at
re-examination
Criterion A: Depressed mood for most of the day, for more days than not, as indicated by the claimant’s subjective account and observed by her clinical team for more than 2 years at the time of this re-examination.
Criterion B: Presence, while depressed, two or more symptoms as follows:
1. Loss of appetite as reported to the prior assessor and at the time of this re-examination with more than 5 kgs in weight loss.
2. Insomnia with poor sleep and difficulty remaining asleep due to depressive ruminations and dreams of children the claimant had assessed being in danger, waking her from sleep with her having difficulty returning to sleep.
3. Low energy and constant fatigue most days for most of the day.
4. Low self-esteem with the claimant feeling increasingly worthless and unable to perform her role – resulting in the claimant leaving her role and not returning to any employment.
5. Poor concentration, with difficulty making decisions which commenced whilst having to recurrently check she had not made any errors whilst closing about two hundred cases and subsequent inability to make decisions regarding her future life and career.
Criterion C: During the 2-year period of disturbance, the individual has never been without the symptoms in criteria A and B for more than 2 months at a time.
The claimant meets these criteria as she has continued to experience her depressive symptoms as defined by criterion A and B persistently most days for most of the day since the onset of this primary psychological injury.
Criterion D: Criterion D is not an essential part of the diagnosis of persistent depressive disorder, as this criterion defines the presents of episode of major depressive disorder concurrent with persistent depressive disorder. The claimant had not reported that she had suffered from major depressive disorder concurrent with her primary psychological injury.
Criterion E. There has never been a manic episode or hypomanic episode, and criteria have never been met for cyclothymic disorder.
This criterion is met as the claimant did not report any of these conditions and the forwarded documents did not demonstrate the claimant as having any of these conditions.
Criterion F. The disturbance is not better explained by a persistent schizo-affective disorder, schizophrenia, delusional disorder, or other specific or unspecified schizophrenia spectrum and other psychotic disorder.
This criterion is met as the claimant did not report any of these conditions and the forwarded documents did not demonstrate the claimant as having any of these conditions.
Criterion G. The symptoms are not attributable to the physiological effects of a substance (e.g. a drug of abuse, a medication) or another medical condition (e.g. hypothyroidism).
This criterion is met as the claimant does not have any effects of a substance or any drug of abuse or medication. The claimant condition of hyperparathyroidism is not related to hypothyroidism, as the parathyroid glands are adjacent but not part of the thyroid gland.
Criterion H. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
This criterion is met as the claimant became increasingly distressed in her workplace whilst her primary psychological injury was developing, and she had left the workplace after the onset of this primary psychological injury without her returning to any employment in any capacity since leaving this employment.
For the above reasons, the diagnosis of DSM-5-TR F43.1 Persistent depressive disorder made.
Treatment
The clamant reported that she attended her general practitioner for psychiatric treatment. Her medical team treated her with various antidepressant medication and mood stabilising medication to augment her antidepressant treatment.
Dr Andrea Rose a psychiatrist had treated the claimant. The claimant had been treated with quetiapine up to 400mg at night and bupropion, 150 milligrams twice daily. These medications were removed prior to this re-examination.
The claimant said she had commenced seeing a new psychiatrist about once each month by telehealth from her home. The claimant reported that at the re-examination her new antidepressant regime was Venlafaxine XR 225mg daily with Mirtazapine 30mg at night.
The claimant’s medical practitioner referred her to a clinical psychologist. The claimant said no rapport established between her and the “young” psychologist. The claimant elected to use the employer’s Employee Assistance Program (EAP) for psychological treatment. The claimant was never admitted to psychiatric hospital for inpatient psychiatric treatment.
The claimant reported she continued to attend her general practitioner in person as she is close to her home. She said she would attend about once each month for ongoing treatment. The claimant also would attend her clinical psychologist once per month in-person for ongoing psychological treatment.
Permanent Impairment Ratings Scale
The claimant’s permanent impairment was assessed.
Selfcare and personal hygiene
The claimant reported that she lived alone in her own home. She reported that she had pets that lived inside and outside of her home. The claimant reported that she had low energy and was less able to maintain her pets, hygiene, and routine care of their common animal health (e.g. fleas and worms). She was less able to clean the litter trays and groom her pets which lead to increased animal dander throughout the home. The claimant was able to feed her animals as per her pets’ routine since the onset of this primary psychological injury.
The claimant was able to live independently in her home. She was less able to maintain her self-care and personal hygiene. She laundered her clothes less; she had poorer nutrition and relied on ‘snacks’ instead of preparing and cooking meals for herself. She would eat one meal most days and had lost about 5 kgs since losing her appetite over recent months. She would leave her dishes to pile up unwashed. She reported she would shower less, and she had stopped attending her hairdresser completely as the usual time taken for her haircare, cutting and colouring was too long and too noisy. She would become irritable and distressed whilst her hairdressers chatted and played music which the claimant no longer enjoyed.
The claimant’s daughter would only attend her home about three times each year. Her daughter would do the washing piles and cleaning inside the home. The claimant’s daughter’s partner would also attend and perform outdoor home maintenance for the claimant. The claimant had a mower-man to cut her lawn and shrubs. The claimant reported she would due light cleaning, less often due to her easily becoming fatigued and delaying essential selfcare and personal hygiene routines.
The claimant reported that her daughter was planning to move such that her daughter was closer to her mother – however at the time of this assessment these arrangements were not in place and the claimant did not offer an expected commencement date.
The claimant had a mild impairment class 2 for self-care and personal hygiene.
Travel
The claimant provided and extensive history of being a skilled traveller in south America into Cuba, Mexico and Nicaragua without difficulty, illness, or complications. She had also travelled into Papua New Guinea without complications, illness, or difficulty. She said that she could travel to unfamiliar locations without impairment before the onset of this primary psychological injury.
The claimant said she could easily travel to visit her sister’s nieces who lived about 10 minutes away by car. She said she could travel to visit these members of her extended family without difficulty before the onset of this primary psychological injury.
The claimant said in the past her daughter would visit, and the claimant and her daughter would travel on to Byron Bay or Coff’s Harbour for day trips. She said she enjoyed the travel time as she had an opportunity to chat with her daughter for longer periods during the day. She would take these day trips twice each year before the onset of this primary psychological injury.
The claimant said she could travel to her gym, alone three times per week. She would walk her dogs frequently before the onset of this primary psychological injury.
The claimant reported that after the onset of the primary psychological she began to have low energy. She reported she would easily fatigue, and she was no longer interested in travel. She said she had to plan to leave the house. She said her dogs would prompt to walk them should she be late on their walking schedule.
The claimant could attend her medical and psychological appointments in-person when told to attend in-person by her clinicians. She said that she would text message her psychologist should her energy levels and depressed mood be too severe to enable her to leave the home and the appointment would be by telehealth.
The claimant reported she had reduced her grocery shopping to once every 2 weeks. She was able to travel to these familiar and local locations alone.
The claimant reported she had not travelled to unfamiliar locations since the onset of this this primary psychological injury. She said she had no interest and no energy to bother about travelling long distances. She had stopped her daytrips with her daughter to Byron or Coff’s Harbour for this reason – she said she would become agitated and distressed should she think about travel for long distances or unfamiliar locations alone.
The claimant reported that she avoided traveling past her old workplace as she did not want to have to explain herself or have incidental contact with her old co-workers as she would become distressed and agitated.
The claimant had a mild impairment class 2 for travel.
Social functioning
The claimant reported that prior to this primary psychological injury she enjoyed visiting her extended family she said her sister’s nieces lived close to her and she would visit these extended family members. She said they would meet weekly.
The claimant said that before the onset of this primary psychological injury she would attend her extended family’s social events where this group would routinely invite her.
The claimant said she was single. She did not have a partner, before this psychological injury.
The claimant said her relationship with her daughter was close and enjoyable. She reported they would communicate by telephone most days and plan future events together.
The claimant said that since the onset of this psychological injury she had become increasingly withdrawn from her extend family. She said that she would not attend the routine weekly meal together with her extended family. She said she had stopped these social events since about Deceme 2024. She said she no longer enjoyed attending and the invitations had finally ‘dried up.’
The claimant reported tension in her relationship with her extended family, and she reported that she was unable to see her newborn nephew for about four months after his birth. She said this was the first time this had happened in relation to her extended family’s relationship towards her, she reported increased depressed mood and sadness due to this incident.
The claimant said her relationship with her daughter was strained by the psychological injury. She described she enjoyed her daughter’s company less since the onset of this psychological injury. She reported she worried that she was a burden to her daughter and that she was no longer able to provide her daughter with happiness since the onset of this primary psychological injury.
The claimant reported that her friends from her gym do not contact her.
The claimant had a mild impairment class 2 for social function.
Employability
The claimant reported that before the onset of this primary psychological injury she was a resilient woman committed to providing child protection to vulnerable children within her region. She said, ‘When you’re in child protection – you’re all in.’
The claimant had been success full in working in various roles prior to successfully completing her university Bachelor of Social Work as an adult correspondence student. She found employment at Coff’s Harbor Hospital and then for this employer. The claimant was very skilled in her role. She was promoted to manager. She was isolated and left with an overwhelming number of complex cases that required detailed work for presentation to the courts. The claimant was able to provide these complex services without impairment before the onset of this primary psychological injury.
The claimant said as her primary psychological injury manifested, she became increasingly depressed and sullen in her mood. She lost energy. She said her self-confidence broke because of her manager overwhelming her with work. She was no longer resilient working in her emotionally demanding role. Her self-esteem broke because of the psychological injury – she began to worry and doubt herself. She reported that she began to worry about children been returned to mothers who previously had their children removed. She stated that she had depressive rumination of been guilty or responsible for future harm to the two hundred children whose cases she closed. She became overwhelmed by the more severe cases that were in the court system. The claimant reported she sought help however her depression became too severe, and she was no longer able to persist with her work. She left her employment and has been unfit to return in any capacity to any role. She said she had lost her capacity to work in any role as she worried, she will make errors and be responsible for not performing at a satisfactory level for her employer.
The claimant reported that she had never worked in a home-based work role. She said she would not be able to get out of bed each morning to maintain a minimum employable standard. She reported that her pace work would be too slow, and she would socially withdraw from the task as she would not be able to experience any positive emotions of any job. She said her energy levels were too low, and her self-esteem broken.
The claimant had a total impairment class 5 for employability.”
The Appeal Panel considers that the examination undertaken by Medical Assessor John Baker was conducted in a thorough manner. The Appeal Panel notes the history Medical Assessor John Baker has provided in his report to the Appeal Panel, including the history as to the appellant’s ability to function in the PIRS categories that has been challenged on appeal, namely self-care and personal hygiene, travel, social functioning and employability. The Appeal Panel notes Medical Assessor John Baker’s findings on clinical examination of the appellant and his diagnosis made after clinical examination of the appellant, of DSM-5-TR F43.1 Persistent depressive disorder. The Appeal Panel agrees with and adopts the findings of Medical Assessor John Baker that at the time of the re-examination the appellant’s distress and associated anxiety are part of the Criterion H of DSM-5-TR F43.1 Persistent depressive disorder.
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.
The Appeal Panel adopts the findings of Medical Assessor John Baker on re-examination as follows:
“The claimant reported that she lived alone in her own home. She reported that she had pets that lived inside and outside of her home. The claimant reported that she had low energy and was less able to maintain her pets, hygiene, and routine care of their common animal health (e.g. fleas and worms). She was less able to clean the litter trays and groom her pets which lead to increased animal dander throughout the home. The claimant was able to feed her animals as per her pets’ routine since the onset of this primary psychological injury.
The claimant was able to live independently in her home. She was less able to maintain her self-care and personal hygiene. She laundered her clothes less; she had poorer nutrition and relied on ‘snacks’ instead of preparing and cooking meals for herself. She would eat one meal most days and had lost about 5 kgs since losing her appetite over recent months. She would leave her dishes to pile up unwashed. She reported she would shower less, and she had stopped attending her hairdresser completely as the usual time taken for her haircare, cutting and colouring was too long and too noisy. She would become irritable and distressed whilst her hairdressers chatted and played music which the claimant no longer enjoyed.
The claimant’s daughter would only attend her home about three times each year. Her daughter would do the washing piles and cleaning inside the home. The claimant’s daughter’s partner would also attend and perform outdoor home maintenance for the claimant. The claimant had a mower-man to cut her lawn and shrubs. The claimant reported she would due light cleaning, less often due to her easily becoming fatigued and delaying essential selfcare and personal hygiene routines.
The claimant reported that her daughter was planning to move such that her daughter was closer to her mother – however at the time of this assessment these arrangements were not in place and the claimant did not offer an expected commencement date.”
The Appeal Panel considers that based on these findings, the best fit is a mild impairment or class 2 for self care and personal hygiene.
In respect of Travel, Table 11.3 of the Guides provides as follows:
Table 11.3: Psychiatric impairment rating scale – travel
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision.
Class 2
Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.
Class 3
Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.
Class 4
Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person.
Class 5
Totally impaired: may require two or more persons to supervise when travelling.
The Appeal Panel adopts the findings of Medical Assessor John Baker on re-examination as follows:
“The claimant provided and extensive history of being a skilled traveller in south America into Cuba, Mexico and Nicaragua without difficulty, illness, or complications. She had also travelled into Papua New Guinea without complications, illness, or difficulty. She said that she could travel to unfamiliar locations without impairment before the onset of this primary psychological injury.
The claimant said she could easily travel to visit her sister’s nieces who lived about 10 minutes away by car. She said she could travel to visit these members of her extended family without difficulty before the onset of this primary psychological injury.
The claimant said in the past her daughter would visit, and the claimant and her daughter would travel on to Byron Bay or Coff’s Harbour for day trips. She said she enjoyed the travel time as she had an opportunity to chat with her daughter for longer periods during the day. She would take these day trips twice each year before the onset of this primary psychological injury.
The claimant said she could travel to her gym, alone three times per week. She would walk her dogs frequently before the onset of this primary psychological injury.
The claimant reported that after the onset of the primary psychological she began to have low energy. She reported she would easily fatigue, and she was no longer interested in travel. She said she had to plan to leave the house. She said her dogs would prompt to walk them should she be late on their walking schedule.
The claimant could attend her medical and psychological appointments in-person when told to attend in-person by her clinicians. She said that she would text message her psychologist should her energy levels and depressed mood be too severe to enable her to leave the home and the appointment would be by telehealth.
The claimant reported she had reduced her grocery shopping to once every 2 weeks. She was able to travel to these familiar and local locations alone.
The claimant reported she had not travelled to unfamiliar locations since the onset of this this primary psychological injury. She said she had no interest and no energy to bother about travelling long distances. She had stopped her daytrips with her daughter to Byron or Coff’s Harbour for this reason – she said she would become agitated and distressed should she think about travel for long distances or unfamiliar locations alone.
The claimant reported that she avoided traveling past her old workplace as she did not want to have to explain herself or have incidental contact with her old co-workers as she would become distressed and agitated.”
The Appeal Panel considers that based on these findings, the best fit is a mild impairment or class 2 for travel.
In respect of Social Functioning, Table 11.4 of the Guides provides as follows:
Table 11.4: Psychiatric impairment rating scale – social functioning
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).
Class 2
Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
Class 3
Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.
Class 4
Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (eg lost partner, close friends). Unable to care for dependants (eg own children, elderly parent).
Class 5
Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.
The Appeal Panel adopts the findings of Medical Assessor John Baker on re-examination as follows:
“The claimant reported that prior to this primary psychological injury she enjoyed visiting her extended family she said her sister’s nieces lived close to her and she would visit these extended family members. She said they would meet weekly.
The claimant said that before the onset of this primary psychological injury she would attend her extended family’s social events where this group would routinely invite her.
The claimant said she was single. She did not have a partner, before this psychological injury.
The claimant said her relationship with her daughter was close and enjoyable. She reported they would communicate by telephone most days and plan future events together.
The claimant said that since the onset of this psychological injury she had become increasingly withdrawn from her extend family. She said that she would not attend the routine weekly meal together with her extended family. She said she had stopped these social events since about December 2024. She said she no longer enjoyed attending and the invitations had finally ‘dried up.’
The claimant reported tension in her relationship with her extended family, and she reported that she was unable to see her newborn nephew for about four months after his birth. She said this was the first time this had happened in relation to her extended family’s relationship towards her, she reported increased depressed mood and sadness due to this incident.
The claimant said her relationship with her daughter was strained by the psychological injury. She described she enjoyed her daughter’s company less since the onset of this psychological injury. She reported she worried that she was a burden to her daughter and that she was no longer able to provide her daughter with happiness since the onset of this primary psychological injury.
The claimant reported that her friends from her gym do not contact her.”
The Appeal Panel considers that based on these findings, the best fit is a mild impairment or class 2 for social functioning.
In respect of Employability, Table 11.6 of the Guides provides as follows:
| Class 1 | No deficit, or minor deficit attributable to the normal variation in the general population. Able to work full time. Duties and performance are consistent with the injured worker’s education and training. The person is able to cope with the normal demands of the job. |
| Class 2 | Mild impairment. Able to work full time but in a different environment from that of the pre-injury job. The duties require comparable skill and intellect as those of the pre-injury job. Can work in the same position, but no more than 20 hours per week (eg no longer happy to work with specific persons, or work in a specific location due to travel required). |
| Class 3 | Moderate impairment: cannot work at all in same position. Can perform less than 20 hours per week in a different position, which requires less skill or is qualitatively different (eg less stressful). |
| Class 4 | Severe impairment: cannot work more than one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic. |
| Class 5 | Totally impaired: Cannot work at all. |
The Appeal Panel adopts the findings of Medical Assessor Baker on re-examination as follows:
“The claimant reported that before the onset of this primary psychological injury she was a resilient woman committed to providing child protection to vulnerable children within her region. She said, ‘When you’re in child protection – you’re all in.’
The claimant had been successful in working in various roles prior to successfully completing her university Bachelor of Social Work as an adult correspondence student. She found employment at Coff’s Harbor Hospital and then for this employer. The claimant was very skilled in her role. She was promoted to manager. She was isolated and left with an overwhelming number of complex cases that required detailed work for presentation to the courts. The claimant was able to provide these complex services without impairment before the onset of this primary psychological injury.
The claimant said as her primary psychological injury manifested, she became increasingly depressed and sullen in her mood. She lost energy. She said her self-confidence broke because of her manager overwhelming her with work. She was no longer resilient working in her emotionally demanding role. Her self-esteem broke because of the psychological injury – she began to worry and doubt herself. She reported that she began to worry about children been returned to mothers who previously had their children removed. She stated that she had depressive rumination of been guilty or responsible for future harm to the two hundred children whose cases she closed. She became overwhelmed by the more severe cases that were in the court system. The claimant reported she sought help however her depression became too severe, and she was no longer able to persist with her work. She left her employment and has been unfit to return in any capacity to any role. She said she had lost her capacity to work in any role as she worried, she will make errors and be responsible for not performing at a satisfactory level for her employer.
The claimant reported that she had never worked in a home-based work role. She said she would not be able to get out of bed each morning to maintain a minimum employable standard. She reported that her pace work would be too slow, and she would socially withdraw from the task as she would not be able to experience any positive emotions of any job. She said her energy levels were too low, and her self-esteem broken.”
The Appeal Panel considers that based on these findings the best fit for Employability is Class 5 total impairment.
This means the calculations become as follows:
Score
Median Class
2
2
2
3
3
5
=3
Aggregate Score Impairment
Total
%
+2
+4
+6
+9
+12
5
17
19
For these reasons, the Appeal Panel has determined that the MAC issued on
7 March 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: | W30202/24 |
Applicant: | Tracey Lee Robertson |
Respondent: | Secretary, Department of Communities & Justice |
This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.
The Appeal Pane revokes the Medical Assessment Certificate of Medical Assessor Ankur Gupta and issues this new Medical Assessment Certificate as to the matters set out in the table below:
Table - whole person impairment (WPI)
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psychological Injury | 6 March 2023 (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 | 19% | 0% | 19% |
| Total % WPI (the Combined Table values of all sub-totals) | 19% | |||||
The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.
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