Baptistcare NSW & Act v Matheson - [2025] NSWPICMP 511

DETERMINATION OF APPEAL PANEL
CITATION:	Baptistcare NSW & ACT v Matheson [2025] NSWPICMP 511
APPELLANT:	Baptistcare NSW & ACT
RESPONDENT:	Michele Matheson
APPEAL PANEL
MEMBER:	Carolyn Rimmer
MEDICAL ASSESSOR:	Graham Blom
MEDICAL ASSESSOR:	Michael Hong
DATE OF DECISION:	15 July 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of primary psychological injury; parties agreed that respondent worker had suffered a primary psychological injury as alleged, deemed to have occurred on 13 July 2013, and a secondary psychological condition resulting from physical injury sustained on 5 June 2012; Medical Assessor erred in failing to consider the question of a secondary psychological injury; no error in finding that there was no proportion of the impairment due to a previous injury, pre-existing condition or abnormality; error in assessing 1% whole person impairment (WPI) for effects of treatment as no apparent substantial or total elimination of permanent impairment, as required by clause 1.32 of the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed; respondent worker re-examined; Held – MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

On 13 October 2023 Baptistcare NSW & ACT (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Gerard Chew, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 18 September 2023.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

RELEVANT FACTUAL BACKGROUND

Michele Matheson sustained a psychological injury during the course of her employment with the appellant on 30 April 2014.
Ms Matheson commenced proceedings in the Personal Injury Commission (the Commission) by filing an Application to Resolve a Dispute (ARD) claiming medical expenses and lump sum compensation dated 23 March 2023.
In a Certificate of Determination – Consent Orders dated 8 June 2023, Member Diana Benk determined:
“1. The matter is to be remitted…

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.

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Details

Case: [2025] NSWPICMP 511
Decision Date: 15 July 2025

CaseChat Overview and Summary

In the case of Baptistcare NSW & Act v Matheson, the dispute centred on the assessment of a Medical Assessment Certificate (MAC) issued under the Workers Compensation Act 1998. The respondent, who had suffered both a primary psychological injury and a secondary psychological condition resulting from a physical injury, sought a review of the MAC. The primary issue before the court was whether the Medical Assessor correctly evaluated the respondent's impairment, particularly in relation to the proportion attributable to previous injuries, pre-existing conditions, or abnormalities.

The court was tasked with determining if there was any error in the Medical Assessor's decision that no proportion of the impairment was due to a previous injury, pre-existing condition, or abnormality. Additionally, the court had to consider whether the Assessor correctly assessed the 1% whole person impairment (WPI) for the effects of treatment, as required by the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th edition. The court found that the Medical Assessor did not err in their conclusion regarding the proportion of the impairment, but did find an error in the assessment of the 1% WPI, as there was no substantial or total elimination of permanent impairment.

Upon reviewing the evidence, the court determined that the Medical Assessor failed to consider the question of a secondary psychological injury, which was a significant oversight. Consequently, the court revoked the MAC and ordered that the respondent be re-examined. The court's decision was based on the clear error in the assessment of the 1% WPI and the omission to consider the secondary psychological injury. The case underscores the importance of a thorough and comprehensive evaluation of all aspects of an injury when assessing impairment under the Workers Compensation Act.

Orders