Uniting (NSW/Act) v Azam
[2025] NSWPICMP 778
•9 October 2025
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Uniting (NSW/ACT) v Azam [2025] NSWPICMP 778 |
| APPELLANT: | Uniting (NSW/ACT) |
| RESPONDENT: | Famiza Azam |
| APPEAL PANEL | |
| MEMBER: | Marshal Douglas |
| MEDICAL ASSESSOR: | Douglas Andrews |
| MEDICAL ASSESSOR: | Michael Hong |
| DATE OF DECISION: | 9 October 2025 |
CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) had regard to all relevant matters when rating the appellant’s impairment in travel and in employability; Held – MA did not have regard to all relevant matters when rating the appellant’s impairment; respondent re-examined; MAC revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 6 June 2025 Uniting (NSW/ACT) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Christopher Canaris, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 15 May 2025.
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, 4th ed
1 March 2021 (the Guidelines).
RELEVANT FACTUAL BACKGROUND
The appellant employed Famiza Azam, the respondent, as a cleaner. Due to the actions of another employee of the appellant that occurred during the course of the respondent’s employment, the respondent suffered a psychological injury. She claimed compensation from the appellant’s insurer for permanent impairment from her injury. She relied on a report her solicitors obtained from psychiatrist Dr Elsa Yeung dated 4 August 2024, who had examined the respondent on 2 August 2024 and assessed her to have 44% whole person impairment (WPI) from her injury. The appellant offered to settle the respondent’s claim for compensation for permanent impairment by paying her compensation for 15% WPI. It relied on a report its solicitors obtained from psychiatrist Dr Nabil Malik dated 18 November 2024, who had assessed the degree of the respondent’s permanent impairment from her injury is 15% WPI.
The respondent then initiated proceedings in the Personal Injury Commission (Commission), seeking the Commission determine her claim for compensation. A delegate of the President of the Commission referred the matter to the Medical Assessor who conducted an examination of the respondent using Microsoft Teams on 15 May 2025. In the MAC he issued following his examination he certified he assessed the degree of the respondent’s permanent impairment from her injury is 24% WPI. He conducted his assessment by reference to the psychiatric impairment rating scale (PIRS) detailed in Chapter 11 in the Guidelines.
In its appeal against the medical assessment, the appellant has challenged the Medical Assessor’s ratings of the respondent’s impairment in the PIRS categories of travel and employability, in regards to which the Medical Assessor rated the respondent’s impairment, respectively, as Class 3, that is a moderate impairment, and Class 5, that is a total impairment.
In the PIRS rating form, that forms part of the MAC, the Medical Assessor provided the following reasons for his rating of the respondent’s impairment in travel:
“She does not go out of the house except for appointments. She goes nowhere on her own and ‘my son will take me’. She talked of having been out 3 or 4 months ago and seeing her boss- she had a panic attack and had to be taken home. She said, “I’m scared to go out if I see anyone…anyone from work’. She can drive but has to have her son with her saying she is too anxious.”
Within the history the Medical Assessor detailed in the MAC he also recorded that from around six months prior to his examination of the respondent the respondent was staying with her sister in Brisbane, but by the time of his examination the respondent had returned to her normal residence in Goonellabah. Necessarily therefore the Medical Assessor was aware that the respondent had recently travelled between Brisbane and Goonellabah.
The Medical Assessor also compared his rating of the respondent’s impairment in travel with Dr Yeung’s rating, which was Class 4, that is a severe impairment, and Dr Malik’s rating, which was Class 2, that is a mild impairment.
The reasons Dr Yeung provided in her report for her rating of the respondent’s impairment in travel are that the respondent found it difficult to leave her own residence without a support person, that the respondent had left her home with her daughter two weeks prior to examination but experienced anxiety through the trip and had panic symptoms, and that the respondent had been out with a friend in the week preceding examination and experienced a panic attack during the trip. When comparing his assessment with that, the Medical Assessor highlighted that the respondent can leave home when accompanied by her son and while the respondent is uncomfortable doing so, she is able to drive when her son is present.
Dr Malik’s reasons for rating the respondent’s impairment as Class 2 in travel are that the respondent was able to drive but preferred to travel to familiar places within her local area, that the respondent can drive herself to medical appointments but generally avoids leaving home on her own, that the respondent’s son often drives her to appointments or errands, that the respondent feels more comfortable with her son’s support, that the respondent will occasionally drive herself to a medical appointment if it is necessary but now that her son is available to assist her she drives herself to her appointments less frequently that in the past, and that the respondent had no recent long term distant travel and prefers staying within her familiar area. The Medical Assessor commented that he obtained a different history than that and the respondent reported that she does not go anywhere on her own because of her anxiety.
The Medical Assessor provided the following reasons in the PIRS rating form for rating the respondent’s impairment in employability as Class 5:
“She is not back at work saying she is too scared. Her position has been terminated by way of a redundancy. She has wanted to get back to work but says she is too anxious “and I don’t know where to start”.
She added, “I don’t want to go out – I’m just scared he will be there”. She do (sic: does) not know if she could work if she lived elsewhere “but I always can try”. She sees her anxiety and her “dizziness” as a main obstacle saying, “Sometimes my chest is very heavy and I’m suffocating”.
Comment: “she is not employable despite her statement that she would like to get back to work in some capacity.”
The Medical Assessor observed that Dr Yeung had rated the respondent’s impairment in employability as Class 5 and that Dr Malik had rated her impairment as Class 4.
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 respondent should undergo a further medical examination. This because the Appeal Panel found, for reasons explained below, the MAC contained a demonstrable error, which the Appeal Panel would need to correct. To correct that error the Appeal Panel needed further clinical data that it could only obtain from further examination of the respondent. The Appeal Panel appointed one of its Medical Assessor members, namely Dr Douglas Andrews, to conduct that examination. His report to the Appeal Panel is copied below.
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.
SUBMISSIONS
Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
In summary, the appellant submitted that the Medical Assessor did not have regard to significant factual matters relating to the respondent’s impairment in travel including that the respondent had travelled to Fiji in 2022, that she had attended a holiday with her family in December in 2023, and that she had travelled to assist a family member with upcoming surgery in April 2024. The appellant noted Dr Malik had referred to the respondent travelling interstate or overseas in July 2022. The appellant also referred to an email the respondent sent to her workers compensation insurer case manager on 30 June 2022 in which she referred to an upcoming trip she was making to Fiji.
The appellant referred to a record in the clinical notes the respondent’s general practitioner (GP) kept that detailed the respondent being on holidays when a home break in occurred. The appellant submitted that it was unclear whether the Medical Assessor was aware that the home invasion occurred while the respondent was on holidays.
The appellant also referred to a further note in the clinical records the respondent’s GP maintained relating to a consultation on 30 April 2024 in which the respondent’s GP noted the respondent would be away for a period of three weeks to provide assistance to a family member who was having surgery. The appellant highlighted that the Medical Assessor did not refer to that trip.
The appellant submitted that the trips the respondent made indicate the respondent can travel outside of her own residence and away from familiar areas, which renders the Medical Assessor’s rating of Class 3 as “glaringly improbable”.
The appellant referred to the reasons Dr Malik provided for rating the respondent’s impairment as Class 4 in employability, which included that the respondent had clarified for him that she is limited to bookkeeping for her husband’s business and does not do administrative tasks for her husband, that she is not involved in any buying or selling activities for her husband, and that her husband manages his Facebook account and handles calls from his clients, and that she is not paid for the work she does for her husband.
The appellant also referred to an investigation report dated 21 October 2024 that Kylie King of QuantumCorp Australia Pty Ltd had prepared for its insurer, wherein Ms King had noted the respondent had posted to her Facebook account that she had sold various items including a power drill, insulated panels, a manual engine crane and work shirts. The appellant also referred to a certificate of capacity dated 20 July 2021 in which the respondent had noted that her spouse is a sole trader and that she helps him manage his business.
The appellant submitted that in light of that activity, and the bookkeeping work the respondent confirmed to Dr Malik she does for her husband that the Medical Assessor was wrong to rate the respondent’s impairment as Class 5 in employability.
In reply, the respondent submitted that the appellant did not in its submissions identify whether the Medical Assessor applied incorrect criteria when rating her impairment in travel nor did the appellant particularise the demonstrable error that the Medical Assessor had made. The respondent noted that the Medical Assessor’s assessment of her impairment in travel was “the midway point” that between the ratings Dr Yeung and Dr Malik had made. The respondent submitted the Medical Assessor explained his opinion and that his assessment was not glaringly improbable.
The respondent submitted that the report of Kylie King is unconvincing. The respondent said the history she provided to Dr Malik was that she is not involved in online sales which are associated with her social media accounts. The respondent submitted it cannot be seriously suggested that her activity is indicative of her having an employment capacity.
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.
The appellant’s complaint about the Medical Assessor’s rating of the respondent’s impairment in travel is, in substance, that the Medical Assessor did not detail a sufficient history by which to rate the respondent’s impairment in travel because he did not include in the history he detailed in the MAC that the respondent had gone on a trip to Fiji in 2022, and had gone on a family holiday in 2023 and had travelled to a family member to provide assistance to that member while she was having surgery in May 2024.
It is apparent that the Medical Assessor was aware that around six months before he examined the respondent that the respondent had travelled away from her home near Lismore to Brisbane to stay with her sister. The Medical Assessor noted that the respondent’s sister had taken the respondent in on that occasion because the respondent was very sick.
But as the appellant has noted in its submissions, the Medical Assessor did not detail in the history that the respondent had made a trip in May of 2024 to assist a family member or that she made a trip in 2023 for a family holiday or that she had travelled to Fiji in 2022. Consequently, he provided no detail regarding whether the respondent required support to make those trips. Further, he did not detail whether the respondent required support to make her most recent trip between Lismore and Brisbane to stay with her sister.
Absent that detail in the history the Medical Assessor obtained it cannot be known from the MAC whether his rating of the respondent’s impairment in travel is Class 3. If the respondent had been able to make those trips without a support person then that would indicate a Class 2 impairment. In other words, the Appeal Panel considers the MAC contains a demonstrable error with respect to the Medical Assessor’s rating of the respondent’s impairment in travel because the history he detailed was not sufficient to support the rating he made.
The Appeal Panel also considers the Medical Assessor erred with respect to his rating of the respondent’s impairment in employability in that the Medical Assessor did not have regard to the activities the respondent performs in her husband’s business. The evidence revealed that the respondent does some bookkeeping work for her husband and, on its face, that indicates that she could perform that activity elsewhere for renumeration. In other words, that indicates that potentially she has capacity to engage in some work for renumeration.
Having identified those areas the Appeal Panel, as said above, must correct them and to do that it considered necessary to examine the respondent to obtain the necessary history by which to rate her impairment in travel and in employability. As said, the Appeal Panel appointed Medical Assessor Andrews to conduct that examination. His report to the Appeal Panel is as follows:
“PERSONAL INJURY COMMISSION
APPEAL AGAINST MEDICAL ASSESSMENT
REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR
MEMBER OF THE APPEAL PANEL
| Matter Number: | M1-W3379/25 |
| Appellant: | Uniting (NSW/ACT) |
| Respondent: | Famiza Azam |
| Date of Determination: | 15 September 2025 |
| Examination Conducted By: | Douglas Andrews |
| Date of Examination: | 15 September 2025 |
1.The worker's medical history, where it differs from previous records
Medical Assessor Canaris assessed Ms Azam in May 2025, who determined a 24% WPI. This was appealed by the employer for possible errors in the categories of travel and employability.
There have been no new developments for Ms Azam in the months since the assessment. Her treatment and condition remain the same.
2. Additional history since the original Medical Assessment Certificate was performed
Ms Azam is a 44-year-old Indian Fijian woman who migrated to Australia with her family in 2012. She lives in Goonellabah with her second husband of 14 years, who is a truck driver and runs a small business. She also lives with her 19-year-old son, who is studying at TAFE. She has a 23-year-old daughter who lives half an hour away and attends university.
Current treatment:
Ms Azam takes duloxetine 90 mg daily, amitriptyline 10 mg at night, propranolol 10 mg twice daily and prazosin 4 mg at night.
She sees her psychologist, Amy Dempsey, every 1 to 2 weeks for supportive psychotherapy. EMDR has been discussed but never progressed.
She had been consulting with a psychiatrist, Dr Spencer Duke of Lismore, monthly, but the interval had recently been extended.
She was admitted to the Currumbin Clinic in July 2022 for two weeks. In 2023, she had rTMS as an outpatient. Her psychiatrist has recommended readmission to reassess medication for further rehabilitation and support, but this has not yet been approved.
General health:
Ms Azam had breast cancer in 2018/2019 and is now in remission.
She does not smoke cigarettes or drink alcohol.
She said that she is not eating a healthy diet and has gained weight, but could not quantify the amount. At 82 kg and 147 cm, her BMI is 37.9, in the obese range.
She denied any history of mental health problems before the work injury.3. Findings on clinical examination
Current symptoms:
Ms Azam has a pervasively low mood with diurnal mood variation and anhedonia.
She is anxious with prominent fears for her safety. She said, ‘I am scared to go outside.’ When she gets up in the morning, she checks the house to ensure that all the doors are locked. Away from home, she worries that she is being followed and that someone will harm her.
She experiences subjective difficulties with concentration, attention, and memory. She said, ‘I can’t remember things so much.’
She is irritable and easily frustrated.
She is bothered by intrusive thoughts about the sexual harassment and assault at work.
She has had frequent thoughts of suicide without plans or intent. About nine months ago, she cut her leg after a phone call with the insurer. She did so to distract yourself, without intending to die. When distressed, she sometimes punches the walls or swears.
She has severe initial insomnia, but sleeps reasonably well after she falls asleep.
Her appetite is impaired, and she eats a poorer quality diet.
Mental state examination:
Ms Azam was assessed via an audiovisual link in her home for about 15 minutes. The connection quality was adequate to do a comprehensive assessment. I explained that I would not be able to offer her treatment advice, that the assessment could not be recorded and the limits to confidentiality.
She presented as a middle-aged woman of Fijian Indian extraction. Her hair was neatly pulled back, and she wore a dark top. She described a low mood with anxiety. Her affect was restricted, consistent with her stated mood and congruent with the interview content. Her anxiety was evident during the interview. She spoke in a soft and somewhat halting voice.
There was no evidence of disorder of thought-form or perception. Her fears were anxiety-based. She had no delusional thought content or other psychotic features.
She was able to provide a coherent account, albeit with some difficulty recalling details, including medication doses, dates, and event sequences.
At the end of the interview, I reviewed my notes from the PIC brief with her for comment and asked if she had anything further to say. She agreed that we had covered everything necessary.
Consistency:
Ms Azam was open with me and appeared to be giving an honest account of her circumstances. Her narrative was consistent with the provided documents.
Diagnoses:
I make my diagnoses with reference to the DSM-5-TR.· Post-traumatic stress disorder
· Major depressive disorder
These diagnoses are the same as those of the MA and IME psychiatrists, Dr Elsa Yeung and Dr Nabil Malik.
Ms Azam experienced a sexual assault, meeting the mandatory Criterion A. She has intrusion symptoms in the form of unwanted memories and psychological distress at reminders, with marked physiological reactions to distress. She exhibits avoidant behaviours, such as not wanting to go out and avoiding watching things on television that might prompt memories. She has negative alterations in cognition and mood with persistent negative beliefs about the world, diminished interest in activities, and reduced ability to experience positive emotions. She has alterations in arousal and reactivity with increased irritability, self-destructive behaviour, hypervigilance, difficulty concentrating and sleep disturbance.
She describes all nine symptoms of a major depressive episode.
Activities of daily living:
Ms Azam spends most of her time at home alone while her husband is at work or her son is studying. She often lies in bed until 10 or 11 AM.
She showers and dresses three or four times weekly, usually at night and often after prompting from her son.
Her son and daughter do most of the housework. The family often eats preprepared frozen meals, purchased by her son.
She has withdrawn socially from friends but remains close to her extended family. Her parents visited from Fiji in 2024, and they went out to cafés and travelled to Armidale. She went out to a restaurant with her family in Ballina to celebrate her husband’s birthday in April. Last weekend, she travelled to Brisbane to visit her sisters, accompanied by her son and daughter. They stayed for the weekend at her sister’s house.
Ms Azam has a licensed driver and will travel alone within the local area, for example, to see her doctor or psychologist.
She travelled to Fiji three years ago, in December 2022, with her nuclear family to see her unwell father. Her daughter organised the trip. Ms Azam needed support on the journey and took diazepam to reduce her anxiety.
In April 2024, she travelled to New Zealand to visit her elder sister and her mother, who was there at the time. She travelled with her daughter, son and younger sister. Her sister organised the trip. They stayed eight days.
Ms Azam has loving and supportive relationships with her nuclear and extended family.
She can only read for three or four minutes. She rarely watches television because the news upsets her and increases her fear. She has tried to take up knitting and painting, but was unable to persist.
Before becoming unwell, she had been doing bookkeeping for her husband. She occasionally still does tasks for him on an ad hoc basis. Mostly, this is helping him with reading (her husband is functionally illiterate) or setting up a Facebook post to sell an item. When she has posted on Facebook to sell an item, her husband then deals with prospective buyers, and she does nothing further. Her husband’s accountant now deals with most bookkeeping aspects of the business. Ms Azam helps her husband for less than one hour a week, spread out throughout the week.
Whole person impairment:
The following ratings provided by the MA were not appealed:· Self-care and personal hygiene – class 3
· Social & recreational activities – class 3
· Social functioning – class 2
· Concentration, persistence & pace – class 3
Travel – Ms Azam can travel alone in the local area, driving herself to appointments. She is more anxious away from home. She has travelled further afield to Armidale, Brisbane, Fiji and New Zealand. On these occasions, she was accompanied by several family members and required significant support. This is consistent with a mild impairment. – class 2.
Employability – Ms Azam has lost confidence and fears for her safety away from home. She would struggle to trust others in a new work environment. She can only attend to tasks briefly. She has been unable to persist with her projects or hobbies. The support she gives her husband is minimal, for example, reading a document for him or posting something on Facebook. This is not a work-like activity that could be translated to another employer or workplace. She gave up doing her husband’s bookkeeping because she couldn’t cope. Ms Azam has continuing moderately severe symptoms for her conditions. Considering her whole situation, she is unfit to work. – Class 5
She has an aggregate of 18, a median of 3 and a whole person impairment of 22%.
There is no pre-existing condition.
Ms Azam has had evidence-based treatment for her conditions without significant improvement. There has been no substantial or complete elimination of her impairment with treatment. An adjustment for treatment effect is not warranted.4. Results of any additional investigations since the original Medical Assessment Certificate
No additional investigations have been done.
Medical Assessor Douglas Andrews”
The Appeal Panel accepts and adopts the history that Medical Assessor Andrews obtained and detailed in his report. The Appeal Panel also accepts and adopts the detail Medical Assessor Andrews provided in his report relating to the respondent’s present treatment and present symptoms. The Appeal Panel considers that the examination Medical Assessor Andrews conducted of the respondent is thorough.
The Appeal Panel considers that the additional information Medical Assessor Andrews obtained and his findings from his examination are sufficient to correct the errors the Appeal Panel found in the MAC. The correction of those errors requires, in substance, the Appeal Panel to consider and rate the respondent’s impairment in travel and in employability by reference to the information Medical Assessor Andrews obtained and his findings. The Appeal Panel has considered the assessments that Medical Assessor Andrews advised in his report of the respondent’s impairment in the PIRS domains of travel and employability and is of the view they are correct. Consequently, the Appeal Panel adopts those assessments so as to correct the demonstrable errors in the MAC.[1]
[1] Coca Cola Euro Pacific Partners API Pty Ltd v Pombinho [2024] NSWCA191 at [88].
For these reasons, the Appeal Panel has determined that the MAC issued on 15 May 2025 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: | W3379/25 |
Applicant: | Famiza Azam |
Respondent: | Uniting (NSW/ACT) |
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 Canaris and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
Table - whole person impairment (WPI)
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA 5 Guides | % WPI | Proportion of permanent impairment due to pre-existing injury, abnormality or condition | Sub-total/s % WPI (after any deductions in column 6) |
| Psychological/psychiatric disorder | 12/07/2021 | Chapter 11 | - | 22 | - | 22% |
| Total % WPI (the Combined Table values of all sub-totals) | 22% | |||||
0