Plus Doors Pty Ltd v Azari

DETERMINATION OF APPEAL PANEL
CITATION:	Plus Doors Pty Ltd v Azari [2025] NSWPICMP 572
APPELLANT:	Plus Doors Pty Ltd
RESPONDENT:	Amin Azari
APPEAL PANEL
MEMBER:	Marshal Douglas
MEDICAL ASSESSOR:	James Bodel
MEDICAL ASSESSOR:	Margaret Gibson
DATE OF DECISION:	5 August 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); whether Medical Assessor (MA) correctly applied Figure 16-5 of American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5) to rate the respondent’s digital impairment due to an amputation of part of the digital phalanx of the right middle finger; Held – MA correctly applied Figure 16-5 in accordance with the instructions contained within section 16.2c of AMA 5; MAC did not contain a demonstrable error and MA had applied correct criteria to make the assessment; MAC confirmed.

BACKGROUND TO THE APPLICATION TO APPEAL

On 12 May 2025, Plus Doors Pty Ltd, the appellant, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Tommasino Mastroianni, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on
14 April 2025.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

RELEVANT FACTUAL BACKGROUND

The appellant is a company through which Amin Azari, the respondent, conducts a business as a carpenter. His company employs him.
On 22 March 2023 the respondent was a using an electric saw to cut an aluminium door seal. During that process his right hand slipped resulting in his amputating the top of his right middle finger and lacerations to the nail beds of his right index and ring fingers. On the following day he had surgery done by orthopaedic surgeon Dr Daniel Rowe who washed out and repaired his right middle finger.
The respondent claimed compensation from the insurer of the appellant for permanent impairment of the order of 11% whole person impairment (WPI). He relied on a report that his solicitors obtained from orthopaedic surgeon Dr Gehr dated 2 July 2024. Dr Gehr advised he observed from his examination of the respondent that the respondent lost 2cm in length of his right middle finger and 50% in the length of the distal phalanx. Dr Gehr had assessed the respondent at 40% digit impairment on the basis that the respondent had an amputation of his right middle finger at the level of distal interphalangeal joint (DIP) and 22% digit impairment as a consequence of restricted range of movement at the metacarpophalangeal joint (MP) and 36% digit impairment as a consequence of the restricted range movement of his proximal interphalangeal joint (PIP). These combine to 70% digit impairment which converts to 14% hand impairment which in turn converts to 13% upper extremity impairment and 8% WPI. Dr Gehr also assessed the respondent had 3% WPI due to scarring from the surgery to his right middle finger. That, when combined with the 8% WPI resulting from the amputation from the top of his right middle finger and the restricted movement of that finger, equated to 11% WPI.
The insurer disputed the respondent was entitled to compensation for permanent impairment on the basis that the degree of his permanent impairment from his injury was not greater than 10%. It relied on a report on orthopaedic surgeon Dr Todd Gothelf dated
14 October 2024. Dr Gothelf, based on his examination of the respondent, considered the respondent had an amputation at the mid-phalanx with a slight loss MP joint flexion and no loss flexion/extension to the DIP and PIP joints and no loss of sensation. He assessed the respondent had 25% digit impairment due to the amputation of the distal phalanx of the right middle finger and 10% digit impairment due to the restricted range of motion of the DIP joint. These impairments combine to 33% digit impairment which converts to 7% hand impairment and in turn 6% upper extremity impairment and 4% WPI. Dr Gothelf assessed the respondent had 1% WPI due to scarring. The impairments Dr Gothelf assessed the respondent had with relating to the amputation and restricted movement of his right middle finger when combined with the impairment he assessed he had for scarring amount to 5% WPI.
Following the rejection of his claim by the insurer, the respondent initiated proceedings in the Personal Injury Commission (Commission) seeking the Commission determine his claim for compensation for permanent impairment. Before that could be done the medical dispute between the parties relating to the degree of the respondent’s permanent impairment from his injury had to resolved and to that end, and following the appellant filing a reply to the respondent’s application, a delegate of the President of the Commission referred the medical dispute to the Medical Assessor to assess.
The Medical Assessor examined the respondent on 9 April 2025, and as said above, issued the MAC on 14 April 2025. In that he certified he assessed the degree of the respondent’s permanent impairment from the respondent’s injury is 11% WPI, being a combination of 8% WPI relating to the respondent’s right upper extremity (middle finger) and 3% WPI relating to scarring. With respect to his assessment of the respondent’s permanent impairment of his right middle finger the Medical Assessor revealed in a worksheet he attached to the MAC that he assessed the respondent had 40% digit impairment due to the amputation of the top of the respondent’s right middle finger and 47% digit impairment due to abnormal motion of DPI, PIP and MP joints of that finger. That combined to 68% digit impairment which converts to 14% hand impairment and in turn to 13% upper extremity impairment and 8% WPI. In the worksheet the Medical Assessor also shaded in a diagram that depicted the respondent’s right middle finger, that part of the respondent’s right middle finger that he observed had been amputated. Within that worksheet the Medical Assessor also noted that the respondent had 0 degree of flexion and 0 degree extension in his DIP joint.
In the MAC the Medical Assessor recorded making the following findings from his physical examination of the respondent’s right hand:
“Examination of the right hand revealed amputation of the long finger. The ring and index finger on examination were normal with no scarring, no shortening and normal movements at the metacarpo-phalangeal joints, the PIP and IP joints.
The long finger in the right hand is 2cm shorter than the finger in the left hand. The amputation is just distal to the DIP joint and I assess 40%(1) (see 10b) digit impairment.
There is a fine ‘Y’ shaped irregular scar in the stump with some tethering. The stump is irregular and indented centrally with minimal padding. I was able to palpate the stump and there was discomfort, more so on the radial aspect.
Sensation in the digit is normal except the stump. There was abnormal sensation in the stump with light touch and sharp stimuli, more so the latter. There was increased sensitivity generally and I could not find localised tenderness or evidence of a neuroma.
The claimant was able to apply normal downward pressure with the digit and apply normal force with the stump when pushing against resistance. When comparing the hands the skin texture was the same, there was staining in the palms and dirt under the fingernails consistent with one using the hands normally.”
The Medical Assessor explained, with respect to his assessment that the respondent’s degree of permanent impairment relating to his scarring is 3%, that the respondent is conscious of the scar and his skin condition, that he is easily able to locate the scar, that he had contour defects in the stump of the scar and increase sensitivity with some adherence, and that he had some but minor limitation in the performance of some of his activities of daily living.

PRELIMINARY REVIEW

The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
As a result of that preliminary review, the Appeal Panel determined that it was not necessary for the appellant to undergo a further medical examination. This is because the material before the Appeal Panel is sufficient for the Appeal Panel to determine the appeal.

EVIDENCE

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

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
In summary, the appellant submitted that the Medical Assessor failed to apply the relevant criteria and methodology of Figure 16-5 of AMA5 when assessing the respondent’s permanent impairment relating his right middle finger amputation.
The appellant noted that the Medical Assessor found from examination of respondent that the respondent’s amputation of his right middle finger involved a 2cm loss distal to the DIP joint and in the proximal part of the digit. The appellant copied into its submissions that part of the diagram within the worksheet attached to the MAC wherein the Medical Assessor had shaded that part of the respondent’s right middle finger that he observed from his examination had been amputated.
The appellant submitted that based on what the Medical Assessor recorded in the MAC from his examination the respondent’s middle finger for the amount of his finger that had been amputated and based on the diagram in the worksheet that “the amputation falls at about 3/4 of the distal phalanx”.
The appellant noted that Dr Gehr reported the respondent had a 2cm loss of length of the right middle finger and loss of 50% of the length of the distal phalanx and noted that the distal stump was 1.5cm. The appellant noted that Dr Gothelf assessed the respondent had 25% digital impairment for amputation of the middle of the distal phalanx. The appellant highlighted that Dr Gothelf found that the respondent still had the DIP joint in his right middle finger.
The appellant also copied into its submission Figure 16-5 of AMA5.
The Appeal Panel notes Figure 16-5 is titled “Digit Impairment Percent for Finger Amputation at Various Levels” and it contains a graph and to the left and adjacent to that a diagram depicting a finger showing the 3 phalanges of the finger. The graph has an upper horizontal axis that is divided into percentage intervals of 10%. From each of those percentage intervals a broken line descends vertically. The greater the percentage interval the deeper the point to which the broken line descends. An unbroken solid line within the graph links these points. This solid line within the graph has 3 gradients. One grade is from 0% digital impairment to 45% digit impairment. The next and steeper grade is from 45% digit impairment to 80% digital impairment and the final and more steeper grade still is from 80% digital impairment to 100% digital impairment. The purpose of the Figure is to allow a horizontal line to be drawn from the finger diagram at the site at which a finger has been amputated to the unbroken line within the graph and then to draw a line upwards at 90 degrees from the point of intersection to the upper axis and thereby determine the percentage digit impairment for the amputation.
The appellant has drawn two red straight lines on Figure 16-5 that it copied into its submissions. The upper red line tracked leftwards from the solid line for the point for 30% digit impairment to a point in the diagram approximately one third along the distal phalanx above the DIP joint. The bottom red line tracked left from the solid line for the point for 40% digit impairment to the DIP joint in the diagram.
The appellant acknowledged that there may be slight differences in observations between examiners, but the appellant submitted the Figure 16-5 “clearly sets out that the 40% [digital impairment] aligns with amputation at the DIP” (emphasis as per original). The appellant submitted that the Medical Assessor’s description of the amputation being distal to the DIP joint and his shading in the diagram in the worksheet attached to the MAC are inconsistent with an assessment of amputation at the DIP. The appellant submitted that the Medical Assessor’s findings better align with the assessment of 30% digital impairment or less.
The appellant submitted that other evidence before the Medical Assessor is supportive of a level of amputation of the right middle finger being above the DIP joint. That evidence consisted of a report dated 11 October 2023 by orthopaedic surgeon Dr Simon Chan (whom the respondent has been consulting for treatment), who noted that an X-ray demonstrated the amputation was just distal to the DIP joint. The appellant acknowledged that the report on that X-ray was not in evidence.
The evidence to which the appellant referred also included the reports of Dr Gehr and
Dr Gothelf, the clinical records of the respondent’s general practitioner (which also included a diagram of a hand in which the respondent’s general practitioner had shaded that part of the respondent’s right middle finger that had been amputated), certificates of capacity in which it was noted that the respondent had a right finger distal phalanx amputation, and a file note from Western Sydney Hand Physio dated 13 February 2024 who advised the respondent had a traumatic right middle fingertip amputation that had developed a sensitive lump.
The Appeal Panel notes that the appellant, at paragraph 4.3 of its submissions, said “the appellant takes issue with [the Medical Assessor’s] assessment under range of motion or scarring”. The appellant however provided no submissions identifying what the issues were that it had regarding the Medical Assessor’s assessment of the restricted range of motion the respondent had of his right middle finger or of the respondent’s scarring, and it would appear that this particular submission of the appellant omitted “no” between words “takes” and “issues”.
In reply, the respondent submitted that the clinical evaluation the Medical Assessor conducted is paramount. The respondent submitted that the Medical Assessor in his clinical evaluation measured the shortening of his right middle finger compared to his left middle finger. The respondent highlighted that the Medical Assessor described the amputation as being “just distal”, which was the same description that Dr Chan provided.
The respondent submitted that the appellant’s reliance on the Figure 16-5 of AMA5 that the appellant had copied into its submissions and the diagram the Medical Assessor had shaded in the worksheet cannot displace and be given greater weight than the explanation the Medical Assessor provided for rating the respondent digital impairment as 40% due to the amputation of the top of his right middle finger. The respondent submitted that there is no demonstrable error in the MAC and that the Medical Assessor applied the correct criteria to make his assessment.

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.
The Appeal Panel does not accept the appellant’s submission that Figure 16-5 of AMA5 requires an assessment of 40% digital impairment for an amputation at the DIP joint. The figure must be used in accordance with the instructions within the text of AMA5, the relevant part of which appears on page 442 within s 16.2c subtitled “Amputation Impairments: Digital Levels, Principles”, and is as follows:
“Amputation through each joint level of a digit is given a relative value of loss to the entire digit as follows: digit metacarpophalangeal (MP) joint, 100%; thumb interphalangeal (IP) joint, 50%; finger proximal interphalangeal (PIP) joint, 80%; and finger distal interphalangeal (DIP) joint, 45% (Figures 16-3, 16-4, and 16-5; Table 16-4). Digit impairment values for amputation at various levels are shown in Figures 16-4 (thumb) and 16-5 (fingers). Joints should be named rather than numbered.”
When the figure is used in accordance with those instructions, it is apparent that an amputation at the DIP joint correlates with a 45% digital impairment. An amputation above DIP joint, depending upon how much the distal phalanx has been amputated, will be a lesser digital impairment.
In this case the Medical Assessor observed from his examination of the respondent’s right middle finger that the amputation was “just distal” to the DIP joint. That accords with his shading of the diagram within the worksheet attached to the MAC. It also accords with the description that Dr Chan provided in his report. Dr Chan had access to an X-ray of the respondent’s right middle finger. An X-ray is the only objective and definitive method to determine exactly how much of the bone of the distal phalanx has been amputated and how much remains. As the appellant noted, neither party put the report on that X-ray into evidence.
The Appeal Panel also notes that the Medical Assessor found from his examination of the respondent’s right middle finger that the respondent had 0% flexion and 0% extension of his DIP joint. Essentially that accords with the Medical Assessor’s observations that the respondent’s amputation was just distal to the DIP joint. The Medical Assessor’s finding is essentially that the respondent’s joint was near ankylosed, which in turn indicates the respondent really only had a little bone left above the DIP joint. There is no reason to doubt the Medical Assessor’s findings relating to the movement the respondent had of the joints of his finger.
The Medical Assessor was entitled to give pre-eminence to his clinical observations. Based on those observations, and noting that a 45% digital impairment correlates with an amputation at the DIP joint, the Appeal Panel considers that it cannot demonstrated from the MAC that the Medical Assessor made any error by assessing the respondent had 40% digital impairment due to the amputation of part of the distal phalanx of his right middle finger. In other words, the MAC does not contain a demonstrable error. Further, the Medical Assessor based his assessment on the correct criteria in that he applied the instructions of s 16.2c of AMA5 including Figure 16-5.

For completeness, the Appeal Panel notes that the findings the Medical Assessor made with respect to the respondent’s scarring are sufficient to correlate with the criteria for 3% WPI in Table 14.1. In other words, nothing within the MAC demonstrates the Medical Assessor made an error with respect to his rating. As also said, there is nothing within the MAC that indicates the Medical Assessor’s findings regarding relating to the movement the respondent has in the joints in his right middle finger. If it is the case therefore that the appellant did intend to take issue with the Medical Assessor’s assessment relating to the digital impairment of the respondent due to the restricted range movement he has in the joints of his right middle finger and the Medical Assessor’s assessment of the respondent’s impairment relating to scarring, and notwithstanding the appellant made no written submission relating to those matters, the Appeal Panel does not discern any error regarding the Medical Assessor’s assessment of those matters and the Appeal Panel also finds that the Medical Assessor based his assessment of those matters on correct criteria.
The Appeal Panel observes that in the Table in the MAC in which the Medical Assessor summarises his assessment the Medical Assessor inserted 7% WPI in the fifth column from the right for the percentage WPI for the right upper extremity. That is an obvious typographical error. It makes sense for the Appeal Panel to correct that.
In other words, the Appeal Panel finds the MAC contains an error in terms of a typographical error in the Table.
For these reasons, the Appeal Panel has determined that the MAC issued on 14 April 2025 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

WORKERS COMPENSATION DIVISION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter number:	W1163/25
Applicant:	Amin Azari
Respondent:	Plus Doors 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 Tommasino Mastroianni 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)
Right upper extremity (middle finger)	22/03/2023	Chapter 2 Pages 10-12	Chapter 16 Pages 433 to 521	8%	-	8%
Scarring	22/03/2023	Table 14.1	3%	-	3%
Total % WPI (the Combined Table values of all sub-totals)					11%

[2025] NSWPICMP 572

5 August 2025