State of New South Wales (Western NSW Local Health District) v Broughton

DETERMINATION OF APPEAL PANEL
CITATION:	State of New South Wales (Western NSW Local Health District) v Broughton [2025] NSWPICMP 387
APPELLANT:	State of New South Wales (Western NSW Local Health District)
RESPONDENT:	Samantha Broughton
APPEAL PANEL
MEMBER:	Deborah Moore
MEDICAL ASSESSOR:	Douglas Andrews
MEDICAL ASSESSOR:	Graham Blom
DATE OF DECISION:	3 June 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor (MA) erred in his assessments under two categories of the psychiatric impairment rating scale (PIRS) namely social and recreational activities, and travel; the MA further erred in finding the respondent worker had achieved maximum medical improvement (MMI) and in applying a 1% modifier for the effects of treatment as per paragraph 1.32 of the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed 1 March 2021; both parties agreed that the 1% modifier for the effects of treatment was an error; re-examination required; no error in the PIRS categories appealed; reasons given as to why MMI had been reached; Held – MAC revoked because of the error re treatment effects; new certificate issued.

BACKGROUND TO THE APPLICATION TO APPEAL

On 6 December 2024 State of New South Wales (Western NSW Local Health District) (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Yu Tang Shen, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 31 October 2024.
The appellant relies on the following grounds 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 ground(s) 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, 4^th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

PRELIMINARY REVIEW

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.
As a result of that preliminary review, the Appeal Panel determined that the worker should undergo a further medical examination. Although none was requested, the Panel agreed that given the nature of the grounds of appeal, a re-examination was appropriate to properly consider those grounds.

EVIDENCE

Documentary evidence

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

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
In summary, the appellant submits that the MA erred in his assessments under two categories of the Psychiatric Impairment Rating Scale (PIRS), namely Social and recreational activities and Travel and further erred in finding Samantha Broughton (the respondent worker) had achieved maximum medical improvement (MMI); and in applying a 1% modifier for the effects of treatment as per paragraph 1.32 of the Guidelines.
In reply, the respondent agrees that the MA erred in applying a 1% modifier for the effects of treatment but otherwise submits that no errors were made.

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 appellant was referred to the MA for assessment of whole person impairment (WPI) in respect of a primary psychological injury on a date of injury of 13 December 2023.
The MA obtained a history of the circumstances of the injury which we do not intend to repeat here.
Present treatment was noted as follows:
“She is currently on Escitalopram 20mg, and Quetiapine 400mg, Aripiprazole 10mg, Somac and Mounjauro for weight gain. She is seeing her GP every 2 months at least. She is seeing her psychologist every fortnight. She is seeing her psychiatrist every month or so. There are no current plans for treatment escalation or medication changes.”
Present symptoms were noted as follows:
“She said she has been feeling depressed often, and she has been able to enjoy her children’s company but not much else. She said she has been sleeping well with the quetiapine, though she takes a long time to fall asleep, and she gets about 8 hours. Her sleep has been generally poor, and she said she gets about 4-5 hours of sleep. Her appetite has been ok, and she eats about one or two meals, and she has put on weight 26kg from the quetiapine and recently lost 16kg from the Mounjauro. Her energy has been very low, and she spends most of her time on the couch and she doesn’t do any exercise, though she was able to take small walks in the hospital. Her concentration has been poor, and she cannot do Sudoku or read a book. She said she feels worthless often. She has death fantasies that her children would be better off without her, without active suicidal ideations, and her children are her protective factors. Her anxiety has been heightened and [she has] regular panic attacks.
She said she has a lot of intrusive recollection of her work, related to when she was at work and what people have said. I asked if she had any memories related to her childhood and assault in 2016, which she said occurs sometimes, but not often. She said she had gone to the police related to her childhood assault and she had gone to the police as a cousin rang her informing her that she was concerned another child was being assaulted. She said both investigations did not turn out well, and she felt angry about the outcome. She feels she cannot trust people in case they know people from her work.
She said she has been hearing voices including her dead family members, a few that she doesn’t recognise and are sexual in nature, and she showers with her bathers on, and she feels they are inserting songs in her head. She said she gets embarrassed having a thought, as they can read her thought, leading to her being humiliated.
She said she was admitted to Kellyville Private Hospital for a psychiatric admission for 21 days due to poor self-care, and she left hospital on the 24 October.
She was asked if she had any other relevant information she wished to add, and she indicated that she did not have any further information to add.”
When asked to provide “Details of any previous or subsequent accidents, injuries or condition” the MA said:
“Prior the subject injury, she said she saw a psychiatrist in 2005 after her husband died in 2004 and she was diagnosed with Major Depressive Disorder, and she said she saw her psychiatrist over 10 years, and had treatment including escitalopram 10mg and quetiapine 100mg at night for sleep. She said she recovered fully after a couple of years, and she was able to wean off her medications successfully.
She had a sexual assault in Geelong in 2016, and she needed to take Long Service Leave and Annual leave for the police investigation. She said she developed anxiety and was put back on escitalopram and Seroquel for sleep, and she did not have therapy, and she said she was not diagnosed with PTSD at the time, though she endorsed having post-traumatic symptoms at the time, and it improved after she moved in 2019-2020 to Buronga.
She said after she put her house on the market to sell in Geelong, she alleged she had bullying at work after notifying her work she wanted to leave, and she said she developed anxiety, which improved after she left.
She denied any psychological symptoms prior to the subject injury and she had been able to successfully wean off the escitalopram and Seroquel in 2020 when she moved to Buronga. She said she had no difficulties trusting people prior to the subject injury, but during the police investigations in 2019 and 2020, she had some thoughts about her assault, but not in 2021, as she was happy and was functioning well.
Prior to the subject injury, she denied any substance use, and rare alcohol use. Since the subject injury, she denied any increase of alcohol use or substance use.”
After setting out details of her general health and work history, the MA then turned to consider the impact of Ms Broughton’s injury on her social activities and activities of daily living (ADL’s) and said:
“She is currently 53 years old and lives in Buronga since 2020 with her youngest daughter, aged 23. She has another daughter in Melbourne. She said her partner died in 2004 and she has not re partnered since then. She said she has one sister. She said she has parents living in Ocean Grove.
Prior to the subject injury, she said her relationship with her children were good, and she would remain in regular contact with them. She said she had a good relationship with her sister or parents, and would talk to her father weekly, her sister less frequently, though she would visit once a year and rarely with her mother, who has schizophrenia.
Currently. She said that her relationship with her children have [sic] remained good though they don’t want to bother her with their worries, and they have been more caring than before. She said she doesn’t talk to her father or sister now, as she had a falling out with them after the subject injury as she said she felt sick about being gaslighted and lied to, which she felt they were doing to her.
Prior to the subject injury, she said she had a few close friends and she would talk to her friends weekly, and she would see her friends every few months when she drove back to visit them in Geelong 6 hours away. She said she also enjoyed her work, spending time with her friends, and with her children. She would attend the gym regularly. She said she has no friends now, and she has stopped talking to her friends, as she felt they were lying to her and gas-lighting her, and she felt isolated and did not want any more contact from people. She said she has not attended any activities, and she barely leaves the house and goes out with her daughter when needed.
Prior to the subject injury, she said she would shower every day, and she said she would cook a few times a week. She said she would do the cleaning and laundry every second day. She said she -shop. She said she had no issues with driving, and she would drive 6 hours regularly to see her parents.
Since the subject injury, she said since she has left hospital she has not showered and in hospital she had been showering everyday initially, then it was reduced to every second day and she was not able to wash her hair due to her reduced motivation. She said her daughter has been cooking 2-3 times a week, and she said she tries to keep her daughter company and chop onion, but she doesn’t cook any more, and she sometimes organises Menulog to avoid having her daughter cook every day. She said she had been cleaning once a week, and she will do the laundry about once every two weeks, though her daughter has been doing more of it. She said she does not go grocery shopping alone, but she will go to the shops with her daughter while she waits in the car. She said she can drive her daughter to the shops and drop her daughter off to work 3 kilometres away in the morning, and she can drive back home alone with some degree of anxiety, and she can drive alone to her GP appointments 2 kilometres away, and she cannot drive to new places or far away places, due to her anxiety and concentration.
Prior to the subject injury, her concentration was good, and she could drive for 6 hours and she could read for up to an hour.
Since the subject injury, she said her concentration has been poor and she cannot read at all, and her daughter has had to set up the video conference and she has not even been able to follow the set up instructions, or read the two previous medical reports.
She said her mother had schizophrenia.
She was born in Geelong, and she said she had instrumental delivery with some bruising to her head and she was monitored for a while, and she had no developmental delays, and she had no learning delays. She said since she was 4-10 years old, she was sexually abused by an aunt, and she said that as a teenager she struggled a lot and felt it hard to be around her and she had some suicidal thoughts at the time and she had considered taking an overdose of her mot medication, and she never sought treatment and she was still able to pass Year 12, and she did not tell her parents until she was 23 years old.”
Findings on mental state examination were reported as follows:
“She presented as a casually dressed and reasonably groomed woman. She had an average build and appeared to be her stated age. She engaged cordially in the assessment and provided relevant answers to questions asked, spontaneously supplying detail. She told me she was feeling depressed and anxious. She displayed limited emotional reactivity during the interview.
She spoke articulately and in a logical sequence most of the time, without much prompting, with intact prosody. She complained of intrusive recollections of her work experiences.
She had pessimistic thoughts of worthlessness, and death fantasies without suicidal ideations. She was alert, appeared grossly cognitively intact and was able to sustain her concentration for the duration of the assessment.”
In summarising the injuries and diagnoses, the MA said:
“She has a constellation of symptoms that encompasses various psychiatric symptom domains, including anxiety, depression, and psychotic symptoms.
Given her family history, external hallucinations and paranoia about her previous colleagues, and a degree of emotional blunting, I would entertain a psychiatric diagnosis of schizophrenia, with a differential diagnosis of major depressive disorder, with current episode, with psychotic features, or dissociative features.
There are also features of post-traumatic stress disorder from her childhood that appeared to remain mostly in remission that was reactivated with the sexual assault in 2016, leading to a posttraumatic stress disorder, which appeared to remit with treatment prior to the subject accident, but has been re-activated by the current recurrence of her major depressive disorder.
There is also a pre-existing major depressive disorder from 2005, which has recurred as a result of the subject injury.”
The MA assessed 24% WPI from which he deducted 1/10^th pursuant to s 323, and added 1% for treatment effects, leaving a total WPI of 23%.
He then turned to consider the other medical opinions and material before him and said:
“The report written by Dr Russel Davies, psychiatrist, dated 19 April 2023. She had a pre-existing psychiatric history including following the death of her husband and in 2016, she was the victim of a sexual assault and was involved in a protracted police investigation which was unsuccessful. She had a family history of schizophrenia in her mother. She was diagnosed with Adjustment Disorder with features of depressed mood and anxiety with pre-existing vulnerabilities of Complex Posttraumatic Stress Disorder with a favourable prognosis.
The report written by Dr Glen Smith, psychiatrist, dated 28 November 2023. There is a pre-existing history of sexual abuse around the age of 10 by an aunt and she saw her mother’s psychiatrist in her 20’s and was prescribed Oxazepam. Following the death of her husband in 2005, she saw a private psychiatrist in Geelong as she felt overwhelmed and had difficulty sleeping. She was diagnosed with Major Depressive Disorder and was prescribed Escitalopram, Olanzapine and Quetiapine. She had a sexual assault in 2016 and received sexual assault counselling. She was recommenced on Escitalopram. In 2019, her cousin contacted her and said she was concerned about her aunt molesting other children and she subsequently made a statement about her childhood abuse, which she found triggering. She was diagnosed with Major Depressive Disorder and Posttraumatic Stress Disorder. Self-care was moderately impaired, social and recreational activities was moderately impaired, travel was mildly impaired, social functioning was moderately impaired, concentration, persistence and pace was severely impaired and adaptation was totally impaired. She had a whole person impairment of 26% with a 10% deduction for her pre-existing impairment, with a final whole person impairment of 23%.”
The MA added:
“There is some differences with my diagnoses, though they are in broad agreement with significant symptoms of depression, anxiety, posttraumatic stress, and I have placed more significance on her psychotic symptomatology. My opinion regarding her whole person impairment is closely aligned with Dr Glen Smith.”

The appellant’s submissions

Social and recreational activities

These are as follows:
(a)    in assessing the functional impairment associated with social and recreational activities, the MA took a history that “she has not attended any events and she barely leaves the house”. In summary, “as she has been socially isolated, but not to the extent she never leaves her house of residence, she has a moderate impairment”.
(b)    The PIRS category rating for Class 3 with relation to social and recreational activities states: “Rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.”
(c)    The MA has not taken a history that includes sufficient details for a Class 3 impairment to be found noting the extent of the respondent’s overseas travel on her own.
(d)    The clinical entry of Melbourne DBT Centre on 28 May 2024, [Application to Resolve a Dispute (ARD), page 178], described that the patient “will be leaving for Sari Villa Sanur Beach in 2 weeks (leaving 30 May). Feeling a little anxious. Going on her own”. An entry of 4 June 2024, ARD, Page 175] describes that she had been “struggling with keep boundaries with the shop keepers who harass her in Bali.” It is also stated that the respondent “started making acquaintance with holiday makers in Bali” [ARD, page 175]. A further entry of 11 June 2024, [ARD, 173] page describes that “the patient presented on time, drunk too much in Bali last night”.
(e)    Social and recreational activities are directed to the kind of activities that involve interactions with other people, and whilst the MA was persuaded by the respondent’s reporting that she is withdrawn from social activities, this conclusion is at odds with the available evidence.
(f)    The MA did not give proper regard to his examination on the day, as well as the other information before him and thereby committed a demonstrable error.
(g)    The MA overlooked details that were readily apparent from reading the clinical records available. Such evidence was also brought to the MA in filing an Application to Admit Late Documents (AALD) which included correspondence refencing the bundle of clinical records. The MA failed to grapple with this evidence. This resulted in the MA incorrectly categorising the respondent as a Class 3 for social and recreational activities.
(h)    The MA ought to have assessed a Class 2.

Travel

The appellant submits:
(a)    The MA finds at page 12 of the MAC, that:
“…she can drive her daughter to the shops and drop her daughter off to work 3 kilometres away in the morning, and she can drive back home alone with some degree of anxiety, and she can drive alone to her GP appointments 2 kilometres away, and she cannot drive to new places or far-away places, due to her anxiety and concentration”.
(b)    The MA assessed the respondent worker with a Class 2 moderate impairment for travel based noting the assertion that “she can still drive in the local area, she had mild impairment”. This conclusion contradicts what is recorded in the medical evidence before the MA.
(c)    The clinical entry of Melbourne DBT Centre on 28 May 2024, [ARD, page 178], described that the patient “will be leaving for Sari Villa Sanur Beach in 2 weeks (leaving 30 May). Feeling a little anxious. Going on her own”. An entry of 4 June 2024, ARD, Page 175] describes that she had been “struggling with keep boundaries with the shop keepers who harass her in Bali”, “Making acquittance with holiday makers in Bali”. A further entry of 11 June 2024, [ARD, 173] page describes that “the patient presented on time, drunk too much in Bali last night”.
(d)    The respondent neglected to raise the extent of these travels during the medical examination.
(e)    The respondent has shown the ability to travel without a support person to new environments.
(f)    The MA did not grapple with the correspondence of 4 October 2024, nor the records which were referenced throughout this correspondence.
(g)    The categorisation was glaringly improbable based on the available evidence.
(h)    If the evidence before the MA was taken into account, the resulting class impairment rating would be a Class 1 mild impairment.

The MMI Issue
(a)    the MA reported the respondent has had extensive treatment, and while her symptoms have fluctuated, overall “there has not been any significant change”. This opinion is at odds with the available evidence. The MAC, at page 2, states “she feels that overall, she feels that her progress has been up and down”.
(b)    The respondent in her statement dated 3 June 2024 expresses “I believe that my condition continues to deteriorate significantly, where I experience symptoms that have not been thoroughly assessed”
(c)    A medical report was produced by Dr Bikash Shrestha dated 10 September 2024, [Reply, page 25]. Dr Shrestha records “during admission at Kellyville Private Hospital, my initial impression was worsening depressive symptoms with complex PTSD. However, during follow up, she has been showing evidence of psychotic episode.”
(d)    As is prescribed with paragraph 1.15 of the Guidelines, MMI is considered to “have occur[ed] when the worker’s condition is well stabilised”. The appellant respectfully submits that the evidence fails to suggest this has occurred. Dr Shrestha states “My plan is to gradually cross over the antipsychotic medicine from quetiapine to aripiprazole” [Reply, page 26]. “I am planning to gradually reduce the dose of quetiapine. My ultimate goal has always been to establish her on antipsychotic monotherapy - aripiprazole, once her psychotic symptoms get better. This has been clearly communicated to Samantha since the initiation of aripiprazole” [Reply, page 27].
(e)    This is at odds with the MA’s comment at page 3 of the MAC, that “there are no current plans for treatment escalation or medication changes”.
(f)    The necessity for ongoing psychiatric treatment was also acknowledged in the report of Dr Glen Smith dated 28 November 2023 [ARD, page 39]. Dr Smith opined, “She has attempted to find a psychiatrist but she has not been able to obtain an appointment.” Dr Smith records the following, and as seen at page 62 and 63 of the ARD; In my opinion, Ms Broughton requires treatment with a psychiatrist and the cost of an initial assessment would be around $550 and follow-up sessions required on a monthly basis would cost $400. She also requires a further course of trauma focussed psychological therapy with weekly sessions for a duration of at least 12 months and a cost of $280 per session. The need for further psychological therapy after that would depend on her response to treatment. Hospitalisation to a psychiatric unit for a period of four weeks would be appropriate due to her severe anxiety and depressive symptoms.
(g)    Dr Russel Davies also acknowledges that the respondent requires additional treatment in respect of her injury. It is stated:
“Yes, I believe she requires continued treatment in the form of contact with a skilled trauma-informed therapist in conjunction with the support of her general practitioner and in all probability, oversight of a consultant psychiatrist. In addition, she requires prescribed medication with which she reports compliance”.

(h) At page 24 of the ARD, Dr Shrestha requests approval for inpatient treatment, and acknowledges that “the client will be seen for a minimum of 10 consults at the Hils Clinic”. This treatment was accepted and payable by the appellant, and the respondent “underwent a 21-day psychiatric admission due to poor health care” [MAC, page 3]. “She left hospital on 24 October” four days prior to the assessment with the MA. The MA fails to grapple with the outcome, and/or effectiveness of this treatment.
(i) The MA’s finding of MMI is inconsistent with paragraph 1.15 of the Guidelines noting numerous recommendations for additional treatment and the recent admission “due to poor health care.” The medical evidence is at odds with the MA’s comments that there are no current plans for treatment escalation or medication changes” [MAC, page 3].

Discussion

The Appeal Panel agreed with some aspects of the appellant’s submissions, in particular those relating to the category of Travel such that we considered that a re-examination was required to more fully address various matters.
Dr Douglas Andrews of the Appeal Panel did this on 20 May 2025 and reported to the Appeal Panel as follows:
“1.    The worker's medical history, where it differs from previous records
Ms Broughton is a 54-year-old woman (dob 16 January 1971) who lives alone at Buronga, on the NSW border adjacent Mildura, Victoria. She had been living with her 24-year-old daughter, who recently left to travel and is now living with her 26-year-old sister in Melbourne. Ms Broughton’s husband died in a motor vehicle accident in 2004, and she raised her 2 daughters as a single mother. She has never re-partnered.
She started working with Western New South Wales Local Health District as a clinical nurse consultant in mental health in the latter half of 2021. Things went well at first, but problems started late in 2022. The MA has outlined the workplace incidents that led to the onset of mental health problems in late 2022. After a time away from work, Ms Broughton attempted to return without success. She left in December 2023 and has not worked in any capacity, paid or voluntary, since.
She is cared for by general practitioner Dr Tom Gleason, psychologist Mr Jason Geraghty, and psychiatrist Dr Bikash Shrestha.
2.     Additional history since the original Medical Assessment Certificate was performed
The MA assessed Ms Broughton on 28 October 2024. The appellant employer challenged the certificate for error in assessing social and recreational activities and travel, and whether Ms Broughton had reached maximum medical improvement.
Current treatment:
Since the assessment, Ms Broughton has ceased the use of aripiprazole. Her psychiatric medications are citalopram 40 mg once a day, quetiapine slow-release 200 mg in the morning, and immediate-release 400 mg at night.
She has had three admissions to the mental health unit at Kellyville Private Hospital, the most recent between 17 March 2025 and 23 April 2025. On this admission, she had 36 episodes of rTMS, saying, ‘I liked it, I felt calmer.’ She continued to feel well for about 2 weeks post-discharge and then gradually relapsed. Her improvement could likely be attributed to feeling safer in the hospital.
She has gained excessive weight since leaving work and going on medication. She had been 65 kg before the work incidents, and her weight peaked at 96 kg. She takes a GLP-1 receptor agonist, tirzepatide (Mounjaro), 5 mg weekly sci to assist with weight reduction. At 78 kg and 163 cm, her BMI is 29.4, in the overweight range.
She is seeing her psychiatrist this week and will discuss further medication changes.
Ms Broughton has had a minor improvement in her mood and anxiety symptoms, but has persisting psychosis. Overall, she indicated that she had not significantly improved since leaving work. There has been little overall change since her assessment with the MA in October 2024.
General health:
Ms Broughton suffers from gastro-oesophageal reflux, for which she takes pantoprazole (Somac). She rarely drinks alcohol and does not use illicit substances. She has no other health problems.
Psychiatric history before the work injury:
Ms Broughton’s psychiatric history is well outlined in the brief. She was sexually abused between the ages of 4 and 10, leading to emotional problems during her teen years. This was compounded by having her mother diagnosed with schizophrenia when Ms Broughton was just 2. During her 20s, she saw a psychiatrist briefly.
She was with her husband for 13 years, married for 7. After he died in a motor vehicle accident, she sought psychological and psychiatric support. She was on medication, escitalopram and quetiapine, for several years.
She was sexually assaulted in 2016 and went through a challenging time during the police investigation. She saw a counsellor and attended a support group.
In 2019, she had a WorkCover claim in Victoria against Barwon Health for anxiety due to workplace bullying.
She can’t recall whether she was still taking medication during 2022 in the lead up to her workplace accident.
Current symptoms:
Ms Broughton has a variable mood, usually depressed. She looks forward to the evening when she can take a quetiapine, but did not describe diurnal variation.
She is an anxious worrier, prone to panic attacks and occasional dissociation. She had a single dissociative episode before the work accident, but they became more frequent after. She is concerned that she is like her mother and has developed schizophrenia.
She has auditory hallucinations, which she interprets as deceased family members or a previous doctor talking to her, often in a supportive manner. She said that they could read her thoughts and watch her, and were aware of what was going on in her life. Because of this perceived surveillance, she is reluctant to take off her clothes and shower.
She worries that her neighbours or strangers are watching her, or that someone will break into her house while she is walking, and may later attack her in her home. She believes she is under surveillance if she sees a car parked outside.
She is uncomfortable watching the news because she feels that the newscasters are speaking directly to her or that a song she hears has special meaning.
She can sometimes challenge these thoughts and experiences, but she becomes convinced that they are real when they occur.
She is sometimes irritable and may become agitated when she has to leave home.
She has subjective problems with concentration, attention and memory. She often has the television on, but cannot attend to the content.
She has frequent thoughts of suicide and has contemplated hanging herself. She said, ‘Sometimes I wish I had a gun because it would be easier.’ She countered this by saying that she couldn’t go through with a suicide attempt because of the impact it would have on others, especially her daughters.
She goes to bed at about 9 PM and has a latency of several hours, even with her sedative antipsychotic medication. She wakes frequently during the night and is often bothered by nightmares. She rises between 10 AM and 11 AM.
She often skips breakfast or lunch but is hungry in the evening and eats after taking medication.
Activities of daily living:
Ms Broughton lives alone and spends most of her day in her home. She keeps the television on for ‘background noise’. She occasionally puts on documentaries or movies she has seen previously, but doesn’t follow them closely. She spends her day colouring in adult colouring books. She does not read and has no other projects or hobbies.
She usually skips breakfast and lunch but is hungry in the evening after taking her quetiapine. Since her daughter moved to Melbourne, she has purchased prepared meals to reheat from Woolworths and had them delivered.
She rings her daughters daily.
She walks around the block in the afternoon.
She neglects housework but will do occasional cleaning.
She has only showered once since leaving the hospital a month ago. She tries to wash with a face cloth to keep herself clean, but is anxious about undressing and being observed while in the shower.
She occasionally does gardening.
She no longer has contact with friends. After she started hearing voices, she believed they were using her and confronted them as ‘fake friends.’ She is estranged from her parents and sister, saying that she was sick of being ‘gaslit and lied to.’ She sent a text to her sister saying, ‘I haven’t got a sister anymore’ after her sister suggested she get help.
During a stay in the inpatient unit at Kellyville Hospital in early 2024, when she felt safe in the hospital environment, she planned a trip to Bali; she travelled there in May 2024 and stayed for two weeks. Initially, she went to Melbourne, driven by her youngest daughter from home. Her oldest daughter went to the airport to help get her onto the plane. She felt anxious during the travel, but made it to a villa at Sanur Beach. She felt overwhelmed and spent the holiday within the resort, usually staying in her villa. She ate at a restaurant across the road every night, where they served Italian food. She became friendly with two women staying at the resort, and one night, she got drunk with them at the restaurant and had drinks around the pool. Ms Broughton usually drinks little and takes only a few drinks for her to become intoxicated.
She also went camping with her daughters for two days at Halls Gap in the Grampian Mountains. Her daughters drove her there and back, a four-hour trip each way.
She is planning a trip to Melbourne, a six-hour drive each way, and will be driven to and from there by her daughters.
I asked if she would contemplate other trips, such as the one she took to Bali, and she said only if taken by her daughters.
She has maintained a close, supportive, loving relationship with her daughters.
Diagnoses:
The MA diagnosed Ms Broughton with schizophrenia and a major depressive disorder with a pre-existing major depressive disorder and post-traumatic stress disorder.
Dr Russel Davies,3 April 2023, diagnosed Ms Broughton with ‘complex PTSD and a major depressive disorder.
Dr Glen Smith, 28 November 2023, diagnosed a major depressive disorder with mood incongruent psychotic features and anxious distress, and PTSD.
The brief also mentions a diagnosis of borderline personality disorder. According to Ms Broughton, this diagnosis was suggested by her treating psychiatrist and later retracted.
Complex post-traumatic stress disorder (cPTSD) is an ICD-11 diagnosis and is not described in the DSM-5. Ms Broughton has had developmental trauma and was sexually assaulted in 2016. She has had longstanding mental health challenges with mood and anxiety symptoms, for which she has had several years of treatment. However, I could not find symptoms consistent with PTSD or cPTSD. In the ICD-11, cPTSD is distinguished from PTSD by the additional criteria of disturbances in self-organisation. The diagnosis of PTSD must be met with symptoms of reliving the trauma, avoidance of trauma-related stimuli and a persistent sense of current threat. Additionally, the disturbances in self-organisation include an affective dysregulation, negative self-concept and disturbances in relationships. Ms Broughton’s pre-existing mood and anxiety symptoms did not meet these criteria. Her current symptoms can be understood in the context of a psychotic disorder.
My diagnoses rely on criteria outlined in the DSM-5.
·Schizophrenia
·Major depressive disorder with a pre-existing persistent depressive disorder
Ms Broughton has mood symptoms, without diurnal variation, which are not currently prominent and vary across the day. She has significant anxiety that is driven by her paranoid ideation.
She suffers mood-incongruent auditory hallucinations, with voices that are often supportive and caring of her.
She has prominent paranoia and passivity phenomena with ideas of reference. She can sometimes challenge these thoughts, but feels they are real at other times. This paranoia often drives her behaviour. For example, her reluctance to shower is out of fear of being observed.
Her delusions and hallucinations have persisted unabated for more than 2 years, despite significant antipsychotic medication. She does not have disorganised speech, thought disorder, disorganised or catatonic behaviour or obvious prominent negative symptoms such as avolition, anhedonia, asociality, blunted affect or alogia. Her social withdrawal is due to her paranoia and is not present with her daughters. She has impaired functioning in interpersonal relations, self-care and other aspects of daily living.
Ms Broughton meets at least seven of the nine listed criteria for a major depressive episode, missing feelings of worthlessness or excessive or inappropriate guilt. Her weight changes may be due to medication.
Differential diagnoses would be a schizoaffective disorder or a major depressive disorder with psychotic features. A schizoaffective disorder diagnosis would require that Ms Broughton have at least 2 weeks of psychotic symptoms without prominent mood symptoms. Based on the available history, I cannot make this determination. A diagnosis of major depressive disorder with psychotic features is possible, as her symptoms have been prolonged, but her psychotic symptoms are mood-incongruent.
Summary:
The diagnoses offered by the MA are reasonable but may vary if a longitudinal view were possible
He considered that Ms Broughton had reached maximum medical improvement. She has been unwell for more than 2 years without significant improvement in her condition or impairment. She has had multiple hospitalisations and treatment with antidepressant and antipsychotic medication. She has had trials of 2 different antipsychotic medications, aripiprazole and quetiapine. She has had a prolonged course of rTMS, a treatment which might help with mood symptoms. Considering this, her condition is stable and entrenched; the associated impairments will not change significantly over the next 12 months, with or without further medical treatment. She has reached maximum medical improvement.
The MA found a moderate impairment in social and recreational activities and a mild impairment in travel. He had not been aware of or considered her 2-week trip to Bali.
Social and recreational activities – Ms Broughton is socially isolated except from her daughters. She no longer has social or recreational activities where she lives. She has gone camping with her daughters and visited a resort in Bali in early 2024. She interacted socially with two women she met at her resort. She went out to a restaurant with them, where she drank excessive alcohol (for her). While in the hospital, she arranged the trip to Bali when she was feeling relatively safe, but it was not a positive experience. She rarely attends social events and will no longer do so without her daughters as support people. – This is consistent with a Class 3 impairment, as determined by the MA.
Travel – Ms Broughton can drive alone within the local area. She does so when visiting her general practitioner across the border in Mildura. She successfully travelled to Bali early in 2024 but found the journey stressful and often felt unsafe. She had at least one of her daughters when she travelled to Melbourne or the Grampian Mountains. She has no plans to travel overseas again, unless accompanied by her daughters. Her paranoia makes solo international travel unsafe. – Class 2, as determined by the MA.
My assessment accords with that of MA. Ms Broughton’s class ratings are sequentially class 3, 3, 2, 3, 3 and 5 (in ascending order 2, 3, 3, 3, 3 and 5), aggregate 19, median 3 for a 24% WPI. Accepting the MA’s unappealed one-tenth deduction for the pre-existing conditions, the final impairment rating is 22%.
3     Findings on clinical examination
I assessed Ms Broughton in her home via an audiovisual link; the quality was sufficient for a comprehensive assessment.
She presented casually attired, with her hair pulled back. She was wearing dark nail polish that had been applied while an inpatient at Kellyville Private Hospital.
She described her mood as depressed and acknowledged anxiety. Her affect was reactive, consistent with her stated mood and the interview content. She maintained composure.
She gave a coherent history without evidence of disordered thought. She discussed auditory hallucinations, ideas of reference and paranoid ideation. She held to her thoughts with delusional intensity.
She acknowledged thoughts of suicide with contemplated means but without intent to act on these. She expressed concern for those who would find her and for her daughters.
She describes subjective problems with concentration and attention, which were not apparent during my interview. She did not need questions restated or redirected; she gave a consistent and coherent account.
4.     Results of any additional investigations since the original Medical Assessment Certificate
No further investigations have been conducted.”

The Appeal Panel accepts the findings and assessments of Dr Andrews following his thorough and comprehensive assessment of the respondent.
He clearly explained his reasons in respect of the two PIRS categories appealed, and also why he concluded that MMI had been reached.
The MAC of necessity needs to be revoked in light of the parties’ agreement regarding the effects of treatment.
For these reasons, the Appeal Panel has determined that the MAC issued on
31 October 2024 should be revoked, and a new MAC should be 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:	W26263/24
Applicant:	Samantha Broughton
Respondent:	State of New South Wales (Western NSW Local Health District)

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 Yu Tang Shen 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 WorkCover Guides	Chapter, page, paragraph, figure and table numbers in AMA 5 Guides	% WPI	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total/s % WPI (after any deductions in column 6)
Psychological	13/12/2023	Chapter 11	Chapter 14	24%	1/10th	22%
Total % WPI (the Combined Table values of all sub-totals)					22%

[2025] NSWPICMP 387

3 June 2025