Allsopp v Secretary, Department of Communities and Justice
[2024] NSWPICMP 684
•27 September 2024
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Allsopp v Secretary, Department of Communities and Justice [2024] NSWPICMP 684 |
| APPELLANT: | Debra Kay Allsopp |
| RESPONDENT: | Secretary, Department of Communities and Justice |
| APPEAL PANEL | |
| MEMBER: | Carolyn Rimmer |
| MEDICAL ASSESSOR: | Professor Nicholas Glozier |
| MEDICAL ASSESSOR: | Michael Hong |
| DATE OF DECISION: | 27 September 2024 |
CATCHWORDS: | WORKERS COMPENSATION - Appeal against assessment of 8% whole person impairment for a psychiatric injury deemed to have occurred on 25 August 2022; appellant submitted that the Medical Assessor (MA) failed to consider all relevant evidence, failed to provide adequate reasons, and erred/applied incorrect criteria in the assessment of the psychiatric impairment rating scale (PIRS) categories of self-care and personal hygiene and social functioning; Held – assessment in the PIRS categories of self-care and personal hygiene, and social functioning confirmed; MA had considered the evidence and her reasoning was adequate; Medical Assessment Certificate confirmed. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 27 May 2024 Debra Kay Allsopp (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Surabhi Verma, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on
15 May 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): 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) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
RELEVANT FACTUAL BACKGROUND
The appellant suffered a psychological injury in the course of her employment as a Senior Client Service Officer Specialist with the Secretary, Department of Communities and Justice (the respondent) deemed to have occurred on 25 August 2022.
The appellant commenced proceedings in the Personal Injury Commission (Commission) on 4 April 2024 claiming 19% whole person impairment (WPI) pursuant to s 66 of the Worker Compensation Act 1987 (the 1987 Act) in respect of a psychiatric and psychological disorder injury deemed to have occurred on 25 August 2022.
The Medical Assessor examined the appellant on 8 May 2024. The Medical Assessor assessed 8% WPI as a result of the injury deemed to have occurred on 25 August 2022.
PRELIMINARY REVIEW
The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
The appellant requests that she be re-examined by a Medical Assessor who is a member of the Appeal Panel.
As a result of that preliminary review, the Appeal Panel determines that it was unnecessary for the appellant to undergo a further medical examination because there is sufficient evidence on which to make a determination.
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.
Medical Assessment Certificate
The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.
SUBMISSIONS
Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
The appellant’s submissions include the following:
(a) ground 1 – the Medical Assessor erred by failing to consider all relevant evidence.
(b) There is no evidence that the Medical Assessor considered or reviewed the material of Angela Stojcevska of RW Psychology or considered the entries by psychologist, Erin Kremer dated 24 November 2022 25 January 2023, 30 March 2023 and 8 June 2023. The failure to refer to the relevant clinical note evidence which is at odds with her conclusions amounts to a demonstrable error.
(c) There is no evidence that the Medical Assessor considered or reviewed the material of Associate Professor Neil Jeyasingam, specifically, his clinical records as well as the medical reports dated 20 July 2023 and 29 September 2023. The Medical Assessor diagnoses major depressive disorder with anxious distress which is at complete odds with the diagnosis provided by Associate Professor Jeyasingam. The evidence of Associate Professor Jeyasingam is completely at odds with the conclusions made by the Medical Assessor.
(d) Ground 2 – the MAC contains a demonstrable error and is infected by the application of incorrect criteria in respect of the Psychiatric Impairment Rating Scale (PIRS) of self care and personal hygiene.
(e) When assessing self care and personal hygiene, the Medical Assessor fails to consider symptoms reported in the MAC. It remains unclear as to why this was not considered when assessing class 2. Based on the above evidence, the correct self care and personal hygiene rating must be a class 3 or 4.
(f) Ground 3 – the MAC contains a demonstrable error and is infected by the application of incorrect criteria in respect of the PIRS of social functioning.
(g) When assessing social functioning, the Medical Assessor fails to consider symptoms noted in the MAC and the statement of the appellant. Based on the above evidence; the correct social functioning rating must be a class 3.
(h) Ground 4 – the Medical Assessor has erred by not providing any or any adequate reasons as to why she did not take into account all available medical evidence, including the clinical notes and the certificates of capacity, which described a history inconsistent with the history obtained during the assessment.
(i) The Medical Assessor failed to provide any meaningful reasons to enable a reader to understand how the Guidelines have been implemented such as to amount to constructive failure to implement the Guidelines by engaging in those matters outlined at clauses 11.4 -11.8 and 11.11-11.12. The Medical Assessor simply copied or duplicated what she has obtained from the appellant and inserts it into the "Reason for Decision" section when applying the PIRS table. There is no explanation, analysis or justification provided to allow for ease of understanding. This "explanation" does nothing to comply with the implementation of the Guidelines by reference to those matters. The Medical Assessor has fallen into error.
The respondent’s submissions include the following:
(a) The assessment of the Medical Assessor is made on the basis of the correct criteria and that the MAC does not contain a demonstrable error with respect to the assessment for self care and personal hygiene and social functioning. All three doctors who provided an assessment of whole person impairment (WPI) under PIRS (Dr Kumagaya for the appellant, Dr Anand for the respondent and the Medical Assessor) provided the same assessment of class 2 for both categories of Self-Care and Personal Hygiene and Social Functioning, which are the only categories which are the subject of this appeal.
(b) The Medical Assessor considered all the relevant evidence before him, conducted a thorough examination of the appellant and has provided adequate reasons for her opinion and assessment, which, do not fall into error. The Medical Assessor reached her own conclusions in her assessment of the appellant, as she was entitled to do: Stramit Corporation Pty Ltd t/as Stramit Building Products v Holl [2009] NSW WCC MA32.
(c) The PIRS categories are examples of activities only (clause 11.12 of the Guidelines) and are “generic and general in their description”: Jenkins v Ambulance Service of New South Wales [2015] NSWSC 633.The assessment of the appropriate class of impairment within each PIRS category falls within the realms of clinical judgement.
(d) It is necessary for the Medical Appeal Panel to be satisfied that the assessment by the Medical Assessor in the categories was erroneous in one of the following ways: (a) if the categorisation was glaringly improbable; (b) if it could be demonstrated that the Medical Assessor was unaware of significant factual matters; (c) if a clear misunderstanding could be demonstrated, or (d) if an unsupportable reasoning process could be made out. The assessment of the Medical Assessor in this case does not fall into the categories above.
(e) In relation to the assessment for self-care and personal hygiene, the Medical Assessor has properly assessed the appellant in class 2, consistent with the assessments of Dr Kumagaya and Dr Anand.
(f) In relation to the assessment for social functioning, the Medical Assessor has properly assessed the appellant in class 2.
(g) The Medical Assessor has made the assessment based on correct criteria and the MAC does not contain a demonstrable error. The appeal should be dismissed and the MAC should be confirmed.
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.
Ground 1 – failure to consider all relevant evidence
The appellant submits that there is no evidence that Medical Assessor considered or reviewed the material of Angela Stojcevska and Erin Kremer of RW Psychology, and the clinical records of Associate Professor Neil Jeyasingam and his reports dated 20 July 2023 and 29 September 2023.
The Medical Assessor, under “Documentary Evidence”, refers to the documents as listed in the referral. The Medical Assessor notes that the facts on which she had based her assessment of WPI are the clinical interview, mental status examination and the documentation received including the previous independent medical examiner (IME).
The Medical Assessor specifically refers to the report of Dr Anand (2 February 2024), letter by Associated Professor Neil Jeyasingam (18 August 2023) , letter from the general practitioner (GP) Dr Fryer (21 February 2023), case conference summary (24 October 2023), Allied Health Recovery Requests (various dates), medical records from Tahmoor 7 Day Medicate Pty Ltd (various dates), notes of Erin Kramer (various dates), and report of Dr Kumagaya (1 December 2023).
It is important to note that it is not the function of a Medical Assessor to refer to every piece of evidence before her. The function of a Medical Assessor is similar to that required of a Medical Appeal Panel. In Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43 the Court held at [48] that a Medical Assessor’s function is to set out the actual path of reasoning by which he formed his opinion based on his own medical experience and expertise. The Court said: “...The function ....is neither arbitral nor adjudicative: it is neither to choose between competing arguments, nor to opine on the correctness of other opinions on that medical question.”
In Western Sydney Local Health District v Chan [2015] NSWSC 1968, Justice Adams stated:
"As the volume of material in this case shows, to require an AMS to discuss all matters relevant to a claimant's history would often be an enormous task. He or she is required by s 325 to state ‘the facts upon which ...[the] certificate is based.’ He stated those facts were: ‘The clinical examination and perusal of documentation submitted by the parties….
I do not see that he needed to say anything more than he did on this point, namely that he had perused the material provided. It was not unreasonable, let alone ‘illogical and irrational and not based on findings or inferences of fact supported by logical grounds’ for the Panel to conclude, in effect, that Dr Parmegiani was aware of the supplementary and reduced assessment of Dr Snowden but simply did not feel the need to mention or discuss it, a view, which, plainly enough, they shared.”
The Appeal Panel considers that there is no requirement on the Medical Assessor to discuss each and every piece of evidence in the MAC, and any lack of reference should not be taken as the Medical Assessor not having had regard to the material.
Further, the Appeal Panel considered the entries and reports referred to by the appellant were not material to the Medical Assessor’s task of assessing WPI. The notes of Erin Kramer specifically referred to in the appellant’s submissions were dated 24 November 2022, 25 January 2023, 30 March 2023 and 8 June 2023. Not only did these notes refer to consultations that took place some time ago, but the notes described symptoms, rather than function or impairment, which are not germane to the WPI assessment process.
The Appeal Panel was satisfied that the Medical Assessor took into account the notes of Associate Professor Jeyasingam and his reports dated 7 July 2023 and 29 September 2023. The Medical Assessor did refer specifically to the report of Associate Professor Jeyasingam dated 17 August 2023 which the appellant described as a report addressed to her GP with respect to an update on medication. However, the Appeal Panel noted that in the report of 17 August 2023 Associate Professor Jeyasingam noted a reduction in suicidal ideation, reduction in anxiety and “feeling more in control”.
The appellant submits that the Medical Assessor failed to consider the other fundamental material provided by Associate Professor Jeyasingam with respect to her overall functioning and referred to following which was contained in the report dated 20 July 2023:
“…remained with serious difficulties in functioning which persist to now, comprising insomnia, nightmares related to experiences and witnessing trauma related to the environment, and an inability to return to work, with no benefit from sertraline, and only noting affective flattening when at 150 mg about 4 months ago necessitating its reduction to 100 milligrams.
…..
Impression: She has post-traumatic stress disorder with evidence of hypersensitisation”.
The Appeal Panel noted that the area of functioning identified in this report primarily relates to employability. The Medical Assessor rated class 5 for employability, that is, total impairment, which is consistent with the opinion of Associate Professor Jeyasingam. No appeal was made in relation to assessment in the PIRS category of employability.
The Appeal Panel is satisfied that the Medical Assessor had regard to the material that the appellant submits she did not consider adequately or consider at all. The Appeal Panel rejects the submission that the Medical Assessor failed to consider, adequately or at all, the diagnosis made by Associate Professor Jeyasingam. The Medical Assessor made a diagnosis of major depressive disorder with anxious distress. Dr Kumagaya made a diagnosis of major depressive disorder with anxious distress. Dr Anand made a diagnosis of major depressive disorder with prominent anxiety. Associate Professor Jeyasingam was the only psychiatrist to make a diagnosis of post-traumatic stress disorder. All other psychiatrists made a diagnosis of a major depressive disorder.
The appellant has failed to make out this ground of appeal.
Ground 2 – self care and personal hygiene
The appellant submits the MAC contains a demonstrable error and is infected by the application of incorrect criteria in respect of the PIRS category of self care and personal hygiene. The appellant submitted that based on the evidence, the correct self care and personal hygiene rating must be a class 3 or 4.
The examples under Table 11.1 for “Self care and personal hygiene” in the Guidelines are:
“Class 2 Mild impairment: Able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.
Class 3 Moderate impairment: Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes.
Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2-3 times per week to ensure minimum level of hygiene and nutrition.
Class 4 Severe impairment: Needs supervised residential care. If unsupervised, may accidentally or purposefully harm self.”
The Medical Assessor assessed the appellant as class 2 for self care and personal hygiene. In the PIRS Rating Form, the Medical Assessor wrote:
“Self care and personal hygiene- Class 2
She reported that she showers once every two to three days as she at times forgets if she had a shower the day before. She brushes her teeth every day. She changes into clean clothes depending on the weather. She said that, ‘The house is clean and is not messy’. She is able to cook, ‘steak’ vegetables for herself. I asked her that in one of the reports she had mentioned that her house is quite messy to which she replied that her house is clean but she has stuff everywhere”.
Under “present symptoms” the Medical Assessor wrote:
“Present symptoms: Ms Allsopp reported that ‘she is not good’ overall. She said that she is ‘anxious, has sleep disturbances and low mood most of the time’. She said that every night, she ‘tosses and turns’, and her sleep fluctuates from 10 hours to 6 hours. Her appetite is ‘poor’ and she forgets to eat and sometimes only eats at 2 pm. She said she gained about 6 kilos in the last 12 months and attributed the weight gain to ‘probably eating junk food’.
She said that her rings are not tight and cannot take them off”.
Under “Social Activities/ADL” the Medical Assessor noted:
She reported that she showers once every two to three days as she at times needs to remember if she had a shower the day before. She brushes her teeth every day. She changes into clean clothes depending on the weather. She said that ‘The house is clean and is not messy’. She can cook ‘steak’ vegetables for herself. I asked her that in one of the reports, she had mentioned that her house is quite messy, to which she replied that her ‘home is clean, but she has stuff everywhere’
… She can do household chores like washing, cleaning and cooking through the day. She can go out shopping and does that once a week”.
Dr David Kumagaya, consultant psychiatrist, in his report dated 1 December 2023, assessed a class 2 providing the following reasons:
“Whilst Ms Allsopp is able to live independently, she regularly misses meals and showers throughout the week owing to her low mood and decreased energy levels.”
Dr Ashwinder Anand, consultant psychiatrist, in a report dated 7 February 2024 assessed a class 2 providing the following reasons:
“In a typical week she stated that she showers every two to three days. She struggles with the chores and describes her house has been quite messy. She does not do much cooking.”
The Medical Assessor, Dr Kumagaya and Dr Anand all assessed a class 2 impairment for self care and personal hygiene.
The appellant submits that the Medical Assessor failed to consider the present symptoms set out in the MAC in justifying and ascertaining class "2", and then cuts and pastes this paragraph from the MAC:
“Ms Allsopp reported that ‘she is not good’ overall. She said that she is ‘anxious, has sleep disturbances and low mood most of the time’. She said that every night, she ‘tosses and turns’, and her sleep fluctuates from 10 hours to 6 hours. Her appetite is ‘poor’ and she forgets to eat and sometimes only eats at 2 pm. She said she gained about 6 kilos in the last 12 months and attributed the weight gain to ‘probably eating junk food’.
She said that her rings are tight and cannot take them off”.
The appellant suggests that “It remains unclear as to why this was not considered when assessing class 2”. The Appeal Panel fail to understand this argument as not only was this “considered” but it was the precise reasoning used by the Medical Assessor in justifying the class 2 Assessment. The appellant forwards no argument or evidence as to why a different class should have been assessed.
A key difference between a class 2 and a class 3 impairment is the ability to live independently without support. The appellant lives alone in a retirement village. However, the appellant lived with one of her sons for six months when she returned from Lismore, that is after the subject injury, and then moved out because she “needed her own space”. The appellant describes independent functioning in being able to self care, do chores around the home, go shopping, and cook. Her weight gain is not significant clinically and would indicate sufficient intake.
Based on the evidence before the Appeal Panel, and for the reasons provided by the Medical Assessor in the MAC, the Appeal Panel agrees with the Medical Assessor’s assessment of class 2 for self care and personal hygiene.
The Appeal Panel is satisfied that there was no demonstrable error in the MAC in relation to the ratings in the PIRS category of self care and personal hygiene and the assessment in this class is made on the basis of correct criteria. The categorisation of class 2 for self care and personal hygiene was not glaringly improbable; the Medical Assessor was not unaware of significant factual matters, there was no clear misunderstanding by the Medical Assessor and the reasoning process was sufficiently clear.
Ground 3 – cocial functioning
The appellant submits that she should have been placed into class 3 on the basis that the Medical Assessor failed to consider she has “now distanced herself from others and is socially recluse” and failed to consider her statement.
The examples under Table 11.4 for “Social functioning” in the Guidelines are:
“Table 11.4: Psychiatric impairment rating scale – social functioning:
Class 2 Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
Class 3 Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children”.
Under “present symptoms” the Medical Assessor wrote:
“… She added, ‘she has no compassion, no empathy and feels numb’.
She has now distanced herself from others and is socially recluse. She added that she continues to have symptoms of low mood, sleep disturbances, irritability, restlessness, low motivation and low energy levels. She said that she feels numb at times to the extent that she is even unable to cry. She said she is no longer “concerned about others and is happy to be in her own bubble”.
In the MAC under “Social activities/ADL”, the Medical Assessor wrote:
“She said that now, ‘a lot of her friends have dropped off as she does not want to have conversations with them’. She added that she still has friends who are in touch and come and meet her at her home. She said that she ‘may go out for a coffee’. She added that one of her friends passed away because of cardiac arrest and her husband comes over and they have coffee at her home.
….
She said that she has a good relationship with her sons, who are 42 and 30 years old. She said that they call to check on her, but she does not like to talk to them about her mental health. She has a brother who lives in Newcastle, and they talk on the phone rarely as ‘they have never been close anyways.’ She has distanced herself from most of her friends.”
The Medical Assessor assessed the appellant as class 2 for social functioning. In the PIRS Rating Form, the Medical Assessor wrote:
“Social functioning – Class 2
She said that she has good relationship with her sons who are aged 42 and 30 years. She said that they call to check on her but she does not like to talk to them about her mental health. She has a brother who lives in Newcastle and they talk on phone rarely as, ‘they have never been close anyways’. She has distanced herself from most of her friends.”
In her statement dated 28 September 2023, the appellant stated that she continued to suffer from disabilities including social isolation and being isolated from friends and family. In a supplementary statement dated 23 February 2024, the appellant wrote:” I have no desire to socialise or be around anyone. I am very happy being in my own bubble.”
Dr Kumagaya, in a report dated 1 December 2023, assessed a class 2 for social functioning providing the following reasons:
“Ms Allsopp reported the straining and loss of several friendships as a result of her depressive and anxious symptoms”.
Dr Anand, in a report dated 7 February 2024, assessed a class 2 for social functioning providing the following reasons:
“From a premorbid perspective, she was quite social and used to enjoy outings. She has distanced herself from her friends. She keeps in touch with her sons over the phone.”
The Medical Assessor, Dr Kumagaya and Dr Anand all assessed a class 2 impairment for social functioning.
The appellant extracts one sentence from the entire MAC, suggests ‘this was not considered’, yet the Medical Assessor has prepared and certified the MAC.
The Appeal Panel accepts that the appellant has lost some but not all of her friends. She has some friends who come to her home. She maintains a good relationship with her sons and her relationship with her brother has not changed.
The appellant submits that the impairment is more appropriately rated as a class 3 under Table 11.4. but provides no reasons why this should be so. The Appeal Panel is satisfied that the descriptors provided in Table 11.4 by the Medical Assessor are class 2 descriptors. Therefore, the Appeal Panel is satisfied that the reasoning process for assessing the appellant as class 2 in this category is able to be made out based upon the evidence before the Medical Assessor. The Appeal Panel agrees that the appellant should be rated as class 2 for social functioning.
The Appeal Panel is satisfied that there was no demonstrable error in the MAC in relation to the ratings in the PIRS category of social functioning and the assessment in this class is made on the basis of correct criteria. The categorisation of class 2 for social functioning was not glaringly improbable; the Medical Assessor was not unaware of significant factual matters, there was no clear misunderstanding by the Medical Assessor and her reasoning process was sufficiently clear.
Ground 4 – failure to provide adequate reasons
The appellant submits that the Medical Assessor has erred by not providing any or any adequate reasons as to why she did not take into account all available medical evidence, including the clinical notes and the certificates of capacity, which she argued described a history inconsistent with the history obtained during the assessment.
The Appeal Panel rejects this submission, noting that the appellant failed to detail in any way how the clinical notes and certificates of capacity described a history inconsistent with the history obtained during the assessment by the Medical Assessor. The Appeal Panel already noted above that the Medical Assessor assessed class 5 for employability and the rating for employability was not appealed.
The appellant submits that the Medical Assessor failed to provide any meaningful reasons to enable an understanding of how the Guidelines have been implement, and this would appear to amount to constructive failure to implement the Guidelines by engaging in those matters outlined at clauses 11.4 -11.8 and 11.11-11.12.
The Appeal Panel rejects this submission. Clauses 11.4 to 11.6 are concerned with diagnosis and the Medical Assessor followed those Guidelines making a diagnosis specifying the diagnostic criteria as required. The Appeal Panel considers that the Medical Assessor provided a rationale for the rating based on the appellant’s symptoms as reported at the time of assessment and on the documents forwarded to the Medical Assessor, and identified the DSM5 criteria by which she made that diagnosis.
Clause 11.7 relates to the assessment of permanent impairment and consideration of the duration of impairment, likelihood of improvement, whether reasonable rehabilitative treatment was undertaken and any other relevant matters. The Appeal Panel is satisfied that the Medical Assessor considered all these matters in her assessment. Clause 11.8 of the Guidelines relates to the effects of treatment. The Medical Assessor noted details of past and present treatment. The Appeal Panel is satisfied that the Medical Assessor adequately considered the effects of treatment.
Clauses 11.11 to 11.12 relate to the PIRS. The Appeal Panel is satisfied that the Medical Assessor took these clauses into account in making her assessment on the six scales and provided adequate reasoning and class descriptors.
The Appeal Panel rejects the submission that the Medical Assessor failed to engage in those matters outlined at clauses 11.4 -11.8 and 11.11-11.12.
The appellant submits that the Medical Assessor has simply copied or duplicated what she has obtained from the appellant and inserts it into the "Reason for Decision" section when applying the PIRS table and no analysis is provided to allow for ease of understanding.
The Appeal Panel accept that the Medical Assessor recorded some verbatim quotes obtained from the appellant during the assessment and inserted it into the "Reason for Decision" section when applying the PIRS table. However, the Appeal Panel does not consider that any additional explanation, analysis or justification is required and considers that the reasons as given are adequate and easy to understand. Such quotes provide concrete examples supporting the reasoning used by the Medical Assessor and their use in reports is common practice.
The Appeal Panel rejects the submission that the Medical Assessor did not provide sufficient reasons to enable the reader to understand the path by which the decision maker reached the conclusions she did. The Appeal Panel is satisfied that the Medical Assessor provided sufficient reasons outlining the history taken on examination, details of the treatment undertaken and its effect, the extent of symptomatology and properly rated impairment in each scale in the PIRS table.
As noted above, the Appeal Panel is satisfied that there was no demonstrable error in the MAC in relation to the ratings in the PIRS categories of self care and personal hygiene, and social functioning. Further, the Medical Assessor has made the assessment based on correct criteria.
For these reasons, the Appeal Panel determines that the MAC issued on 15 May 2024 should be confirmed.
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