Oraha v Settlement Services International

[2024] NSWPICMP 171

DETERMINATION OF APPEAL PANEL
CITATION:	Oraha v Settlement Services International [2024] NSWPICMP 171
APPELLANT:	Dina Oraha
RESPONDENT:	Settlement Services International Pty ltd
APPEAL PANEL
MEMBER:	Marshal Douglas
MEDICAL ASSESSOR:	Douglas Andrews
MEDICAL ASSESSOR:	Graham Blom
DATE OF DECISION:	22 March 2024
CATCHWORDS:	WORKERS COMPENSATION - Whether Medical Assessor (MA) erred by not explaining why he disagreed with the assessment of the appellant’s independent medical examiner (IME); whether MA had regard to all relevant evidence when assessing her impairment in several psychiatric impairment rating scale (PIRS) categories; whether MA erred with his ratings of the appellant’s impairment in several PIRS categories; Appeal Panel held MA was not required to explain why his assessment differed from the assessment of the appellant’s IME; Appeal Panel found that the MA had regard to all relevant evidence; Appeal Panel found that the MA’s rating of appellant’s impairment in social and recreational activities was not supported by the evidence and was consequently an error; Held – Medical Assessment Certificate revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

1. On 15 November 2023 Dina Oraha (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr John Baker, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 18 October 2023.

2. The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act):

   ·        the assessment was made on the basis of incorrect criteria, and

   ·        the MAC contains a demonstrable error.

3. 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.

4. Rule 128 of the Personal Injury Commission Rules 2021 (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.

5. 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).

RELEVANT FACTUAL BACKGROUND

1. The appellant commenced employment as a recruitment consultant with Settlement Services International Pty Ltd, the respondent, in January 2018. She ceased her employment on 4 March 2021. Due to incidents to which she was exposed from November 2019 she suffered a psychological injury.

2. She claimed compensation against the respondent for permanent impairment she said resulted from her injury. She relied on a report of psychiatrist Dr Christopher Canaris dated 12 January 2023 who assessed the degree of her permanent impairment from her injury was 16% whole person impairment (WPI).

3. The respondent’s insurer denied it was liable to pay her compensation because it considered the degree of her permanent impairment from her injury was not at least 15%, which is the threshold imposed by s 65A(3) of the Workers Compensation Act 1987 (the 1987 Act) for a worker to have an entitlement to compensation for permanent impairment from a psychological injury. The insurer relied on a report of Dr Yajuvendra Bisht dated 20 May 2023, who assessed the appellant had 7% WPI from her injury.

4. The appellant then initiated proceedings in the Personal Injury Commission (Commission) seeking determination of her claim for compensation for permanent impairment from her injury. A delegate of the President issued a referral to the Medical Assessor dated 10 July 2023.

5. The Medical Assessor examined the appellant on 3 October 2023 in order to assess the medical disputes that the President’s delegate referred to him to assess. As said, he issued the MAC on 18 October 2023 in response to that referral.

6. In that he certified that the appellant’s impairment was permanent and that the degree of her permanent impairment is fully ascertainable. He certified that no proportion of her permanent impairment is due to a pervious injury or pre-existing condition or abnormality. He certified that the degree of her permanent impairment as a result of her psychological injury was 9%. His assessment was based on paragraph 1.32 and Chapter 11 of the Guidelines.

7. He advised in the MAC that he had rated the appellant’s impairment in the psychiatric impairment rating scale (PIRS) for self-care and personal hygiene as class 2, in social and recreational activities as class 2, in travel as class 2, in social functioning as class 3, in concentration, persistence and pace (CPP) as class 2, and in employability as class 3. He noted that the median of those class scores was 3, but that was an obvious typographical error as it was class 2. He noted that the aggregate of his class scores was 14. That median score and aggregate score converts to 7% WPI, in accordance with Table 11.7 of the Guidelines. The Medical Assessor added 2% WPI to that, pursuant to paragraph 1.32 of the Guidelines because he was of the opinion that the appellant’s ongoing medical and psychological treatment had enabled her to sustain her present level of function and without that treatment she more probably than not deteriorate in her employability such that she would be totally impaired in employability.

8. The matters the appellant raised in her appeal against the MAC relates to the Medical Assessor’s ratings of her impairment in the PIRS for self-care and personal hygiene, social and recreational activities and CPP. The Medical Assessor’s explanation for his ratings in those PIRS were as follows:

Self care and personal hygiene	2	The claimant reported that she was able to live independently at the time of this assessment. She reported that she spent most of her days at home. She was less interested in maintaining her home than she had prior to the primary psychological injury. The claimant was more reliant on her husband and her mother. Her husband vacuumed, cleaned the bathroom and washed clothes and dishes. Her husband assisted with bathing their 3-year-old child. The claimant appeared unkempt and ungroomed. She said she was able to assist with some cooking and cleaning. She would skip meals. She reported loss of motivation in maintaining her self-care and personal hygiene. Her groceries were delivered.
Social and recreational activities	2	The claimant had celebrations in her home. She had participated at Christmas and her son’s birthday. She enjoyed these events less than prior to the onset of this primary psychological injury. She had stopped her participation in past friendship groups. She preferred to be isolated and avoid social and recreational activities with others, such as attending Sunday Mass as she had prior to the injury. She had stopped watching her favourite television shows and movies with her husband. She no longer enjoyed these activities. She could attend the local coffee shop that was close to her home on occasion.
Concentration, persistence and pace	2	The claimant could concentrate for up to 30 minutes. She reported she would frequently have to take breaks and her rate of completion of complex tasks such as updating and lodging advertisements on multiple sites was slow. The claimant reported that she had made errors after becoming distracted. She reported that she had been reminded by her supervisor on how to prioritise and organise herself in her home office.

1. The Medical Assessor noted that Dr Canaris had assessed the degree of the appellant’s permanent impairment from her injury was 16% WPI and commented that he did not concur with that assessment. The Medical Assessor also noted that Dr Bisht had assessed the appellant had 7% WPI and similarly commented that he did not concur with that assessment.

PRELIMINARY REVIEW

1. 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.

2. As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the appellant to undergo a further medical examination. This is because the material before the Appeal Panel is sufficient for it to deal with the appeal.

EVIDENCE

1. 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

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

2. In summary, the appellant submitted that the Medical Assessor failed to disclose any proper reasoning for disagreeing with the opinion of Dr Canaris and had made no attempt to engage with the opinion of Dr Canaris other than to repeat a summary of his opinion. The appellant referred to Wingfoot Australia Partners Pty Ltd v Kocak[1] (Kocak) and Lederer v Insurance Australia Limited t/as NRMA Insurance ACN 000016722[2] (Lederer) as authority for her submission that the Medical Assessor was required to engage with the opinion of Dr Canaris.

   [1] [2013] HCA 43.

   [2] [2022] NSWSC322.

3. The appellant submitted that the Medical Assessor did not have regard to all relevant evidence when rating her impairment in the PIRS for self-care and personal hygiene. The appellant extracted those parts of the evidence that she contended the Medical Assessor did not consider. The appellant also submitted that the history the Medical Assessor obtained indicates that she has significant disability in self-care and personal hygiene because that history indicates she is unable to live independently.

4. The appellant submitted that the Medical Assessor ignored relevant evidence when rating her impairment in the PIRS for social and recreational activities. The appellant referred to parts of a statement she signed on 2 November 2021 and parts of Dr Canaris’ reports of 11 November 2021 and 12 January 2023. The appellant also referred to parts of Dr Bisht’s report. The appellant also submitted that based on that evidence and the history the Medical Assessor obtained, the Medical Assessor ought to have rated her impairment in the PIRS for social and recreational activities as class 3, and the appellant submitted that the Medical Assessor made an error by assessing her impairment as class 2.

5. The appellant also submitted that the evidence before the Medical Assessor was such that her impairment in the PIRS for CPP ought to have been rated as class 3. She again referred to parts of her statement signed on 2 November 2021, to parts of Dr Canaris’ evidence within his report of 12 January 2023, and parts of Dr Bisht’s report. The appellant submitted that based on that evidence and the history the Medical Assessor obtained he ought to have rated her impairment as class 3 in the PIRS for CPP.

6. In reply, the respondent submitted that it is evident from the MAC why the Medical Assessor’s assessment differed from the assessment Dr Canaris made. The respondent submitted that the Medical Assessor provided detailed reasons for his assessments of the appellant’s impairment in each of the PIRS categories and was not bound to agree with the findings of Dr Canaris.

7. The respondent submitted, with respect to the Medical Assessor’s rating of the appellant’s impairment in the PIRS for self-care and personal hygiene, that the Medical Assessor considered the appellant’s statement, the reports of Dr Canaris and the consultation notes of Ms Dionisopoulos. The respondent further submitted that, in accordance with paragraph 1.6 of the Guidelines, the Medical Assessor was required to make an assessment of the appellant’s impairment at the time she presented for assessment.

8. The respondent submitted that the Medical Assessor’s assessment of the appellant’s impairment in self-care and personal hygiene was consistent with the documentary evidence available to him as well as the information the appellant provided to him at the time of examination. The respondent submitted that:

   “…intervention by an Appeal Panel will only be justified if categorisation of the PIRS was glaringly improbably, or the Medical Assessor was unaware of significant factual matters relevant to the assessment of impairment, or if a clear misunderstanding could be demonstrated, or if an unsupportable reasoning process could be made out”.

   The respondent cited Ferguson v State of New South Wales[3] (Ferguson) at [24] in support of that submission.

   [3] [2017] NSWSC887.

9. The respondent submitted that the Medical Assessor’s path of reasoning was sufficiently exposed to justify his rating of the appellant’s impairment in self-care and personal hygiene and the respondent submitted that there was no demonstrable error contained in the MAC regarding the rating the Medical Assessor made.

10. With respect to the Medical Assessor’s rating of the appellant’s impairment in the PIRS for social and recreational activities, the respondent submitted that the Medical Assessor had regard to relevant evidence including the appellant’s statement, the reports of Dr Canaris and the report of Dr Bisht. The respondent submitted that it was open to the Medical Assessor to exercise his clinical judgement when rating the appellant’s impairment in the PIRS for social and recreational activity and it was open for him to assess the appellant’s impairment as class 2.

11. With respect to the Medical Assessor’s rating of the appellant’s impairment in the PIRS for CPP, the respondent again submitted that the Medical Assessor had regard to the relevant evidence including the appellant’s statement, the reports of Dr Canaris and the report of Dr Bisht. The respondent submitted that the Medical Assessor was not bound to agree with the findings of Dr Canaris. The respondent submitted that the Medical Assessor’s findings and assessment of a class 2 rating in CPP did not demonstrate error.

FINDINGS AND REASONS

1. 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.

2. In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons.

Dr Canaris’ opinion

1. A Medical Assessor is required in accordance with s 325(2) of the 1998 Act to set out his or her reasons for the assessment made and to set out the facts upon which the assessment is based. That obligation requires a Medical Assessor to explain his or her opinion by revealing the actual path of reasoning by which he or she arrived at that opinion in sufficient detail such that an Appeal Panel can ascertain whether there is any error in the Medical Assessor’s reasoning.[4]

   [4] Wingfoot Aust Partners Pty Ltd v Kocak [2013] HCA 43, 22 CLR 480 (Wingfoot) at [55]; applied by Campbell J in State of New South Wales (NSW Department of Education) v Kaur [2016] NSWSC 346 at [24]-[25] (Kaur) and by Harrison AsJ in Broadspectrum (Aust) Pty Ltd v Fiona Louise Wills [2018] NSWSC 1320.

2. The obligation of a Medical Assessor does not require the Medical Assessor to explain why s/he did not form an opinion that s/he did not reach, even if that opinion is different from those of other medical examiners. Nor does it require the Medical Assessor to sit as a decision maker choosing between competing medical opinions put forward by the parties.

3. Lederer is not inconsistent with those principles. Lederer however involved different legislation and a different scheme and related to a situation in which a Medical Assessor was required to determine whether a specific event caused a “degenerative cascade” of the plaintiff’s cervical spine. Brereton JA held in that case that the Medical Assessor had not responded to an argument the plaintiff had put to the Medical Assessor with respect to that issue. The court held that the Medical Assessor was required to show how he had considered the issue. The case is not authority for the proposition that a Medical Assessor is required to explain, in a circumstance where the Medical Assessor is assessing a worker’s permanent impairment in accordance with s 322 of the 1998 Act, why his or her opinion differs from the assessment another examiner has made. Again, the Medical Assessor is only required to reveal in sufficient detail the path by which s/he arrived at his or her opinion.

4. It is apparent from the MAC that the Medical Assessor had regard to the opinions of Dr Canaris and Dr Bisht, and also the appellant’s statement and the clinical notes of
   Ms Dionisopoulos. It is clear because the Medical Assessor extracted parts of that evidence in the MAC.

5. The Medical Assessor was not required to explain why Dr Canaris assessed the appellant’s permanent impairment from her injury differently than what he had assessed it. His obligation required him to explain his opinion for his assessment of the appellant’s permanent impairment from her injury.

6. In the Appeal Panel’s view the Medical Assessor provided sufficient reasoning and referred to the relevant evidence such that his reasoning for how he rated the appellant’s permanent impairment from her injury is understood. He has, in other words, sufficiently exposed his path of reasoning for his assessment.

7. Because the Medical Assessor has done that, it is consequently and readily apparent, when the MAC is read as whole, why the Medical Assessor did come to a different view than Dr Canaris regarding the degree of the appellant’s permanent impairment from her injury.

8. No error is demonstrated in the MAC by virtue of the Medical Assessor coming a to a different view than Dr Canaris regarding the degree of permanent impairment of the appellant from her injury. The Medical Assessor sufficiently explained his reasons for his assessment.

The PIRS ratings

1. An assessment of a worker’s impairment resulting from a psychiatric injury is, in accordance with paragraphs 11.11 and 11.12 of the Guidelines, done by reference to the effect the worker’s injury has in six categories of activity and function. Together these comprise the PIRS. Each PIRS is divided into five classes, ranging from Class 1 to Class 5, by which the Medical Assessor must rate the seriousness of the effect of the worker’s injury for the particular area of activity or function. Class 1 is at one end and relates to a circumstance where the worker has no psychological deficit in the particular category or a minor deficit attributable to the normal variation in the general population. Class 5 is at the other end and relates to the circumstance where the worker is totally impaired.

2. Clause 11.12 of the Guidelines contains a table for each PIRS. Each table provides examples, for each of the several classes by which a worker’s impairment in the particular PIRS can be rated, of how the worker’s injury may have affected the worker. Because clause 11.12 stipulates that “the examples of activities are examples only”, they are intended only to provide guidance or assistance to a Medical Assessor in the Medical Assessor’s task of rating the worker’s impairment within the particular PIRS. They are not prescriptive.[5] What is important is the seriousness of the worker’s impairment, that is whether the worker has no, mild, moderate, severe or total impairment, in the particular activity or function the subject of the table.

   [5] Jenkins v Ambulance Service of NSW[2015] NSWSC 633 at [65].

3. Paragraph 1.6 of the Guidelines requires a Medical Assessor to rate a worker’s impairment at the time when the assessment is done. The assessment must be based on all relevant medical information available to the Medical Assessor, which of course includes the history the Medical Assessor has obtained at the time of the assessment and also the clinical observations the Medical Assessor makes of the worker during the Medical Assessor’s mental state examination of the worker. The Medical Assessor is entitled to give pre-eminence to his or her clinical observations when rating the worker’s impairment.[6]

   [6] Ferguson v State of NSW [2017] NSWSC 887 at [23], citing with approval NSW Police Force v Daniel Wark [2012] NSWWCCMA 36; Coenradi v the GEO Group Australia Pty Ltd [2002] NSWSC 864 (Coenradi) at [135].

1. To establish that a Medical Assessor has rated a worker’s impairment incorrectly in any of the PIRS there must be more than a difference of opinion on the subject matter about which reasonable minds might differ.[7]

   [7] Parker v Select Civil Pty Ltd [2018] NSWSC 140 at [66]; Coenradi at [136].

2. What all that means, in this matter, is that for the Appeal Panel to be satisfied that the Medical Assessor erred with respect to his classifications of the appellant’s impairment in the several PIRS categories about which the appellant contends there is error, the Appeal Panel must be satisfied that it was not open to the Medical Assessor to make the rating he did based on the material before the Medical Assessor, including the history the Medical Assessor obtained and his clinical observations. In other words, the Appeal Panel must be satisfied that the material before the Medical Assessor do not support the Medical Assessor’s ratings.

Self-care and personal hygiene

1. The examples provided in Table 11.1 of the Guidelines, which relates to the PIRS category of self-care and personal hygiene, for a class 2 and class 3 impairment, are:

Class 2	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.
Class 3	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.

1. The Medical Assessor rated the appellant’s impairment in this PIRS as class 2. The appellant contends he should have rated it as class 3, based on the evidence before him, and erred by not doing so. The Medical Assessor’s explanation for rating the appellant’s impairment as class 2 were:

   “The claimant reported that she was able to live independently at the time of this assessment. She reported that she spent most of her days at home. She was less interested in maintaining her home than she had prior to the primary psychological injury.

   The claimant was more reliant on her husband and her mother. Her husband vacuumed, cleaned the bathroom and washed clothes and dishes. Her husband assisted with bathing their 3-year-old child.

   The claimant appeared unkempt and ungroomed. She said she was able to assist with some cooking and cleaning. She would skip meals. She reported loss of motivation in maintaining her self-care and personal hygiene. Her groceries were delivered.”

2. The Appeal Panel considers that the reasons the Medical Assessor provided for rating the appellant’s impairment as class 2 adequately explain his rating. They reveal that the appellant is able to live independently, although with less diligence to her self-care and personal health than prior to her injury. The Medical Assessor’s assessment was based upon the history he obtained at the time he examined the appellant. As the respondent indicated that was around two years subsequent to her signing her statement on 2 November 2021. The Medical Assessor’s history is consequently the most up to date account of how the appellant’s injury affects her function in self-care and personal hygiene and also her function in the other PIRS. It is apparent that the history was obtained by the Medical Assessor against the background of the documentary evidence he was provided, which included the appellant’s statement, the clinical notes of her psychologist, and the reports of Dr Canaris and Dr Bisht. It is apparent because he has extracts large portions of that evidence in the MAC.

3. The Medical Assessor was entitled to rely upon that history to assess the appellant’s impairment. It was open to the Medical Assessor to assess the appellant’s impairment as class 2 based on the history he obtained.

4. The Appeal Panel does not consider that the Medical Assessor’s rating of the appellant’s impairment in self-care and personal hygiene is class 2 is glaringly improbable, based on the matters to which he referred. Further, his reasons do not demonstrate that he was unaware of any factual matters. The Appeal Panel considers he took into account all relevant matters. It is not apparent that he misunderstood any matter. His reasoning is supported by the matters to which he referred.[8]

   [8] See Ferguson at [24].

5. On that basis, it cannot be found that the Medical Assessor erred. The fact other Medical Assessors rated the appellant’s impairment differently from the Medical Assessor merely demonstrates that, in the Appeal Panel’s view, this is a matter about which reasonable minds can differ. It does not demonstrate error.

CPP

1. The examples provided in Table 11.5 of the Guidelines, which relates to the PIRS category of CPP for a class 2 and class 3 impairment are:

Class 2	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.
Class 3	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.

1. The Medical Assessor rated the appellant’s impairment in CPP as class 2, and the appellant contends that the Medical Assessor erred by not rating this as class 3. The reasons the Medical Assessor provided for rating the appellant’s impairment as class 2 were:

   “The claimant could concentrate for up to 30 minutes. She reported she would frequently have to take breaks and her rate of completion of complex tasks such as updating and lodging advertisements on multiple sites was slow. The claimant reported that she had made errors after becoming distracted. She reported that she had been reminded by her supervisor on how to prioritise and organise herself in her home office.”

2. Again, the Appeal Panel considers it was open to the Medical Assessor based upon the material before him and for the reasons he explained to rate the appellant’s impairment in this PIRS as class 2. He based his assessment on the history he obtained. He composed that history having regard to the evidence before him including the appellant’s statement and the evidence contained in the reports of Dr Canaris and Dr Bisht and the clinical records of the appellant’s psychologist. It does not matter that Dr Canaris rated her impairment differently than the Medical Assessor, as again that just demonstrates a different opinion about a matter upon which reasonable minds might differ.

3. Again, the Appeal Panel does not consider the Medical Assessor’s rating is glaringly improbable or that he was aware of significant factual matters or he had a clear misunderstanding of any matter or that is not based upon a supportable reasoning process.

Social and recreational activities

1. The descriptors for a class 2 and class 3 impairment provided in Table 11.2 of the Guidelines, which relates to the PIRS category of social and recreational activities, are:

Class 2	Mild impairment: occasionally goes out to such events eg without needing a support person, but does not become actively involved (eg dancing, cheering favourite team).
Class 3	Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.

1. The Medical Assessor rated the appellant’s impairment in this PIRS as class 2. The appellant contends he erred by not rating it as class 3. The Medical Assessor’s reasons for his rating the appellant’s impairment as class 2 were:

   “The claimant had celebrations in her home. She had participated at Christmas and her son’s birthday. She enjoyed these events less than prior to the onset of this primary psychological injury. She had stopped her participation in past friendship groups.

   She preferred to be isolated and avoid social and recreational activities with others, such as attending Sunday Mass as she had prior to the injury.

   She had stopped watching her favourite television shows and movies with her husband. She no longer enjoyed these activities.

   She could attend the local coffee shop that was close to her home on occasion.”

2. The Appeal Panel observes that the only activities that the Medical Assessor highlighted in which the appellant has engaged were activities within her home, such as Christmas and her son’s birthday. The appellant’s attendance at Sunday Mass cannot be considered to be a social and recreational activity. It is, in essence, a religious ritual.

3. The only activity that the Medical Assessor identified that involved the appellant leaving her house for some form of recreation was her occasionally attending a coffee shop. There is no indication that she does so in company with anyone.

4. Given the Medical Assessor has identified only very limited activity in which the appellant engages socially and recreationally, the Appeal Panel considers the Medical Assessor has erred by not rating the appellant’s impairment as moderate. The Appeal Panel considers that the Medical Assessor’s reasoning does not support a class 2 impairment.

5. Accordingly, the Appeal Panel must correct that error. It does so by rating the appellant’s impairment as class 3 in social and recreational activities. That consequently mean that her median score is class 3 and the aggregate score is 15, which converts to 15% WPI.

6. As noted earlier, the Medical Assessor included 2% WPI in his assessment of the appellant’s WPI, pursuant to paragraph 1.32 of the Guidelines, because he was of the opinion that the appellant’s ongoing treatment had enable her to sustain her present level of function in employability and without that treatment her function in this area more probably than not would deteriorate. Neither party has challenged that finding, and accordingly the Appeal Panel also includes 2%WPI in its assessment of the appellant’s permanent impairment.

7. For these reasons, the Appeal Panel has determined that the MAC issued on 18 October 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:	W4175/23
Applicant:	Dina Oraha
Respondent:	Settlement Services International 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 John Baker and issues this new Medical Assessment Certificate as to the matters set out in the table below:

Table - whole person impairment (WPI)

Body Part or system	Date of Injury	Chapter, page and paragraph number in WorkCover Guides	Chapter, page, paragraph, figure and table numbers in AMA 5 Guides	% WPI	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total/s % WPI (after any deductions in column 6)
Psychological	1/11/2019	Chapter 11	-	17%	-	17%
Total % WPI (the Combined Table values of all sub-totals)					17%