Ashton v QBE Insurance (Australia) Limited - [2023] NSWPICMP 402

DETERMINATION OF REVIEW PANEL

CITATION:

Ashton v QBE Insurance (Australia) Limited [2023] NSWPICMP 402

CLAIMANT:

Scott Ashton

INSURER:

QBE

REVIEW PANEL

MEMBER:

Gary Victor Patterson

MEDICAL ASSESSOR:

Dawn Piebenga

MEDICAL ASSESSOR:

Lauren Alach

DATE OF DECISION:

21 August 2023

CATCHWORDS:

MOTOR ACCIDENTS – The claimant suffered injury on 2 July 2018; the dispute related to whether 0 – 49 hours per week of domestic care at the claimant’s remote property is reasonable and necessary; claimant wheelchair-bound with extensive co-morbidities; Held – 15 hours per week of domestic assistance at claimant’s remote property reasonable and necessary; original certificate revoked.

DETERMINATIONS MADE:

CERTIFICATE

The Review Panel revokes the certificate dated 21 September 2022 and issues a new certificate determining that:

The following treatment and care:

0 – 14 hours per week of domestic care at the Mogo Creek property.

16 – 49 hours per week of domestic care at the Mogo Creek property

IS NOT REASONABLE AND NECESSARY in the circumstances.

The following treatment and care:

15 hours per week of domestic care at the Mogo Creek property

IS REASONABLE AND NECESSARY in the circumstances.

STATEMENT OF REASONS

INTRODUCTION

Scott Ashton, (the claimant), was 48 years old at the time of the motor accident. The claimant is divorced. He divides his time between his single-storey residence at Mogo Creek, an isolated location some 10 kilometres from Buckety, and his mother’s home at North Turramurra. The claimant has an adult daughter who lives separately. He weighs more than 180 kilograms and utilises a wheelchair periodically.
The claimant has a history of Diabetes Mellitus Type II, hypertension, sleep apnoea and kidney stones. He suffers from obesity.
In 1989, he was involved in a motorcycle accident in which he sustained a concussive brain injury and a broken jaw. He was hospitalised for a month.
In April 2012, he slipped and fell at Macquarie Centre, sustaining a Weber B fracture to his right ankle. He underwent open reduction and external fixation of the fracture. Hardware was removed in April 2013.
The claimant had a high-speed motorcycle accident on 19 July 2015 in which he suffered the following injuries:
·        Open book pelvic fracture.
·        Right sacroiliac diastasis and displaced right ileum.
·        Left femur fracture.
·        Left ankle dislocation.
·        Fractured lateral malleolus.
·        Right L2 transverse process fracture.
·        Bilateral 12^th rib fractures.
·        Pain radiating down the right side.
·        Torn TP tendon in right foot.
·        Concussion.
·        Right foot drop.
·        Right intertrochanteric femur fracture (secondary).
·        Burns/abrasion to lower back.
·        Psychological (PTSD, Anxiety, Depression, Shock).
The motorcycle accident caused peripheral nerve damage resulting in a permanent foot drop. The claimant had a tibialis posterior tendon transfer surgery to assist in managing the foot drop. That surgery was performed on 2 May 2016.
The claimant returned to work after the 2015 motor accident. He was not in a wheelchair. He says he was able to walk and work normally.
On 2 July 2018, the claimant was driving a work utility and stopped at traffic lights, when a Jeep collided with the rear of his vehicle. His vehicle was written off. He was driven to Royal Northshore Hospital and admitted overnight. He felt immediate symptoms in his right leg which was “not working properly”. Upon examination by Medical Assessors Cameron and Shahzad, the claimant was found to have complete right foot drop with power 0/5. Numbness was present in the medial aspect of the right foot. Assessor Cameron accepts that the subject motor accident caused a recurrence of the claimant’s right foot drop. Assessor Cameron thinks that is due to rupture of the anchor stabilising the prior tibialis posterior tendon. He does not discount other possible explanations such as a further nerve injury.
The claimant suffered a mechanical fall at his mother’s home in December 2018 when his right foot struck the shower hob. That resulted in a right intertrochanteric femur fracture for which he underwent surgery. He suffered a fall at his Mogo Creek property in October 2020 when he fractured his left wrist. The insurer accepts that the right hip fracture in December 2018 is a secondary injury which is causally related to the subject motor accident.[1]
[1] Paragraph 36 of the Insurer’s DRS Reply Submissions – Treatment Dispute (14/10/2020)
Assessor Davidson certified in November 2020 that certain modifications were required to the claimant’s Mogo Creek property to facilitate his living more independently. Those modifications were undertaken.
In September 2020, the claimant’s compensation claim[LA1] was transferred to iCare, who were funding 49 hours per week of paid domestic assistance.
The claimant was referred for medical assessment because there is a dispute between him and the insurer about whether and how much care he requires because of the motor accident. The results were as follows:
·        Medical Assessor Ian Cameron saw the claimant on 6 November 2020 and certified that the recommended level of care up to 49 hours per week relates to the injury caused by the motor accident.
·        Medical Assessor Farhan Shahzad saw the claimant on 8 December 2020 and certified that domestic assistance claimed from 8 April 2020 until 2 December 2020 does not relate to the injury caused by the motor accident.
·        Assessor Judith Davidson saw the claimant on 1 November 2021 and certified as follows:
(i)13 hours per week of domestic care at the Mogo Creek property, self-care, indoor domestic tasks is reasonable and necessary in the circumstances.
(ii)0 to 12 hours per week of domestic care at the Mogo Creek property is not reasonable and necessary in the circumstances.
(iii)14 to 49 hours per week of domestic care at the Mogo Creek property is not reasonable and necessary in the circumstances.
The terms of the Referral for Assessment to Assessor Davidson were as follows:
Disputes to be assessed:
·        Treatment and care reasonable and necessary.
Injuries to be assessed:
·        Right foot.
Treatment to be assessed:
·        Whether 0 to 49 hours per week of domestic care for transport to and from medical and therapy appointments and to and from the Mogo Creek property, self-care, indoor domestic tasks and associated essential power and supplies is reasonable and necessary.
There has been no challenge to the certificates of Medical Assessors Cameron and Shahzad. Having regard to the nature of the dispute and the prescription of the treatment to be assessed, it is not open to the Panel to assess than[DP2] 49 hours per week of domestic care at the Mogo Creek property.

THE REVIEW

The claimant sought a review of Assessor Davidson’s Certificate, on the basis that the assessment was incorrect in a material respect, within the meaning of s 7.26 of the Motor Accident Injuries Act 2017 (the MAI Act). It was submitted that Assessor Davidson:
·        failed to properly quantify the hours required for care;
·        failed to provide sufficient reasoning;
·        was prejudiced against the claimant;
·        incorrectly stated her own powers;
·        failed to properly assess the claimant’s current capacity;
·        failed to provide alternative recommendations for treatment and care where the proposed treatment was deemed inadequate;
·        considered issues outside the parameters of the dispute;
·        considered issues outside the parameters of the Assessor’s powers;
·        failed to consider relevant evidence;
·        made an incorrect adverse inference;
·        failed to ask the claimant relevant questions; and
·        incorrectly stated the claimant’s desires.
An issue arose at the assessment as to whether Assessor Davidson could recommend more than 49 hours of care or whether the assessment was limited to a maximum of that amount. It was submitted for the claimant that the Assessor was not there to just determine whether 49 hours of care was required, but to determine what the claimant’s need would be when he lived permanently at Mogo Creek.
The claimant’s application for review was opposed by the insurer. In its written submissions in reply, the insurer addressed each of the bases upon which it was alleged that Assessor Davidson had fallen into error.
President’s delegate Tami O’Carroll issued a Determination of an Application for Review of a Medical Assessment dated 25 March 2022. That stated that the President’s delegate was satisfied that there was a reasonable cause to suspect that Assessor Davidson’s assessment was incorrect in a material respect. Her findings were as follows:
·        The claimant submits that the Certificate of Assessor Davidson is “rife” with prejudice against the claimant … prejudice has caused the Assessor to inadequately consider the claimant’s current care needs … in the circumstances.
·        The claimant states the question for the assessor was whether the treatment and care is reasonable and necessary, taking into consideration the claimant’s remoteness and isolation, and this was not adequately considered.
·        The assessor notes on page 25 of the Certificate that “care calculations do not include transport for the carer to the place of work”. The assessor states “the transport method of the carers to this property should not be considered the responsibility of the insurer”.
President’s Delegate O’Carroll says that:
“Considering the above ground and having regard to the particulars set out in the application, I am satisfied that there is reasonable cause to suspect that the medical assessment was incorrect in a material respect”.
The following treatment and related care have been referred for assessment:
Treatment Type: Domestic assistance – reasonable and necessary.
Treatment Description: 13 hours per week of domestic care at the Mogo Creek property.
Treatment Type: Domestic assistance – reasonable and necessary.
Treatment Description: 0 – 12[DP3] hours per week of domestic care at the Mogo Creek property.
Treatment Type: Domestic assistance – reasonable and necessary.
Treatment Description: 14 – 49 hours per week of domestic care at the Mogo Creek property.
It is to be noted that, unlike the referral to Assessor Davidson, no injuries are specified in the referral to the Medical Review Panel for assessment. Statutory provisions
Part 5 of the Personal Injury Commission Act 2020 (the PIC Act) enables the Commission to make rules with respect to the practice and procedure before the Commission, including proceedings before a panel, reviewing a decision of a medical assessor.[2]
[2] s 41(2) of the PIC Act
Rules 127 to 130 of the Personal Injury Commission Rules 2021 (the PIC Rules) are made pursuant to Part 5 of the PIC Act. A Review Panel determines how it conducts and determines the proceedings and may determine the proceedings solely based on the written application.[3]
[3] Rule 128 of the PIC Rules
The review of the medical assessment is by way of new assessment of all the matters with which the medical assessment is concerned.[4]
[4] s 7.26(6) of the MAI Act
All members of the Panel had no previous involvement with the claimant or with this matter.
The application for referral of the assessment of Assessor Judith Davidson was made by the claimant within 28 days after the parties were issues with the original Certificate for the assessment, for which the review is sought.

MATERIAL BEFORE THE REVIEW PANEL

The claimant relied upon the following material:
·        Submissions dated 3 December 2021 for review of Assessor Davidson’s Certificate.
·        Statement dated 3 December 2021 by Robert Cowan.
·        Treating medical records re Lymphedema.
The insurer relied upon the following material:
·        Submissions dated 21 December 2021 in Reply to Review Application.
·        Activities of Daily Living Assessment dated 13 April 2023 by Nigel Wind, Occupational Therapist, who considered that the claimant required between 14.5 and 16 hours total care a week over the next 12 months.
Assessor Alach contacted Mr Ashton’s physiotherapist, Ms Kim Allan. She has been treating him for his lymphedema. Assessor Alach made detailed notes of her conversation with Ms Allan which were provided to the parties. They were invited to make further submissions in relation to the claimant’s lymphedema. Further submissions were received from the insurer as follows:
This is an application for review of a medical assessment. The medical assessment matter in dispute has two limbs as set out in Schedule 2 (2)(b) as follows:
(b)     whether any treatment and care provided or to be provided to the injured person is reasonable and necessary in the circumstances or relates to the injury caused by the motor accident for the purposes of section 3.24 (Entitlement to statutory benefits for treatment and care).
The first limb of the medical assessment matter was assessed by Professor Cameron who issued a certificate on 8 November 2020. That certificate has never been challenged and remains binding on the parties as to the medical assessment matter certified, namely whether the claimed care to be provided to the claimant relates to an injury caused by the motor accident.
The claimant’s lymphoedema has never been claimed as causally related to the accident. Professor Cameron assessed the injury caused by the accident that give rise to a need for care. The injury assessed was the right foot drop. Specifically in relation to causation Professor Cameron said:
In the motor vehicle crash on 2 July 2018 Mr Ashton has had a recurrence of his right foot drop. Plausibly this is due to a rupture of the anchor stabilising the tibialis posterior tendon. However, there are other possible (but unlikely) explanations, such as a further nerve injury.
Mr Ashton has very significant other health issues.
Mr Ashton’s requirement for a recommended level of care up to 49 hours per week is related to the subject motor vehicle accident. The reasons are that there is adequately documented evidence of recurrence of the right foot drop in the subject motor vehicle crash. This is consistent with the information provided by Mr Ashton as well as the contemporaneous clinical information and the information from Mr Ashton’s treating medical practitioners.
The insurer submits that it is the task of the review panel to now assess the reasonable and necessary need for care arising from the injuries certified by Professor Cameron. It is not for the review panel to further consider causation of injury as to do so would be to fall into error. Whatever need for care may arise from lymphoedema is not causally related to the accident. The insurer will be denied procedural fairness if there is a finding of a need for care caused by injury other than what has been assessed by Professor Cameron as the insurer has not had the opportunity to have that injury assessed.
For the reasons explained in s 15 of the Assessor’s report, under the heading Lymphedema, the Panel is satisfied that the claimant’s right foot drop, which was caused by the motor accident, complicates the treatment of his lymphedema and increases his necessary and reasonable care needs. The Panel notes that neither party suggests that the claimant’s Lymphedema was caused by the motor accident.
The Panel has considered all the material submitted by the parties.

RE-EXAMINATION

The claimant was seen by Assessors Alach and Piebenga on 30 May 2022 at his Mogo Creek property. He told the assessors that he was not living there at the time.. The Assessors’ findings and report is set out below:
“Background
1.There is a dispute between the claimant and the insurer about:
• Whether 0 to 49 hours per week of domestic care for transport to and from medical and therapy appointments and to and from the Mogo Creek property, self-care, indoor domestic tasks and associated essential power and the supplies is reasonable and necessary
Care Disputes to be assessed
2.The following care disputes were referred by the Personal Injury Commission for further[LA4] assessment:
Treatment Type: Domestic assistance – reasonable and necessary.
Treatment Description: 13 hours per week of domestic care at the Mogo Creek property.
Treatment Type: Domestic assistance – reasonable and necessary.
Treatment Description: 0 – 12 hours per week of domestic care at the Mogo Creek property.
Treatment Type: Domestic assistance – reasonable and necessary.
Treatment Description: 14[DP5] – 49 hours per week of domestic care at the Mogo Creek property.
REASONS HISTORY

3.Psychosocial history and pre-accident history
Prior to the MVA on 23 July 2018, Mr Ashton said that he was working full time as a self-employed earthmoving contractor. He lived in his Mogo Creek property and had undertaken improvements there, prior to an earlier motor vehicle accident in 2015.
His reported performance of daily living tasks before the 2018 accident and currently is documented in the table in section 20.
4.History of the motor accident
A detailed history was not taken because that has been provided to all assessors previously and the purpose of our review is to assess Mr Ashton’s current care needs. A summary of some relevant information from medical and other reports is in the Introduction and other sections.
5.Present Social Situation
Mr Ashton expressed to us, as he had to Ms Davidson previously, that he wishes to live at Mogo Creek full-time. Therefore, when assessing his current injury-related care needs we have done that based on the circumstances of that desire to live on his rural property.
However, at the date of the examination for the review assessment he said that he was still living at his mother’s home in North Turramurra. He doesn’t think he can manage at Mogo Creek without a high level of paid care. He said that the insurer had only agreed to pay for 13 hours of care per week, but he didn’t think that any was being paid for currently. Therefore, he had decided it is not safe to reside at his property, until he has more paid attendant care.
6.Current symptoms
When asked to describe his current symptoms, Mr Ashton commented “to start with I have a drop foot. I had a drop foot in 2015. They operated on it and repaired it. I went back to work”. He said that the tendon was ripped off the bone again in the 2018 accident. Professor Balough attempted to reattach it, but explained to him that was unsuccessful. He has tried wearing an ankle foot orthosis but, because of the lymphedema he can’t use it.
He also has pain in his right hip, which has been present since his fall in December 2018 and resulting surgery, for which he sometimes takes Oxycontin. He tries not to take it every day. He only takes non-prescription medication when he needs to drive, noting that he is even reluctant to take Panadeine Forte then. He said that his brother was killed in a road accident next to him, so he takes road safety seriously.
7.Current and proposed treatment
Mr Ashton said that he still attends his GP, Dr Alex Raffles at North Turramurra most weeks. Dr Raffles has referred him to Sydney Pain Specialists and to Macquarie University for weight management, but he hadn’t attended yet.
He said that he was admitted to Mt Wilga Private Hospital, and attends a physiotherapist specialising in lymphoedema management for treatment of both legs. He said that his support worker or mother puts a pump on each leg for an hour a day, adding they were meant to give him a pump for both legs, so that would only take one hour total.
He doesn’t do any exercise at home, which he said is because he has been told that the risk of him falling is too high. He doesn’t currently do hydrotherapy.

Mr Ashton said he has been referred for psychological treatment at RN Plus, Toronto. That is not relevant to this review assessment which is related to Mr Ashton’s physical needs because of the accident in 2018.
8.Employment Status
Mr Ashton said he isn’t working currently.

CLINICAL EXAMINATION
Ms Lauren Alach and Ms Dawn Piebenga visited Mt Ashton’s home at 2529 Wollombi Road, Mogo Creek NSW 2775 for in-person assessment. His home is on a remote, 40-hectare property. From the main road, there is a ten-kilometre single lane dirt road with a final steep descent to access his house.
Present at the assessment were:
·        Mr Scott Ashton – Applicant
·        Robert Cowan – Applicant’s friend and unpaid support worker
·        Lauren Alach – Occupational Therapist
·        Dawn Piebenga – Occupational Therapist

Our clinical examination involved observation of Mr Ashton during the assessment. We asked him to perform some movements and activities, and observed his mobility at the start of the assessment and when he was demonstrating transfers. He was reluctant to walk much and sat on a dining chair for most of the assessment.
The main difference between his presentation on the day of our assessment and when he was assessed by Ms Davidson for the Personal Injury Commission in November 2021, and by Mr Nigel Wind on referral from the insurer in March 2023, is that his wheelchair remained in the car. He said that he now usually uses elbow crutches to walk at home in Mogo Creek and to walk between the car and his home.
Following our assessment, we contacted his physiotherapist, Kim Allan who is treating Mr Ashton for his bilateral lower limb lymphoedema. This was relevant to our assessment because we needed to consider the impact of the motor vehicle accident on his ability to self-manage his lymphoedema at home. For the reasons explained in section 15 of this report, under the heading ‘Lymphoedema’, we are satisfied that Mr Ashton’s accident-related right foot drop complicates the treatment of that condition, indirectly increasing his necessary and reasonable care needs.
9.Functional Status
Sitting – Mr Ashton sat on a dining chair for most of the 2 ½ hour assessment. He got up to show us how he transfers on and off an easi-rise lounge chair but declined to get up to demonstrate more mobility. He said that he can sit on that lounge chair for several hours, even sometimes sleeping there. He uses the power function of the chair to get up and down.
We saw Mr Ashton lower himself into the lounge chair without using the power function. He used the power lift feature to stand again. He seemed unlikely to need to use that function all the time because the chair was down when we arrived, and he could stand from a dining chair using only his arms or his crutches for support.
Walking / mobility – He said that he could walk 70 metres at hospital in December 2022, but considers that he has deteriorated since then. He now “couldn’t walk for 5 minutes”.
During the assessment, Mr Ashton was wearing boots and because of the swelling in his ankles it was difficult to notice the foot drop. He wasn’t wearing compression garments or an ankle foot orthosis and was reluctant to demonstrate walking. But he walked from the dining chair to his recliner using two crutches. That is more than he walked with his crutches when assessed by Ms Davidson and Mr Wind, only cruising furniture for a short distance for Mr Wind and not walking at all for Ms Davidson.
Mr Ashton said that he arrived at his home for our assessment a couple of hours before Mr Cowan. His wheelchair was still in his vehicle; therefore he must have walked into his home with his crutches but without assistance.
He keeps his mobility scooter at his mother’s home and uses that to travel to his GP.
Stairs – Mr Ashton said that he avoids stairs. But he must climb 16 steps up to his mother’s home. There is a rail on one side “but I almost crawl up them”.
His physiotherapist, Kim Allan said that he independently climbs up and down the 5 steps to her practice with a close rail and wall for support.
Other functional movements and tolerances: Mr Ashton was reluctant to participate in much functional assessment, preferring to stay seated while we went to look at rooms in his home and outside. He would reasonably have difficulty lifting and carrying items while using crutches. But he could use his arms and hands for walking and transfers and there was no evidence of upper limb problems related to his injury.
10.Environmental Factors
Mr Ashton lives on a 40-acre property in Mogo Creek. He advised that he built his house himself. The property slopes steeply down to a creek at the bottom of the hill. He said “I haven’t been here on my own ever” overnight. He indicated that was because he is concerned about a snake biting him overnight and not being able to manage the other tasks needed on the property.
He said that the insurer funded a concrete path between the home and the large shed. They installed 24 solar panels on the roof of the shed and power is stored in the generator. There are three separate solar panels to run the telephone. There is an issue with the connection between those solar panels and his internet service which needs remedying.
Mr Ashton said that the insurer also paid to renovate the bathroom, including a level access shower with non-slip flooring and rails on either side of his toilet. A threshold ramp was observed at the back door to provide access to the rear yard.
Those modifications are consistent with Ms Davidson’s report from November 2021 which described modifications for 24-hour power, water, mobile phone availability and internet access and access to the bathroom.
Mr Ashton expressed annoyance that he needed to pay for the second bathroom and bedroom to accommodate support workers. Likewise, he was frustrated that he needed to lay additional bitumen to provide access around his home.
Mr Ashton indicated that his mother’s house also does not meet his needs. However, he doesn’t intend to stay there, so the modifications are less urgent. He stated that the bathroom at his mother’s house is currently being renovated.

11.Activities of Daily Living Status

ACTIVITY REPORTED FUNCTIONAL STATUS
(PRE-INJURY) REPORTED FUNCTIONAL STATUS
(POST-INJURY)

Eating, Drinking Toileting, Grooming & Showering Mr Ashton was independent at the time of the accident. He can eat, drink and toilet independently, using the rails for transfers. He has a bidet installed on the Mogo Creek toilet because he can’t reach to clean himself. To shower, he uses a hand-held shower rose, non-slip tiles and a bariatric shower chair. Despite bathroom modifications, he said that he wouldn’t risk showering unless there was somebody else in the home. He doesn’t have a falls alarm.

Dressing Independent Mr Ashton said that he wears loose fitting clothes and uses a long handled reacher to pick things up from the floor as needed. The only thing he needs help with is putting on his supportive boots when he goes out.
Although Assessor Cameron assessed Mr Ashton as having full range of movement at his hips, and there are other factors such as obesity making it difficult for him to reach his feet, his right hip fracture and foot drop would still make putting on his right boot difficult.
He reasonably needs daily help to put his boots on after his lymphoedema treatment. This can be done when support workers are at his home helping with other tasks.

Cooking & Meal Preparation Mr Ashton said that when he was working, he would normally buy food for lunch. He would make himself dinner every night.
That is different to what he told Ms Davidson, being that he rarely prepared his own meals. He tended to buy prepared food on the way home from work. He said he can’t use the oven or reverse cycle air conditioning without the generator turning on. That costs him about $50 every time so he prefers not to use the oven often.
He said that he can’t prepare any food for himself, noting that he prefers to eat eggs on toast but normally spreads avocado on toast. Mr Ashton commented that he only has “so many minutes on my legs every day”. He’s never had a stool in the kitchen. He believes he can’t sit on a stool because of his pelvis adding “Probably at a pinch I could do it”. He has a microwave to heat food up but commented “No carers have ever bulk cooked for me”.
His mother cooks all the meals at her home.
Although Mr Ashton didn’t prepare food at home when he was working, he is no longer going past the store daily. He would reasonably have difficulty standing and moving around with crutches for long enough to prepare full meals. Some assistance with bulk meal preparation to provide meals he can heat up later seems reasonable.

Washing up He said that he could wash up after himself. He now doesn’t do any washing up because he struggles to stand up for long enough. He added “I’m not adverse to getting a dishwasher installed”.
From our observations of Mr Ashton moving across the room, and his ability to walk from his car to his home and get out of this car to open and close the gate, he should be able to stand long enough to wash his own dishes, especially if he isn’t cooking himself. He could let them drain to dry.
In addition, the bending required to load and unload a dishwasher would potentially be more difficult than standing against a sink to wash a few dishes.

Shopping He would buy fresh fruit or vegetables from a local stand or shop at the closest shopping centre, such as Westfield Tuggerah. He now shops twice a week. He contacts Westfield at Tuggerah or the Macquarie Centre to make sure they have a mobility scooter available. He then drives himself to the shopping centre and they bring the scooter out for him. The scooter has a basket on the front which holds a few items. He is limited with how much he can purchase at a time.
Because of his mobility impairments, it is reasonable that Mr Ashton needs help with lifting and carrying heavier bags of shopping, pushing a trolley, and loading in and out of his car and at his home for a large shop weekly.

Laundry
He had a washing machine and would hang clothes on the line to dry.
He said that he can no longer access the washing machine in the small room at the back of his home or take laundry out to the line to hang it.
Although doing some washing could be within his capacity, the location of the washing machine isn’t ideal for him to get to it easily and he reasonably needs help with regular laundering of clothes and bedding. That can be done alongside other tasks during a daily care service.

Bed-making including changing linen He did that himself as needed. One of the support workers was stripping and changing the sheets on his bed. He has three sets of sheets for every room which means that they didn’t need to wait for the sheet to be washed and dried and the bed could be remade immediately.
Based on Mr Ashton’s mobility impairments related to his foot drop and hip fracture, bending, reaching, lifting the mattress and moving around to strip and remake his would be difficult. He reasonably needs help to do that weekly.

Light daily cleaning and tidying (wiping down benches, light dusting) He said that he cleaned his home when needed. No one helped him. “I don’t do any cleaning”. “The carers did that for me”. He has a Dyson stick vacuum but hasn’t used it, commenting “I would be screaming in pain”
Based on our assessment, Mr Ashton should have sufficient mobility to complete light cleaning such as picking up items with his easi-reach to tidy and wiping over surfaces within his reach. He reasonably needs help with moderate to heavy cleaning tasks such as vacuuming, mopping and bathroom cleaning.

Weekly cleaning (vacuuming, sweeping, mopping and cleaning bathroom)

Garbage management There is no council garbage collection from his home residence. What can be burnt gets burnt and he recycles what he can.
Previously he gathered the household rubbish, placed it into his utility vehicle and transported it to the local tip at Mogo creek. He can’t remove the garbage from the house independently. He needs help to take the recycling to a recycling centre in West Gosford where it gets put on a conveyor belt. He takes rubbish to the Mogo Creek tip.
Mr Ashton’s mobility impairments mean that he would have difficulty gathering rubbish and recycling, putting it into his truck and unloading it at various locations. Help with garbage management could be provided at the same time as his weekly shopping.

Gardening and lawn mowing Mr Ashton didn’t have much lawn before the accident. He was more focused on the building than the garden. Mr Ashton commented “I’m not going to be petty and argue about who mows the lawn”.
He lives on 40 acres but there is only a small area of lawn at the back of his home with more grass seed planted around the side. There are no established gardens. He was able to get down to the creek on the gator but hasn’t been able to do that since it has been broken.
Because of Ms Ashton’s mobility impairments related to his right foot drop, he reasonably needs about 19 lawn maintenance services a year to mow the lawn and trim edges on his rear lawn, more frequently in summer.

Car Cleaning Independent. He no longer washes his own car noting that it’s awkward for him to clean it regularly.
Because of his mobility impairments from his foot drop and hip fracture, Mr Ashton would have difficulty reaching to all parts of his care to wash it and clean it internally. It’s reasonable that he should be reimbursed for taking his care to a car wash monthly.

Property Maintenance He has always maintained his property. Mr Ashton reported the following, which was on a list of care tasks that he provided to us at the start of our examination.
“I have security cameras that I need to keep clean and free from cobwebs. I need these because I keep guns”.
“I need the carers to use a chain saw to chop down trees and clear trees when they fall down. I also want the carers to blow the leaf litter and water blast the paved areas around the house. They need to clean the moss off the pavers”.
“The gas bottles need to be refilled. They weigh 90kg. I use the gas for hot water, cooking and heating. The reality is that if I want hot water, I need to refill the gas bottles”.
“I also need the carer to fill and maintain the generator with oil and coolant”.
“I have a petrol pump that needs to be started and levels checked. This pumps the water up to the two tanks at the top of the hill”.
“I need to get the gutter and drains cleaned at least weekly”.
At the examination we reviewed the list with Mr Ashton and explained to him which tasks can’t be performed by a support worker, gardener, or handyman. Therefore those cannot be assessed as a care need.
Based on his mobility impairment from his foot drop and hip fracture, Mr Ashton reasonably needs a monthly maintenance service. That would be for maintenance tasks that can be performed by a handyman, such as clearing the gutters intermittently, cleaning windows, changing light globes and batteries and light unskilled repairs, as are necessary to allow him to reside at Mogo Creek.

Mail Collection My letterbox is 20km down the road. “I could get a PO Box but I haven’t elected to do this”.
By the date of our assessment, Mr Ashton told us that he can open and close the gate at the top of his driveway, get in and out of his car and drive more than 2 hours to his mother’s home. So, he would be able to collect his mail should he decide to leave the letterbox where it is. He is aware that he could elect to have his post redirected to a PO box that is not so far out of his way should he choose to do so.

Medication Management Independent. He collects his medication when he does his shopping. “I have to return my needles at the same time”.
He does not like to self-administer his insulin injections and would prefer a support worker to do that for him. However, he noted that the nurses taught him how to do it independently when he was in hospital, adding “but I don’t want to”.
Based on our assessment, Mr Ashton can drive to the shopping centre himself or use his scooter at his mother’s home to pick up medication. It is not a care role to administer injections, that would need to be done by a nurse and is not a need related to his accident.

Community Access Independent. The main difference between our examination and that of Ms Davidson and Mr Wind is that Mr Ashton told us that he can drive himself to access the local community. He stated, “once the gate is locked, it’s 1 hour and 5 minutes from my house to the end of the freeway at Hornsby”.
When asked about his capacity for driving, he stated “it’s just sitting”. “I can drive where I need to”. His mother lives at 36 Miowera Rd, North Turramurra and his closest shopping centre is Tuggerah. He drives a dual cab Hilux with manual transmission. He is also able to drive his 6-wheeled gator although reported that currently this is broken and unusable.
He has a Disability Parking Permit but said that he struggles to unload his wheelchair and push himself when he has to go to hospital appointments where he needs to walk more than short distances from where he parks.
At Mt Wilga Private, the orderlies wouldn’t come and get him from his car. This was confirmed after the examination by a call to Mt Wilga Private. But Mr Ashton mostly attended there for inpatient treatment for his lymphoedema, and we saw no evidence that he still attends there regularly.
His lymphoedema physiotherapist, Kim Allan said that Mr Ashton can drive to her clinic and come in himself.
Based on the above, Mr Ashton could still need some help to get to appointments at large hospitals, where he is unable to park close to the entrance. He could need a support worker to accompany him for a couple of appointments a year.

Lymphedema Mr Ashton said that he didn’t have lymphoedema before the accident.
He said “I need to put on a device (leg pump) to manage my lymphoedema. It takes an hour. I need to put that on both legs”. It would be easier if I had a second leg pump allowing me to do both legs at the same time.
He said that he can’t use the pump himself because he can’t easily reach to his legs to do it.
Although Mr Ashton’s bilateral lymphoedema is not clearly related to his footdrop from the accident, his physiotherapist said that he now can’t do all of the daily treatment himself. There could be other factors contributing to that difficulty, including obesity. But his right foot drop and hip fracture makes reaching to and putting the pump and compression garment on his right leg more difficult. Therefore, based on our assessment he still needs some accident-related help with that daily treatment.
Kim Allan confirmed that Mr Ashton’s daily home treatment for long-term lymphoedema management includes:

Compression garments daily to stop his legs “filling up”.

Daily use of a lymphoedema pump for an hour to help to move fluid out of his legs and therefore reduce risk of infection.

Daily use of supportive boots.

Putting the pump on and off his legs and then putting on the compression garments could be done during a daily care service.

Firewood Independent chopping and bringing it into the house. “Robbo brings me firewood. It’s one of his businesses”. I need somebody to bring this in for me. If the firewood is inside, he can load and stoke the fire.
Mr Ashton reasonably needs help to bring in firewood because of his foot drop related mobility impairments. That could also be done during a daily care service

ACTIVITY	REPORTED FUNCTIONAL STATUS (PRE-INJURY)	REPORTED FUNCTIONAL STATUS (POST-INJURY)
Eating, Drinking Toileting, Grooming & Showering	Mr Ashton was independent at the time of the accident.	He can eat, drink and toilet independently, using the rails for transfers. He has a bidet installed on the Mogo Creek toilet because he can’t reach to clean himself. To shower, he uses a hand-held shower rose, non-slip tiles and a bariatric shower chair. Despite bathroom modifications, he said that he wouldn’t risk showering unless there was somebody else in the home. He doesn’t have a falls alarm.
Dressing	Independent	Mr Ashton said that he wears loose fitting clothes and uses a long handled reacher to pick things up from the floor as needed. The only thing he needs help with is putting on his supportive boots when he goes out. Although Assessor Cameron assessed Mr Ashton as having full range of movement at his hips, and there are other factors such as obesity making it difficult for him to reach his feet, his right hip fracture and foot drop would still make putting on his right boot difficult. He reasonably needs daily help to put his boots on after his lymphoedema treatment. This can be done when support workers are at his home helping with other tasks.
Cooking & Meal Preparation	Mr Ashton said that when he was working, he would normally buy food for lunch. He would make himself dinner every night. That is different to what he told Ms Davidson, being that he rarely prepared his own meals. He tended to buy prepared food on the way home from work.	He said he can’t use the oven or reverse cycle air conditioning without the generator turning on. That costs him about $50 every time so he prefers not to use the oven often. He said that he can’t prepare any food for himself, noting that he prefers to eat eggs on toast but normally spreads avocado on toast. Mr Ashton commented that he only has “so many minutes on my legs every day”. He’s never had a stool in the kitchen. He believes he can’t sit on a stool because of his pelvis adding “Probably at a pinch I could do it”. He has a microwave to heat food up but commented “No carers have ever bulk cooked for me”. His mother cooks all the meals at her home. Although Mr Ashton didn’t prepare food at home when he was working, he is no longer going past the store daily. He would reasonably have difficulty standing and moving around with crutches for long enough to prepare full meals. Some assistance with bulk meal preparation to provide meals he can heat up later seems reasonable.
Washing up	He said that he could wash up after himself.	He now doesn’t do any washing up because he struggles to stand up for long enough. He added “I’m not adverse to getting a dishwasher installed”. From our observations of Mr Ashton moving across the room, and his ability to walk from his car to his home and get out of this car to open and close the gate, he should be able to stand long enough to wash his own dishes, especially if he isn’t cooking himself. He could let them drain to dry. In addition, the bending required to load and unload a dishwasher would potentially be more difficult than standing against a sink to wash a few dishes.
Shopping	He would buy fresh fruit or vegetables from a local stand or shop at the closest shopping centre, such as Westfield Tuggerah.	He now shops twice a week. He contacts Westfield at Tuggerah or the Macquarie Centre to make sure they have a mobility scooter available. He then drives himself to the shopping centre and they bring the scooter out for him. The scooter has a basket on the front which holds a few items. He is limited with how much he can purchase at a time. Because of his mobility impairments, it is reasonable that Mr Ashton needs help with lifting and carrying heavier bags of shopping, pushing a trolley, and loading in and out of his car and at his home for a large shop weekly.
Laundry	He had a washing machine and would hang clothes on the line to dry.	He said that he can no longer access the washing machine in the small room at the back of his home or take laundry out to the line to hang it. Although doing some washing could be within his capacity, the location of the washing machine isn’t ideal for him to get to it easily and he reasonably needs help with regular laundering of clothes and bedding. That can be done alongside other tasks during a daily care service.
Bed-making including changing linen	He did that himself as needed.	One of the support workers was stripping and changing the sheets on his bed. He has three sets of sheets for every room which means that they didn’t need to wait for the sheet to be washed and dried and the bed could be remade immediately. Based on Mr Ashton’s mobility impairments related to his foot drop and hip fracture, bending, reaching, lifting the mattress and moving around to strip and remake his would be difficult. He reasonably needs help to do that weekly.
Light daily cleaning and tidying (wiping down benches, light dusting)	He said that he cleaned his home when needed. No one helped him.	“I don’t do any cleaning”. “The carers did that for me”. He has a Dyson stick vacuum but hasn’t used it, commenting “I would be screaming in pain” Based on our assessment, Mr Ashton should have sufficient mobility to complete light cleaning such as picking up items with his easi-reach to tidy and wiping over surfaces within his reach. He reasonably needs help with moderate to heavy cleaning tasks such as vacuuming, mopping and bathroom cleaning.
Weekly cleaning (vacuuming, sweeping, mopping and cleaning bathroom)
Garbage management	There is no council garbage collection from his home residence. What can be burnt gets burnt and he recycles what he can. Previously he gathered the household rubbish, placed it into his utility vehicle and transported it to the local tip at Mogo creek.	He can’t remove the garbage from the house independently. He needs help to take the recycling to a recycling centre in West Gosford where it gets put on a conveyor belt. He takes rubbish to the Mogo Creek tip. Mr Ashton’s mobility impairments mean that he would have difficulty gathering rubbish and recycling, putting it into his truck and unloading it at various locations. Help with garbage management could be provided at the same time as his weekly shopping.
Gardening and lawn mowing	Mr Ashton didn’t have much lawn before the accident. He was more focused on the building than the garden.	Mr Ashton commented “I’m not going to be petty and argue about who mows the lawn”. He lives on 40 acres but there is only a small area of lawn at the back of his home with more grass seed planted around the side. There are no established gardens. He was able to get down to the creek on the gator but hasn’t been able to do that since it has been broken. Because of Ms Ashton’s mobility impairments related to his right foot drop, he reasonably needs about 19 lawn maintenance services a year to mow the lawn and trim edges on his rear lawn, more frequently in summer.
Car Cleaning	Independent.	He no longer washes his own car noting that it’s awkward for him to clean it regularly. Because of his mobility impairments from his foot drop and hip fracture, Mr Ashton would have difficulty reaching to all parts of his care to wash it and clean it internally. It’s reasonable that he should be reimbursed for taking his care to a car wash monthly.
Property Maintenance	He has always maintained his property.	Mr Ashton reported the following, which was on a list of care tasks that he provided to us at the start of our examination. “I have security cameras that I need to keep clean and free from cobwebs. I need these because I keep guns”. “I need the carers to use a chain saw to chop down trees and clear trees when they fall down. I also want the carers to blow the leaf litter and water blast the paved areas around the house. They need to clean the moss off the pavers”. “The gas bottles need to be refilled. They weigh 90kg. I use the gas for hot water, cooking and heating. The reality is that if I want hot water, I need to refill the gas bottles”. “I also need the carer to fill and maintain the generator with oil and coolant”. “I have a petrol pump that needs to be started and levels checked. This pumps the water up to the two tanks at the top of the hill”. “I need to get the gutter and drains cleaned at least weekly”. At the examination we reviewed the list with Mr Ashton and explained to him which tasks can’t be performed by a support worker, gardener, or handyman. Therefore those cannot be assessed as a care need. Based on his mobility impairment from his foot drop and hip fracture, Mr Ashton reasonably needs a monthly maintenance service. That would be for maintenance tasks that can be performed by a handyman, such as clearing the gutters intermittently, cleaning windows, changing light globes and batteries and light unskilled repairs, as are necessary to allow him to reside at Mogo Creek.
Mail Collection	My letterbox is 20km down the road.	“I could get a PO Box but I haven’t elected to do this”. By the date of our assessment, Mr Ashton told us that he can open and close the gate at the top of his driveway, get in and out of his car and drive more than 2 hours to his mother’s home. So, he would be able to collect his mail should he decide to leave the letterbox where it is. He is aware that he could elect to have his post redirected to a PO box that is not so far out of his way should he choose to do so.
Medication Management	Independent.	He collects his medication when he does his shopping. “I have to return my needles at the same time”. He does not like to self-administer his insulin injections and would prefer a support worker to do that for him. However, he noted that the nurses taught him how to do it independently when he was in hospital, adding “but I don’t want to”. Based on our assessment, Mr Ashton can drive to the shopping centre himself or use his scooter at his mother’s home to pick up medication. It is not a care role to administer injections, that would need to be done by a nurse and is not a need related to his accident.
Community Access	Independent.	The main difference between our examination and that of Ms Davidson and Mr Wind is that Mr Ashton told us that he can drive himself to access the local community. He stated, “once the gate is locked, it’s 1 hour and 5 minutes from my house to the end of the freeway at Hornsby”. When asked about his capacity for driving, he stated “it’s just sitting”. “I can drive where I need to”. His mother lives at 36 Miowera Rd, North Turramurra and his closest shopping centre is Tuggerah. He drives a dual cab Hilux with manual transmission. He is also able to drive his 6-wheeled gator although reported that currently this is broken and unusable. He has a Disability Parking Permit but said that he struggles to unload his wheelchair and push himself when he has to go to hospital appointments where he needs to walk more than short distances from where he parks. At Mt Wilga Private, the orderlies wouldn’t come and get him from his car. This was confirmed after the examination by a call to Mt Wilga Private. But Mr Ashton mostly attended there for inpatient treatment for his lymphoedema, and we saw no evidence that he still attends there regularly. His lymphoedema physiotherapist, Kim Allan said that Mr Ashton can drive to her clinic and come in himself. Based on the above, Mr Ashton could still need some help to get to appointments at large hospitals, where he is unable to park close to the entrance. He could need a support worker to accompany him for a couple of appointments a year.
Lymphedema	Mr Ashton said that he didn’t have lymphoedema before the accident.	He said “I need to put on a device (leg pump) to manage my lymphoedema. It takes an hour. I need to put that on both legs”. It would be easier if I had a second leg pump allowing me to do both legs at the same time. He said that he can’t use the pump himself because he can’t easily reach to his legs to do it. Although Mr Ashton’s bilateral lymphoedema is not clearly related to his footdrop from the accident, his physiotherapist said that he now can’t do all of the daily treatment himself. There could be other factors contributing to that difficulty, including obesity. But his right foot drop and hip fracture makes reaching to and putting the pump and compression garment on his right leg more difficult. Therefore, based on our assessment he still needs some accident-related help with that daily treatment. Kim Allan confirmed that Mr Ashton’s daily home treatment for long-term lymphoedema management includes: Compression garments daily to stop his legs “filling up”. Daily use of a lymphoedema pump for an hour to help to move fluid out of his legs and therefore reduce risk of infection. Daily use of supportive boots. Putting the pump on and off his legs and then putting on the compression garments could be done during a daily care service.
Firewood	Independent chopping and bringing it into the house.	“Robbo brings me firewood. It’s one of his businesses”. I need somebody to bring this in for me. If the firewood is inside, he can load and stoke the fire. Mr Ashton reasonably needs help to bring in firewood because of his foot drop related mobility impairments. That could also be done during a daily care service

12.Comments on consistency
Mr Ashton sat during most of the assessment and was reluctant to participate much, which is consistent with his presentation at other assessments. The main difference to the assessment of Ms Davidson in November 2021, and Mr Wind in March 2023, is that he wasn’t sitting in his wheelchair and didn’t have that in the house. That was discussed with Mr Ashton who said that he doesn’t currently use a wheelchair inside his home.

DETERMINATIONS – TREATMENT
13.Treatment and Care – reasonable and necessary
Following review of the evidence and our examination, the following care is considered reasonable and necessary to meet Mr Ashton’s current injury-related needs.
Dressing – 1.5 hours per week
Mr Ashton needs 10-15 minutes per day of help to put on his supportive boots.
Lymphoedema home treatment – 1.5 hours per week
He also needs 10-15 minutes per day of help to put the sleeves on his legs for the compression pump and to put on his compression stockings.
Bulk Meal Preparation – 3.0 hours per week
He needs help for 3 hours per week to prepare some meals to divide into portions and store in the fridge/freezer. He can then heat those up to eat on days when he is not driving.
Domestic Cleaning – 2.25 hours week
It is reasonable that Mr Ashton receives assistance with a weekly clean to include vacuuming, mopping and dusting his bedroom, the open plan kitchen/dining area and living room. Weekly cleaning would include a thorough clean of his bathroom and the kitchen, for about 2.0 hours per week. Mr Ashton presents with the capacity to wipe over surfaces within easy reach daily, such as kitchen bench and dining table.
We note that Mr Ashton has recently extended his home to include a second bathroom and guest bedroom. He does not use these areas himself and they do not need to be cleaned weekly. It is reasonable that guests who stay in that section of the house keep it clean and tidy. 1.0 hour per month, or 0.25 hours per week, would be sufficient for a more thorough clean of those areas.
Laundry – 1.5 hours
Mr Ashton needs help to strip and change the bed linen and carry his laundry and bedding to the outside laundry. He doesn’t have sufficient standing tolerance to hang clothes on the clothesline and needs help to hang them and bring them in. That doesn’t have to be done the same day. Laundry can be performed at the commencement of the domestic chores to enable sufficient time for the wash cycle.
Community Access for Shopping and Rubbish Removal – 3.5 hours
Mr Ashton can be helped with fortnightly bulk shopping and rubbish removal after his lymphedema treatment is finished on one day a week. That is to supplement the shopping he can do himself using as mobility scooter.
An estimate of 3.5 hours per week means that the support worker can accompany him from his home to load and unload the rubbish and shopping and help him to put groceries away.
Spring Cleaning – 16.0 hours twice a year (0.33 hours per week)
This is reasonable for a twice a year spring cleaning of Mr Ashton’s home to include interior and exterior windows, cobweb removal, cleaning skirting boards and behind furniture, cleaning the fridge and oven and wiping down walls.
Gardening/lawn care – 19 services per year (0.35 hours per week)
Mr Ashton needs help with lawn maintenance and gardening for 19 services a year, every 2-4 weeks, so that lawn is kept short to reduce the risk of snakes and other vermin. That would support Mrs Ashton’s safe mobility around his home. That includes lawn mowing, edging and minimal pruning.
Home/Property Maintenance – 2.0 hours per month (0.5 hours per week)
Many of the maintenance tasks listed by Mr Ashton are outside the role of a handyman or support worker. They require the use of powered equipment such as a chain saw, heavy lifting such as to remove and replace 90kg gas cylinders, the use of a gun, or the skills of a qualified tradesperson.
Tasks for which handyman assistance is reasonable include high pressure cleaning of concrete areas to maintain safe access for Mr Ashton around his home, and gutter cleaning. Both twice a year. Monthly tasks could include removing and recharging the batteries on security devices, changing light globes and minor repairs that don’t need specialist skills.
Car Washing – Reimbursement of a monthly car wash service
Transport and assistance at some medical appointments – 10 hours per year (0.2 hour/wk)
This extra care should support Mr Ashton when he needs to access treatment that is further from his mother’s home, and where he could need help to get from car park to a treatment facility in his wheelchair because of the amount of walking required. He can get to his GP and physiotherapist alone, therefore we have estimated that he could need help to get to other appointments about every 6 months for 5 hours per appointment.
Total weekly care: 14.63 hours per week (rounded up to 15)
That consists of 13.58 hrs per week of attendant care, plus gardening and home maintenance services and reimbursement of monthly car wash. The Panel thinks it is reasonable to round up to 15 hours care per week which would be more practical for rostering.
That doesn’t include time for support workers and other service providers to travel to Mr Ashton’s residence. If funding to travel to and from Mr Ashton’s home needs to be considered to support recruitment, then negotiations need to be undertaken separately from the assessed care.
Mr Ashton indicated a preference to shower when somebody else is at his home with him. He has recently had bathroom modifications to reduce his risk of falling and wears a waterproof apple watch with a fall’s alarm/alert. That could be set up to alert someone should he have a fall when showering. Having a support worker in the home will not prevent him from falling and they could only help after. However, he could choose to shower when a support worker is in his home providing his other assessed care.
Mr Ashton also expressed a desire to have inactive overnight care in the event of an emergency such as a snake entering his home. When we discussed this with him, he acknowledged that when he is asleep he would not be able to act against a snake regardless of the injuries he sustained in the motor vehicle accident. He can get in and out of bed independently and has a mobile phone and apple watch to call for help if needed. Recent modifications have supported a consistent telephone service. He therefore doesn’t have an injury related need for overnight supervision at Mogo Creek.

FINDINGS

The Panel conducts a new assessment of all the matters with which the medical assessment is concerned.[5] The Panel adopts the extensive reasons of the joint assessment findings of Assessor Alach and Assessor Piebenga
[5] Section 7.26(6) of the MAI Act.
The Panel is not required to choose between competing opinions and is required to form its own opinions.[6] The two assessors have explained the basis of their assessment which are different from those provided by other occupational therapists. The assessment of the claimant’s necessary and reasonable care needs, arising from the motor accident, is undertaken at the time of the examination. In that respect, the previous assessments are outdated and may not reflect the claimant’s current capacities found upon assessment.
[6] Insurance Australia Group Limited v Keen [2021] NSWCA 287 and Insurance Australia Limited v Marsh [2021] NSWCA 31.

CONCLUSION

For these reasons, the Panel concludes that the Certificate issued by Assessor Davidson should be revoked. The new Certificate is attached at the commencement of this reasons.

[LA1]Should this be motor accident claim?

[DP2]? assess over or assess above/more?

[DP3]I changed the numbers on the front page. Don't think I need to change them here… although wonder do we need to be aligned with the reason for referral in which case are we saying 14 to 49 is reasonable and we recommend 15? I'm getting confused Gary so will leave this to you...

[LA4]Should this be just assessment or review assessment?

[DP5]Gary, just flagging… same as above