Lazarus v Connor Clothing Pty Ltd
[2024] NSWPICMP 537
•2 August 2024
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Lazarus v Connor Clothing Pty Ltd [2024] NSWPICMP 537 |
| APPELLANT: | Michelle Lazarus |
| RESPONDENT: | Connor Clothing Pty Ltd |
| APPEAL PANEL | |
| MEMBER: | Richard Perrignon |
| MEDICAL ASSESSOR: | Graham Blom |
| MEDICAL ASSESSOR: | Michael Hong |
| DATE OF DECISION: | 2 August 2024 |
| CATCHWORDS: | WORKERS COMPENSATION - Appeal from assessment of whole person impairment (WPI); psychological injury; whether Medical Assessor (MA) erred when assessing WPI under the psychiatric impairment rating scale (PIRS) in terms of social functioning and employability; whether MA erred by failing to give reasons for deduction; Held – Medical Assessment Certificate revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
The appellant worker, Ms Lazarus, appeals from the Medical Assessment Certificate of Medical Assessor Verma dated 22 February 2024. Medical Assessor Verma examined her on 12 February 2024 by video, and diagnosed post-traumatic stress disorder as a result of injury on 9 June 2023 (deemed date).
She assessed a 19% whole person impairment (psychological). From this, she deducted 7% for a pre-existing psychiatric condition, to arrive at a final whole person impairment of 12%.
In doing so, the Medical Assessor assessed two of the psychiatric impairment rating scales (PIRS) as follows:
(a) Employability: Class 4 impairment.
(b) Social functioning: Class 2 impairment.
The appellant submits that the assessment of these two rating scales, and the deduction of 7% for a pre-existing condition, demonstrate error. No other error is alleged.
The Appeal Panel conducted a preliminary review of the Medical Assessor’s medical assessment in the absence of the parties and in accordance with the Guidelines.
Submissions
The parties made written submissions which have been taken into account. It is unnecessary to repeat them in full. The appellant’s submissions may be summarised briefly as follows:
(a) In respect of Employability:
(i)the assessment of a class 4 impairment was inconsistent with the conclusions expressed by the Medical Assessor at pages 5 and 15 that the worker did not have any capacity to engage in any form of employment. Those conclusions justified a class 5 impairment, and
(ii)the views expressed at pages 10-12 of the Medical Assessment Certificate to the effect that the worker had capacity to work less than 20 hours per fortnight, in answer to the class 5 impairment assessed by independent psychiatrists Dr Doris (relied on by the insurer) and Dr Rastogi (relied on by the worker) were also inconsistent with the conclusions referred to in the preceding paragraph, demonstrating error.
(b) In respect of Social functioning:
(i)the Medical Assessor assessed a class 2 impairment, as had Dr Doris and Dr Rastogi;
(ii)the Medical Assessor took a history that the worker had separated from her husband, though the two continued to live together. That history was not taken by Dr Doris or Dr Rastogi, indicating that separation had probably occurred after their assessments, and represents a deterioration in social functioning since those assessments, and
(iii)the recent separation was consistent with a class 3 impairment. The Medical Assessor failed to give reasons as to why a class 3 impairment was not assessed.
(c) With respect to the deduction of 7% whole person impairment for the effects of a pre-existing psychological condition:
(i)Dr Doris deducted only 1/10th;
(ii)the Medical Assessor failed to give reasons for not applying a 1/10th deduction, for instance on the ground that pre-existing impairment would be costly or difficult to determine, and
(iii)she gave no reasons for assessing pre-existing impairment as class 1 for Travel and class 2 for Concentration persistence and pace.
The respondent submits in brief summary as follows:
(a) In respect of Employability:
(i)the Medical Assessor explicitly found that the worker could work less than 20 hours per week. This was consistent with a class 4 impairment and inconsistent with a class 5 impairment, and
(ii)he also noted that the desktop report indicated that the worker had been working one day a week when she commenced work for the respondent in April 2021, and had not worked at all for the previous 12 years due to a pre-existing ‘injury’. As she was working less than 20 hours per week prior to injury on 9 June 2023 (deemed date), a class 4 impairment was appropriate.
(b) In respect of Social functioning:
(i)a Class 2 impairment was accurate. The applicant was experiencing significant pre-existing marital problems in 2021 and 2022, before commencing employment with the respondent, as noted in the clinical notes of Ms Thomas and Mr Simos;
(ii)she was also experiencing strained relationships with her sister before commencing work and had never had friends as an adult;
(iii)a class 3 assessment was not justified as there were no periods of domestic violence or community services looking after the children, and
(iv)the reasons given by the Medical Assessor in his PIRS table were sufficient to justify a class 2 impairment, and were not inconsistent with the history she took or the evidence before her.
(c) With respect to the deduction of 7% for the effects of a pre-existing condition:
(i)the Medical Assessor found that the worker had a past history of post-traumatic stress disorder and MDD since her mid-20’s, and that impairment resulted from an exacerbation of those conditions by work stressors;
(ii)the evidence of Mr Simos supported a finding that the pre-existing conditions had resulted from the worker’s experiences during an ICAC investigation in 2010, when she was diagnosed with those conditions;
(iii)the Medical Assessor assessed current impairment at 19% whole person impairment, and found 7% of that was due to the pre-existing condition;
(iv)she noted that the worker had received psychiatric treatment since 2010 including a hospital admission due to breakdown a couple of years back;
(v)it was open to the Medical Assessor to find that the pre-existing conditions remain a significant source of the current impairment, and that a 10% deduction would be at odds with the medical evidence;
(vi)the Guidelines at [11.10] required her to measure the impairment caused by injury by first rating the worker’s pre-injury level of functioning in each scale, which is what she did, and
(vii)with respect to the allegation that she gave no reasons for assessing a Class 2 impairment for pre-existing Concentration persistence and pace, that was a matter for her clinical judgment, she is not bound by the opinions of other assessors, and she is not required to list every clinical note and piece of evidence or explain why it was not relied upon. It was in any event her assessment was well reasoned.
Employability
The criteria for rating class 4 and 5 impairment in Employability are as follows:
Class 4
Severe impairment: cannot work more than one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic.
Class 5
Totally impaired: Cannot work at all.
In the PIRS form attached to the Medical Assessment Certificate, the Medical Assessor gave the following reasons for assessing a class 2 impairment:
“Ms Lazarus does not seem to have any capacity to engage in any form of employment because of struggles with her current symptomatology and difficulties in cognitive functioning, and impairment in various PIRS categories.
I have noted that when she started employment with Connor, she started working one day per week which is equivalent to class 3 impairment in the PIRS rating form.”
These reasons express a finding that the appellant had no capacity for any form of employment. That finding compelled a class 5 assessment, unless the assessor was of the view that the impairment did not result from injury. No such view was expressed. The finding that the worker was probably suffering from a class 3 impairment when she commenced employment with the respondent, even if accurate, would not sever the causal relation between injury and current impairment, nor does it explain the assessment of a class 4 impairment in the face of an express finding that there is no capacity for work. This demonstrates error.
The respondent correctly points out that there were findings elsewhere in the reasons that the worker was capable of less than 20 hours work per week. These findings are inconsistent with the finding of no capacity for work. The inconsistency is unexplained, and the contrary findings are irreconcilable. The inconsistency also demonstrates error, requiring that the assessment be set aside.
It is appropriate for the Panel to make its own findings on employability, after a further examination of the worker.
Social functioning
The criteria for rating class 2 and 3 impairment in Social functioning are as follows:
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.
In his PIRS form attached to the Medical Assessment Certificate, the Medical Assessor gave the following reasons for assessing a class 2 impairment – emphasis added:
“Ms Lazarus reported that she ‘never had friends as an adult.’ She does not get along with her sisters even before the incidents at the workplace and even before she started working at Connor. She said that the court case took a toll on her relationship with her sisters. Her mother lives with her sister and hence, she does not see her mother as frequently. She added that her relationship with her husband is strained and although they live together, they have separated.
There have been no periods of domestic violence or community services looking after the children. Overall, her relationships with her sisters and her mother were already strained when she started working with Connor.”
This passage indicates that the Medical Assessor considered that the social impairment evidenced by the worker’s lack of friends, and her failure to get on with her sisters, pre-dated her employment with the respondent, that they did not result from injury, and that her lack of contact with her mother results from that pre-existing situation.
It was the Medical Assessor’s task to identify all impairment in social functioning, and to determine what part of it, if any, resulted from injury. She has done so. We can discern no error in that approach.
Her task was then to have regard to the criteria for each class of impairment, and to assess the class of impairment resulting from injury which was supported by the evidence.
The Medical Assessor had express regard to the fact that the spouses had separated, though living under one roof. That satisfied one of the criteria for a class 3 impairment. In those circumstances it was incumbent on the Medical Assessor to explain why a class 3 impairment was not assessed.
The only explanation given was that other criteria were not satisfied, such as domestic violence and community services looking after the children. The criteria for a class 3 impairment require severe strain in relationships evidenced by periods of separation ‘or’ domestic violence. Where, as here, separation has occurred, it not necessary to establish that domestic violence has also occurred.
The Medical Assessor noted that Ms Lazarus lived at home with her husband and two children, that the children look after themselves, make their own lunches and take themselves to school, and that her husband ‘does the rest’. In context we interpret that to mean that, to the extent the children need assistance, it is provided by him. This is also consistent with the criteria for a class 3 impairment.
The Medical Assessor did not explain why, in those circumstances, a class 3 impairment was not indicated. That amounts to inadequacy of reasons, demonstrating error and requiring that the assessment be set aside.
The error is capable of correction without further examination because, for the reasons already expressed, the criteria for a class 3 impairment were satisfied even if (as the Medical Assessor found) the strain in relationships with the worker’s sisters and mother predated her employment with the respondent, and there was strain in the marital relationship (as distinct from separation) prior to injury.
The Appeal Panel is satisfied that the evidence supports a class 3 impairment, sets aside the Medical Assessment Certificate ,and substitutes its assessment for the class 2 impairment assessed.
Deduction for pre-existing condition
The Medical Assessor took the following history at [4] of her reasons:
“Ms Lazarus was diagnosed with PTSD and depression since 2010 in the context of a complex court case where Ms Lazarus and her sister were accused of fraud for research in their work. She was treated with a number of antidepressants and psychological interventions both with Psychologist and Psychiatrist. She also had a hospital admission due to breakdown a couple of years back.”
And at [7]:
“I have also noted a long history of significant mental health problems dating back approximately 10 years which seemed to have emanated from the court case that she was in. It is quite evident that Ms Lazarus’ chronic mental health problems were exacerbated in the workplace. She has had extensive treatment by a Psychiatrist over several years and subsequently by a Psychologist. She continues to receive antidepressant medications and psychological interventions.”
At [8e], she found that a proportion of the whole person impairment was due to a pre-existing injury, condition or abnormality. She said at [11a]:
“Ms Lazarus has a past extensive history of Post-Traumatic Stress Disorder and Major Depressive Disorder.”
And at [11b]:
“Ms Lazarus appears to have suffered from a Major Depressive Disorder with anxious distress since her mid-20s. Major Depressive Disorder by nature is an illness which can become chronic and tends to vary in intensity. It is known that Major Depressive Disorder and Post-Traumatic Stress Disorder run a chronic course and are often exacerbated by stressors. It seems that the employment with Connor exacerbated her mental health.
I have also noted that Ms Lazarus was noticing improvement in her mental health when she had started working with Connor after a gap of 12 years. It is clear that the past history of Major Depressive Disorder and Post-Traumatic Stress Disorder can be seen as a predisposing factor for her current symptoms.”
In order to make a deduction pursuant to s 323, an assessor must first identify a pre-existing injury, condition or abnormality, and make a finding that it currently contributes to impairment. To make that finding, the assessor must be satisfied that, but for the pre-existing injury, abnormality or condition, current impairment would be less than it now is: Ryder v Sundance Bakehouse (2015) NSWSC 526. No such finding was made by the assessor. The omission to make such a finding, or to consider whether such a finding should be made, demonstrates error, requiring that the certificate be set aside and that the Panel assess whether a deduction is available or appropriate.
Even if it had been open to the assessor to make a deduction, she had first to consider whether the extent of the deduction was difficult or costly to determine and, if so, whether a deduction of one-tenth was at odds with the available evidence. No consideration of either issue appears in the Medical Assessor’s reasons. The reasons are insufficient to explain the conclusion that a deduction of 7% was available or appropriate. The insufficiency of reasons demonstrates error, requiring that the deduction be set aside and the deduction be assessed by the Panel.
The Panel referred the assessment of Employability and of any deduction to Medical Assessor Blom, who is one of its members. His report follows;
“Report of Medical Assessor Blom
1. The worker’s medical history, where it differs from previous records
I initially enquired as to whether Ms Lazarus had read the Medical Assessment of 22 February 2024 and whether she agreed with the History in it. She pointed to what she said were errors in the MA's report. She noted that Dr Verma had said that she was in the top 50% of monthly sales when in fact she was in the top 15% of monthly sales. She commented that Connor Clothing was a large chain of stores with more than 150 outlets. She also noted that whilst she started working six hours/1 day per week this was gradually increased, because of her sales record, to up to 4 hours per day, up to 4 days per week.
I then attempted to clarify the history of her previous injury, related to the lengthy court case that she and her sister had been engaged in. She stated that the court case started in 2010 and extended over a prolonged period. It involved initially ICAC and then later a criminal court case. She began to experience significant anxiety marked by significant gastrointestinal symptoms, loss of weight and panicky feelings early in this process. As the process continued over several years she became depressed with a wide range of depressive symptoms she also described developing “paranoid feelings” by which she meant that she felt that she was being followed and generally felt that she was a ‘pawn of the government’. She was admitted to a private psychiatric hospital in 2015 because of deterioration in her depression and anxiety. At the time of her admission, she said she felt totally overwhelmed both physically and mentally – she described herself as being ‘broken’. She was in hospital for approximately one week. During this time, she was treated with antidepressants, although was unclear as to exactly which one at this point. Her court case was finalised around 2019 when she was convicted of perjury and given a 12-month good behaviour bond. She has appealed this conviction, and the appeal is still underway. Whilst she began to feel more positive at the conclusion of the case, despite the appeal, she said that she continued to experience anxiety and depressive symptoms. In particular she said that her sleep remained erratic, although her nightmares settled, and her motivation was still low, though improved. She continued to have panicky like feelings. She said her concentration at that point allowed her to watch TV for approximately half an hour although she continued to ruminate to some degree over all that she had been through. She said that prior to the court case she had been a regular reader but had not read a book for many years as a result of her difficulty in concentration, resulting from her anxiety and depression related to the court case. She repetitively referred to the lack of trust in people in general that she experienced as a result of the legal process.
From reasonably early in the process she had been consulting a psychologist. Following her admission to hospital in 2015, where her medications were assessed and adjusted by a psychiatrist, she only consulted a psychologist because she said that she could not afford a psychiatrist. Her medications, that is antidepressants, were then managed by her GP. She was unclear, but from what I can gather from around 2019 she again consulted a psychiatrist and from around 2019 she was accepted onto the NDIS. The NDIS provides household assistance with, for example cleaning and also assists her with community engagement. They have also provided funds for a psychologist which I gather she sees in addition to her long-term psychologist.
It was apparent from Ms Lazarus’ history that she first developed significant symptoms of anxiety and depression around 2010 or 2011 and that these disorders have persisted to the present day. Prior to her work whilst there had been some reduction in her overall symptomatology, related to the ending of the original case as well as significant long-term treatment, nevertheless she continued to experience ongoing symptoms and impairment.
She said that during the case, she became disconnected from all of her friends and had ‘no social life’, stating that she cut herself off from the world. She has 2 sisters and a brother and discontinued contact with them during this process. Because her mother was living with one of her sisters, she also lost contact with her.
I also asked Ms Lazarus specifically about Belle Boutique, the business which had been registered to her name and address soon after she left work. This had been raised in the Lee Kelly report. She said that this had been registered on the instigation of her husband, but that no business had ever occurred through this company, or any other company associated with it. She denied working in any sort of business or enterprise, following leaving Connor Clothing.
2. Additional history since the original Medical Assessment Certificate was performed
There has been no significant change in Ms Lazarus’s circumstances since the date of the MAC in mid-February of this year.
3. Current Symptoms.
Ms Lazarus stated that she continued to be extremely anxious about being seen by or meeting staff from Connor Clothing and that she felt that her level of anxiety had ‘gone through the roof’ since her injury at her workplace. As a result, she avoids Menai shopping centre, which has a Connor’s store and other shopping centres where she fears staff members might attend. Her nightmares overall have reduced in frequency and intensity, occurring now every few weeks, whereas previously (that is soon after leaving work) they were occurring 1 – 3 times/week. Nevertheless, her sleep remains restless and disturbed. She continues to feel and anxious quite regularly and ruminate both about her times at Connors as well as incidents that occurred during the court case.
Generally, she is socially avoidant, although she said that she goes out approximately twice a week to appointments or to go shopping. Sometimes she needs her husband’s support to undertake this.
She said that she continues to struggle on her focus and concentration and has significant difficulties attending to television or attempting to read even simple material.
Her mood is flat, and she continues to struggle with motivation, interest and capacity for pleasure.
She continues to have a great difficulty with trust and often feels irritable and overwhelmed by a sense of injustice and unfairness about what has happened to her. She is not currently suicidal.
4. Current Treatment.
She continues to see her psychologist, Mr Theodore Simos, usually on a weekly basis. She also consults a NDIS psychologist once/month. She consulted her general practitioner, Dr Ma, for review and prescription of medications, on a monthly basis.
She is currently being prescribed escitalopram (an antidepressant medication) – 20 mg/day and prazosin (an antihypertensive medication useful in treatment of nightmares), 2 mg/night.
She has not consulted her psychiatrist, Dr Oldham for many months but is planning to return to his care in the future. Having said that, she does not wish to change her medications.
She continues to receive support from the NDIS to assist her in managing her house and to help her to improve her socialising. They assist her to go to Pilates and other physical activity, although even with their help she struggles.
5. Findings on clinical examination
Ms Lazarus was reviewed by audiovisual connection. She was alone throughout the interview. She appeared slightly younger than her stated age and her hair was neat as was the clothing that I could see.
Throughout the interview, although there was some improvement as she became more comfortable with me, she was very easily triggered into anger, distress and a degree of anxiety. She repetitively referred to themes related to what she saw as the injustice and unfairness that she had experienced. This meant that the interview was somewhat difficult, as her preoccupation with these themes often made it difficult to obtain a coherent history. This was compounded by her distractibility and tendency to repetitively justify her symptoms and presentation as the inevitable outcome of this injustice.
She was clearly anxious throughout the interview, evidenced by tension and rumination. She was not overtly depressed although did present feelings of helplessness.
There was no evidence of psychotic phenomena, in particular she did not present evidence of hallucinations, delusions or formal thought disorder.
There was no evidence of organic cognitive disorder, and her cognitive presentation including memory and focus were consistent with her overall presentation and diagnosis.
6. Diagnosis.
Using the DSM 5 classificatory system, Ms Lazarus meets the criteria for the diagnoses of:
Anxiety Disorder Not otherwise specified. This diagnosis is made because Ms Lazarus presents with a variety of anxiety-based symptoms consistent with PTSD (as the MA diagnosed), however I do not believe that any of the traumatic experiences that Ms Lazarus experienced could be considered to meet criteria A - that is exposure to actual or threatened death, serious injury or sexual violence - necessary for the diagnosis of PTSD.
Persistent Depressive disorder with persistent Major Depressive disorder. This diagnosis is made because of the presence of persistent depressed mood marked by feelings of sadness and emptiness, diminished interest and capacity for pleasure, disturbed sleep with regular fatigue and loss of motivation. She also expressed feelings of helplessness and at times worthlessness and had diminished capacity to think and concentrate. She was not suicidal.7. Results of any additional investigations since the original Medical Assessment Certificate
There were no additional investigations.”
Having regard to his specialist expertise, the Panel accepts the clinical observations of Medical Assessor Blom, notes the history recorded by him, and agrees with his diagnoses of persistent depressive disorder with persistent major depressive disorder.
The Panel considers that the appellant is totally incapable of employment because she has significant problems with concentration, is socially avoidant and in our view presents a high risk of relapse into more serious symptoms if exposed to normal stressors of the workplace. The Panel assesses a class 5 impairment in respect of Employability.
Because they are consistent with the history taken by Dr Blom, the Panel agrees with his conclusions that the appellant;
“first developed significant symptoms of anxiety and depression around 2010 or 2011 and that these disorders have persisted to the present day. Prior to her work whilst there had been some reduction in her overall symptomatology, related to the ending of the original case as well as significant long-term treatment, nevertheless she continued to experience ongoing symptoms and impairment.”
In our view, the appellant has suffered from major depressive disorder since about 2009 or 2010 and, despite the alleviation of some symptoms after cessation of the court process in about 2019, she continued to suffer from major depressive disorder when she commenced employment with the respondent. The subsequent events at work caused a significant increase in anxiety, aggravating and exacerbating the pre-existing disorder.
The psychological injury the subject of these proceedings represents an aggravation, exacerbation and deterioration of that pre-existing disorder. The injury has caused her level of impairment to increase beyond that which she suffered as a result of the pre-existing condition, as evidenced by the fact that, immediately prior to injury, she was at least capable of some employment. The degree of impairment which she suffered prior to injury was not caused by injury, but by the pre-existing major depressive disorder. But for that pre-existing disorder, it is likely that the effects of injury, and the resulting impairment, would be significantly less than they now are. The criteria in Ryder being satisfied, we are satisfied that the pre-existing disorder continues to contribute to permanent impairment.
The extent of the deduction is difficult to determine, because there is evidence of a decrease in symptomatology prior to commencement of employment with the respondent due to long term treatment and the cessation of the court process in 2019, and that decrease was sufficient to enable her to commence employment with the respondent, but her ongoing need for treatment makes it difficult to gauge the degree to which her symptoms had improved and, therefore, the degree to which her symptoms have increased as a result of injury.
A deduction of one-tenth is at odds with the evidence because the appellant continued to suffer significant symptoms of her pre-existing condition when she commenced employment, despite having received regular pharmacological and other psychological treatment for the pre-existing condition, and even before injury she continued to need extensive psychological treatment as outlined below.
Medical Assessor Blom recorded that the appellant currently consults her treating psychologist Mr Simos weekly, and her GP and NDIS psychologist monthly, and that she takes 20mg Escitalopram daily and 2mg Prazosin nightly. At [4] under the heading ‘Present treatment’, Medical Assessor Verma recorded that the appellant was taking the same dose of Escitalopram when she commenced employment with the respondent prior to injury, and that Prazosin ‘was later added on to address the nightmares’. According to the same history, the nightmares began after a co-worker acted aggressively towards the appellant on 19 June 2021. Also according to that history, after injury Ms Lazarus commenced seeing psychologist Ms Stewart, but ‘continued to see her existing psychologist’, who we take to be Mr Simos.
This evidence establishes that, when the appellant commenced employment prior to injury, her symptoms required continuation of her Escitalopram at the same dose as now, and continuation of regular consultations with her treating psychologist Mr Simos and her GP. As a result of injury, her symptoms increased, and she required the addition of Prazosin for nightmares and monthly consultations with Ms Stewart. The need to continue the previous dose of Escitalopram and regular consultations with Mr Simos and the GP suggest a continuation of the pre-existing condition with associated impairment to which greater than one-tenth of current impairment is due, notwithstanding the post-injury addition of Prazosin and monthly consultations with Ms Stewart.
Doing our best, we consider that a deduction of one half properly accounts for the significance of the pre-existing condition and the ongoing impairment resulting from it, having regard to the continuing symptomatology prior to injury, the continuing need for daily doses of 20mg of Escitalopram and for regular consultations with Mr Simos and the GP. The post-injury additions of Prazosin, and consultations with Ms Stewart, are consistent with an increase in symptoms as a result of injury, but do not satisfy us that a deduction of more or less than one half is appropriate.
Conclusion
For the reasons given, the Medical Assessment Certificate of Medical Assessor Verma is revoked and replaced with the attached Medical Assessment Certificate.
WORKERS COMPENSATION DIVISION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
Matter number: | W8444/23 |
Applicant: | Michelle Lazarus |
Respondent: | Connor Clothing 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 Verma 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 NSW workers compensation guidelines | 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) |
| Psychological | 9 June 2023 (deemed date) | Chapter 11 Guidelines 11.1-11.3, 11.4-11.6 | Guidelines 11.11,11.12 Table:11.1,11.2,11.3,11. 5,11.5,11.6 | 22% | ½ | 11% |
| Total % WPI (the Combined Table values of all sub-totals) | 11 % | |||||
PERSONAL INJURY COMMISSION
Table 11.8: PIRS Rating Form
| Name | Michelle Lazarus | Claim reference number (if known) | W8444/23 |
| DOB | Age at time of injury | 42 | |
| Date of Injury | 09/06/2023 | Occupation at time of injury | Casual Salesperson |
| Date of Assessment | 12/02/2024 | Marital Status before injury | Married |
| Psychiatric diagnoses | 1. Exacerbation of PTSD. 2. Exacerbation of Major Depressive Disorder. |
| Psychiatric treatment | Yes |
| Is impairment permanent? | Yes |
| PIRS Category | Class | Reason for Decision | Class for Pre-existing Impairment | |||||||||
| Self-Care and personal hygiene | 3 | Ms Lazarus reported that she showers when her husband encourages her. She changes into clean clothes and wears the same clothes as long as she can as she does not have the energy to change. Ms Lazarus reported that she does not do the cooking as she has NDIS workers for cleaning, vacuuming and doing the meal prep, and she had them even before the incidents at her workplace. | 3 | |||||||||
| Social and recreational activities | 3 | Ms Lazarus reported that she used to enjoy going to the beach and NDIS workers supported her going to the beach frequently. She reported that she used to go to church and attended a farewell for the priest in the last four weeks. She has stopped going to the beach with the NDIS workers and she will only go infrequently now. She tries to go shopping once per week but most weeks, she struggles to do so. She also added that she tries to attend the Pilates and yoga sessions but often misses several weeks in a row as her mood is particularly depressed. | 2 | |||||||||
| Travel | 2 | Ms Lazarus reported that she is able to drive on her own, but her husband needs to be on the phone when she drives. She is able to go to the local shops but has to be accompanied by her husband or someone from the church. She further added that she prefers to be at home and rarely goes out. | 1 | |||||||||
| Social functioning | 2 | Ms Lazarus reported that she “never had friends as an adult.” She does not get along with her sisters even before the incidents at the workplace and even before she started working at Connor. She said that the court case took a toll on her relationship with her sisters. Her mother lives with her sister and hence, she does not see her mother as frequently. She added that her relationship with her husband is strained and although they live together, they have separated. There have been no periods of domestic violence or community services looking after the children. Overall, her relationships with her sisters and her mother were already strained when she started working with Connor. | 2 | |||||||||
| Concentration, persistence and pace | 3 | Ms Lazarus reported that she is unable to read books as her mind is so “overworked” and she does not have the capacity to concentrate on anything. She is unable to listen to her children and gets anxious when they are talking to her. She is unable to organise herself and procrastinates tasks a lot. Ms Lazarus also reported that she has difficulty even in watching TV and gets distracted even while doing that and is unable to concentrate. | 2 | |||||||||
| Employability | 5 | Ms Lazarus does not seem to have any capacity to engage in any form of employment because of struggles with her current symptomatology and difficulties in cognitive functioning, and impairment in various PIRS categories. | 3 | |||||||||
| Score (Current ) | Median Class | |||||||||||
| 2 | 2 | 3 | 3 | 3 | 5 | =3 | ||||||
| Aggregate Score Impairment | Total | % | ||||||||||
| +2 | +4 | +7 | +10 | +13 | 18 | 22 | ||||||
Final Impairment = 22-11 = 11%
Final WPI = 11%
0