Blackmores Group v Moore
[2023] NSWPICMP 595
•16 November 2023
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Blackmores Group v Moore [2023] NSWPICMP 595 |
| APPELLANT: | Blackmores Group |
| RESPONDENT: | Catherine Anne Moore |
| APPEAL PANEL | |
| MEMBER: | Jane Peacock |
| MEDICAL ASSESSOR: | Nicholas Glozier |
| MEDICAL ASSESSOR: | Douglas Andrews |
| DATE OF DECISION: | 16 November 2023 |
| CATCHWORDS: | WORKERS COMPENSATION - Appellant alleged error in the assessment in respect of three of the categories under the psychiatric impairment ratings scale (PIRS), social and recreational activities, travel and social functioning; the Appeal Panel could discern no error; all ratings were open to the Medical Assessor and assessed in accordance with correct criteria; Held – Medical Assessment Certificate confirmed. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 24 July 2023 the employer Blackmore Group (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Michael Hong, who issued a Medical Assessment Certificate (MAC) on 26 June 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 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).
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 requested a re-examination. As a result of the Appeal Panel’s preliminary review, the Appeal Panel determined that the worker should not undergo a further medical examination because the Appeal Panel was not satisfied as to error and absent a finding of error the Appeal Panel has no power to require the worker undergo a re-examination: see New South Wales Police Force v Registrar of the Personal Injury Commission of New South Wales [2013] NSWSC 1792.
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.
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.
The matter was referred to the Medical Assessor as follows:
“The following matters have been referred for assessment (s 319 of the 1998 Act):
· Date of injury: 12 October 2022 - deemed
· Body parts/systems referred: Psychiatric/Psychological disorder
· Method of assessment: Whole Person Impairment”
The Medical Assessor issued a MAC as follows:
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psycho-logical | 12 OCTOBER 2022 – DEEMED | 11 page 55-60 | 14 | 22 | 0 | 22 |
| 2. | ||||||
| 3. | ||||||
| 4. | ||||||
| 5. | ||||||
| 6. | ||||||
| Total % WPI (the Combined Table values of all sub-totals) | 22% | |||||
The assessment of impairment was based on the ratings ascribed by the Medical Assessor under the psychiatric impairment ratings scale (PIRS) as follows:
Table 11.8: PIRS Rating Form
| Name | Catherine Anne Moore | Claim reference number (if known) | W697/23 |
| DOB | XXXX | Age at time of injury | 38-year-old |
| Date of Injury | 12 OCTOBER 2022 – DEEMED | Occupation at time of injury | Blackmores Limited |
| Date of Assessment | 16/6/2023 | Marital Status before injury | Never married |
| Psychiatric diagnoses | 1. Major depressive disorder | 2. | |||||||||
| 3. | 4. | ||||||||||
| Psychiatric treatment | Psychologists Psychiatrists Antidepressant medications No psychiatric admission | ||||||||||
| Is impairment permanent? | Yes | ||||||||||
| PIRS Category | Class | Reason for Decision | |||||||||
| Self-care and personal hygiene | 2 | Ms Moore has been neglecting her self-care. She said she skips meals and relies on premade meals and sometimes relies on takeaway food. She showers daily. Her weight fluctuated significantly and she loses or gains weight with stress. Her diet and weight management were better when her ex-partner used to bring her food. She is capable of independent living without regular support and does not need prompting with her self-care. | |||||||||
| Social and recreational activities | 3 | She no longer participates in her normal recreational activities, due to social anxieties. She can engage in one-on-one catch-ups, but struggles and remains quiet and withdrawn when she is at parties. She attended 2-3 parties in the past 12 months. She no longer engages in charity or community events as she cannot socialize in groups. Her recreational activities have not improved with eased COVID-19 restrictions. | |||||||||
| Travel | 2 | Ms Moore is anxious and avoids highways, and sometimes pulls over when driving due to panic attacks. | |||||||||
| Social functioning | 3 | Ms Moore's relationship with her partner of 12 months ended. She is anxious and socially avoidant, and ceased contact with some of her friends. She is able to maintain a few long-term friendships. The relationship with her general family is good and they are close. | |||||||||
| Concentration, persistence and pace | 3 | Ms Moore described having poor concentration. She has not undertaken study since the subject injury. Her mental state examination is consistent with 3 and she does not engage in intellectually demanding tasks now. | |||||||||
| Employability | 5 | Ms Moore is anxious in social settings and struggles with interaction with strangers, and has poor concentration and memory and energy levels. She has no work capacity. | |||||||||
| Score | Median Class | ||||||||||
| 2 | 2 | 3 | 3 | 3 | 5 | =3 | |||||
| Aggregate Score Impairment | Total | % | |||||||||
| + | + | + | + | + | 18 | 22 | |||||
Pre-existing injury
0
Treatment effects
No substantial or total elimination of impairment with treatment, and therefore no treatment uplift.
0
Final WPI
22
The employer appealed.
In summary, the appellant submitted on appeal that the Medical Assessor made demonstrable error and made assessments on the basis of incorrect criteria as follows:
(a) when assessing Class 3 for social and recreational activities when he should have assessed Class 2;
(b) when assessing Class 2 for travel when he should have assessed Class 1, and
(c) when assessing Class 3 for social functioning when he should have assessed Class 2;
In summary, the worker Ms Catherine Anne Moore (the respondent) submitted on appeal that the Medical Assessor did not err or make an assessment on the basis of incorrect criteria and that the MAC should be confirmed.
The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS scale for mere difference of opinion but must be satisfied as to error.
The Medical Assessor took a detailed history as follows:
“● Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:
Ms Moore reported that there has been a series of events over long periods leading to her developing a psychological injury. She said that she was under a tremendous amount of stress for 10 months before she eventually consulted her GP – she stated she was at breaking point by then, she could not sleep and was panicking, and was always anxious.
Ms Moore said that she normally would have six-monthly reviews, and in February 2017 they identified that she was doing the work of three people, and managing the team but did not have a manager to support her. However, she stated management never addressed the identified issues. She carried a high workload with little support for a long time and then, over six months, there were many changes in Blackmores. They transferred to a new software system and relocated to a new office, which also meant they lost a lot of employees from the previous warehouse. Ms Moore had an extra staff member who was suddenly taken away from her. She recalled she was always exhausted and could not stop thinking and stressing, and could not sleep.
Since she stopped working she has had regular treatment but has not gained substantial improvement.
· Present treatment:
Ms Moore is taking:
· Restavit
· Melatonin
She previously took Luvox, Citalopram and then Valdoxan a couple of months ago, all antidepressant medications. She also took Temazepam and Diazepam.
She is currently consulting Jacki Elphistone, psychologist every 3 weeks. She consulted Dr Mark Scurrah, psychiatrist between 2017 and 2018, and her current psychiatrist is Dr Peter Sefken.
No psychiatric admission.
· Present symptoms:
Ms Moore reported she is easily stressed and recently, she has been having anxiety attacks every month, usually when her stress level builds up or after a night when she has had particularly poor sleep.
She reported having a chronic fluctuating depressed mood.
She reported an inability to enjoy things she would normally enjoy.
She reported having major problems with her memory and concentration.
She is easily fatigued, with the afternoon being worse.
She described having low self-esteem.
She was 58kg normally and lost weight with stress and was 50kg. She then gained weight, and is currently 68kg. She reported in 2022, she had a personal trainer and her ex-partner helped her with food, and she was able to lose weight. Subsequently, she gained weight with stress again.
She reported having sleep problems.
She worries and is unable to switch off her thoughts at night.
She has panic attacks.
Ms Moore denied having suicidal ideation or irritability problems.
· Details of any previous or subsequent accidents, injuries or condition:
Ms Moore has no past psychiatric history.
I note that Ms Moore had a termination in August 2021. Whilst being stressful it is no longer impacting on her mental state and Dr Smith’s report on 6 July 2022, also took a similar history and that no psychological impacts were noted by her GP.
No subsequent injury identified.
Ms Moore was born in Australia and grew up with her parents, being the youngest of three sisters.
She grew up in a stable home environment and did not encounter abuse or any major adverse events in her early life. She had a good relationship with her family.
She does not have a family history of psychiatric illness.
There is no forensic history.
She does not have recreational drug or alcohol problems. She is not drinking to excess now.
· general health:
No relevant medical conditions.
· Work history including previous work history if relevant:
She left school after Year 12 and did a Certificate 4 in Kinesiology and a Certificate 2 in Pharmacy Assistance. She worked in a pharmacy for about 15 years.
Ms Moore had worked at Blackmores from October 2014, initially as a receptionist, and later as a full-time team leader with no secondary employment. Due to her anxiety and depression, she stopped working in 2018 and briefly returned to work at Blackmores doing basic administration work, however, she said she could not cope. They relocated to an open office and she felt very anxious surrounded by people and her psychological health declined. Since then she has not performed any other work.
· Social activities/ADL:
Ms Moore is currently living on her own at a friend's house. She reported that she had lived on the same property for three years, but in May 2023 she could no longer afford the rent, and started staying between friends’ homes.
She had a long-term relationship that ended in 2012. She then had a 12-month de facto relationship which ended maybe two years ago. After they separated, she was living next to his house in a studio, and he would bring food for her and help her. She explained that even though they tried to make it work, she had no libido and found it hard to connect with people, and sometimes they argued and so the relationship eventually dissolved. They are still on talking terms now.
Day to day, she finds her concentration is poor, she has to write everything down and write lists when she goes to the shops, however, she said she would either forget things on the list or she becomes so exhausted she comes back home early. She generally only attended appointments in the morning, because by the afternoon she finds she is too tired to do anything.
Ms Moore reported having problems driving since 2017 and said she has also told the other IMEs about the issue, but no one had recorded it in their reports. She was driving on the Hume Highway and suffered a panic attack and has not driven on the highway since around 2017. She said even driving over bridges and over water, she becomes anxious but she cannot explain why. Sometimes she pulls over when she is particularly anxious on the road. In the past, she stated she was a confident driver and she liked travel generally, and visiting new places.
She said she was very sociable normally and found it easy to make friends. She belonged to a women’s circle and they would catch up two or three times a week to talk, for self-development and to share their experiences, but she left that several years ago as she felt anxious to talk to people.
Ms Moore is on the Byron Bay Lighthouse Community Run board, which is a charity event. She said she used to go regularly, but since 2018 she stopped going, even though technically she is still on the board. She does not belong to any other clubs or organisations and has not attended any community events for many years now.
She said she has lost friends and still has maybe five close friends. She finds it very hard to socialise in groups, and tends to catch up with them one on one, every few weeks. Sometimes she will be invited to social events, for example, she went to a birthday recently, and she coped by only talking to one person and avoided talking to other people at the party, even people she knew. She finds it extremely difficult to talk to strangers and said she worries people will ask questions about where she lives or what she does. In the last 12 months, she might have gone to two or three parties or birthdays, however, she remained quiet and withdrawn and avoids having conversations with people.
Ms Moore does the cooking and shopping herself, and mostly she will buy frozen premade meals. Her sister and mother live in Albury, but she has not visited them for several years now.
Her father is about an hour away, and a sister lives an hour away as well. They visit each other sometimes and they talk regularly, and they are reasonably close.”
The Medical Assessor conducted a mental state examination of which he recorded as follows:
“Ms Moore was assessed by video. She was at a friend’s home during the assessment. I assessed her from my Sydney office. I have completed a full psychiatric assessment with consent. I have taken handwritten notes, and there was no audio-visual recording of the assessment.
Ms Moore's hair was tied back and she presented as psychologically fragile.
She engaged well with the video assessment process.
She was anxious and cried at times during the assessment. She was consistently restricted in her affect reactivity.
She spoke spontaneously. She had a disorganized narrative and was not thought disordered.
At the end of the assessment, I asked Ms Moore for additional information that she thought may be relevant and she discussed she is disappointed with herself and that this has been a very challenging time in her life.”
The Medical Assessor summarised the injury and diagnosis and noted any differences with the other expert opinions as follows:
“summary of injuries and diagnoses:
Ms Moore had no prior psychiatric difficulties and reported that due to chronic work stress, high workload and lack of support, she developed persisting depression and anxiety symptoms. While initially resistant to antidepressants, she has since trialled several psychotropic medications and antidepressants, but did not find medication helpful or could not tolerate some of the side effects. Her overall functioning has been on a similar trajectory for a long time and therefore my view is that her condition is well-stabilised.
In terms of WPI assessment, Dr Chowdary rated Ms Moore's self-care as a 1, but did not really explain why. In my assessment, I noted there are clear deficits in her self-care and she relied on her ex-partner for food when they were together. She is now living on her own but struggles with her self-care, and similar to Dr Smith, I rated a 2. Her impairment is almost 3.
In terms of social and recreational activities, Dr Smith rated a 2 on the basis that Ms Moore occasionally goes to social events without needing a support person, and also noted her isolation due to the COVID lockdown. In my assessment, I noted that she tried to connect with people and can tolerate one on one catch-ups, but when she has to go to a larger function, she remains quiet and withdrawn and tends to only talk to one person the entire time, and cannot engage in conversation with strangers or in groups. Therefore, my view is a rating of 3 is more accurate and certainly she relies on the support of a close friend or friends, to allow her to attend larger gatherings, which she used to enjoy.
Both Dr Smith and Dr Chowdary rated travel as a 1 and my view is that she has definite impairments, particularly as she can no longer drive on the highway due to her anxiety, which is consistent with a 2.
In terms of social functioning, Dr Smith rated a 2 but did not consider the loss of a de facto relationship of 12 months. I rated a 3 on the basis that she lost friends, and also lost that partnership.”
The Medical Assessor considered that the worker was consistent in her presentation.
The Medical Assessor explained his reasons for assessment under each of the PIRS categories as set out in the table above.
The Medical Assessor made brief comment on the other evidence and opinions that were before him as well as his comments on the PIRS ratings by the other experts as set out above:
“Ms Moore's statement noted her work with Blackmores, and she started experiencing stress and anxieties, particularly from 2017. She described chronic workload problems. She described her psychological symptoms and noted she does not want to take antidepressants, but she did try some medication.
Dr Zarrar Chowdary, IME psychiatrist provided a report dated 8 October 2022, noted structural changes when Global Therapeutics took over Blackmores. Her stress kept increasing until she stopped working. She is easily overwhelmed and suffered from poor sleep and does not want to go out. For a period of time, she drank more alcohol and then improved. He diagnosed an adjustment disorder and provided a WPI and the rating came to 17%.
Ms Moore's psychiatrist, Dr Scurrah, had written in 2017 and 2018 and noted she presented with mixed depression and anxiety, and was at the time drinking half a bottle of wine.
There were several psychologists, including Ross Simpson, and they provided a consistent history and noted she has chronic depression and anxiety affecting her daily functioning.
Ms Moore's psychologist, Elphinstone, 23 July 2019, noted she is easily triggered and reacting to reminders of workplace stressors and recommended further treatment.
Ms Moore's GP record has been noted. There were no other relevant factors. Anxiety had been a prominent feature. Her prescription history noted several antidepressants.
Dr Clayton Smith, IME psychiatrist reported on 6 July 2022, noted Ms Moore first left work in August 2017 and then tried to return to work in October, but remained off work until June 2018, working four hours a day three days a week, but then stopped again by September 2018. She is a board member of the Byron Bay Lighthouse Run and has no charity obligations and does not perform volunteer work or belong to a women's group. She travelled to see her mother in Albury in May 2021 and flew by herself. Dr Smith advised she required assertive medical management for a major depressive disorder including an antidepressant, and provided a WPI and the ratings came to 7%.
Dr Smith, 22 November 2022. She has not worked since she left Blackmores in 2018. Her father is her main support and she sees him every two or three weeks. She tries to catch up with a friend once a month and is over-stimulated in a normal social environment, and only goes to one-to-one catch-ups. She had been back to her ex-partners from time to time and he is still helpful. He reviewed Dr Chowdary’s report and advised she started an antidepressant in the last two weeks and is yet to reach a therapeutic dose. He advised Ms Moore had not reached MMI
Comment:
Ms Moore did not find the last antidepressant medication, Agomelatine to have helped and it was ceased. Her psychiatric functioning remains at a static level, therefore, my view is MMI has been reached.
Procare Investigation, 14 October 2020, noted Ms Moore's membership and potential business activity and that she joined the Byron Bay Lighthouse Run in 2017. 2
Comment: I discussed this issue with her and she said she is not engaged in any business activities.”
The appellant complains that the Medical Assessor has erred in respect of three of the categories assessed, namely Social and Recreational Activities, Travel, and Social Functioning.
The Panel cannot interfere with these ratings absent error by the Medical Assessor. The Panel cannot interfere with the rating because opinions might differ as to the best fit in each category. There must be error or assessment on the basis of incorrect criteria. The Panel will deal with each category in turn.
The appellant complained on appeal that the Medical Assessor should have assessed a Class 2 or mild impairment for Social and Recreational Activities rather than the Class 3 or moderate impairment that was assessed.
In respect of Social and Recreational Activities, Table 11.2 of the Guides provides as follows:
Table 11.2: Psychiatric impairment rating scale – social and recreational activities
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: regularly participates in social activities that are age, sex and culturally appropriate. May belong to clubs or associations and is actively involved with these.
Class 2
Mild impairment: occasionally goes out to such events eg without needing a support person, but does not become actively involved (eg dancing, cheering favourite team).
Class 3
Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.
Class 4
Severe impairment: never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate.
Class 5
Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.
The Medical Assessor rated moderate impairment at Class 3 with the following reasoning:
“She no longer participates in her normal recreational activities, due to social anxieties.
She can engage in one-on-one catch-ups, but struggles and remains quiet and withdrawn when she is at parties. She attended 2-3 parties in the past 12 months.
She no longer engages in charity or community events as she cannot socialize in groups.
Her recreational activities have not improved with eased COVID-19 restrictions.”
The Medical Assessor has to make an independent assessment and do so in accordance with the criteria in the Guides.
The Medical Assessor explained carefully how he arrived at the Class 3 rating and why he differed from Dr Smith who had assessed a Class 2 as follows:
“In terms of social and recreational activities, Dr Smith rated a 2 on the basis that Ms Moore occasionally goes to social events without needing a support person, and also noted her isolation due to the COVID lockdown. In my assessment, I noted that she tried to connect with people and can tolerate one on one catch-ups, but when she has to go to a larger function, she remains quiet and withdrawn and tends to only talk to one person the entire time, and cannot engage in conversation with strangers or in groups. Therefore, my view is a rating of 3 is more accurate and certainly she relies on the support of a close friend or friends, to allow her to attend larger gatherings, which she used to enjoy.”
The Appeal Panel can discern no error in the rating of a moderate impairment. The respondent worker can engage on a one to one basis but otherwise is quiet and withdrawn in larger groups. The guides give examples and it is up to the Medical Assessor to use his or her clinical judgment in deciding the best fit. The Appeal Panel cannot interfere because reasonable minds might differ in ascribing Class 2 or 3. Rather the Appeal Panel must be satisfied as to error. Here the Appeal Panel considers that a Class 3 for social and recreational activities was open to the Medical Assessor in accordance with application of correct criteria and the Appeal Panel can discern no error.
In respect of Travel, Table 11.3 of the Guides provides as follows:
Table 11.3: Psychiatric impairment rating scale – travel
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: Can travel to new environments without supervision.
Class 2
Mild impairment: can travel without support person, but only in a familiar area such as local shops, visiting a neighbour.
Class 3
Moderate impairment: cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment.
Class 4
Severe impairment: finds it extremely uncomfortable to leave own residence even with trusted person.
Class 5
Totally impaired: may require two or more persons to supervise when travelling.
The Medical Assessor assessed a mild impairment at Class 2 with the following reasoning:
“Ms Moore is anxious and avoids highways, and sometimes pulls over when driving due to panic attacks.”
The appellant submitted that a Class 1 should have been assessed.
The appellant notes that the respondent worker was considered to have no deficit by the IME qualified on her behalf, Dr Chowdary and no deficit by Dr Smith the IME qualified to provide an opinion of behalf of the appellant. The appellant notes that anxiety whilst driving is first recorded in the examination by the Medical Assessor and appears nowhere else in the evidence.
The Medical Assessor must reach his own independent opinion.
He has explained why his opinion differs from the other experts as follows:
“Both Dr Smith and Dr Chowdary rated travel as a 1 and my view is that she has definite impairments, particularly as she can no longer drive on the highway due to her anxiety, which is consistent with a 2.”
The Appeal Panel can discern no error.
In respect of Social Functioning, Table 11.4 of the Guides provides as follows:
Table 11.4: Psychiatric impairment rating scale – social functioning
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).
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.
Class 4
Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (eg lost partner, close friends). Unable to care for dependants (eg own children, elderly parent).
Class 5
Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.
The Medical Assessor assessed Class 3 with the following reasoning:
“Ms Moore's relationship with her partner of 12 months ended.
She is anxious and socially avoidant, and ceased contact with some of her friends.
She is able to maintain a few long-term friendships.
The relationship with her general family is good and they are close.”
The appellant submitted that the Medical Assessor should have assessed a mild impairment at Class 2.
Dr Smith, the IME qualified to provide an opinion on behalf of the appellant had assessed a Class 2 and Dr Chowdary the IME qualified on behalf of the worker had assessed Class 3.
The Medical Assessor again carefully explained why his opinion differed from that of Dr Smith as follows:
“In terms of social functioning, Dr Smith rated a 2 but did not consider the loss of a de facto relationship of 12 months. I rated a 3 on the basis that she lost friends, and also lost that partnership.”
The assessment by the Medical Assessor was open to him and is in accordance with correct criteria. The appeal panel can discern no error in the Class 3 rating.
For these reasons, the Appeal Panel has determined that the MAC issued on 23 June 2023 should be confirmed.
0
2
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