Cavaleri v Woolworths Limited

DETERMINATION OF APPEAL PANEL
CITATION:	Cavaleri v Woolworths Limited [2023] NSWPICMP 23
APPELLANT:	Josephine Cavaleri
RESPONDENT:	Woolworths Limited
Appeal Panel
MEMBER:	Deborah Moore
MEDICAL ASSESSOR:	Douglas Andrews
MEDICAL ASSESSOR:	Nicholas Glozier
DATE OF DECISION:	27 January 2023
CATCHWORDS:	wORKERS cOMPENSATION - The appellant submitted that the Medical Assessor (MA) erred with respect to three categories in the psychiatric impairment rating scale (PIRS); Held – Appeal Panel found no errors by the MA in all PIRS categories the subject of appeal; Medical Assessment Certificate confirmed.

BACKGROUND TO THE APPLICATION TO APPEAL

On 21 November 2022 Josephine Cavaleri (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Michael Hong, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 31 October 2022.
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): deterioration of the worker’s condition that results in an increase in the degree of permanent impairment,
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error pursuant to s 327(3)(d) of the 1998 Act.
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.
The WorkCover Medical Assessment Guidelines 2006 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 the WorkCover Medical Assessment Guidelines 2006.
The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed
1 April 2016 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th 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 WorkCover Medical Assessment Guidelines 2006.
As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because although one was requested, no specific reasons were given as to why this was necessary, and in any event, we consider that we have sufficient evidence before us to enable us to determine this appeal.

EVIDENCE

Documentary evidence

The Appeal Panel has before it all the documents that were sent to the MA for the original medical assessment and has taken them into account in making this determination.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
In summary, the appellant submits that the MA erred in finding there was a Class 2 in the category of self-care and personal hygiene, social functioning, and concentration, persistence and pace (cpp) of the psychiatric impairment rating scale (PIRS) when there should have been a finding of a Class 3 impairment.
In reply, the respondent submits that no errors were made.

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 appellant was referred to the MA for assessment of whole person impairment (WPI) in respect of a primary psychiatric/psychological injury resulting from a deemed date of injury of 26 October 2021.
The MA obtained the following history:
“Ms Cavaleri worked at Woolworths from 1990 for about 28 years. She performed various roles, including working at the stores for ten years, and then became the range planner. She worked full-time and received redundancy in 2019, with the last day of work on 2 May 2019.
Her job involved finding warehouses for the new product that they were going to sell, and she found it increasingly difficult to do her job and was eventually put on a Performance improvement plan.
She described stress at work over a few years, and reported the main problem started around 2017 when a new supervisor / team leader commenced work. She reported once the new supervisor started, the supervisor made her life very difficult and after a while, she stated she could not function as she felt stressed at work all the time. The supervisor turned the other workers against her.
She said as a result of the way her employer treated her, she lost all confidence; she said nobody supported her and she had no help from HR.
She consulted Employee assistance program and once she ceased work, she started treatment with a private psychologist.”
After documenting Ms Cavaleri’s current treatment, the MA then set out her present symptoms as follows:
“She reported that she does not feel like herself, she has no confidence in doing anything. She is anxious. She only leaves home if absolutely necessary and the thought of returning to work makes her very anxious, to the point that she wants to vomit.
She reported having chronically depressed mood.
She has reduced enjoyment and motivation.
She described having reduced concentration and memory, and said this may be age-related. She uses post-it notes to remind herself of important activities.
She is easily fatigued.
Anxiety affects her bowel symptoms.
Suicidal ideation mostly occurred during her marriage. Since then, she has had transient suicidal thoughts, e.g. ‘everything just stop’ without acute suicidal ideation.
She gained weight, around 5kg in 2022, and explained she does not exercise.
She reported having “on-and-off” sleep problems, and said she sleeps well sometimes.
She feels anxious.
She stated irritability and anger were major problems during her marriage, and then she became a calm person. However, as a result of work stress, she is irritable again, sometimes she would speak with a loud voice or yell when upset. She reported being quiet and socially withdrawn.
Ms Cavaleri denied having self-harm behaviour.”
The MA then turned to consider “Details of any previous or subsequent accidents, injuries or conditions” noting that there had been episodes of depression in the past which we do not need to repeat here, given the nature of the issues in dispute.
After noting Ms Cavaleri’s general health and work history, the MA then set out details of the impact of her injury on her social activities and activities of daily living (ADL’s) as follows:
“Ms Cavaleri is living on her own. Her daughter and granddaughter were living with her, and moved out six weeks ago. She has another daughter living next door. She has three adult daughters.
She cooks occasionally and reported there is no problem with shopping. She attends to the housework, but not as much now.
She has been told she has Irritable bowel syndrome and has to see a gastroenterologist soon, and may need another endoscopy. She has had IBS for maybe five or six years and said that when she goes out, she does not eat because if she eats she would have loose bowels and need to use the toilet immediately.
She said before the subject work injury, she was quite active. She liked going out to dinner and dances with five or ten girlfriends, however, since the work injury she cannot remember the last time she has done anything like that as she became quite socially anxious.
She prepares simple foods such as sandwiches and cooks meat dishes, but she does not cook every day. Sometimes her daughter would come over with some food. One daughter comes once a week, the other one almost every day as she lives next door. Sometimes the 4-year-old grandson will come as well and they do some arts and craft together.
Ms Cavaleri said she potters in her garden and watches television. She does laundry once a week.
She likes to read fantasy books. She is reading the third of four-book series, but said she has trouble following the characters. She said she would get up in the morning, drink coffee and then read for one hour, or sometimes she would read the book at night or watch television until she falls asleep.
In the daytime, she feels like she is busy but often finds that she does not get much done. She might call somebody and attends to various house work, such as vacuuming and mopping. She said she is not as house proud now as she was in the past.
Sometimes Ms Cavaleri has visitors. A cousin lives locally, and about four weeks ago she organised and took Ms Cavaleri out to get facial treatment. She has a friend who lives up the coast and the friend visited her maybe twice this year. Another friend visited her recently as well. She mostly has phone calls with her friends as they are not nearby.
Ms Cavaleri goes to some family functions with her sisters and nieces, such as birthday parties, and estimated she may have gone two or three times, however, she tends to be quite withdrawn.
She does not exercise.”
Findings on mental state examination were reported as follows:
“Ms Cavaleri was assessed by video. She was at 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. The assessment took 60 minutes.
Ms Cavaleri had greying hair and her hair was tied back. She engaged well with the video assessment process. There was no psychomotor slowing or abnormal movements.
She was mildly restricted in her affect range and reactivity. Her affect appeared reactive, and she laughed regularly. She gesticulated freely and frequently.
Ms Cavaleri provided a coherent history and elaborated on various aspects of her history. She was consistently focused throughout the assessment. She did not perseverate and there was no set-shifting difficulty. She demonstrated a normal speed and pace.
At the end of the assessment, I asked Ms Cavaleri for additional information that she thought may be relevant and she discussed she feels lost now.”
The MA summarised the injuries and diagnoses as follows:
“Ms Cavaleri has suffered recurrent depression, anxiety and trauma symptoms. My view is that she had Posttraumatic stress disorder and Major depressive disorder in the past. She has achieved symptomatic remission and returned to work without difficulty. She remained asymptomatic for years.
As a result of prolonged work stress, predominantly related to a new team leader at work, she developed depression and anxiety symptoms again. My view is that she has sustained a relapse of Major depressive disorder.
It is now more than three years since she stopped working and she has had sufficient treatment and my view is her psychological condition has stabilised.
I have diagnosed Major depressive disorder and noted that her symptoms have not resolved any time since her work injury.
There was limited or no past psychiatric history recorded in Dr Clark and Dr Vickery’s reports. Overall my view is that she has suffered recurrent episodes with similar symptoms, her previous episode of depression and anxiety has significantly increased her vulnerability and increased her overall current impairment. As she has maintained symptomatic remission for years before the subject injury, my view is that her pre-existing injury only has a small contribution and therefore I deducted one-tenth for her pre-existing injury.”
The MA assessed 9% WPI from which he deducted one-tenth in respect of the pre-existing condition, a total of 8% WPI.
He then turned to consider the other medical opinions and evidence and said:
“Ms Cavaleri’s statement had been noted, which outlined her workplace difficulties with the supervisor, and she started having counselling through EAP in 2016 with Sarah Hoski.
Ms Cavaleri's further statement noted that she found her daughter living with her to be great help and provided motivation for her. She had been extremely unmotivated since she stopped working. She still talked to some friends on the phone and travelled locally to do the shopping. She does believe she can form romantic relation now. Her concentration is extremely limited. She forgets things and writes a lot of notes. She was a very social person, but she is not now.
Dr Thomas Oldtree Clark IME psychiatrist reported on 5 March 2020, noted that she suffered work stress relating to a new team leader. She is still carrying out all the normal household duties. In 2001, she had a leg fracture driving a forklift. Comment: There was no specific previous psychiatric history recorded. Ms Cavaleri's GP noted a past psychiatric history.
Dr Clark advised Ms Cavaleri's condition is permanent and provided WPI with ratings of 3, 3, 1, 3, 2, 3.
Dr Clark, 11 October 2021 noted Ms Cavaleri's progress and diagnosed major depressive disorder. There was no comment about her past psychiatric history. He also provided a WPI on this occasion 3, 3, 1, 4, 2, 5 totalling 22% with one line explanation for his rating. He also added 1% because she had attended psychologist treatment.
Ms Cavaleri's treatment record and handwritten notes have been noted. There were also psychologist entries.
Her GP record, 14 August 2019 from Dr Calabresi noted depression in 1999, sleep apnoea and also depression in August 2019.
GP care plan, 14 August 2019, noted history of depression and anxiety in the past and noted severe depression and anxiety from intense stressful work environment.
Psychologist handwritten notes 30 January 2020 noted PTSD, applied CBT and STOP thought challenging. On 9 July 2020, handwritten notes noted antidepressant helping feeling better improved sleep.
MLC Life Insurance treating doctor report noticed severe depression and anxiety, thyroid dysfunction with a history of depression and consultation during 2020 and 2021 and this was dated 2 February 2021 by Dr Calabresi.
WCC Certificate determination, 11 September 2020 had determined that Ms Cavaleri does have a current work capacity based on the current evidence.
Dr Graham Vickery IME psychiatrist reported on 21 June 2021 noted Ms Cavaleri had psychological counselling from 2001 to 2004. The personal stressor includes IBS and not wanting to leave house to go places due to her bowel dysfunction. She enjoyed reading and gardening and does housework and did shopping. There was some reduction in showering, and not showering unless she has to go out. She is close with her sister and daughter and two close friends. He diagnosed Specific phobic disorder of job interview. He provided WPI ratings of 2, 1, 1, 1, 2 totalling 1% - he also advised her WPI is not due to her employment.
Dr Vickery, 31 January 2022, had reassessed Ms Cavaleri with largely similar history of her symptoms and functioning. At this time, he diagnosed Persistent depressive disorder with bouts of Major depressive disorder and advised she is not fit for employment, however, he also advised that she needs further treatment and the condition is not yet stabilised. He advised his assessment differed from Dr Clark in that Ms Cavaleri has not reached MMI, he advised that it is significant Dr Clark has not documented features of Major depressive disorder.
Comment:
Dr Vickery raised concerns with Dr Clark’s diagnosis of Major depressive disorder, nevertheless Dr Vickery diagnosed Major depressive disorder himself. There was no specific reference to DSM-5.
I consider Ms Cavaleri's psychological response to have fulfilled all of the diagnostic criteria of Major depressive disorder. The DSM-5 listed 9 core symptoms of MDD. She has had more than 5 of the listed symptoms for at least 2 weeks, and there are no other better explanations for her depressive symptoms. She has pervasively depressed mood and significant anhedonia, she has experienced significant weight gain, significant sleep impairment, a significant loss of energy and reported having had suicidal ideation.
Her symptoms cause her clinically significant distress. Her symptoms are not due to the physiological effects of a medication or substance, and are not part of a general medical condition. Her symptoms are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or schizophrenia/psychosis spectrum disorder, acute stress disorder symptoms or adjustment disorder. She has never experienced manic or hypomanic symptoms.
It is difficult to compare with Dr Clark’s PIRS assessment, as it contained generally one-line explanation.
It is difficult to compare with Dr Vickery’s PIRS, as he initially only assessed her for a non-work injury, and subsequently he advised she has not reached MMI.”
The appellant commenced her submissions by setting out in some detail the legislative framework as it applies to medical assessments.
We agree with the principles set out therein.
Turning firstly to the category of self-care and personal hygiene, the appellant makes the following submissions:
(a)     The history provided to the MA included:
(i)“Only leaves home if absolutely necessary” (pg 2);
(ii)ses “post-it notes” to remind herself of important activities (pg 2);
(iii)has anxiety affected bowel symptoms (pg 2);
(iv)has gained 5kg in weight (pg 3);
(v)is quiet and socially withdrawn (pg 3).
(vi)that she only prepares simple foods and does not cook every day (pg 4);
(vii)that her daughter would sometimes come over with food (pg 4);
(viii)that one daughter visits once a week, the other almost daily (pg 4), and
(ix)that she does laundry once a week.
(b)     The statement dated 13 April 2022 is even more telling as to the assistance she gets from her relatives.
(c)     On the history given, it is hardly the case that she is truly independent. She is clearly not independent; she requires significant assistance from others.
(d)     Indeed, the MA seems to have recognised that:
“[she] reported neglecting her self-care. She said she does not eat regularly and generally has 1 or 2 meals a day. She said she showers when she goes out, generally only twice a week. She does not need prompting with her self-care. She is capable of independent living without regular support.” (pg 11).
(e)     The first four sentences unequivocally support a finding of at least Class 3. The last sentence is inconsistent with the rest. It amounts to a non-sequitur. It could easily have said “…she is incapable of independent living without regular support” (pg 11).
(f)     Moreover, the last sentence is plainly inconsistent with the findings on pg 3 and 4. It supports a finding of Class 3. So too does the evidence set out in the statement dated 13 April 2022.
(g)     Alternatively, the MA has failed to properly explain how, in light of the history provided, she was otherwise capable of living independently without regular support.
To begin with, the appellant has confused what constitutes “self-care and personal hygiene” in the context of the various PIRS categories.
For example, her ability to leave home, visits by her daughters and her claimed social isolation are more relevant to the category of either social functioning, social and recreational activities or perhaps travel. Similarly leaving herself post-it notes is more relevant to the category of cpp.

The MA assessed a Class 2 rating, stating:
“Ms Cavaleri reported neglecting her self-care. She said she does not eat regularly and generally has 1 or 2 meals a day. She said she showers when she goes out, generally only twice a week. She does not need prompting with her self-care.
She is capable of independent living without regular support.”
The descriptor for a Class 2 rating reads:
“Mild impairment: able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.”
The descriptor for a Class 3 rating reads:
“Moderate impairment: Can’t live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit) 2- 3 times per week to ensure minimum level of hygiene and nutrition.”
In our view, there is nothing in the evidence to support a Class 3 rating in this category for reasons that follow.
To begin with, the only relevant submission by the appellant on this issue is the claim that “she only prepares simple foods and does not cook every day” and that “her daughter would sometimes come over with food”.
That is not consistent with a Class 3 rating.
The MA clearly acknowledged that Ms Cavaleri neglected her self care and personal hygiene to a degree, but there was no suggestion that she was unable to live independently or required regular support.
As the MA noted:
“She cooks occasionally and reported there is no problem with shopping… She prepares simple foods such as sandwiches and cooks meat dishes, but she does not cook every day… She attends to the housework, but not as much now…. She does laundry once a week…
She… attends to various house work, such as vacuuming and mopping…”
He also noted that: “One daughter comes once a week, the other one almost every day as she lives next door”.
That is the kind of familial help one might expect from adult daughters, particularly the one living next door, rather than a reflection of a need for a “Family member or community nurse [to] visit (or should visit) 2- 3 times per week to ensure a minimum level of hygiene and nutrition” (our emphasis) as noted in the Class 3 descriptor.
In addition, as the respondent pointed out, we note that Ms Cavaleri had a facial treatment only four weeks prior to the assessment. Although in our view that is not a significant factor, it merely reinforces our view that a Class 2 rating as found by the MA was appropriate.
The focus of the appellant’s submissions seems to be that she cannot be regarded as capable of living independently without regular support.
For the reasons stated, we do not accept that this is so, and we cannot see any error by the MA with respect to this category. He explained clearly and in detail the actual path of his reasoning.
Turning next to the category of social functioning, the appellant submits as follows:
“The history provided to the assessor was that the appellant:
a. Only goes out when absolutely necessary (pg 2)
b. Is irritable (pg 3).
c. Speaks in a loud voice or yells when upset (pg 3).
d. Is quiet and socially withdrawn (pg 3).
e. Cannot remember the last time she has gone out to dinner or dances and she has become socially anxious (pg 4).
f. She may have gone to two or three times to family functions, although she does have some visitors (pg 4).
These features fit more comfortably within Class 3, than Class 2.
An important aspect of the appellant’s impairment relates to the relationship/circumstances with her daughter. That is because the daughter previously lived with her, assisted her greatly (see the statement dated 13 April 2022), but recently moved out.
At page 3, the MA records: ‘In terms of other stressors [the appellant] reported that her daughter moved in and they lived together about two and a half years. They did not get along that well and it was stressful at times. She found herself moody and irritable with her daughter’.
It is not known what is meant by “other stressors”. If the MA was using the term to distinguish between work related stresses and unrelated stresses, it is not clear why he has done so.
If he was not doing that, it is not clear why the MA did not regard the moving out as a “separation” within the meaning of Class 3. That would fit comfortably with the history provided by the appellant as to the effects the injury has on her every day relationships (see also paragraph 10 of the Statement dated 13 April 2022).
The appellant submits that in all the circumstances she ought to have been assessed with a Class 3 impairment.
Alternatively, the MA has failed to provide a clear pathway of reasoning as to what was meant by ‘other stressors’ and/or why the appellant was only a Class 2 impairment.”
Again, many of the submissions made with respect to this category are more relevant to other PIRS categories, in particular, social and recreational activities, which are not the subject of appeal.
This category is primarily concerned with relationships.
The descriptor for a Class 2 reads:
“Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.”
Class 3 reads:
“Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services.”
In assessing a Class 2, the MA said:
“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.”
It is clear that the MA’s reference to “other stressors” was made in the context of him considering “Details of any previous or subsequent accidents, injuries or conditions”. That involved consideration of various events commencing in about 1998 with other events in “2001 to 2004” including separation and episodes of domestic violence.
He said:
“Ms Cavaleri reported that her daughter moved in and they lived together about two and a half years. They did not get along that well and it was stressful at times. She found herself moody and irritable with her daughter.”
There is no evidence of any subsequent strain in the relationship with any of her daughters. Indeed, they appear to visit regularly as noted above. Indeed, the MA noted that at the time of the assessment, “The relationship with her general family is good and they are close”.
The MA also noted that the appellant had “ceased contact with some of her friends”, but as the respondent points out, “she provided no history of such cessation in contact being caused by a strain upon the relationship as a result of the work-related psychiatric injury”.
The appellant has continued to keep in contact with friends, albeit mostly by way of telephone as they did not live nearby. She also continued to receive visitors.
Even if the appellant has lost some friends because of strain or her social disengagement due to her work injury, this would not be a sufficient reason to find a Class 3 impairment in this case.
Chapter 1.6 of the Guidelines makes it clear that “assessing permanent impairment involves clinical assessment of the claimant as they present on the day…”.
The weight of the evidence in our view clearly supports a finding of a Class 2 rating.
Turning finally to the category of cpp, the appellant submitted that she should be rated a Class 3 and not 2 as found by the MA. She makes the following submissions:
“The assessor said: Ms Cavaleri reported having reduced concentration.
She has not undertaken study or retraining since the subject injury.
She reads books, around 60 minutes on most days.
Her mental state examination is consistent with 2.”
The difficulty with this is:
(a) the MA seems to have confined his conclusion as to how she presented at the “mental state examination” (i.e as opposed to assessing her in accordance with the relevant PIRS tables at large), and
(b) there is no section in the report setting out the relevant “mental state examination”.
This is not trivial. The appellant is entitled to know exactly what were the reasons that she was found to have only a Class 2 impairment. The MA either confined the assessment, misunderstood the nature of his role, or failed to provide proper reasons, in assessing this category.
To begin with, the MA clearly documented his findings on examination at Part 5 of the MAC although we concede that the template, somewhat misleadingly, refers to “Findings on Physical Examination”.
As noted above, the MA is required to make his assessment on the day of the examination, in accordance with the Guidelines.
It is also clear from the extensive material referred to by the MA at Part 10 of the MAC that he did not rely solely on his findings on examination.
The descriptor for a Class 2 reads:
“Mild impairment: can undertake a basic re-training course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feel fatigued or develops headache.”
The descriptor for a Class 3 reads:
“Moderate impairment: unable to read more than newspaper articles. Finds it difficult to follow complex instructions (eg, operating manuals, building plans), make significant repairs to motor vehicle, type long documents, follow a pattern for making clothes, tapestry or knitting.”
On mental state examination, the MA noted:
“Ms Cavaleri provided a coherent history and elaborated on various aspects of her history. She was consistently focused throughout the assessment. She did not perseverate [sic] and there was no set-shifting difficulty. She demonstrated a normal speed and pace.”
It is noted that he saw Ms Cavaleri in October 2022, a year after she was assessed by
Dr Clark.
The MA clearly explained why he disagreed with Dr Clark.
The MA conducted a thorough mental state examination. The assessment itself is a cognitively demanding task that enables an objective evaluation of an appellant’s impairment in concentrating and persisting with such a task, and the pace at which an appellant can do this. The MA recorded Ms Cavaleri’s presentation as set out above, during an assessment that took one hour.
The MA concluded that the appellant’s abilities in this category were mildly impaired and consistent with the general descriptor of a Class 2 rating.
The descriptors are just that: a broad outline of the sorts of activities or cognitive impairments in a particular category.
Consistent with his task, the MA based his assessment on all of the evidence to which he referred including his own detailed assessment on the day of examination.
In our view, the MAC was both thorough and detailed, and we cannot see any errors in the findings and assessment of the MA.
For these reasons, the Appeal Panel has determined that the MAC issued on
31 October 2022 should be confirmed.

[2023] NSWPICMP 23

27 January 2023