Camacho v Convoluted Technologies Pty Ltd
[2023] NSWPICMP 280
•19 June 2023
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Camacho v Convoluted Technologies Pty Ltd [2023] NSWPICMP 280 |
| APPELLANT: | Byron Valle Camacho |
| RESPONDENT: | Convoluted Technologies Pty Ltd |
| Appeal Panel | |
| MEMBER: | Catherine McDonald |
| MEDICAL ASSESSOR: | John Baker |
| MEDICAL ASSESSOR: | Michael Hong |
| DATE OF DECISION: | 19 June 2023 |
CATCHWORDS: | wORKERS cOMPENSATION - Psychological injury; consideration of statements in the file; requirements for a medical assessment certificate; section 352(2) of the Workplace Injury Management and Workers Compensation Act 1998 and the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021; need to disclose reasoning process; assessment under the Psychiatric Impairment Rating Scale (PIRS); Jenkins v Ambulance Service of NSW and State of NSW v Kaur discussed; re-assessment required; Held – Medical Assessment Certificate revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 15 March 2023 Byron Valle Camacho (Mr Camacho) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Gerald Chew, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 15 February 2023.
Mr Camacho 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 was satisfied that, on the face of the application, at least one ground of appeal had been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the grounds of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 – Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed 1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
RELEVANT FACTUAL BACKGROUND
Mr Camacho was employed by Convoluted Technologies Pty Ltd (Convoluted) as a welder. He suffered a psychological injury as a result of interactions with his manager on 6 May 2021. The manager denied Mr Camacho the opportunity to fix a trivial mistake, verbally abused him and told him to go to the carpark so the manager could “bash” him. Mr Camacho returned to work on 10 May but was unable to continue and saw his general practitioner. He has not worked since and remains under treatment.
The Medical Assessor prepared a very brief MAC in which he assessed 8% whole person impairment (WPI). Using the Psychiatric Impairment Rating Scale (PIRS), he assessed Mr Valle Camacho in class 2 for self-care and personal hygiene, social and recreational activities, travel, and social functioning. He assessed Mr Valle Camacho in class 3 for concentration, persistence and pace and in class 4 for employability.
PRELIMINARY REVIEW
We conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
As a result of that preliminary review, we determined that Mr Camacho should undergo a further medical examination because the MAC was so brief as to fail to disclose the Medical Assessor’s path of reasoning and he failed to refer to relevant evidence. Those failures constitute a demonstrable error.
EVIDENCE
We have all the documents that were sent to the Medical Assessor for the original medical assessment and have taken them into account in making this determination.
Dr Hong conducted an examination of the worker on 8 June 2023. His report is attached to these reasons.
The parts of the MAC 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 we have considered them.
In summary and in submissions prepared by his solicitor, Ms Pawlikowski, Mr Comacho, submitted that the Medical Assessor failed to address key evidence. He noted that the Medical Assessor agreed with Dr Young who examined him for Convoluted. Dr Young had dramatically changed his assessment after his consultation when he was asked to review social media evidence. Mr Comacho and his partner provided statements addressing that evidence to which the Medical Assessor did not refer, leading to an inference that he had not considered them.
In addition, Mr Comacho submitted that the Medical Assessor had made an incorrect assessment in respect of social and recreational activities, stating he had travelled overseas with his partner. Mr Comacho referred to his statement which confirmed that he had travelled alone to visit family. He said that assessment in class 3 better reflected the social isolation described in his evidence.
He also said that the Medical Assessor’s assessment of social functioning was made because he “has regular support of partner.” He said that the Medical Assessor did not have regard to the evidence and that assessment in class 3 was appropriate, noting that his relationship with his partner is severely strained. Mr Comacho also said that the assessment in class 3 for employability was inconsistent with his statements and the certificates of capacity.
In reply and in submissions prepared by Ms Israil, Convoluted submitted that the Medical Assessor obtained an accurate history through appropriate enquiry and carefully considered the material before him. It said that Mr Comacho was seeking to cavil with the findings rather than address any demonstrable error. With respect to the grounds relying on the PIRS tables, Convoluted said that the Medical Assessor had applied the correct criteria.
FINDINGS AND REASONS
The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is by way of a 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[1] 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 is 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.
[1] [2006] NSWCA 284.
The Medical Assessor is an administrative decision maker and his reasons are to be considered in that light. In Bojko v ICM Property Service Pty Ltd [2] Handley AJA (with whom the other members of the Court agreed) said that the worker had failed to establish his grounds of appeal because:
“Both involved a hyper-critical approach to the reasons of the Panel which is contrary to authority and ignores the presumption of regularity which attends administrative action. The correct approach is that mandated by the joint judgment in Minister for Immigration and Ethnic Affairs v Wu Shan Liang [1996] HCA 6, 185 CLR 259, 272 which approved the following statement of principle in a decision of the full Federal Court:
‘… a court should not be concerned with looseness in the language nor with unhappy phrasing of the reasons of an administrative decision-maker. … the reasons for the decision under review are not to be construed minutely and finely with an eye keenly attuned to the perception of error.’ "
[2] At [36].
However, in this case the MAC is quite remarkably brief and practically devoid of reasons for the Medical Assessor’s opinion. The absence of detailed reasons for any of the assessments made and the failure to engage with the evidence in the file are demonstrable errors.
Section 325(2) of the 1998 Act sets out the requirements for a MAC:
“(2) A medical assessment certificate is to be in a form approved by the President and is to—
(a)set out details of the matters referred for assessment, and
(b)certify as to the medical assessor’s assessment with respect to those matters, and
(c)set out the medical assessor’s reasons for that assessment, and
(d)set out the facts on which that assessment is based.”
The Guidelines provide additional assistance to the Medical Assessor when they describe what is required by an independent medical examiner undertaking an assessment and preparing a report for the evaluation of permanent impairment. The principles apply to a MAC as much as a report commissioned by one of the parties.
Paragraph 1.6 of the Guidelines provides:
“a. Assessing permanent impairment involves clinical assessment of the claimant as they present on the day of assessment taking account the claimant’s relevant medical history and all available relevant medical information to determine:
·whether the condition has reached Maximum Medical Improvement (MMI)
·whether the claimant’s compensable injury/condition has resulted in an impairment
·whether the resultant impairment is permanent
·the degree of permanent impairment that results from the injury
·the proportion of permanent impairment due to any previous injury, pre-existing condition or abnormality,
·if any, in accordance with diagnostic and other objective criteria as outlined in these Guidelines.
b. ...”
Paragraph 1.46 requires that the report be “accurate, comprehensive and fair”. Paragraph 1.47 reads:
“The report should contain factual information based on all available medical information and results of investigations, the assessor’s own history-taking and clinical examination. The other reports or investigations that are relied upon in arriving at an opinion should be appropriately referenced in the assessor’s report.”
Complying with those requirements obliged the Medical Assessor to write in sentences and not merely to briefly complete the template approved by the President for physical injury claims as if it was a form. An example of the latter is the Medical Assessor’s description of the facts on which he based his assessment of permanent impairment where he merely said “[h]istory, examination and collateral information.”
The MAC is not comprehensive. Because of the Medical Assessor’s failure to consider all of the evidence, it was neither accurate nor fair.
Convoluted submitted that the Medical Assessor had recorded an accurate history and carefully considered the material before him. That submission cannot be accepted because the Medical Assessor failed to show in the MAC that he had done so.
The Medical Assessor was also required to undertake his assessment in accordance with paragraph 11.6 of the Guidelines:
“It is expected that the psychiatrist will provide a rationale for the rating based on the injured worker’s psychiatric symptoms. The diagnosis is among the factors to be considered in assessing the severity and possible duration of the impairment, but is not the sole criterion to be used. Clinical assessment of the person may include information from the injured worker’s own description of his or her functioning and limitations, and from family members and others who may have knowledge of the person. Medical reports, feedback from treating professionals and the results of standardised tests – including appropriate psychometric testing performed by a qualified clinical psychologist and work evaluations – may provide useful information to assist with the assessment. Evaluation of impairment will need to take into account variations in the level of functioning over time. Percentage impairment refers to whole person impairment (WPI).”
That paragraph alerted the Medical Assessor to carefully consider Mr Comache’s statements and that of his partner.
The extent of the history set out by the Medical Assessor was:
“He has been unable to return to work.
He had been employed as a production welder for Pirtek for about 20 months. He reported bullying and harassment by other staff. On 6/5/21 a particularly significant incident occurred where his supervisor screamed at him and pushed him. He threatened to bash him. He attended his GP. He tried to go back to work but eventually stopped on 10/5/21.
He reported anxiety, depression, loss of libido, poor sleep, poor energy, poor concentration.
He sought treatment with GP and was referred to psychiatrist and psychologist. He was treated with antidepressant medication.”It was necessary for the Medical Assessor to expose his reasoning so that the parties (and any Appeal Panel or Court) can understand why he reached the decision he did. The MAC in respect of a psychological injury requires a description of any past psychological history, a detailed description of the injury and a history of the worker’s social activities and activities of daily living on which an assessment of WPI arising from the injury can be transparently made.
With respect to social activities and activities of daily living, the Medical Assessor said in the MAC:
“Social activities/ADL: he enjoys hiking and walking with his partner. He attends to ADLs he has reduced socialisation. He has reduced concentration. He is able to travel independently. He reported that he has had an overseas holiday as documented.”
A mental state examination should be described in some detail because it provides the basis for the diagnosis and PIRS assessment. The Medical Assessor’s description was terse:
“On mental state examination he appeared his stated age. He had no abnormal psychomotor activity. His affect was dysphoric. He reported his mood as depressed. He had no suicidality. There was no psychosis. There were no thoughts of self harm. He was oriented to time, place and person.”
The Medical Assessor did make a diagnosis of persistent depressive disorder but did not explain why he had chosen that diagnosis over those made by other examiners.
Application of the PIRS
The Medical Assessor completed the PIRS Rating Form in very short form. He did not give any reasons for his assessment in the summary of injuries and diagnoses, and his evaluation of WPI in the body of the MAC.
The important part of the description of each class in the PIRS is the level of impairment – e.g. no deficit, mild impairment, moderate impairment. Rather than providing criteria for assessment, what follows in each class are examples of limitations on activities which are consistent with the level of impairment. In Jenkins v Ambulance Service of NSW[3] Garling J said:
“I am satisfied that the descriptions of the activities which give rise to a conclusion by an AMS of the extent of a disability of an individual by reference to each table in the PIRS, are simply, in my view, examples of activities which would indicate an assessable level of disability. Those examples, on their face, are not necessary to be found in each case, but may, in any particular case, be sufficient to support a conclusion as to the level of disability.”
[3] [2015] NSWSC 633 at [65].
The Medical Assessor was required to explain the impact of the injury on Mr Camacho’s level of functioning in each of those categories and not merely to quote from the examples in the Guidelines. He did not provide any explanation in the PIRS Rating Form or the MAC of the examples he used. For example, the Medical Assessor rated Mr Camacho in class 2 for self-care and personal hygiene but merely said “decrease in motivation for personal care”. He did not explain how that decreased motivation was manifested. In respect of social and recreational activities he said:
“Reduced social or recreational activities.
Has travelled with partner overseas.”
The PIRS form can only be completed on the basis of a history which has already been set out in the body of the MAC. The Medical Assessor did not provide any history to explain his assessments. By way of further example, the Medical Assessor did not provide any history to support his assessment in class 4 for employability and his opinion that Mr Camacho could return to work in a less stressful role.
The documents in the file do not support the assumptions relied on by the Medical Assessor in making the assessment. For example, he said that Mr Comache had an overseas holiday “as documented” and that it was with his partner. In his statement dated 9 August 2022, Mr Comache explained that he separated from his partner between December 2021 and March 2022 and during that period went to visit his family in Ecuador. He travelled briefly with his partner to Cairns on his return, at her request. Ms Downing’s statement dated 28 July 2022 confirmed that evidence. The Medical Assessor was required to consider that material and raise it with Mr Comache before drawing adverse conclusions from it. The failure to consider that evidence is a demonstrable error. Because it impacts on many of the PIRS Tables, a reassessment was necessary.
Medico-legal reports
The Medical Assessor was required to explain why he agreed with and differed from the other opinions in the file – it was not sufficient merely to say that he agreed with Dr Young’s assessment because that did not explain why he disagreed with the significantly higher assessment of 22% WPI made by Dr Khan. The Medical Assessor did not mention Dr Young’s significant change of opinion after seeing a social media investigation and did not refer to the statements made by Mr Comache and Ms Downing responding to the material in the investigation report, nor did he refer in detail to Dr Khan’s report dated 29 August 2022 dealing with all of that material.
Dr Young accepted in his report dated 28 June 2021 that Mr Comache had suffered a psychological injury. He had experienced some improvement in his condition though Dr Young considered that he required further treatment. He did not assess permanent impairment. In his report dated 17 May 2022, Dr Young noted that Mr Comache’s symptoms had progressed and diagnosed major depressive disorder. He assessed 22% WPI and generally agreed with Dr Khan’s report (though did not agree with the diagnosis of post-traumatic stress disorder).
Dr Young was asked to review a desktop investigation report dated 27 June 2022. The description of four photographs contained in the report is very brief and some of it is supposition. Dr Young was asked a series of questions directed to the PIRS and, on the basis of the four photographs and those questions, reviewed and changed his assessment for social functioning, social and recreational activities, concentration, persistence and pace and employability. His amended estimate was 8% WPI. Dr Young did not give detailed reasons for changing his opinion.
The Medical Assessor was not required to choose between the assessments of other examiners but he was required to engage with their reports. In State of New South Wales (NSW Department of Education) v Kaur[4] (Kaur) Campbell J said:
“In Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43; 252 CLR 480, the High Court of Australia dealt with the nature of the jurisdiction exercised by a medical panel under cognate Victorian legislation. The legislation is not entirely the same but it is broadly similar in purpose. Allowing for some differences, the High Court said at page 498 [47]:
‘The material supplied to a medical panel may include the opinions of other medical practitioners, and submissions to the Medical Panel may seek to persuade the Medical Panel to adopt reasoning or conclusions expressed in those opinions. The Medical Panel may choose in a particular case to place weight on the medical opinion supplied to it in forming and giving its own opinion. It goes too far, however, to conceive of the functions of the panel as being either to decide a dispute or to make up its mind by reference to completing contentions or competing medical opinions. The function of a medical panel is neither arbitral or adjudicative: It is neither to choose between competing arguments nor to opine on the correctness of other opinions on that medical question. The function is in every case to perform and to give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.’
Not all of this, as I have said, is apposite in the context of the New South Wales legislation. In particular it is obvious that approved medical specialists are required to decide disputes referred to them by the process of medical assessment. Even so, it is not necessary that approved medical specialists should sit as decision makers choosing between the competing medical opinions put forward by the parties. Essentially, the function is the same as that described by the High Court in Wingfoot Australia. That is to say, their function is in every case to form and give his or her own opinion on the medical question referred by applying his or her own medical experience and his or her own medical expertise. It is sufficient, as their Honours pointed out at [55], that:
‘The statement of reasons… explain the actual path of reasoning in sufficient detail to enable the Court to see whether the opinion does or does not involve any error of law.’”
[4] [2016] NSWSC 346.
The Medical Assessor did not explain his actual path of reasoning so that a re-assessment was required. The statements from Mr Comache and Ms Downing explained the photographs on social media and it does not appear from the face of the MAC that the Medical Assessor engaged with those statements or sought to discuss their content with Mr Comache during the assessment. His uncritical acceptance of Dr Young’s report was, in those circumstances, an error.
Dr Hong undertook a reassessment and we adopt his report.
For these reasons, we have determined that the MAC issued on 15 February 2023 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.
WORKERS COMPENSATION DIVISION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
Matter number: | W5875/22 |
Applicant: | Byron Valle Camacho |
Respondent: | Convoluted Technologies Pty Ltd |
This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.
The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Dr Gerald Chew and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
Table - whole person impairment (WPI)
| Body Part or system | Date of Injury | Chapter, page and paragraph number in WorkCover Guides | Chapter, page, paragraph, figure and table numbers in AMA 5 Guides | % WPI | Proportion of permanent impairment due to pre-existing injury, abnormality or condition | Sub-total/s % WPI (after any deductions in column 6) |
| Psychiatric and psychological injury | 6 May 2021 | Chapter 11 | 19 | 0 | 19 | |
| Total % WPI (the Combined Table values of all sub-totals) | 19% | |||||
PERSONAL INJURY COMMISSION
APPEAL AGAINST MEDICAL ASSESSMENT
REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR MEMBER OF THE APPEAL PANEL
MatterNumber: | M1-W5875/22 |
Appellant: | Byron Valle Camacho |
Respondent: | Convoluted Technologies Pty Ltd |
Examinationby: | Dr Michael Hong |
DateofExamination: | 8 June 2023 |
HISTORY RELATING TO THE INJURY
·Update history:
Mr Camacho has been a welder for 15 years and joined Convoluted Technology and worked full-time for 1 year and 8 months. He stopped work in May 2021 and has not performed any other work.
He had no prior psychiatric difficulty and described that within a couple of weeks of work, he started feeling stressed because of the supervisor. The other workers warned him about the supervisor being a horrible person. He found the supervisor to have aggressive manners. Sometimes he will ask the supervisor a question and he would not respond. He made negative comments and demeaned him. He said he focused on doing his work and was subjected to constant bullying and harassment.
On 6 May 2021, Mr Camacho recalled it was the end of the work day and a co-worker handed him a part to weld. He did not check the dimensions and did not realize it was too short. When the supervisor discovered this, he became furious. He tried to explain how the mistake was made and that they could fix it, but the supervisor continued to berate him, then pushed him several times and pushed him into metal rods behind him, and made comments like “Let’s go to the carpark, I’m going to bash you up”. He was swearing and made comments he would fire him. Mr Camacho remembered he was crying and distraught. He consulted his GP and was certified unfit for work, but during that time, his employer contacted him and said that he had to come back to work, which further distressed him.
After Dr Chew's assessment in February 2023, Mr Camacho described being particularly upset and presented to the hospital again, and overall, his psychological symptoms and functioning remained at a similar level. There has been no further life stressors.
He described chronic depression and anxiety and frequent panic attacks.
·Present treatment:
Mr Camacho is taking:
· Mirtazapine
· Temazepam
He consults Dr Raymond Way, psychiatrist recently every 3 months. He consults Professor Thiagarajan Sitharthan, psychologist recently every 4 weeks.
He presented to Blacktown Hospital with a panic attack in May 2021 and again after Dr Chew's assessment, on 21/2/2023. He said he had chest pain after an argument with his partner. He was not admitted and the Mental Health Team checked on him a few days later. His treatment was not changed.
·Present symptoms:
Mr Camacho reported having chronic fluctuating and depressed moods.
He has reduced enjoyment and motivation.
He said his concentration remained the same in the last 12 months, and he rarely watched television or Netflix because he cannot follow it.
He has fleeting suicidal ideation and never acts on it.
His weight fluctuated by a couple of kilograms over time.
He reported having sleep problems and sometimes nightmares.
He has panic attacks.
He reported having a low tolerance for frustration. He said he sometimes he argues with his partner and this is "not constant".
He avoids social situations due to his anxieties.
· Social activities/ADL:
Mr Camacho is 38 and he is living with his de facto partner of seven years. He has two daughters from his previous marriage, and he sees the 13-year-old every second week. The older one is at university.
He does not want to go out and mostly stays at home. He wakes up in the morning, he will drink some water, check his phone, watch a bit of YouTube or check Facebook. He will pace around the apartment. He usually goes out to take a walk in the park. He rides his bicycle to the shops, which is only five minutes away, once a week.
He talks to his mother every day and talks to his three brothers regularly. They are overseas. He sees his father maybe once a month and he lives 40 minutes away.
Mr Camacho said he has a lot of friends but he does not talk to them anymore. He remains in contact with his friends on Facebook. He said that in the past, he liked to go hiking, do 4-wheel drive and camping with his friends, but now he has no motivation to do it and does not engage in any recreational activities with his friends.
We discussed the surveillance report, his statement, and his partner's statement in relation to the surveillance. He reported that in the last two years, the only overseas trip had been in January 2022. He went back to Ecuador on his own because his mother had a COVID infection and was sick. He was there for two months and when he returned, he said that his partner had organised a surprise trip to go to Cairns for ten days and he went scuba diving with an instructor. Only the two of them took that trip. Aside from this, he has not taken other interstate or overseas trips.
He said the only time he went hiking in the past 12 months, was to the Blue Mountains a couple of weeks ago with his partner and no one else, however, he felt anxious and said that he was anxious with heights, which was not a problem before.
Mr Camacho said he has only been to the Nepean Bridge to ride his bicycle once and since the surveillance photo, he has not done it again or taken other long rides on his bicycle.
I also confirmed the cruise was taken on Australia Day and uploaded many months after it was taken, and he has not been on other cruises in the past 2 years.
He said there was never any problem with his partner and the relationship suffered because of his changed behaviour after his work injury. She wants to go out and do things, but he refuses so they start arguing. He said that she has a strong character and they separated for two months. He said that he was very depressed at the time and she said to him that he was selfish and did not consider her feelings, at the same time his mother was not well and he wanted to go back to visit her. I discussed with him, the statements made by his partner in his updated statement about the relationship. I confirmed the two-month separation was during the time he was in Ecuador. On return, he was back at the apartment with his partner, and she had organised a surprise trip and then they went to Queensland. He said the relationship is better now and they love each other very much. I asked Mr Camacho whether they would likely separate again, he said that they do not want to do that, however, he cannot predict the future. Previously they discussed having children and now, he does not think it would happen.
He reported that he was driving with his partner and was not paying attention and went through a red light, so he has stopped driving in the last six weeks. When he goes out now, he has to walk or ride his bicycle.
FINDINGS ON EXAMINATION
Mr Camacho was assessed by video. He was at home during the assessment. I assessed him from my Sydney office. I have completed a full psychiatric assessment with consent.
Mr Camacho had a goatee beard and presented as dishevelled. He warmed up and smiled as the assessment progressed. He engaged well with the video assessment process. There was no psychomotor slowing or abnormal movements. He was moderately restricted in his affect range and reactivity. He gesticulated freely and frequently. He spoke with an accent and was easy to understand.
SUMMARY
· summary of injuries and diagnoses:
Mr Camacho suffered chronic depressive symptoms and anxiety as a result of the described workplace issues, which has been variously diagnosed as Major depression, Adjustment disorder and Persistent depressed disorder. His current presentation is consistent with chronic Major depressive disorder. His symptoms fluctuated and there has been no substantial change for more than 12 months. His condition is stable and MMI has been reached.
· consistency of presentation
I have found no inconsistency in Mr Camacho's presentation.
PERSONAL INJURY COMMISSION
Table 11.8: PIRS Rating Form
| PIRS Category | Class | Reason for Decision | |||||||||
| Self-care and personal hygiene | 2 | Mr Camacho skips meals sometimes. He said he cooks 3 days per week and his partner cooks more than he does. He does the shopping and some household chores. Sometimes, he only showers every 3 days. He does not need prompting with self-care. | |||||||||
| Social and recreational activities | 3 | He used to go out with his friends, and enjoyed camping, hiking and eating out. He relinquished these activities. He has taken one trip which involved social and recreational activities. He tried hiking with his partner recently and felt anxious. | |||||||||
| Travel | 2 | Mr Camacho is anxious and avoids crowded places. He can travel overseas on his own and visit his family in Ecuador in early 2022. He has panic attacks when driving. | |||||||||
| Social functioning | 2 | Mr Camacho's relationship with his partner deteriorated and they argue intermittently. They separated when he visited his family overseas and they are back together. The relationship has improved and unlikely to separate again. | |||||||||
| Concentration, persistence and pace | 3 | Mr Camacho struggles with his concentration and ran through a red light due to inattentiveness. He does not engage in intellectually demanding tasks now. He can follow short videos and read online posts, but not more demanding tasks. | |||||||||
| Employability | 5 | Mr Camacho is anxious and avoidant, and described being fearful of people and being bullied again. He does not engage in meaningful activities that could be considered compatible with employment. | |||||||||
Score | Median Class | ||||||||||
| 2 | 2 | 2 | 3 | 3 | 5 | = 3 | |||||
| Aggregate Score Impairment | Total | % | |||||||||
| + | + | + | + | + | 17 | 19 | |||||
0
5
0