Zeballos v State of NSW (Central Coast Local Health District)

DETERMINATION OF APPEAL PANEL
CITATION:	Zeballos v State of NSW (Central Coast Local Health District) [2025] NSWPICMP 537
APPELLANT:	Andre Zeballos
RESPONDENT:	State of NSW (Central Coast Local Health District)
APPEAL PANEL
MEMBER:	Marshal Douglas
MEDICAL ASSESSOR:	Graham Blom
MEDICAL ASSESSOR:	Michael Hong
DATE OF DECISION:	23 July 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) obtained sufficient history to rate the appellant’s impairment in social functioning and in concentration, persistence and pace; whether MA erred with his ratings of the appellant’s impairment in social functioning and in concentration, persistence and pace; whether additional information would lead the Appeal Panel to a different conclusion; Held –MA did not obtain sufficient history to rate the appellant’s impairment in social functioning but did so with respect to concentration, persistence and pace; MA’s rating of appellant’s impairment in concentration, persistence and pace did not involve error but his rating of the appellant’s impairment in social functioning did involve error; appellant re-examined; MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

On 27 February 2025 Andre Zeballos, the appellant, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Mukesh Kumar, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 30 January 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):
·        availability of additional relevant information (being additional information that was not available to, and that could not reasonably have been obtained by, the appellant before the medical assessment appealed against);
·        the assessment was made on the basis of incorrect criteria, and
·        the MAC contains a demonstrable error.
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 was employed by the State of New South Wales (Central Coast Area Health Service) as a member of its harm minimisation team. He commenced his employment in 2016. Due to adverse interactions with another within his workplace, and also with some of the respondent’s clients, he suffered a psychological injury.
The appellant claimed compensation from the respondent’s insurer, relying on a report of psychiatrist Dr Glen Smith dated 4 December 2023, who had assessed the degree of the appellant’s permanent impairment from his injury is 22% whole person impairment (WPI).
The respondent, through its solicitors, advised the appellant, through his solicitors, that the respondent considered the appellant had not reached maximum medical improvement. It consequently did not accept his claim or make a counter offer. It relied on reports of psychiatrist Dr Nadeem Anwar dated 27 November 2023 and 24 April 2024. Hence, various medical disputes arose between the parties relating to the appellant’s claim for compensation.
The appellant lodged with the Personal Injury Commission (Commission) an Application to Resolve a Dispute dated 23 October 2024, seeking the Commission determine his claim for compensation. That could only be done once the medical disputes between the parties were resolved and to that end, and after the respondent had filed a Reply to the appellant’s application, a delegate of the President of the Commission issued a referral to the Medical Assessor on 14 November 2024.
The Medical Assessor conducted an examination of the appellant on 24 November 2024 through video conferencing. As said, he issued the MAC on 30 January 2025. In that he advised the appellant’s condition had reached maximum medical improvement, and it is implicit from that he was of the view that the appellant’s impairment is permanent and that his permanent impairment is fully ascertainable. He also certified he assessed the degree of the appellant’s permanent impairment from his injury is 8% WPI.
The Medical Assessor’s assessment of the appellant’s permanent impairment was done by reference to the degree of the appellant’s severity of impairment in the six categories of behaviour comprising the Psychiatric Impairment Rating Scale (PIRS). In this appeal, the appellant has challenged the Medical Assessor’s ratings of his impairment in the PIRS categories of social functioning and concentration, persistence and pace (CPP), for both of which the Medical Assessor rated the appellant’s impairment as Class 2. The appellant also contended that the Medical Assessor did not afford him procedural fairness.
In the PIRS rating form within the MAC the Medical Assessor provided the following reasons for rating the appellant’s impairment in social functioning as Class 2:
“Mild impairment:
·Mr Zeballos reported that his relationship with his family is now quite good and is improving.
·He is able to meet with his friends, though his social interactions have reduced.
·Impairment in this domain is Class 2.”
Within the body of the MAC the Medical Assessor recorded within the history he set out that the appellant had moved in with his parents for support. The Medical Assessor also noted that the appellant previously saw his friends three to four times a week but now only catches up with them once a fortnight. The Medical Assessor noted that the appellant spends time with his family and that he chats with friends.
The Medical Assessor noted that Dr Smith had rated the appellant’s impairment in social functioning as Class 3. The Medical Assessor copied within the MAC the reasons Dr Smith provided for that rating which were, in substance, that the appellant had lost friends because he had withdrawn from activities, that the appellant had been able to develop a new relationship, and that the appellant had recently become estranged from family members. The Medical Assessor expressed his disagreement with Dr Smith’s rating. The Medical Assessor explained this was because the appellant had not had a separation from any partners due to “work place conditions”, that any inability of the appellant to engage in a new relationship “cannot be solely attributed to work place conditions or any disorders subsequent to work place conditions”, and that the appellant has a good relationship with his family and friends and meets his friends once a fortnight. The Medical Assessor said that the appellant’s level of social functioning did not reach the threshold of a moderate impairment.
The Medical Assessor provided the following reasons for rating the appellant’s impairment in CPP as Class 2:
“Mild impairment:
·Mr Zeballos said that his concentration is difficult described [sic].
·He said that certain days he is able to concentrate and certain days he is not.
·He added that he is able to focus on his guitar lessons between 30 to 45 minutes per day.
·He added that he also likes to listen to podcasts and is interested in podcasts about history, Quantum Physics, and technology etc.
·He said that he is able to focus on these for a maximum of 45 minutes each time.
·Impairment in this domain is class 2.”
Within the body of the MAC the Medical Assessor noted that the appellant experienced difficulties in his childhood completing his homework and with concentration, and that he was impulsive and had risk taking behaviour. The Medical Assessor noted that the appellant was diagnosed with ADHD in 2021, for which he takes dexamphetamine 45mg daily. The Medical Assessor also recorded that during his mental state examination of the appellant, the appellant was easy to engage in conversation and able to articulate his thoughts rationally and logically and did not exhibit any formal thought disorders.
The Medical Assessor noted that Dr Smith rated the appellant’s impairment in CPP as Class 4 and that Dr Smith’s reasons for that were that the appellant presented with marked difficulties with thinking and concentration, that the appellant found it difficult to read due to poor focus and that he found the appellant had concentration deficits in brief conversations. The Medical Assessor expressed his disagreement with Dr Smith’s ratings explaining that the appellant did not present to him with marked difficulties with his thinking and concentration and that there were no concentration difficulties during his assessment of the appellant. The Medical Assessor further explained that the appellant was able to provide him a clear account of work place events as well as his current functioning and that the appellant had been learning to play guitar and was able to focus on that for a maximum of 45 minutes. The Medical Assessor also noted within the history he set out that the appellant had an interest in history, quantum physics, and technology and that he listens to podcasts.
In terms of the appellant’s complaint that the Medical Assessor did not afford him procedural fairness, the Appeal Panel notes from the MAC that the Medical Assessor did not reveal that he had any difficulty eliciting information from the appellant in order to compose a relevant clinical history for the purposes of assessing the medical disputes that had been referred. Further, the Medical Assessor stated that the appellant was able to provide a consistent account of workplace incidents and of his symptoms and his condition and provide a clear account of his treatment as well as his functioning. The Medical Assessor noted from his mental state examination that the appellant was able to articulate his thoughts rationally and logically.

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. This is because the Appeal Panel found, for reasons explained below, that the MAC contained a demonstrable error, which the Appeal Panel would need to correct. To do this the Appeal Panel considered it needed further information which could only be obtained by a further examination of the appellant. Medical Assessor Graham Blom, one of the members of the Appeal Panel, was appointed to do this. He did so on 10 July 2025 and his report 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 based on the history the Medical Assessor obtained and the history Dr Smith had detailed in his report of 4 December 2023 that in between the time Dr Smith examined him and the Medical Assessor examined him, his relationship with his partner had ended. The appellant submitted that the Medical Assessor “seemingly failed to take any history” regarding why he broke up with his partner.
The appellant referred to the history Dr Anwar set out in his report of 24 April 2024 wherein Dr Anwar noted that he had separated from his partner because of his partner’s mental health issues.
The appellant referred to Dr Smith including in the history he obtained that he has been estranged from family members.
The appellant submitted that the Medical Assessor did not take any history to form the conclusion that his failure to engage in a new relationship cannot be solely attributable to his injury. The appellant further submitted that his injury does need to be the sole reason for any inability he has to engage in a new relationship in order for the effects of his injury to be weighed as a factor when rating his impairment in social functioning.
The appellant submitted that the history the Medical Assessor elicited was insufficient to enable the Medical Assessor to conclude that he had lost friends because of his withdrawal from activities.
The appellant noted that Dr Smith had obtained a history that he is estranged from his family members. The appellant submitted that the Medical Assessor did not obtain a history to enable him to form a conclusion that he has good relationships with his family and friends.
The appellant submitted that a Class 3 rating in social functioning requires relationships to be severely strained and evidenced by periods of separation. The appellant submitted that “prima facie” there appears to be severe strain in his relationships evidenced by periods of separation in that he has lost friends, has been estranged from family members at least at a point in time, and appears to have lost one partner.
The appellant referred to entries in the clinical records of his general practitioner for 15 April 2024 and 13 May 2024 that indicated he was feeling disorganised with poor short-term memory and agoraphobia and that he had a bad day cognitively. The appellant submitted that the Medical Assessor placed undue weight on his guitar lessons and his interest in podcasts when rating his impairment in CPP. The appellant submitted that his listening to podcasts and learning to play a guitar “is more akin to recreational pursuit than one which would require pace and concentration to produce an outcome”.
The appellant submitted that the Medical Assessor did not take a history relating to the extent he is able to read or follow instructions.
The appellant submitted that the assessment was conducted in circumstances where he could not speak frankly and openly about his family situation, which was a denial of procedure fairness. The appellant referred to additional evidence in the form of a statement he signed on 28 February 2025 wherein he says that:
(a)    the video assessment was done at his parents’ house when his parents were present and within hearing range which impacted his ability to speak freely regarding family dynamics,
(b)    he told the Medical Assessor that he could not discuss matters of family violence and domestic situations in depth,
(c)    he was forced to brief limited responses,
(d)    one of his major goals was living independently, and
(e)    he had to leave his parents’ house two weeks ago due to an escalation of abusive behaviour, and he is currently homeless.
In reply, the respondent submitted that the Medical Assessor was entitled to determine what weight he should give to the documents referred to him and the information provided. The respondent submitted that the Medical Assessor was not bound to adopt the findings of Dr Smith.
The respondent submitted, relying on Lukacevic v Coates Hire Operations Pty Ltd[1] and Petrovic v BC Serv No. 14 Pty Ltd & ors[2], but without providing any reference to the paragraphs within those authorities, that the appellant’s additional statement is not additional relevant information for the purposes of s 327(3)(b). The respondent submitted that is not part of the “procedure of the Commission” that commentary be allowed on the conduct of examinations and assessments and it not in the interest of justice for the Appeal Panel to take into account such comments.
[1] [2011] NSWCA 112
[2] [2007] NSWSC 1156
The respondent submitted that any failure on the Medical Assessor’s part to refer specifically or to draw inferences from the reports of Dr Anwar and Dr Smith and the clinical records of the general practitioner does not amount to a demonstrable error.
The respondent submitted that the Medical Assessor provided his path of reasoning to rate the appellant’s impairment as Class 2 in social functioning and that the Medical Assessor had regard to the relevant evidence, including the reports of Dr Smith and Dr Anwar when rating the appellant’s impairment in social functioning.
The respondent submitted that the Medical Assessor did not have to provide reasons as to why he considered particular evidence when forming his opinion. The respondent repeated that the Medical Assessor was permitted to determine what weight he should give to the documents provided and what weight he should place on the information before him.
The respondent submitted that the Medical Assessor’s rating of the appellant’s impairment in CPP was an exercise of the Medical Assessor’s clinical judgment. The respondent submitted that the Medical Assessor formed his own opinion regarding these matters. The respondent submitted that the Medical Assessor’s rating of the appellant’s impairment in CPP accords with the history and the medical evidence.
The respondent submitted that the Medical Assessor acted within his scope of authority.
The respondent submitted that the appellant had ample opportunity to ensure that he was at a location in which the assessment could be conducted privately.

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.

Section 327(3)(b)

The question an Appeal Panel must ask itself when considering whether the ground for appeal provided in s 327(3)(b) of the 1998 Act is established is whether the additional information would lead the Appeal Panel to a different conclusion from that reached by the Medical Assessor.[3] Further the additional information must be something other than evidence relating to the process by which the Medical Assessor makes his or her assessment. That is, additional information does not include information that relates to how the Medical Assessor carried out his or her examination of a worker or the manner in which the Medical Assessor put questions to the worker or the Medical Assessor’s interpretation of the worker’s answers.[4]
[3] Lancaster v Foxtel Management Pty Ltd [2022] NSWSC 929 at [13].
[4] Luck v Workers Compensation Nominal Insurers [2023] NSWSC 842 at [45] and [63]; Petrovic v BC ServNo. 14 Pty Ltd [2007] NSWSC 1156 at [31]-[32]
The appellant’s statement dated 28 February 2025, with the exception of paragraph 8, consists of firstly, matters relating to the manner in which the Medical Assessor conducted his assessment and the questions he asked of the appellant and his interpretation of the answers the appellant provided, and secondly, a conclusion the appellant formed relating to procedural fairness that he does not the expertise to make. Consistent with what was held in Petrovic, that evidence is not additional relevant information.
With respect to paragraph 8, wherein the appellant says that two weeks prior to signing his statement, which would be around 14 February 2025 and subsequent to the medical assessment, he left his parents’ home and is currently homeless. That is additional relevant information that potentially might lead the Appeal Panel to a different conclusion from that reached by the Medical Assessor with respect to the appellant’s impairment in social functioning.

The Appeal Panel considered that it would need further information relating to that particular matter in order to determine conclusively whether it would for a different view than that reached by the Medical Assessor with respect to the appellant’s impairment in social functioning. It is for that reason, and also because, for reasons explained immediately below, the Appeal Panel found the Medical Assessor erred with respect to his rating of the appellant’s impairment in social functioning, that the Appeal Panel decided to have Medical Assessor Blom re-examine the appellant.

Social functioning

The Appeal Panel accepts the appellant’s submissions to the effect that the Medical Assessor did not obtain a sufficient history to be able to rate correctly the appellant’s impairment in social functioning, and specifically whether it ought to be rated as Class 3 rather than Class 2.
The examples provided in Table 11.4 of the Guidelines for a Class 2 rating in social functioning are:
“Mild impairment:
Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.”
The examples provided for a Class 3 rating are:
“Moderate impairment:
Previously established relationships severely strained, evidenced by periods of separation or domestic violence. Smells??, relatives or community services looking after children.”
Further, as the appellant submitted, the deterioration of his capacity to maintain social relationships does not have to be solely attributable to his work injury in order that it can be considered when rating his impairment in social functioning. So long as his work injury is a material factor with respect his being able to maintain or not maintain relationships then it must be taken into account when rating his impairment in social functioning.
The Medical Assessor when explaining why he disagreed with the assessment of Dr Smith relating to the appellant’s impairment in social functioning said that the appellant “may not have been able to engage in a new relationship, this cannot be solely attributed to work place conditions or any disorder subsequent to work place conditions”. Essentially, the Medical Assessor applied a “but for” test, and by so doing he erred. As indicated, what he was required to do was to consider whether the appellant’s injury was a material factor in the appellant’s inability to form new relationships.
Further, as the appellant submitted, the Medical Assessor did not explore with the appellant or elicit from him whether and to what extent he has been able to form new relationships.
The history that Dr Smith obtained in December 2023 indicated that the appellant was then in a relationship. The history that Dr Anwar obtained in April 2024 revealed that the appellant had separated from his partner because of his partner’s mental health issues. The Medical Assessor did not explore with the appellant or elicit from him the circumstances pertaining to that relationship, such as the nature of the relationship and the duration of it, and why it ended. That was a factor to consider when rating the appellant’s impairment in social functioning. The Medical Assessor’s failure to obtain a history relating to that is an error such that the MAC contains a demonstrable error.

CPP

The examples provided in Table 11.5 of the Guidelines for a Class 2 rating in CPP are:
“Mild impairment:
Can undertake a basic re-training 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 headaches.”
The examples provided for a Class 3 rating are:
“Moderate impairment:
Unable to read more than newspaper articles. Finds it difficult to follow complex instructions (example operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making cloths, tapestry or knitting.”
The history the Medical Assessor obtained to rate the appellant’s impairment in CPP was sufficient. That revealed that the appellant at the time of examination was able to focus on guitar lessons for 30 to 45 minutes a day and focus on podcasts about history, quantum physics and technology. The Medical Assessor also found that the appellant was able to articulate his thoughts rationally and logically during his examination of him and that he exhibited no thought disorder and could provide a consistent account of his symptoms and of his condition and also the incidents as a result of which he suffered he psychological injury.
The Medical Assessor was entitled to give pre-eminence to his clinical observations at the time he assessed the appellant.
Those matters clearly accord, in the Appeal Panel’s view, with a severity of impairment described by the examples for a Class 2 rating, rather than a Class 3 rating. This is because the appellant’s function indicates that he could undertake a basic re-training course and focus on intellectually demanding tasks for 30 minutes. That is evident from the fact that he was able to engage without trouble during the examination with the Medical Assessor and is able to focus on guitar lessons and the content of podcasts for 45 minutes. That indicates in the Appeal Panel’s view, that he would not have difficulty following complex instructions or typing long documents.
The Appeal Panel discerns no error with the Medical Assessor’s rating of the appellant’s impairment in CPP.

Procedural fairness

It is the case, as the appellant submitted, that a Medical Assessor when conducting an assessment of a worker must afford the worker procedural fairness.[5]
[5] Frost v Kourouche [2014] NSWCA 39 at [32], [35]; Hutchison v Wyong Race Club Ltd [2020] NSWSC1592 at [74]-[78] and cases discussed therein.
There is however nothing within the MAC that demonstrates the Medical Assessor failed to afford procedural fairness to the appellant. It is apparent from the MAC that the Medical Assessor was able to obtain what he considered was a complete and relevant history to assess the appellant’s impairment, although as said for reasons explained above, the Appeal Panel considers that the Medical Assessor erred with respect to the fullness of the history he obtained relating to the appellant’s capacity in social functioning. That error however does not pertain to the Medical Assessor affording procedural fairness to the appellant through the interview process and his making observations of the appellant during the assessment.
Further, the Medical Assessor is a specialist medical practitioner in the field of psychiatry. It can be inferred he has the necessary skills and experience to conduct an examination, including interviewing a worker to elicit relevant clinical information. It can be inferred that the appellant does not have clinical experience. Based on the Medical Assessor having the necessary clinical expertise regarding how an examination assessment should be conducted the Appeal Panel discerns nothing within the MAC that indicates the Medical Assessor did not afford the appellant procedural fairness.

Re-examination and assessment

As mentioned, the Appeal Panel considered it was necessary for the appellant to be
re-examined. This was firstly to put the Appeal Panel in the situation where is could weigh properly the additional information relating to the appellant’s current relationship with his family and also to correct the error the Medical Assessor made in failing to obtain a sufficient history to rate properly the appellant’s impairment in social functioning. Medical Assessor Blom’s report to the Appeal Panel on his examination follows:

“APPEAL AGAINST MEDICAL ASSESSMENT

REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR

MEMBER OF THE APPEAL PANEL

Matter Number:	M1-W27775/24
Appellant:	Andre Zeballos
Respondent:	State of NSW (Central Coast Local Health District)
Date of Determination:	10 July 2025

Examination Conducted By:	Graham Blom
Date of Examination:	10 July 2025

1.     The workers medical history, where it differs from previous records
Given the nature of the current appeal, I spent a considerable amount of time reviewing the history of all of Mr Zeballos’s relationships.
History Prior to The Injury.
Mr Zeballos said that prior to the injury, he had lived on his own in rented accommodation for about 12 to 15 years. During this time, he dated other men on and off although had only two longer term relationships. He said that often there were long periods of time, in between the long-term relationships where he would not date or desire to be in a relationship because he wished to be independent and “not settle for just any relationship”. He said that over the last 15 years or so he had only two longer term relationships, one between 2013 and 2015 and then subsequently a relationship between 2018 and 2020. In the latter relationship he said that he lived with a man for about one year in a house on the Central Coast. He said that neither relationship broke up acrimoniously, but tended to come to a natural conclusion because they had “outgrown each other”.
He said that during this time he had lots of friendship however, and that he was socially very active. He said he would socialise with friends up to 3 nights/week as well as occasionally on weekends. He was engaged with the gay community in Sydney he said and this provided him also with a range of friendships and social acquaintances. He also was an active participant in, attending a gym usually about five days/week where he also had acquaintances.
His relationship with his family, has always been problematical. He described his father as a “classic narcissist” and said that he was homophobic, aggressive and bullying. He also had difficulties with his mother, and he said that he worked hard in his adolescence, to get away from both his mother and father. The situation was made more difficult as both of his parents were members of a “fringe Pentecostal church” and that his father was in fact a pastor in this church. He said that by the time of the injury he had very limited and brief contact only with his parents because of the difficulties, long-term, that he had had in the relationship with them. He was at pains to point out that he still loved them and wanted to retain a relationship but that he could not tolerate one that was close or demanding because of their personal characteristics and demands. He also has a sister, Liana, who is 11 years younger than him. Despite the significant age difference, he said that they were generally fairly close. His sister also had considerable difficulties with their parents because of their abuse and incapacity to maintain reasonable boundaries. He said that his sister is married and that she currently has a three-month-old baby and that she has become somewhat more distant from the whole family over the last several months because of her wish to establish her own family with her new baby, without interference from the family. This has meant that they have had less contact although he did not feel that the relationship itself was particularly strained.
History since the Injury.
Following the injury described in the original MAC as well as the considerable documentation, Mr Zeballos developed a range of symptoms with predominant panic attacks, avoidance and recurrent nightmares related to difficult and frightening clients that he had dealt with, associated with disturbed sleep. He described low mood with a loss of sense of purpose and regular fatigue during the daytime. He experienced low motivation and reduced energy and complained of subjective difficulties with concentration. He said that he also often had what he described as dissociative experiences, where he felt disconnected from his body – these were particularly associated with panic attacks. He also intermittently experiences flashbacks again related to particular difficulties with clients especially the man described in the documentation who was using steroids and was aggressively demanding excessive injecting equipment from him and where he had not felt supported by management.
As a result of the injury and associated symptomatology, Mr Zeballos became more withdrawn and avoidant and this meant that he did not form any relationships, nor did he go on dates for about 12 – 15 months. However around January 2024, he began a relationship with a man, Daniel, with whom he had been friends for many years. They began dating, although he said that this was difficult because of his illness. He feels that because of his illness he overlooked the “red flags” in the relationship because he really wanted to make it work. Subsequently he and Daniel moved in together in June 2024 and remained together for about four months. The relationship eventually broke up when Mr Zeballos said that he became increasingly aware of the “red flags” in the relationship. These red flags had to do with the difficulties of living together in a relationship compounded by his illness and awareness that Daniel was not as sensitive and understanding as he would wish. He said that the breakup was not acrimonious and they continue to be friends. As a consequence, however he was left without accommodation, and so reluctantly decided to move in with his parents. He said that he only did this because of his “housing crisis” as well as the fact that he was financially impecunious. Despite his situation he said he remained hesitant about moving back with his parents and his hesitancy appears to have been well-placed because after about four months he felt unable to continue there and moved out, moving into various temporary accommodations (mainly B and Bs) in the Newcastle area. He continued this through till around May 2025 when he said that “everything fell apart as he had run out of money”. He began sleeping rough, for about four weeks – sleeping in his car or other emergency accommodation usually. His symptoms deteriorated with increasing panic attacks, depressed mood and with multiple presentations to hospital because of his symptomatology and also because of his homelessness crisis. He said he presented to Mater Hospital, Newcastle, Belmont hospital and Wyong hospital but was only reviewed in the Emergency Department and not admitted. Eventually the situation became dire and so he returned to living with his parents at the beginning of June. He said that this only lasted for about four weeks at which time they gave him a caravan to live in and suggested that he should leave their home as the relationship was so acrimonious. This does not appear to have been directly related to the injury but reflective of long-term difficulties in the relationship with his parents.
Mr Zeballos has gradually lost contact with most of his friends since his injury to the point now where he has very little contact with them. In part this is due to his withdrawal and because of the itinerant nature of his accommodation, especially over the last 12 months. However, he also noted that his friends have “moved on with their lives”, stating that a couple of friends had moved interstate and one friend had formed a long-term partnership and was very involved in this relationship but he noted that his own avoidance and withdrawal had further compound the difficulties in maintaining his friendships.
2.     Additional history since the original Medical Assessment Certificate was performed
As noted, at the time of the previous MAC Mr Zeballos was living with his parents - he subsequently left his parents’ house because of the long-term difficulties in their relationship. He lived in various temporary accommodations for several months and was briefly homeless for about four weeks. He subsequently returned to his parents’ house and remained there for about a month before leaving. Currently he is living in a caravan given to him by his parents. He said that he had driven the caravan to Queensland and currently was living in a town called Esk which is northwest of Brisbane.
Since the MAC he has had multiple presentations to hospitals both in Newcastle and one presentation to Royal Brisbane Hospital where he remained overnight. These presentations were associated with deterioration of his symptoms as well as difficulties with his accommodations. Overall, however he said that his symptoms have remained generally the same although there have been periods where there have been deterioration although these have tended to be relatively brief and situationally determined. Currently he is living alone in a caravan in Esk. He has only been there for a week or two and has only limited social contact although he is getting to know a couple of the permanent residents. He remains quite withdrawn generally and spends considerable amount of his time ruminating about the difficulties of his circumstances and the general unfairness of his position.
3.     Findings on clinical examination
Mr Zeballos was seen via the Teams teleconference app. The quality of the streaming was good with no disruptions. I was able to conduct my assessment without any difficulties. Prior to the formal assessment I specifically clarified with Mr Zeballos that he was in a space where he felt able to speak freely about family and friends and where he felt safe – he confirmed this situation.
Mr Zeballos was well-groomed with combed hair and shaved face. He was wearing neat casual clothing. He was sitting on the bunk of his caravan during the interview. Generally, he engaged warmly throughout the interview although was noticeably anxious at the beginning of the interview. He gradually settled as the interview progressed except towards the end when he became very distressed, anxious and angry as he began talking about the impact of the injury on his life and particularly the devastating impact of his symptomatology. At this point he became angry and described feeling repetitively judged by the various doctors who examined him and by the system in general. He complained that he felt that no one had really listened to him. I spent some considerable time attempting to deal with these feelings by both acknowledging the difficulties of the legal elements of the workers compensation system as well as the considerable social difficulties that he had experienced as a result of his injury. As a result, he settled and was able to reflect on his distress and continue with the assessment .
He did not appear overtly depressed and in particular he did not display any flattening of affect. He had a full range of appropriate affect with capacity to show both humour as well as sadness and anger. He described a sense of hopelessness and purposelessness with a feeling of helplessness in his ability to change his situation. This led to the description of a feeling of suicidality which he said had been present since his injury and that fluctuated in intensity. He has never made a suicide attempt, although he did describe the feeling that he could see “no logical reason for living”.
There was no evidence of cognitive impairment. He was able to present his history in a coherent and fluent manner. At times he became slightly confused in chronology, but I was able to clarify this with him and I was thus able to form a clear and coherent chronology of events. He also displayed a capacity to reflect on his feelings and on his responses both verbal and emotional.
There was no evidence of any psychotic phenomena, in particular he did not display delusions, hallucinations or formal thought disorder.
There was no evidence of any organic brain disorder. He presented as a honest witness who demonstrated insight and motivation.
4.     Diagnosis
Diagnostically he meets the criteria for:
I.Persistent Depressive disorder. He describes persistently low mood compounded by difficulties with motivation and drive, problems with concentration, loss of energy and disturbed sleep. He has suicidal ideation. His symptoms currently are not sufficient to meet the criteria for a Major Depressive Disorder although he may have met these criteria in the past.

II.Panic disorder without agoraphobia. Whilst he is avoidant, the avoidance relates to his fear of running into people associated with his injury or that circumstances may trigger memories of his injury rather than true agoraphobia. He has regular panic attacks marked by hyperventilation, dissociative experiences, various cardiovascular experiences associated with extreme anxiety on a regular basis.
III.Anxiety disorder not otherwise specified. This diagnosis is made because of the presence of PTSD-like symptoms without the original trigger required to meet criteria A of this diagnosis – that is there has been no event that was life-threatening, horrifying or involved sexual or very significant physical violence. However, he continues to experience re-intrusive reliving of various traumatic events in nightmares and flashbacks. He also experiences avoidance and withdrawal, and general hypervigilance and increased startle. He is unquestionably significantly impacted by these symptoms.

5. Current Treatment.
Mr Zeballos continues to consult his general practitioner Dr Donovan, whom he has been consulting since the beginning of his illness. As he is now living in Queensland, he consults Dr Donovan via tele-health. Dr Donovan provides support, medical assessment and appropriate medical treatment. Currently Mr Zeballos is prescribed olanzapine, an antipsychotic medication with significant sedative properties, at a dose of 5 mg/night as well as 5 mg as required. He says that usually he takes 10 mg of olanzapine/day. He denies any excess use of this medication.
He was previously prescribed dexamphetamine but as he has terminated the relationship with his previous psychiatrist Dr Pearson he has ceased the amphetamines. He terminated the relationship with Dr Pearson in February 2024 because he said that he felt that Dr Pearson did not have a collaborative approach in treatment and in particular he objected to the benzodiazepine medications he was prescribing. He subsequently ceased all benzodiazepines. He continued the dexamphetamine for 12 months after he terminated with Dr Pearson as he had prescribed a 12-month script and Dr Donovan was willing to provide the regular prescriptions but as the 12 month approval has ceased he has decided to stop dexamphetamine. He described this as a positive outcome.
He previously consulted a psychologist Ms Michael’s but felt that this therapy was not helping him any further and decided to terminate the relationship in November 2024. He is not currently consulting any psychologist and has no plans to in the immediate future.
He has presented at ED on multiple occasions and on one occasion stayed overnight there but has never had a formal admission for his psychiatric disorder.
6. Results of any additional investigations since the original Medical Assessment Certificate.
There have been no further investigations.
Signed
Dr. Graham Blom, Medical Assessor.”

The Appeal Panel considers that Medical Assessor Blom has conducted a thorough examination of the appellant and consequently the Appeal Panel adopts the history Medical Assessor Blom obtained, his findings from his examination of the appellant and accepts the diagnosis he has made.
Based on the history Medical Assessor Blom obtained the Appeal Panel does not consider that the tension between the appellant and his parents caused by the appellant ceasing to remain in their house is related to the appellant’s injury. The evidence reveals that the appellant’s relationship with his parents has always been fraught and the appellant’s estrangement from his parents is due to those long standing difficulties and not his injury.
The appellant’s injury however, was a material factor in the cessation of his relationship with his most recent partner. Further, the appellant is withdrawn which is a consequence of his injury and due to that he has lost contact with most of his friends to the point where he now has very little contact with them. Whilst this is partly due to the current itinerant nature of his accommodation and his friends moving on with their lives, his injury is also a material factor in the loss of his friends.
In the Appeal Panel’s view these matters accords best with a severity of impairment described by the examples for a Class 3 impairment, rather than a Class 2 impairment. That is to say, because his injury has been a material factor in the cessation of his most recent relationship and to his decreasing involvement with and loss of most of his friends, he has a moderate impairment in social functioning.
The Appeal Panel corrects the error the Medical Assessor made by rating the appellant’s impairment in social functioning as Class 3. That bring the aggregate of his class scores to 16 and the median to 3, which converts to 19% WPI.
It is noted that the appellant did not challenge the Medical Assessor making a deduction under s 323(1) of the 1998 Act for a proportion of the appellant’s permanent impairment being due to a pre-existing condition of attention deficit hyperactivity disorder. The Appeal Panel in any event confirms that that condition contributes to the appellant’s permanent impairment in that it adversely affects his concentration. The evidence does not enable an assessment of what his permanent impairment would have been pre-injury. Consequently, in accordance with paragraph 11.10 of the Guidelines the Appeal Panel again considers that the one-tenth deduction the Medical Assessor made is correct.
For these reasons, the Appeal Panel has determined that the MAC issued on 30 January 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:	W27775/24
Applicant:	Andre Zeballos
Respondent:	State of NSW (Central Coast 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 Mukesh Kumar 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)
Psychiatric/ psychological disorders	13/10/2022	Chapter 11	-	19%	1/10	17%
Total % WPI (the Combined Table values of all sub-totals)					17%

[2025] NSWPICMP 537

23 July 2025