Pirwitz v Anglicare - Jean Ross House
[2025] NSWPICMP 477
•2 July 2025
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Pirwitz v Anglicare – Jean Ross House [2025] NSWPICMP 477 |
| APPELLANT: | Monika Pirwitz |
| RESPONDENT: | Anglicare – Jean Ross House |
| APPEAL PANEL | |
| SENIOR MEMBER: | Elizabeth Beilby |
| MEDICAL ASSESSOR: | Dr Douglas Andrews |
| MEDICAL ASSESSOR: | Dr John Baker |
| DATE OF DECISION: | 2 July 2025 |
| CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appeal based on the application of section 323; no error established; Held – MAC confirmed. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 10 December 2024 Monica Pirwitz lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Surabhi Verma, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 13 November 2024.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
RELEVANT FACTUAL BACKGROUND
The appellant commenced working at the Jene Ross House, an aged care facility, in February 2019. It is not in dispute that while she was in that employment she suffered a psychological injury. What is in dispute is the extent of the psychological injury.
The applicant was examined by purposes of ascertaining her whole person impairment by Medical Assessor Verma, who produced a medical assessment certificate dated
13 November 2024.The appellant has appealed the medical assessment on the basis that errors were made in respect of four of the five psychiatric impairment rating scale (PIRS) categories. Those categories are self-care and personal hygiene, social and recreational activities, social functioning and employability.
The appellant submits that she should have been awarded a Class 3 for self-care and personal hygiene, Class 3 for social and recreational activities, Class 3 for social functioning and Class 5 for employability.
PRELIMINARY REVIEW
The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
As a result of that preliminary review, the Appeal Panel determined that the worker should undergo a further medical examination because the path of reasoning by which the Medical Assessor arrived at his opinion, was not clearly articulated for reasons set out below.
The examination took place on 30 April 2025 and the report dated 30 April 2025 is attached to and forms part of these reasons. The panel has considered the report and finds it well reasoned and articulated.
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.
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 in their determination.
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 Appeal Panel will deal with the submissions as presented by the appellant, that is by considering each of the addressed PIRS challenged on appeal.
Self-Care and personal hygiene
Table 11.1 of The Guidelines sets out the PIRS Class descriptors for self-care and personal hygiene, and relevant to this Appeal are the following Classes:
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.
The Medical Assessor assessed the applicant as a Class 2 for this PIRS category. The relevant parts of the MAC are as follows:
(a) she mostly does cooking in the evening and cooks rice and at times barbecues chicken (page 4);
(b) Ms Pirwitz reported, “I don't shower regularly, and I don't eat very well.” She at one time said that she does not cook regularly, and then at other times said “I mostly barbecue chicken and make rice.” She also relies on eating chocolates, chips and Pepsi (page 4), and
(c) Ms Pirwitz reported I don't shower regularly, and I don't eat very well. She at one time said that she does not cook regularly, and then at other times said I mostly barbecue chicken and make rice. She also relies on eating chocolates, chips and Pepsi. She has been able to do her household chores including vacuuming, doing the dishes etc. but procrastinates doing so. She has been living independently and has been able to look after her dog as well (Class 2) – (Page 11).
Social and recreational activities
Table 11.2 of The Guidelines sets out the PIRS Class descriptors for social and recreational activities, and relevant to this Appeal are the following Classes:
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.
The Medical Assessor assess the applicant as a Class 2 for this PIRS category. The relevant parts of the MAC are as follows:
(a) on a typical day, she said that she wakes up in the lounger and then holds her dog to comfort herself. She then spends some time with her dog and has her coffee. She later takes her dog out for a walk (page 4);
(b) Ms Pirwitz reported that she enjoyed gardening and playing with her dog. She said that she does not do gardening currently, more so because of her physical difficulties and strength in her legs (page 4);
(c) she also reported that she does not like leaving her house. She is however able to go out for walk for at least 500m around the block with her dog, but feels a lack of strength in her legs after about 500m, which she attributed to her spinal cord injury. She is able to leave her house to go for grocery shopping and her medical appointments (page 5), and
(d) Ms Pirwitz reported that she enjoyed gardening and playing with her dog. She said that she does not do gardening currently, more so because of her physical difficulties and strength in her legs. She also reported that she does not like leaving her house. She is however able to go out for walk for at least 500m around the block with her dog, but feels a lack of strength in her legs after about 500m, which she attributed to her spinal cord injury (page 11).
Social functioning
Table 11.4 of the Guidelines sets out the PIRS Class descriptors for social functioning, and relevant to this Appeal are the following Classes:
Class 2: Mild impairment: Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
Class 3: Moderate impairment: Previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.
The Medical Assessor assessed a Class 2 for this category. The relevant parts of the MAC are as follows:
(a) she has been able to drive to Sydney to meet her parents and brother and was able to drive independently. She denied having any difficulties doing so. She denied having any near misses or accidents, and
(b) Ms Pirwitz reported that even though she lives independently, but her family has tried to be supportive. However, she does not want to burden them as they live in Sydney. She talks to them “a couple of times a week”. She said that she used to have friends at work but once she stopped working, she stopped seeing them
(page 5, repeated page 11).
Employability
Table 11.6 of the Guidelines sets out the PIRS Class descriptors for employability, and relevant to this Appeal are the following classes:
Class 4: Severe impairment: Cannot work more than one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic.
Class 5: Totally impaired: Cannot work at all.
The Medical Assessor assessed a Class 4 for this category. The relevant parts of the MAC are as follows:
(a) Ms Pirwitz has limited capacity to return to work. I find that she cannot work for more than one or two days at a time, less than 20 hours per fortnight in a supportive environment (page 12).
Consideration and Determination
The Appeal Panel has considered the submissions made by the parties in this Appeal.
A Medical Assessor is bound to set out in a statement of reasons the actual path of reasoning by which he or she arrived at their opinion (Wingfoot Australia Pty Ltd v Kocak [2013] HCA 43). The Appeal Panel has considered the Medical Assessment Certificate and has considered that there is not a clear path of reasoning therein in respect of assessment of several of the PIRS categories. It then becomes difficult to assess the extensive submissions made by the parties regarding the assessments made by the Medical Assessor.
In respect of self- care and personal hygiene, the Panel notes that the claimant lives independently, is less attentive to hygiene, sometimes skips meals and has moderated her alcohol intake. We found no error in the MA’s assessment of a Class 2 impairment,
In respect of social and recreational activities, the Appeal Panel has concluded that the level of detail contained in the Medical Assessment Certificate does not disclose a clear path of reasoning. For instance, whilst the appellant is able to drive to Sydney to meet her parents and brother, what she actually does with them, relevant to the determination of social and recreational activities, we are not told.
In respect of social functioning, the Appeal Panel has formed the view that there is a similar lack of detail. For instance, the appellant has lost her only friend, but we do not understand what the nature of the relationship was. We are also not told why the relationship ended, it could be due to conflict or geographical change, details of which are not explained. She has maintained her relationships with her family, although they are geographically separated and she is reluctant to share details about her predicament with them.
In respect of employability, the appellant is not currently working, yet the Medical Assessor asserts that she is able to work with significantly reduced capacity but does not explain on what basis the conclusion is reached.
Because of the lack of detail and explanation, the Appeal Panel determined that it was appropriate to re-examine the appellant. The examination took place on 23 April 2025.
The examination and findings have been clearly recorded and are attached in the examination report of Dr Andrews. The report assesses social and recreational activities classification as Class 3. The report clearly, and appropriately, identifies the reasoning as to an assessment of Class 3 as follows:
“Ms Pirwitz no longer sees friends and has no social outings. She walks her dog twice daily but chooses times when she is not likely to bump into other people. She visits her family 3 times a year for birthday celebrations. On those occasions, she stays at her parents’ or brother’s homes and doesn’t go to venues such as cafés or restaurants.”
The report also assessed employability classification as Class 5. The report, once again clearly identifies the reasoning as to the assessment of Class 5 as follows:
“Ms Pirwitz has moderately severe symptoms of depression and anxiety. She has isolated herself and is highly anxious away from home. She has subjective problems with concentration and memory. She has not worked in any capacity since July 2019. For these reasons, I consider her unfit.”
The examination confirmed the Medical Assessors assessments in terms of self-care and personal hygiene, and social functioning with clearly articulated reasoning in the report.
The Appeal Panel has formed the view that a demonstrable error has been shown and as such the Appeal Panel has determined that the MAC issued on 13 November 2024 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.
PERSONAL INJURY COMMISSION
APPEAL AGAINST MEDICAL ASSESSMENT
REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR
MEMBER OF THE APPEAL PANEL
Matter Number: | M1-W26432/24 |
Appellant: | Monika Pirwitz |
Respondent: | Anglicare – Jean Ross House |
Date of Determination: | 23 June 2025 |
Examination Conducted By: | Dr Douglas Andrews |
Date of Examination: | 30 April 2025 |
The worker's medical history, where it differs from previous records
Ms Pirwitz is a 54-year-old widow of 10 years who lives alone in a housing commission unit at Nowra. She has no children.
She commenced as a care worker at Jean Ross House, an aged care facility, in February 2019. In June 2019, a registered nurse (RN) was involved in a manual handling incident. The RN asked Ms Pirwitz to say that she had been present when she had not been. Ms Pirwitz reported this request to superiors and, subsequently, was bullied by the RN. She described the bullying as relentless and left work in July 2019. She has not worked in any capacity since.
Additional history since the original Medical Assessment Certificate was performed
After her assessment with the MA in November 2024, Ms Pirwitz felt hopeless and that her mental health deteriorated.
In March 2025, she was accepted for a disability support pension (DSP) based on her mental health challenges. She has also had an NDIS application for support approved.
Current treatment:
Ms Pirwitz takes no medication. She has previously used antidepressants such as duloxetine and desvenlafaxine but found them unhelpful. She used quetiapine, and it caused palpitations. Now she says, “I just don’t care, I have lost hope.”
She sees a psychologist, Ms Kate Vejaca, every 2 weeks. Ms Pirwitz is anxious about attending and sometimes has telephone consultations because she has had a panic attack before leaving home. Treatment is primarily supportive psychotherapy.
She saw psychiatrist Dr Abdul Burhan of Wollongong on 2 or 3 occasions. On the last occasion, Ms Pirwitz expressed her distress by repeatedly swearing, and Dr Burhan terminated the session. She has not seen him since.
In 2024, she spent one month as a voluntary inpatient at the Nowra Mental Health Unit, resulting in a temporary improvement. There have been no other hospitalisations.
There are no treatment changes planned.
General health:
After leaving work with Anglicare, Ms Pirwitz developed peripheral neurological signs and needed a T10 surgical decompression. This has been successful and is not currently causing impairment.
She had been drinking alcohol excessively, up to a bottle of spirits daily, for about 6 months. She stopped this a couple of years ago. The excessive drinking started after the work injury; before that, Ms Pirwitz had been a social drinker.
Current symptoms:
Ms Pirwitz has a pervasively low mood without diurnal variation. She has a limited capacity to experience positive emotion but enjoys interacting with her 15-month-old puppy.
She is anxious, especially if she needs to leave home. She experiences frequent panic.
She described her concentration and memory as “shocking.”
She feels hopeless and has thoughts of suicide. Having a dog protects her, and she said she wouldn’t be here otherwise.
She sleeps poorly with initial and middle insomnia.
Her appetite is impaired, and she has lost weight, but was unable to quantify it.
Diagnoses:
Ms Pirwitz meets all 9 DSM-5 criteria for a major depressive disorder with anxious distress.
Her frequent panic attacks and associated avoidant behaviours qualify for an additional diagnosis of panic disorder.
Ms Pirwitz had pre-existing depressive symptoms in her early 20s. She experienced grief when her husband died 10 years ago. In 2018 and early 2019, she had mild depression and was on desvenlafaxine.
Activities of daily living:
Ms Pirwitz rises early, has a cup of coffee and takes her dog for a walk. She often walks the dog very early in the morning or late in the evening because she wants to avoid the possibility of interacting with others.
She said she is “pretty slack” with housework but will wash dishes when they pile up. She vacuums and sweeps, but not as frequently as she used to. She said, “I used to be pretty house proud.” She manages to do her laundry regularly.
She shops locally, driving herself to and from the market. She eats one meal daily, usually chicken with some microwaved frozen vegetables.
She neglects hygiene, showering weekly. She said, “I don’t go anywhere; I don’t see the point; why bother?” She neglects dental care.
Before becoming unwell, she had a close friend whom she visited frequently. They played pool or ping-pong and had a few drinks. They often walked the dogs together and frequently went to a local beach. Together with her friend’s husband, they visited a cocktail bar about once a month, where they met other friends from an expanded group.
She no longer has contact with any friends. Regarding her close friends, she said, “We both worked at Anglicare; there was a conflict of interest. I got ghosted.”
Ms Pirwitz has her parents and brother in Sydney. She travels to see them (a more than 2-hour drive) three times a year, in March, September, and Christmas, when they have birthdays. She said, “I don’t like driving; I do it because I have to.” She keeps in touch with her parents and brother regularly by phone. Ms Pirwitz is putting up a false front with them, telling them she is well when she is not.
Her relationships with family are reasonable, but she has had arguments with her mother, who has complained about Ms Pirwitz’s attitude and lack of empathy. Ms Pirwitz thought she might be “rude in how I say things.”
She no longer reads, a previously enjoyed hobby. She struggles to fill out her tax forms and found the DSP and NDIS application process challenging. She prefers documentaries or comedies on television and can focus for up to 30 minutes. She doesn’t watch dramas because she cannot engage with the characters or plots. She only watches pre-recorded shows because she often needs to rewind. She has no projects or hobbies.
Whole-person impairment:
The appellant alleged that the MA erred in her ratings in self-care and personal hygiene, social and recreational activities, social functioning and employability.
Self-care and personal hygiene – Ms Pirwitz is independent and lives alone in a unit. She manages housework, including cleaning, laundry and cooking, although at a lower standard than previously. She eats only one meal daily, usually cooking chicken and heating frozen vegetables. She said that she tries to eat a healthy diet. Her weight is now stable, although lower than it had been at the time of the injury. She neglects hygiene and dental care, showering weekly. She has applied for NDIS support but hopes to use it for socialisation. – Class 2.
Social and recreational – Ms Pirwitz no longer sees friends and has no social outings. She walks her dog twice daily but chooses times when she is not likely to bump into other people. She visits her family 3 times a year for birthday celebrations. On those occasions, she stays at her parents’ or brother’s homes and doesn’t go to venues such as cafés or restaurants. – Class 3.
Social functioning – Ms Pirwitz no longer has contact with her previous friendship group. She suggested that her closest friend had pulled away and that she had disengaged from the others. She remains close to her parents and brother, although there has been discord with her mother. She had not been in an intimate relationship, and she had little interest in forming a new relationship after her husband died. She maintains regular contact with her family. – Class 2.
Employability – Ms Pirwitz has moderately severe symptoms of depression and anxiety. She has isolated herself and is highly anxious away from home. She has subjective problems with concentration and memory. She has not worked in any capacity since July 2019. For these reasons, I consider her unfit. – Class 5.
In the unappealed categories, the MA rated travel as a class 1 and concentration, persistence, and pace as class 3.
Sequentially, the class ratings are 1, 2, 2, 3, 3, and 5. The aggregate is 16, median 3, resulting in a 17% WPI. The one-tenth deduction was not appealed, so the final impairment rating is 15%.
Ms Pirwitz has not significantly improved in symptoms or impairment, so an adjustment for treatment effect is not warranted.
Findings on clinical examination
I assessed Ms Pirwitz via an audiovisual link for 60 minutes in her home. The connection quality was excellent, allowing for a comprehensive assessment.
She presented casually attired, appearing mildly dishevelled. She wore no make-up or jewellery.
She appeared restless and anxious during the interview. She agreed that she was anxious and her mood was low. Her affect was restricted, consistent with her stated mood and congruent with the interview content. She often looked distressed, but did not lose composure.
She was polite and cooperative during the interview.
There is no evidence of any disorder of thought form or perception.
She gave a coherent account but occasionally needed redirection.
She acknowledged thoughts of suicide.
Results of any additional investigations since the original Medical Assessment Certificate
No additional investigations have been done.
Signed: Dr Douglas Andrews
Date: 30 April 2025
WORKERS COMPENSATION DIVISION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
Matter number: | W26432/24 |
Applicant: | Monika Pirwitz |
Respondent: | Anglicare – Jean Ross House |
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 Surabhi Verma and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
Table - whole person impairment (WPI)
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA 5 Guides | % WPI | Proportion of permanent impairment due to pre-existing injury, abnormality or condition | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psychological injury | 11 July 2019 | Ch 11, Guidelines 11.1 to 11.3, 11.4 to 11.6 | Guidelines 11.11, 11.12,Table 11.1,11.2,11.3,11.5,11.6 | 17% | 1/10th | 15% |
| Total % WPI (the Combined Table values of all sub-totals) | 15% | |||||
0
2
0