Lister v State of New South Wales (NSW Ambulance Service)

DETERMINATION OF APPEAL PANEL
CITATION:	Lister v State of New South Wales (NSW Ambulance Service) [2024] NSWPICMP 745
APPELLANT:	Shannon Lister
RESPONDENT:	State of New South Wales (NSW Ambulance Service)
APPEAL PANEL
MEMBER:	Deborah Moore
MEDICAL ASSESSOR:	John Baker
MEDICAL ASSESSOR:	Professor Nicholas Glozier
DATE OF DECISION:	30 October 2024
CATCHWORDS:	WORKERS COMPENSATION - The appellant submits that the Medical Assessor erred in his assessments under two categories of the psychiatric impairment rating scale (PIRS), namely ‘self-care and personal hygiene’ and concentration, persistence and pace (cpp); Held – Medical Appeal Panel found no errors; the Medical Assessment Certificate (MAC) was thorough and well-reasoned; MAC confirmed.

BACKGROUND TO THE APPLICATION TO APPEAL

On 8 August 2024 Shannon Lister (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, who issued a Medical Assessment Certificate (MAC) on 19 July 2024.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

PRELIMINARY REVIEW

The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
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, we consider that we have sufficient evidence before us to enable us to determine this appeal for reasons that will be addressed in due course.

EVIDENCE

Documentary evidence

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

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 Medical Assessor erred in his assessments under two categories of the Psychiatric Impairment Rating Scale (PIRS), namely ‘self-care and personal hygiene’ and concentration, persistence and pace (cpp).
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 Medical Assessor for assessment of whole person impairment (WPI) in respect of a primary psychological injury on a deemed date of injury of 30 July 2019.
The Medical Assessor obtained the following history:
“Mr Lister joined the ambulance service in 2004 and had always been a full-time paramedic, and performed special operations. He last worked in December 2021 and medically retired in December 2023. He has not performed other work since.
He reported that his first incident at work was in 2006 and happened in Walgett when he was sent to support a job. There was a semi-conscious man, and he did everything according to protocol. When they were in the local hospital, there was no doctor, and the nurse removed the airway and then intubated the patient the wrong way. He repeatedly raised concerns about the patient's compromised airway. They did CPR for the next four hours. He said that the man died from negligence and that he was part of it. They contacted various hospitals and eventually, a doctor flew out to support them. The doctor arrived and, after a short period of time, said, "Is everyone okay to call it?" In other words, he discontinued resuscitation. He said that the patient's relatives were given false information and that things were swept undercover, and that he's encountered similar events in his job many times since. He said that when he received a thank you letter from the family, he experienced mixed emotions and felt guilty for killing somebody and being thanked for it. Mr Lister said he didn’t get help at the time because there was no support available, and he just kept going.
In 2010, he recalled he had a nervous breakdown and was off work for two shifts. However, the manager said that he wasn’t allowed to take time off and get paid for it. He had to pay back the two shifts, or he’d be sacked. He felt they were trying to run him into the ground.
In 2017, Mr Lister became increasingly anxious about his safety and began carrying a knife for protection at work. He described many accumulated incidents over the years, with exposure to deaths and people with horrific injuries, violence and major accidents. He felt lethargic and burnt out.
He began treatment with his psychologist in 2019 and said that he stopped working in 2021 because it was a melting point where so many different but similar issues, and led to him being unable to cope. He remembered that when he was driving to jobs, other workers would comment that he seemed disconnected and he was zoning out. He reached a point where his wife told him he had to get help.
Mr Lister has had more psychological/psychiatric treatment since he stopped working.”
After setting out details of Mr Lister’s current treatment, the Medical Assessor noted current symptoms as follows:
“Psychologically, Mr Lister said he's unsafe everywhere and he feels separated from people. He feels depressed all the time and has become distant from people.
Mr Lister reportedly goes through different cycles of moods. Sometimes he's anxious with fight and flight response. Sometimes he feels okay. Sometimes he becomes aggressive, when he felt threatened. He says his son plays tricks and jumps out of the closet. He gets scared and starts swearing at his son. Mr Lister has not had elevated moods or symptoms consistent with Bipolar disorder.
He said his concentration and memory have been the same for a long time and are not good. He has transient suicidal thoughts and said this is not as bad in the past 18 months. He has not attempted suicide. He does not carry weapons anymore. He has been irritable and speaks with a raised voice or yells when angry. He described sleep problems and often wakes up at 3am and finds it difficult to fall asleep again. He has fewer nightmares over time. He said he lost 3kg in 2024 as he skips meals. He has anxiety symptoms.
He reported having tried mushrooms and edible cannabis a few times, maybe two years ago, to manage his moods. He's never suffered hallucinations.”
The Medical Assessor then turned to consider the impact of Mr Lister’s injury on his social activities and activities of daily living (ADL’s) and said:
“Mr Lister is living with his wife, who runs her own business. Their son is 13 years old and lives with them.
He said he does not do much and sleeps in more than he should. He wakes up and has breakfast. He eats porridge his wife makes.
He spends time with his dog and goes to the garage for workouts and does callisthenics (body weight exercises).
He goes to Brazilian Jujitsu, BJJ class two or three times per week, for 60 to 90 minutes each time. After BJJ, he said he always showers without prompting and eats something if he feels like it. He said he has been doing BJJ for about eight years and is a purple belt. He says it helps him keep calm. He usually goes twice a week, sometimes three times a week, for 60 to 90 minutes. The class involves 5 to 10 students and one teacher usually. He says this is all wrestling-related. They practice technique in pairs, and towards the end of the class he would do sparring with another student.
He said he does not have friends. He has acquaintances in BJJ only. He said he had friends before, but they do not contact him and he does not contact them anymore as he has no interest. He said he has people he knows on social media but does not talk to them often, although sometimes they exchange funny videos.
He watches TV and spends time scrolling on his mobile phone and checking social media updates.
He said he tinkers in the garage. He said ten years ago he rode bikes and even though he does not ride now, he does something with the bicycles and cleans it up. His son asked him to fix his bike, lube the chains, do maintenance work, pump the tyres. He instructs his son on how to clean the bike. He spends more time with his son as it is school holidays.
His son plays rugby. He drops him off at the games locally and would sit in the car and wait for him. His son rides to school or catches the bus. Occasionally, he would drive him to the school drop-off.
Mr Lister said his wife puts on the washing and asks him to hang it up, but he would use the dryer instead, and does not always do what she asks. He said he has no set household chores.
He shops irregularly, for example, getting small items or bread. He said his psychologist gave him techniques to manage his anxiety to go to the shops. His wife does most of the grocery shopping.
Sometimes Mr Lister's wife tells him he smells and he said he does not shower as much as she likes. He said he used to look after himself better when at work, and was showering and shaving daily. Now, he showers after exercise and BJJ, and when he has not gone to BJJ, he said he showers when he feels like it, e.g. after he does exercise at home. He says he showers around four times a week and changes into clean clothes without prompting. He said he shaves when he feels like it. He cuts his nails regularly because of wrestling.
Mr Lister drives locally. He said that as a family, they went to Burleigh Heads near Queensland in December 2023 as his wife needed a holiday. He said she drove the family there. They had two trips in the past two years, including Hawaii in 2023, which he struggled with due to heightened anxiety dealing with "not knowing" and new things. He recalled he enjoyed going to the beach in Hawaii and generally avoided people. He said his wife is usually busy, and so she needs a holiday and he goes in support of the family. His wife has planned more trips this year.
He said his relationship with his siblings and parents, and stepfather is good. His brother is in the USA and visits yearly; they have a catch-up. His father is in Sydney and visited him one month ago. He talks to his mother and stepfather regularly, and the relationship with his sister is good.
He said he has not read a book for 20, or 10 to 15 years. He can focus on BJJ techniques in class for 60-90 minutes.
Mr Lister said his wife supports him by telling him to get up in the morning and to do things around the house and also she drives and drops him off at places. She makes a list of things that he should do around the house.
He rarely cooks and said he doesn't want to. He says if he cooks, it would be when his wife asks him to put the chicken in the oven and he wouldn't go out of his way to cook dinner.
Mr Lister says he spends time trying to do something in the garage and ends up burning himself and had to go to the hospital because of the burn. He explained his son's bike needed something, he tried to use the welding machine at home but then a melted metal fell onto his ankle. He is mostly healed by now.
He also said he did some gardening and ended up causing injury to his foot with machetes.
Mr Lister was married for five years with no children and has been in his current marriage for 15 years. He said he blows up at her but she's very supportive and their marital relationship is very good.
Previously, he had other hobbies including going to the gym, riding bicycles and surfing. He said he doesn't do these anymore.
I noted his other activities in the PIRS.”
Findings on mental state examination were reported as follows:
“Mr Lister 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. I have taken handwritten notes, and there was no audio-visual recording of the assessment.
Mr Lister wore glasses and had a light beard and wore a clean tee shirt. He appeared somewhat tanned. He engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. He was mildly restricted in his affect range and reactivity and smiled appropriately. He spoke spontaneously and readily. He was not thought disordered.
Mr Lister was attentive and gave a clear history and provided clarification when asked. He remained focused throughout the assessment. He maintained a steady pace. Before I completed the assessment, I asked him for additional information that he wanted to add and he had no specific comments to make.”
The Medical Assessor diagnosed:
“Mr Lister does not have a past psychiatric history and reported stress, anxiety and depressive symptoms as a result of various issues at work over the years, and gradually developed persisting symptoms of Post-traumatic stress disorder. Despite having regular treatment, his psychological injury has not resolved and MMI has been reached.”
The Medical Assessor added: “I have found no inconsistency in Mr Lister's presentation.”
The Medical Assessor assessed 8% WPI.
He then turned to consider the other medical opinions and material before him and said:
“Dr Peter Young IME psychiatrist’s report dated 1/5/24 reassessment, noted work stress from 2006 and many incidents over time, he became disillusioned and burnt out at work, he carried a knife. There is no past psychiatric history. He diagnosed pre-existing personality, paranoid and Autism spectrum features and Other specified trauma and stressor related disorder (or Complex PTSD in ICD terms) from work. He does not agree with psychometric testing results that he has non-credible cognitive difficulties. He deducted 1/10 for pre-existing vulnerability (Comment: I do not believe a pre-existing vulnerability is basis for s323 deduction). He provided a PIRS with ratings 222225. He said he cannot read books but can engage in regular self- directed exercise and BJJ.
The claimant’s statement noted his work history and exposure to trauma at work with symptoms from 2006. He said the issues were too numerous to list. He discussed psychometric testing results from Yolla Makhoud 28/2/22. He provided a list of symptoms and disabilities, with nightmares and anxiety and depression. He started treatment with Dr Murray 3/3/20.
His further statement, discussed his symptoms and marked concentration difficulties.
Dr Murry, treating psychiatrist reports diagnosed Post-traumatic stress disorder and he carried a knife, and had mood cycling.
Dr Shannon Paisley, IME psychiatrist’s report dated 25/6/22 ( 2 reports), diagnosed Post-traumatic stress disorder, psychologically, he declined over the years and was no longer the life of the party. There is no past psychiatric history. His medication refusal was understandable. He left raw chicken in the kitchen and forgot to put it in the fridge overnight. He does not cook and only prepares simple foods. He relied on his wife for meals. He performs bicycle repairs. He provided a PIRS with ratings 322 235, and assessed Mr Lister's self-care and personal hygiene 3, and explained he sometimes misses meals or will only prepare simple meals. Relies on his wife for meal preparation. Does put effort into his fitness. Unable to live independently without significant support. Concentration, persistence and pace 3, Impaired concentration and memory. Frequently makes mistakes. Concentrates on tasks for up to 5 to 10 minutes (e.g. cleaning son’s mountain bike). No longer able to read books.
Comment:
I have found Mr Lister less impaired in self-care and personal hygiene and agreed with Dr Young’s assessment and I rated 2. Mr Lister reported he prepares simple foods and shops sometimes, he skips meals and omits showering sometimes but does not need prompting as he would attend to it and can maintain basic nutrition and hygiene.
In terms of concentration, persistence and pace, I agree with Dr Young, practising techniques in pairs and then sparring with another student, for 60 to 90 minutes is an intellectually demanding task, as is bicycle maintenance and repairs. I noted there has been clear cognitive deficits in that he left food out overnight, dropped things when welding and gardening and therefore, I rated 2.”

The appellant’s submissions

As regards the category of self-care and personal hygiene, the appellant submits:
(a)    The Medical Assessor failed to have regard to the following lay and medical evidence demonstrating that he is not capable of maintaining an independent lifestyle.
(i)Dr Paisley, records under ‘Current Functioning’: “He does not cook and relies on his wife to assist with housework and meal preparation. He may prepare simple meals such as bread-and-butter. He described his wife as supportive and said – ‘I just would not eat if she was not so supportive’.”;
(ii)Dr Paisley proceeds to record the following in his assessment of the PIRS category of ‘self-care and personal hygiene’ assigning a class 3: “Sometimes misses meals or will only prepare simple meals. Relies on his wife for meal preparation. Does put effort into his fitness. Unable to live independently without significant support”;
(iii)Dr Young does not record anything under current functioning and proceeds to record the following in his assessment of the PIRS category of ‘self-care and personal hygiene’ assigning a class 2: “Mr Lister does not maintain the level of personal appearance as when he was working. He showers and changes clothes less frequently. He has a regular home gym routine. He is able to shop with his wife locally for groceries and can prepare simple meals”;
(iv)The conduct reported by Dr Young, as noted immediately above, more appropriately meets an assessment of class 3 for ‘self-care and personal hygiene’ as assessed by Dr Paisley;
(v)the Medical Assessor reports the following in the Certificate as evidence of the applicant worker’s ability to live an independent lifestyle: Page 3 under ‘Present Symptoms’: He said he lost 3kg in 2024 as he skips meals. Page 3 under ‘Social activities/ADL’: He wakes up and has breakfast. He eats porridge his wife makes, and
(vi)page 4 under ‘Social activities/ADL’: Mr Lister said his wife puts on the washing and asks him to hang it up, but he would use the dryer instead, and does not always do what she asks. He said he has no set household chores. He shops irregularly, for example, getting small items or bread. He said his psychologist gave him techniques to manage his anxiety to go to the shops. His wife does most of the grocery shopping. Sometimes Mr Lister's wife tells him he smells and he said he does not shower as much as she likes. He said he used to look after himself better when at work, and was showering and shaving daily. Now, he showers after exercise and BJJ, and when he has not gone to BJJ, he said he showers Mr Lister said his wife supports him by telling him to get up in the morning and to do things around the house and also she drives and drops him off at places. She makes a list of things that he should do around the house.
Page 5 under ‘Social activities/ADL’: Mr Lister said his wife supports him by telling him to get up in the morning and to do things around the house and also she drives and drops him off at places. She makes a list of things that he should do around the house. He rarely cooks and said he doesn't want to. He says if he cooks, it would be when his wife asks him to put the chicken in the oven and he wouldn't go out of his way to cook dinner.
(b)    When this evidence is considered in its totality, it clearly demonstrates that he is unable to live an independent lifestyle and remains dependent on the regular support of his wife.
(c)    The Medical Assessor paraphrases the evidence of Dr Paisley regarding the worker’s lack of independence and records evidence of the level of support he requires to complete self and personal hygiene tasks throughout the MAC, yet in his assessment of the PIRS category of ‘self-care and personal hygiene’ he assigns a class 2 and states ‘He is capable of independent living without regular support, and does not need prompting with selfcare.’
(d)    The Medical Assessor has erred in assessing class 2 for the category of ‘selfcare and hygiene’ when the totality of the evidence supports a finding of class 3.
(e)    The Medical Assessor has failed to explain his path of reasoning for agreeing with Dr Young’s assessment of class 2 for self-care and hygiene over
Dr Paisley’s who, in contrast with Dr Young, has provided a clear path of reasoning and evidence in his report for his assignment of class 3. He also fails to explain his reason for concluding that “[h]e is capable of independent living without regular support and does not need prompting with self-care” which is in direct contrast to the findings set out in the MAC.

Discussion
Self-care and personal hygiene

The Medical Assessor assessed a Class 2 rating and said:
“Mr Lister's self-care has declined. He told me he does not shower daily and no longer cares about his appearance. He showers a few times per week without prompting. He occasionally shops and rarely cooks. He is capable of independent living without regular support and does not need prompting with self-care.”
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 concept of “self-care and personal hygiene” is not defined in the Guidelines. They refer to examples or “descriptors” relevant to the assigning of a specific class.
The descriptors are just that: a general overview of the types of behaviour relevant to each class, and are not intended to be exclusive (Parker v Select Civil Pty Ltd [2018] NSWSC 140 at [68]). The Medical Assessor is not required to directly refer to these examples in providing his assessment.
For example, in this category, he noted:
“He said he does not do much and sleeps in more than he should. He wakes up and has breakfast. He eats porridge his wife makes. He spends time with his dog and goes to the garage for workouts and does callisthenics (body weight exercises). He goes to Brazilian Jujitsu, BJJ class two or three times per week, for 60 to 90 minutes each time. After BJJ, he said he always showers without prompting and eats something if he feels like it.”
Relevant to this category is Mr Lister’s ability to shower after classes without prompting and to eat appropriately when “he feels like it.” His extensive exercise regime demonstrates a significant commitment to his physical health and wellbeing, in addition to its recreational aspects.
The appellant’s submissions rely extensively on the opinion of Dr Paisley who reported on
25 June 2022. The Medical Assessor saw Mr Lister on 16 July 2024, over two years later.
In his further statement of 5 June 2024 Mr Lister discussed his symptoms and there is no mention of any aspect of self-care.
Clause 1.6 of the Guidelines notes that the task of a Medical Assessor is to assess a claimant as they present on the day of the assessment.
There is nothing in the history obtained by the Medical Assessor that accords with the descriptor for a Class 3 rating.
Indeed, in our view, the evidence points strongly to a Class 2 rating as assessed by the Medical Assessor.
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 his submissions, the appellant, rather oddly states:
“Dr Paisley proceeds to record the following in his assessment of the PIRS category of ‘self-care and personal hygiene’ assigning a class 3: ‘Sometimes misses meals or will only prepare simple meals. Relies on his wife for meal preparation. Does put effort into his fitness. Unable to live independently without significant support.’”
This is precisely the descriptor for a Class 2 rating.
The Medical Assessor clearly explained why he disagreed with Dr Paisley and said:
“I have found Mr Lister less impaired in self-care and personal hygiene and agreed with Dr Young’s assessment and I rated 2. Mr Lister reported he prepares simple foods and shops sometimes, he skips meals and omits showering sometimes but does not need prompting as he would attend to it and can maintain basic nutrition and hygiene.”
For these reasons, we do not see any error in the Medical Assessor’s assessment in this category.

Concentration, persistence and pace

As regards this category, the appellant submits:
(a)    The Medical Assessor failed to have regard to the lay and medical evidence before him that the applicant worker has impaired concentration, persistence and pace, in that he is unable to read more than simple social media posts on his phone, unable to undertake complex tasks and is unable to focus on tasks for more than 5 to 10 minutes at a time.
(b)    Dr Paisley, records under ‘Current Functioning’: He has difficulty concentrating and once left raw chicken on the kitchen bench overnight because he forgot to put in the fridge. He no longer reads books. He performs basic repairs and maintenance on pushbikes.
(c)    Dr Paisely opines that he meets criterion E of the DMS-5 criteria for a diagnosis of post-traumatic stress disorder because ‘he has marked alterations in arousal and activity characterised by hypervigilance, irritability, poor concentration and insomnia.’
(d)    Dr Paisley proceeds to record the following in his assessment of the PIRS category of ‘concentration, persistence and pace’ assigning a class 3: “Impaired concentration and memory. Frequently makes mistakes. Concentrates on tasks for up to 5 to 10 minutes (e.g. cleaning son’s mountain bike). No longer able to read books.”
(e)    Dr Young does not record anything under current functioning and proceeds to record the following in his assessment of the PIRS category of ‘concentration, persistence and pace’ assigning a class 2: “Mr Lister reports that he struggles with attention and concentration. He says that he can no longer read books and can persist at tasks for only brief periods, however he is able to participate in regular self-directed exercise and Ju Jitsu classes, and psychometric testing indicates over statement of cognitive impairment.”
(f)    The conduct reported by Dr Young, as noted immediately above, more appropriately meets an assessment of class 3 for ‘concentration, persistence and pace’ as assessed by Dr Paisley.
The Medical Assessor assessed a Class 2 rating and said:
“Mr Lister has not read a book for more than 10 years. He described mistakes with injuries, when using a welding machine and gardening. He can focus on practising techniques in BJJ and focus for 60 to 90 minutes. His mental state examination is consistent with 2, during the assessment for 65 minutes.”
The descriptor for a Class 2 rating reads:
“Mild impairment: Can undertake a basic retraining course, or a standard course at a slower pace. Can focus on intellectually demanding tasks for periods of up to 30 minutes, then feels fatigued or develops headache.”
For a Class 3 it 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.”
Once again, the appellant’s submissions focus heavily on the opinion of Dr Paisley.
And once again, we note that “the examples in Table 11.5 are examples only and are not exclusive”.
As is often the case, there are some characteristics in Mr Lister’s presentation to the Medical Assessor that may well fulfil some of the descriptors for a Class 3, but the task of the Medical Assessor is to consider what constitutes the “best fit” in all categories.
The assessment process is of itself a relatively demanding process.
The Medical Assessor assessed Mr Lister for 65 minutes and as he noted:
“Mr Lister spoke spontaneously and readily. He was not thought disordered. He was attentive and gave a clear history and provided clarification when asked. He remained focused throughout the assessment. He maintained a steady pace.”
Of all of the PIRS categories CPP is the one where a worker’s impairment can be objectively evaluated within the assessment and the Medical Assessor has used this clinical information to inform his opinion.
In our view, the Medical Assessor’s examination was both well- reasoned and detailed, and he clearly explained his reasons and, where appropriate, why his opinion differed from other doctors.
For these reasons, the Appeal Panel has determined that the MAC issued on 19 July 2024 should be confirmed.

[2024] NSWPICMP 745

30 October 2024