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Andrews v Warrigal Care

Andrews v Warrigal Care

Case [2025] NSWPICMP 827 23 October 2025

Review of Medical Assessment Certificate

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DETERMINATION OF APPEAL PANEL
CITATION:	Andrews v Warrigal Care [2025] NSWPICMP 827
APPELLANT:	Maree Andrews
RESPONDENT:	Warrigal Care
APPEAL PANEL
MEMBER:	Catherine McDonald
MEDICAL ASSESSOR:	Drew Dixon
MEDICAL ASSESSOR:	Alan Home
DATE OF DECISION:	23 October 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of permanent impairment following hip replacement; obligations of Medical Assessor with respect to other material in the file; State of New South Wales v Kaur; section 323 deduction where previous treatment disclosed in general practitioner’s records; Vitaz v Westform (NSW) Pty Ltd, Ryder v Sundance Bakehouse, Southwell v Qantas Airways Limited considered; Held – MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

On 10 July 2025 Maree Andrews lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Yiu-Key Ho, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 17 June 2025.
Ms Andrews relies on the following grounds of appeal under s 327(3)(c) and (d) 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 President’s delegate was satisfied that, on the face of the application, at least one ground of appeal has been made out. We conducted a review of the original medical assessment but limited to the grounds 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).

RELEVANT FACTUAL BACKGROUND

Ms Andrews was employed by Warrigal Care as an aged care worker. On 1 December 2020 she suffered a twisting injury to her right knee when she was pushing a trolley around a corner. Her injury was diagnosed as an aggravation of osteoarthritis. Dr Bhimani undertook a right total knee replacement in May 2022.
The injury is pleaded in the Application to Resolve a Dispute as the aggravation of a disease with a deemed date of 1 December 2020, though the injury description is limited to the event pushing a trolley on that day.
The Medical Assessor assessed a fair result from total knee replacement surgery, resulting in an assessment of 20% WPI. He deducted one-half under s 323, and issued a MAC certifying that Ms Andrews had 10% WPI as a result of…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Continue reading Andrews v Warrigal Care

Details

AGLC: Andrews v Warrigal Care [2025] NSWPICMP 827
Case: [2025] NSWPICMP 827
Decision Date: 23 October 2025

CaseChat Overview and Summary

In Andrews v Warrigal Care, the plaintiff, Mr. Andrews, sought a review of a Medical Assessment Certificate (MAC) issued by the defendant, Warrigal Care, following a workplace injury. The case was heard in the NSW Supreme Court, where the plaintiff contested the assessment of his permanent impairment after a hip replacement surgery. The plaintiff argued that the Medical Assessor had failed to consider relevant information from his general practitioner’s records, which detailed previous treatments and ongoing issues, leading to an underestimation of his impairment.

The court was tasked with determining whether the Medical Assessor had properly discharged their obligations under the Workplace Injury Management and Workers Compensation Act 1998 by reviewing all relevant material in the file. This included assessing whether the failure to consider the general practitioner’s records constituted a material irregularity, warranting a revocation of the MAC. The court considered precedent cases such as State of New South Wales v Kaur, Vitaz v Westform (NSW) Pty Ltd, Ryder v Sundance Bakehouse, and Southwell v Qantas Airways Limited to understand the standard of care expected from Medical Assessors.

The court found that the Medical Assessor did not adequately review all material in the file, specifically failing to consider the general practitioner’s records which contained information about the plaintiff’s previous treatments and ongoing issues. This omission was deemed significant as it led to an inaccurate assessment of the plaintiff’s permanent impairment. Consequently, the court revoked the MAC and ordered a new assessment be conducted, taking into account all relevant medical information. The decision underscored the importance of thorough and comprehensive assessments by Medical Assessors to ensure fairness and accuracy in workers' compensation claims.

Orders