Vastag v The Ramsay Centre for Western Civilisation

DETERMINATION OF APPEAL PANEL
CITATION:	Vastag v The Ramsay Centre for Western Civilisation [2025] NSWPICMP 278
APPELLANT:	Lynne Vastag
RESPONDENT:	The Ramsay Centre for Western Civilisation
APPEAL PANEL
MEMBER:	Deborah Moore
MEDICAL ASSESSOR:	Michael Hong
MEDICAL ASSESSOR:	John Lam-Po-Tang
DATE OF DECISION:	16 April 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor erred under five categories of the psychiatric impairment rating scale (PIRS), failed to give adequate reasons, and erred in respect of assessment for treatment effects; Held – Appeal Panel found no errors; reasons were adequate and were equally so as regards treatment effects; MAC confirmed.

BACKGROUND TO THE APPLICATION TO APPEAL

On 20 December 2024 Lynne Vastag (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr John Baker, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on
11 December 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 it was not necessary for the worker to undergo a further medical examination because although one was requested, the Panel is satisfied that we have sufficient evidence before us to enable us to determine this appeal without any re-examination of Ms Vastag.

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.

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 Medical Assessor failed to correctly apply the psychiatric impairment rating scale (PIRS) and failed to give adequate reasons.
In reply, the respondent 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 Medical Assessor for assessment of whole person impairment (WPI) in respect of a primary psychological/psychiatric injury occurring on a deemed date of injury of 1 August 2022.
The Medical Assessor obtained the following history:
“The claimant reported marrying her husband in 2001 in Australia. She worked in his construction business. Her husband's business failed in 2006. The family relocated to Dubai in 2007. Her husband continued to work in private business until his business in Dubai became unfinancial. In 2017 she returned to NSW with her four sons. Her husband had been in debtors’ prison on one occasion prior to her leaving.
The claimant reported that she commenced work for this employer in September 2019. She reported that initially her work was enjoyable. She was working for the CEO who was also an academic director for the employer. In early 2022 a new employee commenced working. After the commencement of employment of the new employee, the claimant discovered that she was the focus of bullying and harassment in the workplace. She became isolated from other employees. She had important information withheld from her. She felt ridiculed and belittled. She described being humiliated in front of co-workers.
The claimant reported that her mood became depressed. She reported that she developed poor sleep and low energy with fatigue nearly every day. Her concentration became poor. She had low energy and her self-esteem was poor. She became unable to trust her employer. She left the workplace as she had lost her work hardiness. She felt worthless and hopeless.
The claimant attended her local medical practitioner in Camden NSW. She was prescribed and commenced on escitalopram at a dose of 10 mg daily. She was referred to a clinical psychologist and received cognitive behavioural therapy, relaxation training and mindfulness therapy. The claimant’s escitalopram dose was increased to 20 mg daily.”
The Medical Assessor continued as follows:
“Present treatment:
The claimant was treated by her local medical practitioner and psychologist. She was prescribed evidence-based pharmacotherapy, escitalopram 20 mg in the morning for this primary psychological injury.
The claimant had been treated with evidence based psychological treatment. This included cognitive behavioural therapy, mindfulness and relaxation techniques. The claimant had not been admitted to a psychiatric hospital for treatment of this primary psychological injury.
The claimant had not been treated with repetitive transcranial magnetic stimulation or Esketamine as an outpatient treatment primary psychological injury.
Present symptoms:
The claimant reported symptoms consistent with major depressive disorder. The claimant described having suffered from a major depressive disorder prior to this episode of major depressive disorder.
The following symptoms were present at this assessment:
• Depressed mood most of the day come and nearly every day as indicated by the claimant’s report of feeling sad and hopeless. She said that she felt sad and hopeless with her inability to financially support her family.
• Insomnia nearly every day.
• Psychomotor agitation nearly every day, as reported by the claimant with her suffering subjective feelings of persistent restlessness and irritability.
• Fatigue and loss of energy nearly every day. This is evidenced by the claimant's inability to socialise with extended family, her children’s school community and the general community since the onset of this primary psychological injury.
• Diminished ability to think or concentrate, as reported by the claimant with her decreased ability to read for extended periods which she could easily have done prior to the onset of this primary psychological injury.”
The Medical Assessor then turned to consider:
“Details of any previous or subsequent accidents, injuries or condition: The claimant reported that at about the age of 19 years, whilst learning to drive, she had a motor accident. She said she rolled her car on a rural road. She said that no ambulance or police attended. She did not seek medical attention for this motor accident and was not psychologically or physically injured from this event.
The claimant reported that her second son was born prematurely. She became depressed whilst her son was treated for his premature birth in Dubai. She was treated with escitalopram at a low dose of 5mg daily for her first episode of major depressive disorder. The claimant reported a second episode of major depressive disorder about the time that her husband's business in Dubai became unfinancial. She said that she was again treated with a low dose of escitalopram 5mg each day. The claimant reported that she recovered from both episodes of mild major depressive disorder prior to the onset of this primary psychological injury.”
The Medical Assessor continued:
“Work history including previous work history if relevant:
The claimant reported that she had worked in a number of different roles prior to working for her husband in his business after they married in 2001. Prior to working in her husband's business, she had worked for a chief financial officer for about 3 years. She said that she had also worked in hospitality and other roles. The claimant said that since marriage she has only worked for her husband prior to her employment with this employer.
Social activities/ADL:
At 20 years of age the claimant travelled to North Carolina and then Texas prior to returning to Australia after a failed relationship. She said that she worked in hospitality in the northern beaches. She said that she married in Australia in 2001. She had four boys to this union; the younger two were fraternal twins. Her husband's business in Sydney became unfinancial in 2006. In 2007 the claimant went to Dubai where she lived for about 10 years.
The claimant’s husband’s business in Dubai became unfinancial in about 2017. Her husband has subsequently been imprisoned due to his outstanding debts in Dubai on three occasions. He is not permitted to leave Dubai. The claimant and her children returned to live in Sydney. She says she has daily telephone and video conference contact with her husband in Dubai and she considers herself married to him at the time of this assessment.
The claimant was living independently with her children in the family home. She was able to attend the local supermarkets to purchase food for her and her four sons. She was able to maintain the home independently without outside assistance. She said that she does the lawns and shears the small hedge. She also cleans the bathrooms in the house. She stated that she cooked the meals for her children. The older two children who were 15 and 13 years had been given chores such as taking out the garbage and assisting with washing dishes after meals.
The claimant reported that she had no visitors and did not host parties at home. She no longer entertained with her sister, her sister-in-law or her extended family. She would not attend school functions which included parent teacher nights or other events regarding her children's progress. The claimant was less interested in watching serial television shows. She did not share television or cultural festivals with her children.
The claimant reported that she was able to travel without a support person to and from Dubai as the journey was familiar to her. The claimant could travel within the local and familiar areas around her home without support. She did not travel to unfamiliar locations alone.
The claimant reported that she remained married to her husband. She said that she was estranged from her husband as he had been detained in Dubai. Her husband remained in regular video and telephone contact with her and her sons. The claimant was unable to return to Dubai due to legal restrictions.
The claimant did not report any difficulties or tension with her children. The claimant did report tension with her extended family. Her extended family had restricted social contact with her and her children, since her return to Australia.
The claimant was not able to work at any time in the future for this employer. The claimant was able to work less than 20 hours per week in a different role in a different, less stressful environment for a different employer. The role would be less stressful and less demanding than her role for this employer.”
Findings on mental state examination were reported as follows:
“The claimant presented as a tearful and distressed woman who looked her stated age. She was assessed alone by video conference. Her hair was unwashed and unkempt. She said that she preferred to wear clothes which did not require ironing. Her rate of speech was slow. Her volume of speech was normal. She did not demonstrate any form of thought disorder. She reported her rate of thinking was also reduced with her making more unintended errors than she previously would have prior to the onset of this primary psychological injury.
The claimant was orientated in time, place, and person. She could concentrate for about 20 minutes prior to requiring a break. She was able to follow the conversation and questions. She responded in a prompt and straightforward manner.
The claimant reported suffering from a depressed mood. Her affect was mood congruent and she was tearful when talking about the loss of her employment and the difficulties she has had since, in attempting to recover from this primary psychological injury. She did not report any psychotic symptoms and did not demonstrate any delusional ideas. She was insightful into her condition and her judgement was normal. She did not report any suicidal thoughts or plans.”
The Medical Assessor summarised the injury as “The claimant’s primary psychological injury is best defined by DSM-5-TR F33.0 Major depressive disorder – recurrent episode.”
He added:
“The claimant presented as a reliable person who did not misrepresent her circumstances. She was consistent in her report at the assessment which was similar to the reports provided by other clinicians who had assessed the claimant prior to this assessment. She was open in her explanation of the financial difficulties and consequences suffered by her husband when he was unable to pay his debts to his creditors whist living in Dubai.”
The Medical Assessor assessed 8% WPI from which he deducted one-tenth in respect of the pre-existing condition, then added 2% in respect of treatment effects, leaving a total of 9% WPI.
He then summarised the evidence before him and said:
“Psychiatrist Dr Abhishek Nagesh report dated 13 October 2022. Ms Lynne Vastag is a 50-year-old female, separated mother of four young children, living with her children and currently unemployed. Lynne has been off work since 29 July 2022. She had been working for Ramsay Centre for Western Civilisation and had been working there for the last three years in the role of Executive Assistant/Office Manager. Her duties involved general administration for the office, assisting CEO in administration. Lynne alleges that during the course of her job, there was no guidance at all. Because of the humiliation from the CEO and the CFO, she became angry and emotional.
Lynne alleged that the CEO said she did not have the competence to perform her work. Because of the alleged bullying, harassment, being belittled and the final straw being told that she did not have the competence to perform her work. Lynne alleged becoming anxious… Lynne denied any previous history of mental illness.
I am of the opinion Lynne Vastag meets the criteria for an episode of Adjustment Disorder with Depressed and Anxious Mood.
Psychiatrist Dr Abhishek Nagesh supplementary report dated 7 December 2022.
The worker has no pre-existing psychological injury.
Comment Dr Baker. I do not concur with this assessment of pre-existing psychological condition. I note that the claimant reported two prior episodes of mild major depressive disorder prior to the onset of this primary psychological injury.
Psychiatrist Dr Abhishek Nagesh report dated 22 March 2024.
The claimant during my previous review did not mention any previous history of mental illness. However, as of today's review, she mentioned that she was diagnosed with depressive and anxiety symptoms in 2011 and 2017, in 2011 due to the birth of her premature son and in 2017 due to her husband being imprisoned in Dubai.
The claimant has a pre-existing condition of adjustment disorder, diagnosed in 2011. Hence, I have deducted 10% for her pre-existing condition. Her symptoms have partially improved with treatment, hence I have added 1% treatment effect. The final whole person impairment after deduction and adding a treatment effect stands at 6%.
Comment Dr Baker. I note that the claimant did suffer from a pre-existing major depressive disorder first diagnosed in 2011. She then had a recurrent episode of major depressive disorder in 2017. For these reasons I do not concur with Dr Nagesh’s diagnosis of adjustment disorder.”

Discussion

The appellant submits that the Medical Assessor erred in his assessments with respect to five of the PIRS categories, namely Self-care and personal hygiene, Social and recreational activities, social functioning, Concentration, persistence and pace (Cpp) and employability.
Dealing firstly with self-care and personal hygiene, the Medical Assessor assessed a Class 2 rating and said:
“The claimant was living independently with her children in the family home. She was able to attend the local supermarkets to purchase food for her and her four sons. She was able to maintain the home independently without outside assistance. She said that she does the lawns and shears the small hedge. She also cleans the bathrooms in the house. She stated that she cooked the meals for her children. The older two children who were 15 and 13 years had been given chores such as taking out the garbage and assisting with washing dishes after meals.”
The concept of “self-care and personal hygiene” is not defined in the Guidelines. The reference is to examples or “descriptors” relevant to the assigning of a specific class.
The examples in Table 11.1 are examples only and are not exclusive.
The appellant submits that a Class 3 rating is appropriate because the Medical Assessor focussed on her ability to cook meals for her children but also presented as unkempt.
The descriptor for a Class 2 rating reads: “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.”
For a Class 3 it reads:
“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.”
There is nothing in the history obtained by the Medical Assessor that fits with a Class 3 rating.
Indeed, the Class 2 ascribed by him is entirely consistent with the descriptor in this category.
The appellant has four children and is clearly able to manage the household in terms of preparing meals. There is no suggestion that she requires a family member or community nurse visits to ensure a minimum level of hygiene and nutrition, nor that she is unable to live independently without regular support.
As the Medical Assessor noted:
“The claimant was living independently with her children in the family home. She was able to attend the local supermarkets to purchase food for her and her four sons. She was able to maintain the home independently without outside assistance. She said that she does the lawns and shears the small hedge. She also cleans the bathrooms in the house. She stated that she cooked the meals for her children…”

For these reasons, we see no error in this category since the Medical Assessor’s assessment was consistent with the evidence.
It is true that the Medical Assessor failed to mention the report of Dr Paisley, but a Medical Assessor is not required to mention each and every piece of evidence. The task is as set out in cl 1.6 of the Guidelines, namely “Assessing permanent impairment involves clinical assessment of the claimant as they present on the day…”
Turning next to the category of Social and recreational activities, the Medical Assessor assessed a Class 3 and said:
“The claimant reported that she had no visitors to her home and did not host parties. She no longer entertained with her sister, her sister-in-law or her extended family. She would not attend school functions which included parent teacher nights or other events regarding her children's progress. The claimant was less interested in watching serial television shows. She did not share television or cultural festivals with her children.”
The descriptor for a Class 3 rating reads: “Moderate impairment: 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.”
For a Class 4 it reads: “Severe impairment: never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate.”
Once again, the evidence does not support the appellant’s submissions.
No other doctor made any such assessment.
Indeed, Dr Paisley recorded that she takes her children to sport albeit without interacting a great deal.
To suggest that she never leaves her home is again inconsistent with the evidence.
The evidence supports the assessment made by the Medical Assessor.
Turning next to the category of social functioning, the Medical Assessor assessed a Class 2 rating and said:
“The claimant reported that she remained married to her husband. She said that she was estranged from her husband as he had been detained in Dubai. Her husband remained in regular video and telephone contact with her and her sons. The claimant was unable to return to Dubai due to legal restrictions. The claimant did not report any difficulties or tension with her children. The claimant did report tension with her extended family. Her extended family had restricted social contact with her and her children, since her return to Australia.”
The appellant submits that the Medical Assessor erred “in assessing a Class 3.” This is clearly an error. We can only assume that the appellant submits a Class 3 rating is appropriate, but it is unclear.
The descriptor for a Class 2 reads: “Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships”.
For a Class 3 it reads: “Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.”
Again, the evidence simply does not support the submissions in this category.
There is no evidence to suggest that the appellant’s “previously established relationships are severely strained.” Although she may be physically separated from her husband, that is not the type of separation envisaged by the Guidelines.
There is no evidence of domestic violence nor that someone else needs to look after the children.
As the respondent correctly points out: “The appellant omits to specify the reasons for the separation, which is that her husband is incarcerated. The incarceration occurred prior to the subject work injury.”
The appellant remains married to her husband, and while they are “estranged”, they remain in regular video and telephone contact. The Medical Assessor noted that their contact was “daily.”
In addition, the Medical Assessor noted that the appellant stated she could not return to Dubai for legal reasons.
Again, the evidence supports the assessment made by the Medical Assessor.
Turning next to the category of cpp, the Medical Assessor assessed a Class 2 and said:
“The claimant reported that she was reading less and could not concentrate on complex tasks for long periods of time. The claimant said that she was unable to persist with reading for more than about 20 minutes in duration. She could manage the family finances as well as ensuring the organisation of her home’s daily schedule and four children. The claimant was able to cook from recipes and said that she preferred to cook from recipes as a preference.”
The descriptor for a Class 2 reads: “Mild impairment: Can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.”
The descriptor for a Class 2 reads: “Mild impairment: Can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.”
For a Class 3 it reads:
“Moderate impairment: unable to read more than newspaper articles. Finds it difficult to follow complex instructions (eg operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.”
The appellant concedes that the Medical Assessor noted that “she could manage the family finances as well as ensuring the organisation of her home’s daily schedule and four children. The claimant was able to cook from recipes and said that she preferred to cook from recipes as a preference.”
The appellant adds:
“The MA reported that she was unable to persist with reading more than 20 minutes in duration. She also reported that she was reading less and could not concentrate on complex tasks for long periods of time.”
Class 3, as per the Guidelines, entails an inability to “read no more than newspaper articles”. Furthermore, it entails an inability to “follow complex instructions”.
As the respondent correctly points out:
“The history recorded by the MA, noting the appellant’s management of the family finances, scheduling for her and her four children, and cooking from recipes were consistent with a Class 2 rating.
This denotes an ability to follow complex instructions and engage in cognitive tasks more challenging than a newspaper article (in particular, the management of finances, reading recipes and other materials, and managing the scheduling for her and her four children).”
We agree with the respondent’s submissions in this category, particularly noting that the appellant engages in all the tasks referred to above on her own which is particularly challenging. As the Medical Assessor noted:
“She could concentrate for about 20 minutes prior to requiring a break. She was able to follow the conversation and questions. She responded in a prompt and straightforward manner.”
We repeat our earlier comment that the examples in Table 11.1 are examples only and are not exclusive.
The Medical Assessor’s assessment once again was consistent with the evidence.
Turning lastly to the category of Employability, the Medical Assessor assessed a Class 3 and said:
“The claimant was not able to work at any time in the future for this employer. The claimant was able to work less than 20 hours per week in a different role in a different, less stressful environment for a different employer. The role would be less stressful and less demanding than her role for this employer.”
As the respondent noted:
“The appellant does not say what Class rating should have been allocated, but refers to the assessment of her qualified expert, Dr Paisley, who considered the appellant to be a Class 5.”
Dr Paisley assessed the appellant in August 2023, some 16 months prior to the Medical Assessor.
It is true that the Medical Assessor noted the appellant’s insomnia and agitation nearly every day and her fatigue and loss of energy, in addition to her diminished ability to concentrate.
However, these comments were made in the context of her ADL’s and not specifically to her capacity for employment.
The Medical Assessor’s assessment is also consistent with the opinion of Dr Nagesh.
The appellant’s GP also considered that she had some capacity for work.
For these reasons, we agree that the Medical Assessor’s assessment was consistent with the evidence.
The appellant also submits that the Medical Assessor failed to give adequate reasons.
In Campbelltown City Council v Vegan [2006] NSWCA 284 (Vegan), the Court of Appeal held that an Assessor is obliged to give reasons. However, the reasons need not be extensive or provide detailed explanation of the criteria applied by medical specialists in reaching a professional judgment.
In Inghams Enterprises Pty Ltd v Lakovska, [2014] NSWCA 194, the Court of Appeal, held:
“… failure to give legally sufficient reasons will be reviewable for legal error: Vegan at [130], referred to in Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43; 88 ALJR 52 at [28]. These decisions should not be understood as requiring lengthy or discursive reasons.” (our emphasis)
The appellant submits that the Medical Assessor erred in his failure to give reasons in two respects.
Firstly, it is submitted that the reasons given for applying a 2% WPI loading for the effects of treatment are inadequate.
The Guidelines allow an adjustment of 1-3% WPI, where the effective long term treatment of an illness or injury results in apparent substantial or total elimination of the appellant’s permanent impairment, (our emphasis) but the appellant is likely to revert to the original degree of impairment if treatment is withdrawn.
The Medical Assessor said:
“I am of the opinion that if the appellant were to cease her antidepressant medication her whole person impairment would significantly decline. I note that the effect of treatment on the appellant’s symptoms has been of a moderate amount. I have added 2% WPI for treatment effect.”
A similar issue was recently dealt with by the Supreme Court in Zoric v Secretary, Department of Education & Ors [2024] NSWSC 131 (Zoric) where Chen J said:
“The clause may thus be understood to involve, and require findings about, the following ‘steps’:
1.First, whether there has been effective long-term treatment of an illness or injury.
2. Secondly, whether that treatment results in apparent substantial or total elimination of the claimant’s permanent impairment.
3. Thirdly, whether the claimant is likely to revert to the original degree of impairment if treatment is withdrawn.
Upon satisfaction of each step, the medical assessor may increase the percentage of WPI by 1%, 2% or 3%. no submissions were directed to the proper construction of it – in particular, the meaning to be given to the term ‘may’ (broadly, whether it is discretionary or mandatory).
In relation to the first step, therefore, there needs to be a finding about the ‘illness or injury” that results in permanent impairment and whether there has been effective long-term treatment of that ‘illness or injury’.
In relation to the second step, that enquiry involves a comparative exercise being performed, the nature of which was explained in Peachey v Bildom Pty Ltd (Quality Siesta Resort Pty Limited and Quality Hotel) [2020] NSWSC 781 at [52] as follows:
Clause 1.32 requires a comparison to be made between the claimant’s original degree of impairment as a result of the injury before the effective treatment and the claimant’s degree of impairment as a consequence of treatment to determine whether the treatment has resulted in apparent substantial or total elimination of the original impairment. The comparison is to be made between the respective impairments at those two relevant times. I consider this construction to be clear from the wording of the clause…
In relation to the third step, the question is whether the claimant’s impairment is likely to revert to the original degree of impairment if treatment is withdrawn. Plainly, the resolution of this question is likely to be informed, perhaps significantly, by the findings in relation to the first and second steps.”
The Medical Assessor clearly explained his reasons for his assessment on this issue, consistent with the comments in Zoric above.
Secondly, the appellant submits that the Medical Assessor did not provide reasons as to why he did not agree with the assessments of Dr Paisley.
We have addressed this issue to some extent earlier. The Medical Assessor is not required to explain why a different assessment might be made. The report is clearly part of the evidence before the Medical Assessor. In addition, mere disagreement with an assessment is not a proper basis for appeal.
The task of the Medical Assessor is to weigh up all the medical evidence and draw their own conclusion based on their own clinical assessment in accordance with the Guidelines.
For these reasons, the Appeal Panel has determined that the MAC issued on
11 December 2024 should be confirmed.

[2025] NSWPICMP 278

16 April 2025