OOh! Media Operations Pty Ltd v Kaur
[2024] NSWPICMP 272
•6 May 2024
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | OOh! Media Operations Pty Ltd v Kaur [2024] NSWPICMP 272 |
| APPELLANT: | Ooh! Media Operations Pty Ltd |
| RESPONDENT: | Ramandeep Kaur |
| APPEAL PANEL | |
| MEMBER: | Jane Peacock |
| MEDICAL ASSESSOR: | Douglas Andrews |
| MEDICAL ASSESSOR: | Ask Takyar |
| DATE OF DECISION: | 6 May 2024 |
| CATCHWORDS: | WORKERS COMPENSATION - Psychological injury; appellant alleged demonstrable error in the assessment because reasons so brief that an adequate path of reasoning not disclosed; Appeal Panel agreed; error found; re-examination considered necessary; Held – Medical Assessment Certificate revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 13 October 2023 the employer Ooh! Media Operations Pty Ltd (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Gerald Chew, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 18 September 2023.
The appellant relies on the following ground of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· 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 grounds of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
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.
The appellant requested that the worker undergo a re-examination. As a result of its preliminary review, the Appeal Panel determined that it was necessary for the worker to undergo a further medical examination because the Appeal Panel found error.
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.
Further medical examination
Medical Assessor Ash Takyar of the Appeal Panel conducted an examination of the worker on 23 February 2024 and reported to the Appeal Panel on 26 April 2024.
Medical Assessment Certificate
The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.
SUBMISSIONS
Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
FINDINGS AND REASONS
The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
The matter was referred to the Medical Assessor for assessment as follows:
“The following matters have been referred for assessment (s 319 of the 1998 Act):
· Date of injury: 17 June 2022
· Body parts/systems referred: psychological
· Method of assessment: WPI”
The Medical Assessor issued a MAC certifying as follows:
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. psychological | 11 | 11 | 19 | 19 | ||
| 2. | ||||||
| 3. | ||||||
| 4. | ||||||
| 5. | ||||||
| 6. | ||||||
| Total % WPI (the Combined Table values of all sub-totals) | 19 | |||||
The assessment was based on his assessment under the psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows:
“Table 11.8: PIRS Rating Form
Name
Kaur
Claim reference number (if known)
DOB
xxxx
Age at time of injury
Date of Injury
Occupation at time of injury
AIN
Date of Assessment
14/9/23
Marital Status before injury
Psychiatric diagnoses
1. major depressive disorder
2.
3.
4.
Psychiatric treatment
Psychotropic medication, psychotherapy, psychiatrist, GP
Is impairment permanent?
Yes
| PIRS Category | Class | Reason for Decision | |||||||||
| Self Care and personal hygiene | 2 | Reduction in self care | |||||||||
| Needs prompting by husband | |||||||||||
| Social and recreational activities | 3 | Reduced social functioning. Moderate impairment. | |||||||||
| Travel | 2 | able to travel locally without support to familiar places if required but prefers to go with husband. | |||||||||
| Social functioning | 2 | Her husband is supportive | |||||||||
| difficulty maintaining with friends | |||||||||||
| Concentration, persistence and pace | 3 | Subjectively impaired concentration | |||||||||
| Able to read and do puzzles for short periods– she finds that this helps her anxiety | |||||||||||
| Employability | 5 | Unable to work at all | |||||||||
| Score | Median Class | ||||||||||
| 2 | 2 | 2 | 3 | 3 | 5 | 3 | |||||
| Aggregate Score Impairment | Total | % | |||||||||
| + | + | + | + | + | 17 | 19% | |||||
The employer appealed.
In summary the appellant submitted that the Medical Assessor made demonstrable error “in circumstances where the contents of the MAC do not disclose an adequate path of reasoning for the MA’s ultimate conclusions”.
In summary, the respondent worker, Ramandeep Kaur (the respondent), submitted that although the Medical Assessor referred to reports of doctors whose reports were not in evidence before him, this error does not invalidate his assessment which was otherwise adequately reasoned.
The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS scale for mere difference of opinion but must be satisfied as to error.
The path of reasoning disclosed by the Medical Assessor must be adequate. The Appeal Panel agreed with the appellant’s submissions as to the brevity of the reasons given as well as the error in his reference to reports of doctors who were not in evidence before him. In these circumstances the Appeal Panel was satisfied as to error and considered a re-examination was necessary.
In these circumstances of a finding of error the Appeal Panel considered that a re-examination by a Medical Assessor member of the Appeal Panel was necessary. Medical Assessor Ash Takyar was appointed to conduct the re-examination and he reported to the Appeal Panel as follows: (emphasis in original)
“REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR
MEMBER OF THE APPEAL PANEL
Matter Number: | M1-W5786/23 |
Appellant: | Ooh! Media Operations Pty Ltd |
Respondent: | Ramandeep Kaur |
Examination Conducted By: | Dr Ashish Takyar |
Date of Examination: | 23/02/2024 |
1. The workers medical history, where it differs from previous records
Ms Kaur had commenced at Ooh! Media Operations Pty Ltd as a Safety & Injury Management Advisor on 4 May 2022, while her manager, Cheryl had begun on 30 May 2022. She worked in a team of three, with Rosemary the WHS manager. When her manager began, Rosemary had time off for foot surgery, and it was understood that from this time there were issues with her manager in terms of her manner, tone and micromanagement, which Ms Kaur recalled.
Incidents as described in her statement through June 2022 were noted, and she described getting to the point where her mental state had deteriorated to a point such that she could not continue working.
Ms Kaur recalled the associated changes in her mental state: ‘That I remember, on that day I cried a lot, something changed on the same day. I was… I don’t know depressed but I was very hopeless, starting feeling hopeless that maybe I am the worthless, not the manager, that why she saying all these nasty things to me. It was from day one. I never had a claim, I did not want to put the claim… a workers compensation claim. For a good one month, I was in touch with the employer and I requesting them to support me, assist me. I started taking counselling sessions’, reporting that she had one EAP session and then started seeing her previous psychologist.
Ms Kaur added, ‘When employer refused to help me, after July I had no choice but to put the claim – that month was very difficult for me, the anxiety, frustration… mood change’.
She reported depressed mood and associated symptoms were present ‘from the date of injury, there was all mixed feelings… lots of things in my mind, I think you can say anxiety’, reporting depressive changes then too, on further history.
Ms Kaur reported micromanagement, and recalled harsh treatment – ‘We had our first meeting on 7 June, and she made me cry in the first meeting… after that she went on and on at me, screaming I think on the 17th was the date of injury’.
In terms of treatment, Ms Kaur reported seeing her general practitioner, Dr Ravinder Singh at Glenwood Medical Centre, usually monthly for workers compensation certificates of capacity. She said he has referred her for both psychological therapy and to a psychiatrist.
She noted that recent blood tests ordered by Dr Singh had revealed that she has ‘very low vitamin D and iron… so I’m on medicine for Vitamin D and Iron’.
Ms Kaur has consulted two psychologists over time. Noting that the records described treatment with Dr Swati Tyagi, she was asked about this therapy, reporting, ‘I started seeing her first, I had so many sessions with her, then I think she recommended some specific EDMR [eye movement desensitisation reprocessing], but she said she doesn’t do that, so now I’m seeing um, Cheema’, in reference to her current psychologist, Supreet Cheema.
She sees Ms Cheema every two weeks, but could not remember when treatment began. The file material indicates this was from about 23 March 2023, but on putting this to Ms Kaur, she remained confused and reported, ‘I don’t remember, I don’t have any plan in front of me’. In terms of this therapy currently, she stated, ‘It’s okay, obviously we talk, at the moment she is doing the goals she discussed with me, at the moment we are focussing on my self-care, that is her main goal at the moment’. Asked if the current work includes any EMDR, Ms Kaur answered, ‘She is doing both at the moment and EDMR [sic] is more than a one hour session, it’s a 90 minute session and… sometimes I get headache and feeling tired, so she is going slow. But whatever Swati was doing… some breathing techniques and capping… we talk as well. Sometimes I get very anxious and dizzy and she has to talk about something else as well. And I go off track, so she is doing a mix of everything’.
Psychiatrist, Dr Jaspreet Singh has seen Ms Kaur, according to his correspondence, from 26 October 2022; she could not identify the start date when asked – ‘I think it’s been long time… ‘Date I don’t remember, initially I started seeing only psychologist and then she recommended medication, so the doctor referred me to the specialist… I don’t remember’. He is based in Bella Vista and currently sees her monthly.
At current, he prescribes:
· The SNRI, venlafaxine XR 225mg mane
· Melatonin 2mg CR nocte, for sleep induction
· Quetiapine XR (an atypical antipsychotic with mood stabilising, sedative and at low doses, anxiolytic qualities; the XR denotes the slower release formulation) 50mg for sleep induction.
When she was asked if she tolerates the medication, she replied, ‘Obviously since I’ve been on this medication I am more calm… I was more agitated, for minor things’. Upon further enquiring, she said she is tolerating her medicines, then adding, ‘I’m feeling more calm and less agitated’.
The benzodiazepine, diazepam was prescribed previously as required (PRN), and Dr Singh’s letter of 31 January 2023 recorded that she was prescribed 2mg tablets, with a supply of ten at the time. Ms Kaur said that antidepressants had been prescribed in the past – ‘I had Lexapro [escitalopram] as well, and then Valdoxan [agomelatine] second, I don’t know which one first and which one second, and then he prescribed the venlafaxine’. The file material indicates that she commenced escitalopram in August 2022, while agomelatine began in September 2022.
In terms of her medical history, Ms Kaur said she had had two caesarean sections. Her most recent investigations revealed that she has borderline cholesterol levels, which her general practitioner is following up.
She denied any family history of psychiatric illness, weeping as she declared, ‘I am the only lucky one’.
She was not aware of any pre-existing psychiatric history, such as of a mood or anxiety disorder, panic attacks or trauma re-experiencing nightmares or flashbacks. ‘Never’ has she required treatment under the care of a psychiatrist, psychologist or on psychotropic medicines pre-injury.
Ms Kaur denied any history of any previous or subsequent accident, injuries or conditions since the work injury had begun or since the Dr Chew’s MAC.
2. Additional history since the original Medical Assessment Certificate was performed
This history was obtained as an average over the last two months.
Pre-injury, Ms Kaur reported better sleep, which was unbroken, without initial insomnia: ‘I did not have any problem, so roughly 9 or 10 I sleep and then I wake up, I had a good sleep, without any interruptions’. On further history, she stated, ‘it’s good, maybe 8 hours sleep’ and said she might have woken once or twice a week to go to the toilet. She said that sedative medicines have improved it, but without quetiapine XR or melatonin, sleep is ‘very interrupted, first of all I couldn’t go to sleep, maybe 12 o’clock, 12:30… then if I sleep, if I don’t take medicine I have nightmares as well. If I wake up at night, I told my psychologist and doctor as well – if I woke up at night I feel scared… I feel like someone is watching me behind the door’. It was established that while she knows no one is there, she feels anxious. She noted that if she wakes to attend the toilet, she has to wake her husband due to fear, stating, ‘even if I take my medicine if I have to go to the toilet, I wake up my husband, because I feel scared’. Without the medicines, Ms Kaur sleeps and hour or two (three or four with them in total) and needs two hours or longer to fall asleep (half an hour with them) – asked why, she reported, ‘I couldn’t stop thinking’. With middle insomnia, ‘it will take at least an hour’ with the sedative medication, longer without them.
Prominent concentration disruption was observed during the assessment, with refocusing often needed. Comparing it nowadays to pre-injury, she reported, ‘The biggest thing what I feel is changed now, is my daughter is in high school now, and before my injury, I was teaching her, I was helping her in her assignments. I think she was in Year 7 or something, before my injury… in my home country. I studied myself whatever she was studying, then I was teaching her’. Returning her to her current situation, she stated, ‘Now she’s in Year 9, even more difficult class and obviously it’s been a while so my kids understood that mummy is not well…’ Further refocussed, she explained, ‘Now I couldn’t read properly, I couldn’t comprehend. Even with the psychologist, she is asking something and I am saying something else’, going on to state that she loses focus while she is answering questions, remarking, ‘I just feel worthless because of that’. Ms Kaur said she no longer watches the television, uses Facebook or LinkedIn (platforms she reported often using pre-injury) or reads (she did, pre-injury). Instead, asked what she can do, she replied, ‘drawing’, clarifying that her psychologist had introduced her to mindful colouring. She does this ‘little by little’ for five to seven minutes at a time as an escape, which Ms Kaur finds therapeutic: ‘while I am doing that, I am not thinking about anything, I am at that place at that time, there’s no negative feelings, no positive feelings, I like doing that for some time. Then after 5, 7 minutes I stop doing it’, usually due to fatigue or loss of focus. Clear memory deficits were noticed during the examination – Ms Kaur frequently was unable to recall dates, such as about her treatments. She said she often enters her kitchen but does not recall why, and loses her phone so often she no longer uses silent mode, so she can locate it when it is lost.
Her mood was explored; Ms Kaur stated, ‘I’m sad all the time, obviously anxiety is just when there is something I have to do’. Refocussing back to her mood, she re-iterated, ‘I’m sad all the time, and then I cry all the time when thinking of something’, occurring ‘most of the days, especially when I am alone’, which she did not do pre-injury. She rated her mood at around 2-3/10 (where 1-2 are most severely depressed, 3-4 moderately depressed, 5-6 mildly depressed, 7-8 euthymic mood and 9-10 elation). Energy is lacking these days: ‘I am easily tired, sometimes I lay down for half an hour… if my mind is tired, my body is tired too’, rated at around 30% of her pre-injury baseline. Ms Kaur said she will ‘lay down quite often but I couldn’t sleep’, reporting that she also sleeps in due to fatigue. On refocusing her for lapsing concentration, she said her naps last for ‘maybe for a couple hours’ and occur ‘Most of the days’. She is anhedonic: ‘maybe zero, I don’t even enjoy talking to my husband’ and feels ‘maybe hopeless, I can’t help my kids with study, I don’t see my friends… only my husband and kids know about my condition, my parents and my family they don’t’. Ms Kaur described losing touch with friends (further history has been moved where her functioning is discussed), said she feels worthless and helpless and avoids her friends, remarking, ‘If you know our Indian community, people always ask, ‘How’s your job? How are things?’… and I don’t want to lie in front of people, with my face you can tell from my face if I am lying about anything or if I am sad or if I exaggerate or am hiding things, so I don’t want to look stupid in front of people… so I just avoided them, better to have no contact. I had so many friends but now I lost it. I have no friends, you can say… I feel worthless’. Motivation is poorer. She denied any acute self-harm or suicidal ideation, intent or plans, which last occurred ‘a few months ago’ (she said her doctor is aware of this – she took diazepam at the time, which settled it). Ms Kaur ate three meals a day pre-injury, now eating less – ‘I hardly eat, maybe one in a day… Sometime[s] I don’t feel anything to eat all day, and I don’t eat anything in the day… a couple times a week, maybe two or three days. Mostly my husband will make a sandwich for me, if I feel like, I eat… I don’t feel hungry’. She enjoys food less and noted, ‘Even size is less, or sometimes I skip it, I don’t eat at all’, though she acknowledged being less active now. She does not weigh herself, stating, ‘I can see myself in the mirror and I am fat and ugly… the way I look now, it’s ugly’.
Anxiety ‘is on and off… it’s not like I am anxious all the time, if I have an appointment, go to an appointment, if I have to do something then I am very, very anxious…’ It has been heightened in the last fortnight (since she received the time and details for this examination). Refocussed to the broader two-month period, Ms Kaur stated that she has felt anxious for half of her waking period overall, rated on average around at 7-8/10 (where 1-3 represent low anxiety, 4-6 moderate anxiety, 7-8 high anxiety and 9-10 severe anxiety). Noting that the history suggested that her anxiety is high and likely more pervasive than reported (perhaps being less aware of it at times, though likely to be expressed more often and possibly more severely if she had to go out more, noting that she had described reclusive cocooning at home and not leaving home alone now). When she is anxious, physiological changes occur, with sweaty hands, shortness of breath, dizziness and tingling in her hands; while she was asked several times about the frequency at which this cluster of physiological changes occurs together (a panic attack), Ms Kaur reported, ‘Whenever I am anxious’, finding it challenging when this was explored again, then reporting that they occur ‘Whenever I am anxious I am having heavy breath, I am dizzy, I have sweaty hands and then I feel shoulder, all the muscles here [pointing to her shoulders] get sore, tense’. Anxious muscle tension also occurs in her neck, and tension headaches occur ‘when I talk too much with the psychologist’. Restless fidgeting was both noticed in the videoframe for the entire duration of the assessment and prominent in degree; acknowledging this when noted at times, reporting that her hands were sweaty. Irritability with anxiety had occurred more severely earlier in the injury history: ‘it was much before, I was agitated and irritable before… yelling at kids and yelling at my husband, and now I am quiet and lonely’, though it was learned that it is still present internally ‘but not as compared as before, more sadness inside’, referring to the current period.
Ms Kaur denied having any current flashbacks or nightmares of injury circumstances, stating that a year ago she had been experiencing unrelated disturbing dreams – ‘I would start to see dead people, walking towards me, in the forest’.
Other history
Asked about her substance and forensic history, she reported that she has never smoked cigarettes, consumed alcohol or any illicit substances, nor does she gamble or have any forensic history.
In considering her employment, a fresh history was obtained. After finishing Year 12 in India, Ms Kaur attended university and completed a Bachelor of Physiotherapy in Dehradun in the state of Uttarakhand, over four and a half years. She was then married and did not work until she had migrated to Australia in 2008. Her first tole was in reception duties for an immigration consultancy though she could not say how long for. Following this, she had worked with an insurer – it took her some time to remember, but Ms Kaur this period of ‘maybe two or three years’ was spent in duties as an assistant case manager and then as a case manager Gallagher Bassett. She then ‘moved to Catholic Church Insurance – I worked there as well for maybe two to three years over there as well, as a case manager, same work and then after that, after Catholic Church Insurance I moved to Arnott’s… as an injury management coordinator. That was my first job… like towards the employer side’. Ms Kaur felt she was employed there for ‘three years maybe’, before commencing with her pre-injury employer, where she had commenced pre-injury ‘Not long, I started in May and the injury is in June’.
She has not worked anywhere else since her injury.
A further history of Functioning and Daily Living Tasks
This history was obtained as an average over the last two months.
Ms Kaur lives with her husband (of 15 years, she calculated) and their children – a 14-year-old daughter and a son, 9. A history of her typical routine as an average in the last two months was obtained – she said she wakes around 9 or 9:30am, sometimes at 8 or 8:30am, needing half an hour to arise out of bed due to depressive fatigue and amotivation, with low mood. Once out, her day varies, and she goes to the bathroom and then may sit on the lounge for ‘half an hour or 45 minutes maximum’ or lay down again in bed for a variable period of time, stating that she does not have a routine, usually. She said her husband might prompt her to eat a sandwich he has made her, or to take her medicine/s. While he did the school drop off, picks ups were ‘mostly me, I think once or twice it was him, in the afternoon’, but he now does both due to her mental state. Asked about other things in a typical day, she said her doctor has told her to sit in the backyard due to low vitamin D, which she does for an unspecified period before she feels tired and then comes back indoors. Asked if anything else is done, she said she had worked pre-injury. Returned to nowadays, she struggled, with her focus lapsing repeatedly, and after some time repeated her history about sitting outside.
Self Care and Personal Hygiene
Ms Kaur reported no longer cooking these days – her husband took over following her injury, which she described being in the context of her depressive symptoms, then describing withdrawal socially (moved to the next heading). While he did most of the grocery shopping before her injury, she would still go herself three or four times a week. These days, ‘I don’t go at all now… there are too many people there, and in Glenwood we all know people, neighbours, they all go to the same Woolies’, which is due to her anxiety. Ms Kaur did about 90% of the house chores pre-injury, which has declined significantly to around 5%.
Asked about her appetite, she said she had packed her own lunch pre-injury, eating three times a day. These days, ‘I hardly eat, maybe one in a day… Sometime[s] I don’t feel anything to eat all day, and I don’t eat anything in the day… a couple times a week, maybe two or three days. Mostly my husband will make a sandwich for me, if I feel like, I eat… I don’t feel hungry’. Asked about portion sizes, she stated, ‘Even size is less, or sometimes I skip it, I don’t eat at all”, though she acknowledged being less active now. Prior to her injury, Ms Kaur bathed once, sometimes twice a day if it was hot. Asked about now, she paused before reporting, ‘I am doing maybe once a week but my psychologist, we are working maybe to increase it but maybe once a week’, which has been like this for over a year. She said she needs prompting for many tasks these days, such as eating or to take her medicines, as noted.
Social and Recreational Activities
Ms Kaur saw friends weekly pre-injury, recalling, ‘I had friends but I did not call them since the injury, I did not call them, I did not go to their house, maybe they’re thinking I’m rude, so at the moment I have no friends at the moment’, weeping as she spoke. She does not see friends at all these days, and she no longer uses social media (for her, Facebook and LinkedIn), nor does she go to the Gurudwara (the Sikh temple), ceasing ‘since my injury, we did not go at all’, due to her anxiety since it. Of her hobbies pre-injury, Ms Kaur reported, ‘I liked gardening, I liked singing, I was doing yoga before. Swimming, even though I did not swim properly, I loved swimming with my kids. We loved to go to Gurdwara as well… and reading, some suspense books’, stating that she enjoyed reading daily at times, finishing a book in two or three weeks. All hobbies have ceased since the injury due to her mental state. In terms of social events, she said she attended these on weekends with friends of the family, but this has ceased. She is psychiatrically unable to attend any social functions alone, nor would she attend or be able to attend with her husband, explaining, ‘I don’t feel like talking to anybody… it’s too much effort… which I can’t do now’.
Travel
Pre-injury, Ms Kaur would drive to work and locally, and said she could split long drives with her husband (these were to Canberra or Melbourne). Of the current situation, she stated, ‘I don’t drive at all now. After my injury I tried, but I jump the red light two times, and once I went black out and I jumped the red light, and after that I am not… my husband is not giving me, driving, I am not driving at all’. Ms Kaur is driven to general practitioner, psychiatry and psychology appointments, and does not drive. No longer does she take rideshare or public transport services, leaving her home alone rarely – on seeking to quantify this in more detail, she denied going for walks by herself these days, stating that she has just started to go into her own backyard, with the encouragement of her psychologist. Further history revealed that Ms Kaur does not go into the front yard or leave her home alone. On asking when she last left her home by herself, Ms Kaur reported, ‘I don’t remember, after the injury I saw the doctor in Glenwood by myself… took the public bus. It’s been more than year’.
Social Functioning
The quality of Ms Kaur’s interpersonal relationships was explored relative to before her injury. ‘Honestly, I don’t talk much with my husband or kids… much. My son, cos he is small I listen to him and talking about school. My daughter is busy in her class. My husband, I don’t like talking’. Prior to her injury, she said she played with her children, taking them to classes, adding, ‘I feel the bond was very close”, stating that she feels less close or bonded to them and her husband, and that she does not feel like talking to him. The history revealed that she has anxiety-related irritability was more severe earlier in the injury history: ‘it was much before, I was agitated and irritable before… yelling at kids and yelling at my husband, and now I am quiet and lonely’, though it was learned that it is still present internally ‘but not as compared as before, more sadness inside’, referring to the current period. She denied having fights or fracturing of friendships through arguments but described losing touch over time through not answering calls or messages, or seeing them, due to her mental state. Despite the strain on her marriage, it remains intact.
Concentration, Pace and Persistence
Prominent concentration disruption was observed during the assessment, with refocusing often needed. Comparing it nowadays to pre-injury, she reported, ‘The biggest thing what I feel is changed now, is my daughter is in high school now, and before my injury, I was teaching her, I was helping her in her assignments. I think she was in Year 7 or something, before my injury… in my home country. I studied myself whatever she was studying, then I was teaching her’. Returning her to her current situation, she stated, ‘Now she’s in Year 9, even more difficult class and obviously it’s been a while so my kids understood that mummy is not well’ Further refocussed, she explained, ‘Now I couldn’t read properly, I couldn’t comprehend. Even with the psychologist, she is asking something and I am saying something else’, going on to state that she loses focus while she is answering questions, remarking, ‘I just feel worthless because of that’. Ms Kaur said she no longer watches the television, uses Facebook or LinkedIn (platforms she reported often using pre-injury) or reads (she did, pre-injury). Instead, asked what she can do, she replied, ‘drawing’, clarifying that her psychologist had introduced her to mindful colouring. She does this ‘little by little’, for five to seven minutes at a time as an escape, which Ms Kaur finds therapeutic: ‘while I am doing that, I am not thinking about anything, I am at that place at that time, there’s no negative feelings, no positive feelings, I like doing that for some time. Then after 5, 7 minutes I stop doing it’, usually due to fatigue or loss of focus. Clear memory deficits were noticed during the examination – Ms Kaur frequently was unable to recall dates, such as about her treatments. She said she often enters her kitchen but does not recall why, and loses her phone so often she no longer uses silent mode, so she can locate it when it is lost.
Employability
Ms Kaur’s current psychiatric symptoms are of a significant grade, with pervasive depressed mood (moderate-to-severe in grade) and associated symptoms, and anxiety high in grade, reported to be occurring for half her waking week, though her history and presentation suggest that it likely is more pervasive, artificially less so (or noticed less, if her baseline is more pervasively anxious) owing to her cocooning at home, noting that she is no longer leaving home alone. If she had, to her anxiety, on balance, would be more pervasive and likely more severe at times. However, the degree of her depression and anxiety, and the other associated symptoms is such that there is no realistic prospect of her working in a role on the open and competitive labour market with sufficient functioning, including cognitively, to obtain or maintain any such work.
3. Findings on clinical examination
Mental State Examination
Ms Kaur presented as a woman of 40 years of a moderate build and average height, from what could be determined, as she was sitting during the one hour and 45 minute examination via Microsoft Teams, with a good and stable quality connection. She was casually dressed in a printed top, maintained eye contact through the examination and was prominently restless, fidgeting throughout the examination with her fingers and hands, visible through most of the examination in the videoframe. Rapport was fair. Her speech was soft, reduced in volume and the rate was fast for much of the examination, increasing when more anxious. Thought form was prominently tangential due to the degree of anxiety (high), requiring redirection often, and at times it was circumstantial in the same context. Her mood was low, and her affective range was restricted, teary intermittently and quite anxious in quality, well-communicated. It was congruent with what she described, and appropriate. Ms Kaur denied any acute self-harm or suicidal ideation, intent or plans. Thought content revealed anxious and depressive themes. Significant concentration and short-term memory deficits were observed, necessitating refocusing at frequent intervals in the examination. Her insight and judgement were fairly intact, and she described compliance with treatments.
4. Results of any additional investigations since the original Medical Assessment Certificate
Not applicable.”
The Appeal Panel adopts the findings and the report of Medical Assessor Ash Takyar.
The respondent worker is a 40-year-old female who was injured in the course of her employment with the appellant as a Safety & Injury Management Advisor. She described the formation of her work injury through difficulties with her manager, with depressive and anxiety symptoms developing through the course of her employment and the issues at work faced by her. Noting that her history and presentation were suggestive of more pervasive anxiety than reported, and given she is not leaving home these days by herself due to her anxiety, it would likely be more pervasive and severe if she had to leave home alone more often. The severity and depth of both her anxiety and depressive symptom sets are in keeping with diagnoses per DSM-5 of major depressive disorder and generalised anxiety disorder – she experiences pervasive depression of mood (of a moderate-to-severe grade), with degraded sleep (with middle and initial insomnia), concentration and memory, anhedonia and low energy, requiring napping, feelings of worthlessness, helplessness and significant loss of hope, poorer motivation, degraded appetite (number of meals, size, enjoyment). Her anxiety occurs with restlessness, irritability, muscle tension, fatigue and sleep and concentration difficulties, along with panic attacks.
It is noted that Dr Bisht, in his report of June 2023 has also diagnosed a major depressive disorder, and while he briefly mentioned anxiety and related phenomena, it was unclear if history around broader anxiety symptoms was sought. He opined that maximal medical improvement had not been reached, reporting that Ms Kaur had a singular antidepressant trial. However, this is not the case, noting that she had been prescribed escitalopram in August 2022 and agomelatine in 2022, with the current venlafaxine XR commencing in late October 2022, according to treating psychiatrist, Dr Singh’s correspondence in the brief. It is also noted that the venlafaxine XR dose of 225mg is reasonable, around two-thirds of the usual full 375mg dose.
Medical Assessor Chew in his Medical Assessment Certificate of 18 September 2023 diagnosed major depressive disorder, though brevity of his reasons does not allow the Panel to comment on the basis of there being no diagnosed anxiety disorder.
Dr Anand, in his report of May 2023 prefers a diagnosis of an adjustment disorder with mixed anxiety and depressed mood, but the Panel prefer their diagnoses on the basis of the history obtained and the collective experience of the Panel, noting the severity, breadth and duration of the injury and the fact Ms Kaur had ceased work in June 2022, with persistence of her symptoms despite broad attempts at treatment – psychology with two practitioners, psychiatric input regularly, and three antidepressant trials along with adjunctive quetiapine XR and melatonin, along with general practitioner reviews.
Medical Assessor Takyar appointed to conduct the re-examination obtained a detailed history of the respondent worker’s current psychiatric symptoms and of her current functioning.
The Panel’s view is that the re-examination by Medical Assessor Takyar contained sufficient detail and reasoning for their conclusions in terms of the injury history, current symptoms and functioning and other information.
In considering consistency, the respondent worker’s presentation on examination was congruent with her history, though both were suggestive of more pervasive anxiety than reported. Her mental state examination features and history were congruent with the information in the material before the Appeal Panel.
The Medical Appeal Panel considered the various documents submitted by both parties, including the submissions of each party, the respondent worker’s statements, including the more recent one of August 2023, the provided treatment records and correspondence, the psychiatric medicolegal reports and the IMC report of Dr Schiff, and other material, as provided.
The Panel’s PIRS assessment is as follows:
| PIRS Category | Class | Reason for Decision |
| Self Care and personal hygiene | 3 | Ms Kaur reported no longer cooking these days – her husband took over following her injury, which she described being in the context of her depressive symptoms, then describing withdrawal socially (moved to the next heading). While he did most of the grocery shopping before her injury, she would still go herself three or four times a week. These days, “I don’t go at all now… there are too many people there, and in Glenwood we all know people, neighbours, they all go to the same Woolies”, which is due to her anxiety. Ms Kaur did about 90% of the house chores pre-injury, which has declined significantly to around 5%. Asked about her appetite, she said she had packed her own lunch pre-injury, eating three times a day. These days, “I hardly eat, maybe one in a day… Sometime[s] I don’t feel anything to eat all day, and I don’t eat anything in the day… a couple times a week, maybe two or three days. Mostly my husband will make a sandwich for me, if I feel like, I eat… I don’t feel hungry”. Asked about portion sizes, she stated, “Even size is less, or sometimes I skip it, I don’t eat at all”, though she acknowledged being less active now. Prior to her injury, Ms Kaur bathed once, sometimes twice a day if it was hot. Asked about now, she paused before reporting, “I am doing maybe once a week but my psychologist, we are working maybe to increase it but maybe once a week”, which has been like this for over a year. She said she needs prompting for many tasks these days, such as eating or to take her medicines, as noted. |
| Social and recreational activities | 3 | Ms Kaur saw friends weekly pre-injury, recalling, “I had friends but I did not call them since the injury, I did not call them, I did not go to their house, maybe they’re thinking I’m rude, so at the moment I have no friends at the moment”, weeping as she spoke. She does not see friends at all these days, and she no longer uses social media (for her, Facebook and LinkedIn), nor does she go to the Gurudwara (the Sikh temple), ceasing “since my injury, we did not go at all”, due to her anxiety since it. Of her hobbies pre-injury, Ms Kaur reported, “I liked gardening, I liked singing, I was doing yoga before. Swimming, even though I did not swim properly, I loved swimming with my kids. We loved to go to Gurdwara as well… and reading, some suspense books”, stating that she enjoyed reading daily at times, finishing a book in two or three weeks. All hobbies have ceased since the injury due to her mental state. In terms of social events, she said she attended these on weekends with friends of the family, but this has ceased. She is psychiatrically unable to attend any social functions alone, and she might not be able to attend with her husband. “I don’t feel like talking to anybody… it’s too much effort… which I can’t do now”. |
| Travel | 3 | Pre-injury, Ms Kaur would drive to work and locally, and said she could split long drives with her husband (these were to Canberra or Melbourne). Of the current situation, she stated, “I don’t drive at all now. After my injury I tried, but I jump the red light two times, and once I went black out and I jumped the red light, and after that I am not… my husband is not giving me, driving, I am not driving at all”. Ms Kaur is driven to general practitioner, psychiatry and psychology appointments, and does not drive. No longer does she take rideshare or public transport services, leaving her home alone rarely – on seeking to quantify this in more detail, she denied going for walks by herself these days, stating that she has just started to go into her own backyard, with the encouragement of her psychologist. Further history revealed that Ms Kaur does not go into the front yard or leave her home alone. On asking when she last left her home by herself, Ms Kaur reported, “I don’t remember, after the injury I saw the doctor in Glenwood by myself… took the public bus. It’s been more than year”. |
| Social functioning | 2 | The quality of Ms Kaur’s interpersonal relationships was explored relative to before her injury. “Honestly, I don’t talk much with my husband or kids… much. My son, cos he is small I listen to him and talking about school. My daughter is busy in her class. My husband, I don’t like talking”. Prior to her injury, she said she played with her children, taking them to classes, adding, “I feel the bond was very close”, stating that she feels less close or bonded to them and her husband, and that she does not feel like talking to him. The history revealed that she has anxiety-related irritability was more severe earlier in the injury history: “it was much before, I was agitated and irritable before… yelling at kids and yelling at my husband, and now I am quiet and lonely”, though it was learned that it is still present internally “but not as compared as before, more sadness inside”, referring to the current period. She denied having fights or fracturing of friendships through arguments but described losing touch over time through not answering calls or messages, or seeing them, due to her mental state. Despite the strain on her marriage, it remains intact. |
| Concentration, persistence and pace | 3 | Prominent concentration disruption was observed during the assessment, with refocusing often needed. Comparing it nowadays to pre-injury, she reported, “The biggest thing what I feel is changed now, is my daughter is in high school now, and before my injury, I was teaching her, I was helping her in her assignments. I think she was in Year 7 or something, before my injury… in my home country. I studied myself whatever she was studying, then I was teaching her”. Returning her to her current situation, she stated, “Now she’s in Year 9, even more difficult class and obviously it’s been a while so my kids understood that mummy is not well…” Further refocussed, she explained, “Now I couldn’t read properly, I couldn’t comprehend. Even with the psychologist, she is asking something and I am saying something else”, going on to state that she loses focus while she is answering questions, remarking, “I just feel worthless because of that”. Ms Kaur said she no longer watches the television, uses Facebook or LinkedIn (platforms she reported often using pre-injury) or reads (she did, pre-injury). Instead, asked what she can do, she replied, “drawing”, clarifying that her psychologist had introduced her to mindful colouring. She does this “little by little”, for five to seven minutes at a time as an escape, which Ms Kaur finds therapeutic: : “while I am doing that, I am not thinking about anything, I am at that place at that time, there’s no negative feelings, no positive feelings, I like doing that for some time. Then after 5, 7 minutes I stop doing it”, usually due to fatigue or loss of focus. Clear memory deficits were noticed during the examination – Ms Kaur frequently was unable to recall dates, such as about her treatments. She said she often enters her kitchen but does not recall why, and loses her phone so often she no longer uses silent mode, so she can locate it when it is lost. |
| Employability | 5 | Ms Kaur’s current psychiatric symptoms are of a significant grade, with pervasive depressed mood (moderate-to-severe in grade) and associated symptoms, and anxiety high in grade, reported to be occurring for half her waking week, though her history and presentation suggest that it likely is more pervasive, artificially less so (or noticed less, if her baseline is more pervasively anxious) owing to her cocooning at home, noting that she is no longer leaving home alone. If she had, to her anxiety, on balance, would be more pervasive and likely more severe at times. However, the degree of her depression and anxiety, and the other associated symptoms is such that there is no realistic prospect of her working in a role on the open and competitive labour market with sufficient functioning, including cognitively, to obtain or maintain any such work. |
The Appeal Panel notes that Dr Anand, the IME qualified on behalf of the respondent worker, had assessed Ms Kaur in May 2023, and Dr Bisht, the IME qualified on behalf of the appellant in June 2023.
The Panel found that with respect to the PIRS:
(a) its score of Class 3 in Self-Care and Personal Hygiene is greater than Dr Anand (Class 2), noting that she bathes around weekly and needs prompting for many tasks, including to take her medicines and to eat. Prompting to bathe might increase the frequency. While Dr Anand says she does not need prompting to shower, he does not record the frequency of bathing, and his one-paragraph symptom review does not describe her appetite other than reporting that it is “disordered”;
(b) in Social and Recreational Activities, the Panel determined that she has functioning reflective of Class 3, congruent with Dr Anand’s assessment, also agreeing with him in the domains of Social Functioning (Class 2), Concentration, Persistence and Pace (Class 3) and Employability (Class 5), and
(c) it differed in one other domain, Travel, where a higher Class 3 score was determined, above the Class 2 score of Dr Anand, as Ms Kaur cannot travel independently any longer, no longer driving or using public transport, needing to be driven to her medical and other treatment appointments. She does not take rideshare, and on re-examination a history was obtained of her only attending her backyard, but not the front yard or leaving her home alone. She needs a support person to do this, and at the time of Dr Anand’s assessment her husband had recommended she not drive due to a number of mistakes when doing so. He felt she could take public transit, though the history taken on re-examination suggests she cannot at this juncture.
The Panel does not agree with the view of Dr Bisht in his June 2023 report with respect to his opinion that maximal medical improvement had not been reached. Dr Bisht opined that maximal medical improvement had not been reached, reporting that Ms Kaur had a singular antidepressant trial. However, this is not the case, noting that she had been prescribed escitalopram in August 2022 and agomelatine in 2022, with the current venlafaxine XR commencing in late October 2022, according to treating psychiatrist, Dr Singh’s correspondence. It is also noted that the venlafaxine XR dose of 225mg is reasonable, around two-thirds of the usual full 375mg dose. Dr Bisht’s reliance on Ms Kaur having had a singular anti-depressant trial is not factually in keeping with the information obtained from
Ms Kaur on re-examination and from the material before the Appeal Panel which notes she has had three antidepressant trials at the time of his examination. She has also had therapy via two psychologists, and treatment via psychiatrist, Dr Singh since October 2022, currently monthly. In these circumstances the Panel considers that the worker’s condition is deemed to be stabilised – and thus, not likely to change by more than 3%, in the next year, with or without medical treatment.The Panel concluded that Ms Kaur has a median score of 3 under the PIRS, based on the history taken and findings on re-examination by Medical Assessor Takyar, a member of the Appeal Panel, and an aggregate of 19, with a total whole person impairment of 24%, with no pre-existing psychiatric illness pre-injury, nor any other non-injury related factors for which apportionment is required. Upon re-examination of the worker, the Panel found that the relevant class scores above were best applicable in this case. Accordingly, the Appeal Panel will revoke the MAC.
For these reasons, the Appeal Panel has determined that the MAC issued on
18 September 2023 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.
PERSONAL INJURY COMMISSION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
Matter number: | W5786/23 |
Applicant: | Ramandeep Kaur |
Respondent: | Ooh! Media Operations 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 Gerald Chew and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
Table - whole person impairment (WPI)
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psycho-logical | 17/6/22 | 11, page 55-60 | 14 | 24% | NIL | 24% |
| Total % WPI (the Combined Table values of all sub-totals) | 24% | |||||
PERSONAL INJURY COMMISSION
Table 11.8: PIRS Rating Form
| Name | Ramandeep Kaur | Claim reference number (if known) |
| DOB | xxxx | Age at time of injury |
| Date of Injury | 17 June 2022 | Occupation at time of injury |
| Date of Assessment | Marital Status before injury |
| Psychiatric diagnoses | 1. | 2. | |
| 3. | 4. | ||
| Psychiatric treatment | |||
| Is impairment permanent? | Yes | No (circle one) | |
| PIRS Category | Class | Reason for Decision | |||||||||
| Self Care and personal hygiene | 3 | Ms Kaur reported no longer cooking these days – her husband took over following her injury, which she described being in the context of her depressive symptoms, then describing withdrawal socially (moved to the next heading). While he did most of the grocery shopping before her injury, she would still go herself three or four times a week. These days, “I don’t go at all now… there are too many people there, and in Glenwood we all know people, neighbours, they all go to the same Woolies”, which is due to her anxiety. Ms Kaur did about 90% of the house chores pre-injury, which has declined significantly to around 5%. Asked about her appetite, she said she had packed her own lunch pre-injury, eating three times a day. These days, “I hardly eat, maybe one in a day… Sometime[s] I don’t feel anything to eat all day, and I don’t eat anything in the day… a couple times a week, maybe two or three days. Mostly my husband will make a sandwich for me, if I feel like, I eat… I don’t feel hungry”. Asked about portion sizes, she stated, “Even size is less, or sometimes I skip it, I don’t eat at all”, though she acknowledged being less active now. Prior to her injury, Ms Kaur bathed once, sometimes twice a day if it was hot. Asked about now, she paused before reporting, “I am doing maybe once a week but my psychologist, we are working maybe to increase it but maybe once a week”, which has been like this for over a year. She said she needs prompting for many tasks these days, such as eating or to take her medicines, as noted. | |||||||||
| Social and recreational activities | 3 | Ms Kaur saw friends weekly pre-injury, recalling, “I had friends but I did not call them since the injury, I did not call them, I did not go to their house, maybe they’re thinking I’m rude, so at the moment I have no friends at the moment”, weeping as she spoke. She does not see friends at all these days, and she no longer uses social media (for her, Facebook and LinkedIn), nor does she go to the Gurudwara (the Sikh temple), ceasing “since my injury, we did not go at all”, due to her anxiety since it. Of her hobbies pre-injury, Ms Kaur reported, “I liked gardening, I liked singing, I was doing yoga before. Swimming, even though I did not swim properly, I loved swimming with my kids. We loved to go to Gurdwara as well… and reading, some suspense books”, stating that she enjoyed reading daily at times, finishing a book in two or three weeks. All hobbies have ceased since the injury due to her mental state. In terms of social events, she said she attended these on weekends with friends of the family, but this has ceased. She is psychiatrically unable to attend any social functions alone, and she might not be able to attend with her husband. “I don’t feel like talking to anybody… it’s too much effort… which I can’t do now”. | |||||||||
| Travel | 3 | Pre-injury, Ms Kaur would drive to work and locally, and said she could split long drives with her husband (these were to Canberra or Melbourne). Of the current situation, she stated, “I don’t drive at all now. After my injury I tried, but I jump the red light two times, and once I went black out and I jumped the red light, and after that I am not… my husband is not giving me, driving, I am not driving at all”. Ms Kaur is driven to general practitioner, psychiatry and psychology appointments, and does not drive. No longer does she take rideshare or public transport services, leaving her home alone rarely – on seeking to quantify this in more detail, she denied going for walks by herself these days, stating that she has just started to go into her own backyard, with the encouragement of her psychologist. Further history revealed that Ms Kaur does not go into the front yard or leave her home alone. On asking when she last left her home by herself, Ms Kaur reported, “I don’t remember, after the injury I saw the doctor in Glenwood by myself… took the public bus. It’s been more than year”. | |||||||||
| Social functioning | 2 | The quality of Ms Kaur’s interpersonal relationships was explored relative to before her injury. “Honestly, I don’t talk much with my husband or kids… much. My son, cos he is small I listen to him and talking about school. My daughter is busy in her class. My husband, I don’t like talking”. Prior to her injury, she said she played with her children, taking them to classes, adding, “I feel the bond was very close”, stating that she feels less close or bonded to them and her husband, and that she does not feel like talking to him. The history revealed that she has anxiety-related irritability was more severe earlier in the injury history: “it was much before, I was agitated and irritable before… yelling at kids and yelling at my husband, and now I am quiet and lonely”, though it was learned that it is still present internally “but not as compared as before, more sadness inside”, referring to the current period. She denied having fights or fracturing of friendships through arguments but described losing touch over time through not answering calls or messages, or seeing them, due to her mental state. Despite the strain on her marriage, it remains intact. | |||||||||
| Concentration, persistence and pace | 3 | Prominent concentration disruption was observed during the assessment, with refocusing often needed. Comparing it nowadays to pre-injury, she reported, “The biggest thing what I feel is changed now, is my daughter is in high school now, and before my injury, I was teaching her, I was helping her in her assignments. I think she was in Year 7 or something, before my injury… in my home country. I studied myself whatever she was studying, then I was teaching her”. Returning her to her current situation, she stated, “Now she’s in Year 9, even more difficult class and obviously it’s been a while so my kids understood that mummy is not well…” Further refocussed, she explained, “Now I couldn’t read properly, I couldn’t comprehend. Even with the psychologist, she is asking something and I am saying something else”, going on to state that she loses focus while she is answering questions, remarking, “I just feel worthless because of that”. Ms Kaur said she no longer watches the television, uses Facebook or LinkedIn (platforms she reported often using pre-injury) or reads (she did, pre-injury). Instead, asked what she can do, she replied, “drawing”, clarifying that her psychologist had introduced her to mindful colouring. She does this “little by little”, for five to seven minutes at a time as an escape, which Ms Kaur finds therapeutic: : “while I am doing that, I am not thinking about anything, I am at that place at that time, there’s no negative feelings, no positive feelings, I like doing that for some time. Then after 5, 7 minutes I stop doing it”, usually due to fatigue or loss of focus. Clear memory deficits were noticed during the examination – Ms Kaur frequently was unable to recall dates, such as about her treatments. She said she often enters her kitchen but does not recall why, and loses her phone so often she no longer uses silent mode, so she can locate it when it is lost. | |||||||||
| Employability | 5 | Ms Kaur’s current psychiatric symptoms are of a significant grade, with pervasive depressed mood (moderate-to-severe in grade) and associated symptoms, and anxiety high in grade, reported to be occurring for half her waking week, though her history and presentation suggest that it likely is more pervasive, artificially less so (or noticed less, if her baseline is more pervasively anxious) owing to her cocooning at home, noting that she is no longer leaving home alone. If she had, to her anxiety, on balance, would be more pervasive and likely more severe at times. However, the degree of her depression and anxiety, and the other associated symptoms is such that there is no realistic prospect of her working in a role on the open and competitive labour market with sufficient functioning, including cognitively, to obtain or maintain any such work. | |||||||||
| Score | Median Class | ||||||||||
| 2 | 3 | 3 | 3 | 3 | 5 | = 3 | |||||
| Aggregate Score Impairment | Total | % | |||||||||
| +2 | +3 | +3 | +3 | +3 +5 | 19 | = 24% | |||||
0