Secretary, Department of Transport v Haydon
[2021] NSWPICMP 152
•23 August 2021
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Secretary, Department of Transport v Haydon [2021] NSWPICMP 152 |
| APPELLANT: | Secretary, Department of Transport |
| RESPONDENT: | Ronald Haydon |
| APPEAL PANEL: | Member Carolyn Rimmer Dr Paul Curtin Dr Michael McGlynn |
| DATE OF DECISION: | 23 August 2021 |
| CATCHWORDS: | WORKERS COMPENSATION- Matter referred to the Medical Assessor (MA) for assessment under the Table of Disabilities of severe facial disfigurement and severe bodily disfigurement attributable to the injury on 2 August 1991; matter was also referred to the MA in respect of a threshold dispute for assessment of whole person impairment (WPI) of the skin attributable to the injury on 2 August 1991; MA made no assessment under the Table of Disabilities on the basis that the Table of Disabilities did not provide a clear method for assessing permanent impairment of the skin, particularly in relation to skin cancer; Held - Panel agreed with the appellant that it was not open to the MA not to provide an assessment under the Table of Disabilities and the MAC therefore contained a demonstrable error and that the MA used incorrect criteria; MAC revoked. |
STATEMENT OF REASONS FOR DECISION OF THE APPEAL PANEL IN RELATION TO A MEDICAL DISPUTE
BACKGROUND TO THE APPLICATION TO APPEAL
On 16 June the Secretary, Department of Transport (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Ian Hamann, a Medical Assessor (MA), who issued a Medical Assessment Certificate (MAC) on 26 May 2021.
The respondent to the Appeal is Ronald Hayden.
The Secretary, Department of Transport (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,
· 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.
The WorkCover Medical Assessment Guidelines 2006 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 the WorkCover Medical Assessment Guidelines 2006.
This matter was referred for assessment under the Table of Disabilities.
RELEVANT FACTUAL BACKGROUND
The respondent developed severe, widespread actinic skin disease with multiple premalignant and malignant lesions as a result of working outdoors as a cargo plant operator with the Maritime Services Board without sun protection during the period 1977 to 1999.
The matter was referred to the MA, Dr Ian Hamann, on 19 March 2021 for assessment under the Table of Disabilities of severe facial disfigurement and severe bodily disfigurement attributable to the injury on 2 August 1991. The matter was also referred to the MA in respect of a threshold dispute for assessment of whole person impairment (WPI) of the skin attributable to the injury on 2 August 1991.
The MA examined the appellant on 30 April 2021 and assessed 7% WPI in respect of scarring of the face and 15% WPI in respect of skin and scarring of the body. This resulted in a total WPI of 20% attributable to the injury on 2 August 1991. The MA made no assessment under the Table of Disabilities.
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 Mr Hayden be re-examined by a MA, who is a member of the Appeal Panel. The appellant submitted that as extensive photographs had been taken, it was not necessary for the MA to re-examine Mr Hayden in person.
The Appeal Panel requested that photographs of Mr Haydon’s face be provided to the Appeal Panel. Mr Haydon’s solicitors forwarded photographs to the Commission on 4 August 2021. A copy of these photographs was forwarded to the appellant’s solicitor on 4 August 2021. The Appeal Panel proposed to use these photographs (as well as the photographs taken by the MA) in the re-examination of Mr Haydon.
The Panel directed the appellant to advise the Commission within 5 days if there was any objection to the Appeal Panel using the photographs of Mr Haydon’s face which were sent to the Commission on 4 August 2021. No objection has been received from the appellant.
As a result of that preliminary review, the Appeal Panel determined that the worker should undergo a further medical examination because there was a demonstrable error in the MAC and insufficient information on which to make a determination.
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. The Appeal Panel were provided with photographs of Mr Hayden’s face by his solicitor and took these into account in making this determination.
Further medical examination
Dr Paul Curtin of the Appeal Panel conducted an examination of the worker by telephone on 18 August 2021 and reported to the Appeal Panel.
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
The appellant made written submissions. They are not repeated in full but have been considered by the Appeal Panel.
The appellant’s submissions, include the following:
(a) Ground 1 –the MA erred failing to provide an assessment in accordance with the Table of Disabilities for a 1991 injury. The appellant says that this was a demonstrable error and that the assessment was made on the basis of incorrect criteria.
(b) Under s 66 of the Workers Compensation Act 1987 (the 1987 Act), the WPI method of assessment applies to injuries on or after 1 January 2002. Clause 3 of Part 18C of Schedule 6 of the 1987 Act preserved the previous method of assessment (the Table of Disabilities) for injuries before 1 January 2002. The deemed date of injury was 2 August 1991. The MA was therefore required to provide an assessment under the Table of Disabilities.
(c) The MA was asked to provide an assessment under the Table of Disabilities. The MA said the Table of Disabilities did not provide a clear method for assessing permanent impairment of the skin, particularly in relation to skin cancer. He provided an assessment of WPI in accordance with AMA 5 and the Guidelines. It was not open to the MA not to provide an assessment under the Table of Disabilities. The MAC therefore contained a demonstrable error and that the MA used incorrect criteria (namely AMA5 and the Guidelines) in providing an assessment of permanent impairment for the purposes of the lump sum claim.
(d) The matter should be referred to a Medical Appeal Panel (MAP) and that a member of the MAP should conduct an assessment in accordance with the Table of Disabilities. Given that extensive photographs were taken, the appellant does not consider it is necessary for the MAP to re-examine the respondent worker in person.
(e) Ground 2 – the MA used the wrong table when assessing facial scarring and therefore the MAC contained a demonstrable error and that the assessment was made on the basis of incorrect criteria because of this error.
(f) The MA said that he assessed 8% WPI for facial scarring and that this was the upper end of Class 1. The Table of page 9 of the MAC says that the assessment of facial scarring was made by reference to Chapter 8 of AMA 5.
(g) The Guidelines provide that facial disfigurement should be assessed by reference to Table 6.1 of the Guidelines (see paragraph 14.3 of the Guidelines). According to Table 6.1, the upper end of Class 1 is 5% WPI and facial disfigurement should be assessed at 5% WPI not 8% WPI. This was a demonstrable error and that the assessment was made on the basis of incorrect criteria.
The respondent’s legal representatives advised the Commission that the respondent would not lodge a Notice of Opposition to Appeal Against the Decision of a Medical Assessor.
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 role of the Medical Appeal Panel was considered by the Court of Appeal in the case of Siddik v WorkCover Authority of NSW [2008] NSWCA 116 (Siddik). The Court held that while prima facie the Appeal Panel is confined to the grounds the Registrar has let through the gateway, it can consider other grounds capable of coming within one or other of the section 327(3) heads, if it gives the parties an opportunity to be heard. An appeal by way of review may, depending upon the circumstances, involve either a hearing de novo or a rehearing. Such a flexible model assists the objectives of the legislation.
Section 327(2) was amended with the effect that while the appeal was to be by way of review, all appeals as at 1 February 2011 were limited to the ground(s) upon which the appeal was made. In New South Wales Police Force v Registrar of the Workers Compensation Commission of New South Wales [2013] SC 1792 Davies J considered that the form of the words used in s 328(2) of the 1998 Act being, ‘the grounds of appeal on which the appeal is made’ was intended to mean that the appeal is confined to those particular demonstrable errors identified by a party in its submissions.
The MAC
Under “Findings on physical examination” the MA wrote:
“Mr Haydon is a moderately overweight man in his late with a plethoric face.
On the right forehead there is a surgical scar measuring 35mm in length and 7mm wide with cross hatching.
The central right ear helix is deformed with from a poorly healed wedge excision. There is a scar in the right ear conchal bowl.
Mr Haydon has fine actinic keratoses on the forehead
There is poorly healed scarring on the right cheek, measuring 30m in length x 5 mm in width.
There is a small bcc below this area.
On the right chin there is a 23mm long surgical scar scar with cross hatching.
There is a large scar on the left mid to upper cheek measuring 70 mm in length which is well healed.
There is rhombic flap surgical scar on the left jawline, measuring 20 x 35 mm.
He has numerous facial actinic keratoses extending down to the neck.
Mr Haydon has pale skin grafts on both lower eyelids from ectropion repairs measuring 30 x 4 mm. There is a 15 mm surgical scar on the right upper cheek / nasal border with hypertrophy of the nasal border.
Mr Haydon’s dysplasia on the body involves the hands, arms, shoulders most of the trunk, upper thighs, lower legs and proximal feet.
The number of scars from treatment and active NMSC lesions makes description difficult so I took photographs to document his condition.
There were 3 bleeding eroded plaques on the left lower anterior leg suggestive of SCC. On the proximal feet, lower legs and right posterior thigh were plaques of likely BCC. In addition there are numerous actinic keratoses, erythema and areas of scarring.
On the back the dysplasia is mainly concentrated on the mid to upper back with superficial BCCs, actinic keratoses and numerous hypopigmented scars with a large surgical scar centrally, just below the neck.
There are similar lesions on the anterior chest, shoulders, arms and hands with the numbers increasing peripherally. There is very little unaffected skin and some more indurated skin cancers. Surgical scars are numerous and conspicuous.
The abdomen has a few erythematous patches but is significantly spared.”
The MA made a diagnosis of severe solar damage to the skin with active non-melanoma skin cancer (NMSC).
Under “Reasons for assessment” the MA wrote:
“Mr Haydon has widespread surgical scarring involving his face, neck, shoulders, arms, hands, trunk, legs and proximal feet. This is consistent with the pattern of sun exposure he would have received in his work on the docks. It is also consistent with some contribution from childhood and recreational exposure.
He has extensive active actinic damage with pre-malignant and malignant lesions evident on examination. His treatment requirements are ongoing for the rest of his life.
The extent of active NMSC on his trunk and limbs is exceptional, even by Australian standards.
The nature of his employment and the lack of protective clothing are the reason his condition is so severe. He spent long hours in the sun, at times working over 40 hours a week.
There is no evidence of significant sun exposure in his other occupations.
His childhood and recreational exposure is not exceptional in the context of growing up and living in Australia.”
The MA explained his calculations as follows:
“The table of disabilities does not offer a clear mechanism for assessing impairment of the skin, particularly in relation to skin cancer. I have made my impairment assessment based on AMA 5 and the WorkCover Guides, 4th Edition.
The physical evidence of solar damage and NMSC is overwhelming on examination. The work history is of two decades of extreme sun exposure, which is unlikely to be matched by any other non-work related exposure as an adult.
The face has a number of large scars, though the most significant is on the right ear which is deformed. The facial scarring is significant over all but given the clear examples in the WorkCover guides this is still a Class 1 WPI for scarring but I would place the impairment at the higher end at 8%.
The overall impairment is going to be at the higher end of Class 2 WPI as symptoms are constantly present, continuing permanent treatment is required, and there is some impairment of ADLs.
Both the scarring and overall skin symptom impact is most evident on the trunk and limbs.
In my opinion it is exceptional compared to most of the patients that I would see”.
In commenting on the other medical opinions, the MA wrote: “I agree that the Table of Disabilities does provide a practical mechanism for determining skin impairment related to NMSC”.
Discussion
The MA is required to interview the worker and provide an assessment and opinion based upon his own findings as at the date of the examination.
The Appeal Panel reviewed the history recorded by the MA, his findings on examination, and the reasons for his conclusions as well as the evidence referred to above.
Ground 1 – Failing to Provide an Assessment under the Table of Disabilities
The appellant submitted that the MA erred failing to provide an assessment in accordance with the Table of Disabilities for the 1991 injury.
The MA was asked to provide an assessment under the Table of Disabilities. The MA said the Table of Disabilities did not provide a clear method for assessing permanent impairment of the skin, particularly in relation to skin cancer. He therefore only provided an assessment of WPI in accordance with AMA 5 and the Guidelines.
The Appeal Panel agreed with the appellant that it was not open to the MA not to provide an assessment under the Table of Disabilities. The MAC therefore contained a demonstrable error and that the MA used incorrect criteria (namely AMA 5 and the Guidelines) in providing an assessment of permanent impairment for the purposes of the lump sum claim.
Ground 2 – Use of incorrect Table when assessing facial scarring
The appellant submitted that the MA used the wrong table when assessing facial scarring and therefore the MAC contained a demonstrable error and that the assessment was made on the basis of incorrect criteria.
The MA assessed 8% WPI for facial scarring on the basis that this was the upper end of Class 1. The Table at page 9 of the MAC stated that the assessment of facial scarring was made by reference to Chapter 8 of AMA 5, pages 173-189 and Table 8.2. The Table also stated that the assessment of facial scarring was made by reference to Chapter 6, page 34, Table 6.1 and Chapter 14, pages 73-76 and examples 14.5 and 14.6.
The Guidelines at paragraph 14.3 provide that facial disfigurement should be assessed by reference to Table 6.1 of the Guidelines. According to Table 6.1, the upper end of Class 1 is 5% WPI. The Appeal Panel agreed with the appellant that the MA used the wrong table when assessing facial scarring. The facial disfigurement should be assessed at 5% WPI, not 8% WPI. This was a demonstrable error and that the assessment was made on the basis of incorrect criteria.
As noted above, Dr Paul Curtin re-examined Mr Hayden on 18 August 2021. Dr Curtin provided the following report:
“Examination Conducted By: Dr Paul Curtin
Date of Examination: 18 August 2021 – Teleconference 10:00 AM
1. The workers medical history, where it differs from previous records
The history is largely unchanged. There is no history of excessive sun exposure prior to commencing work with Maritime Services in 1977. He grew up in Western Sydney and visits to the beach were a rare event. His main sport as a youth was rugby league and he did not play cricket or golf as a young man. He was aged 30 in 1977, and prior to that time he had been employed in various jobs which did not involve regular work outdoors. Nevertheless, growing up in Sydney, it is inevitable that some degree of solar damage to his skin was sustained prior to commencing work with Maritime Services. Recreational sun exposure in childhood and adolescence has been identified as a significant risk factor for nonmelanoma skin cancer (Stern RS, Weinstein MC, Baker SG (1986) Risk reduction for nonmelanoma skin cancer with childhood sunscreen use. Arch Dermatol. 122:537–545).
His work with Maritime services over 22 years, on the other hand, was largely outdoors. For the first couple of years he says he worked as a general labourer on the docks, after which he worked as a dogman for 12 months before progressing to being a driver of cranes and other heavy machinery. His activities also involved operating a steam driven piledriver on the harbour for some years, work which was hot in itself and required him to wear light clothing.
He states that he first started to require treatment for his skin in the early 1980s, although the earliest record supplied in the documentation is a letter from Dr Anthony Cronin in 1991 which refers to multiple skin lesions on his face, arms, legs and chest. Documents from the Penrith Skin Cancer Clinic include 21 separate pathology reports from surgical procedures for the 12 month period 25/5/10 - 29/4/11. These reports record the presence of skin cancers and precancerous skin lesions. The frequency of these reports reflects a high level of treatment activity, a level which appears to have continued to the present time. Currently, he apparently attends the Dermatology department at Liverpool Hospital every month, and he is on the waiting list for the [1]surgical removal of several skin lesions. He also attends his local doctor separately for additional skin treatments. No doubt the severity of his skin disease has prompted his carers to prescribe Neotigason (acitretin) medication, a vitamin A derivative which has an effect on the growth of skin cells and is anti-inflammatory. The medication has been shown to reduce the incidence of new skin cancers in renal transplant patients (George at al. Acitretin for chemo prevention of nonmelanoma skin cancers in renal transplant recipients. Australas J Dermatol. 2002 Nov;43(4):269-73. Unfortunately the medication has various side-effects which include sensitising the skin to sunlight, dry, cracked lips and skin and delayed wound healing (Dr Eleni Yiasemides, Australian College of Dermatologists website, updated January 2020).
Current symptoms and effects on Activities of Daily Living
Mr Haydon says that his skin is like paper, very thin and easily damaged. He says that he has had padding placed around his bedstead because he has bumped his legs against it several times resulting in lacerations and bleeding. He says that his skin is quite sensitive to heat. He can only tolerate a lukewarm shower and direct sunlight immediately causes burning sensations in his skin. In the past, he has generally gone about wearing shorts, but these days he finds it necessary to wear long trousers all the time to protect his legs. Mr Haydon says that he has had surgery and skin grafts around both ankles and that he now only wears soft casual shoes and cannot manage a normal leather shoe.
He is aware of the danger that skin cancer presents, and he is particularly anxious that he might at some stage develop a melanoma, although he has never had any similar skin lesion in the past. He says that his daughter is married and lives in Japan and that he has had several visits to Japan to see her. He says that his physical restrictions and the need for careful monitoring of his skin condition do restrict his capacity for future overseas travel.
He says that although he has multiple scars from previous treatments, he is not particularly bothered by them. He is aware of a minor deformity of his right ear as a result of surgery.
2. Additional history since the original Medical Assessment Certificate was performed
None
3. Findings on clinical examination. (As evidenced by clinical photographs supplied in the MAP Brief, and in separate facial photographs supplied by Mr Haydon)
The photographs supplied by Mr Haydon reveal pale but florid facial skin which has been described as type I Fitzpatrick skin in the report of Dr Catherine Drummond, Dermatologist (15/6/20). There are noticeable pale, flat scars on the right forehead
(35 x 7 mm), right cheek (30 x 5 mm), right side of nose (15 mm), right chin (23 mm), left cheek (70 x 5 mm) and left jaw line (35 x 7 mm). Pale skin grafts are evident on both lower eyelids, each extending for 30 x 4 mm. There are multiple actinic keratoses, and depigmented spots resulting from previous treatment. There is a punched out deformity of the helix of the right ear where a lesion has been removed.Photographs of the body reveal evidence of very severe actinic change together with hypopigmentation and scarring from previous treatment, mostly concentrated on the limbs, back and upper chest. The lower limbs in particular have multiple keratotic and erythematous lesions, and on the left lower leg there are three frankly ulcerated lesions that required dressings. The dorsal aspect of the hands and forearms have a similar concentration of active skin lesions, altered pigmentation and scarring, with very little of the skin surface unaffected in some way. The back and shoulders display around 100 circular pale patches which are probably the result of cryotherapy, together with other actinic changes, and there is an 8 cm pale scar in the midline just below the neck.
4. Results of any additional investigations since the original Medical Assessment Certificate
Facial photographs in PDF format supplied by Mr Haydon on the 4/8/2021 are attached.
5. Comments on Whole Person Impairment
The injury is deemed to have occurred on 2 August 1991, and therefore impairment is assessed in accordance with the Table of Disabilities. Facial impairment is to be assessed separately from impairment of the skin elsewhere on the body.
There is significant facial disfigurement due to a combination of actinic skin change and surgical scarring. Severe facial disfigurement in this case is assessed at 10% impairment compared to a most extreme case.
As he did not commence work with Maritime services until he was 30 years of age there is a deductible proportion of 1/10th due to solar damage to the facial skin which is likely to have occurred prior to that time. This reduces severe facial disfigurement to 9% impairment.
The report of Dr Edmund Lobel, Dermatologist, dated 6 February 2020 refers to Table 6.1 Table 6.1 in the NSW Workers Compensation Guidelines (4th Ed) and assesses impairment at 5% WPI. A supplementary report from Dr Lobel dated 27 February 2020 refers to the ‘Table of Maims’ and finds 15% severe facial disfigurement.
The report of Dr Catherine Drummond, Dermatologist, dated 15 June 2020 finds 5% severe facial disfigurement.
The skin elsewhere on the body, has also been severely affected by actinic skin change and the effects of surgical treatment. In addition there is evidence that the condition of his skin has resulted in the limited performance of some activities of daily living . The examination findings are consistent with Mr Haydon’s complaints that his skin is fragile and that his physical activity is restricted to some extent as a result. His activities are also restricted by the sensitivity of his skin to direct sunlight and heat. There are some dressing restrictions in that he no longer feels comfortable in shorts and that he also finds it necessary to wear soft shoes. His life is also disrupted by the frequency of medical treatments needed to keep his skin disease under control. In 2017, the most recent of the records available in the documents, there are records of 13 consultations with his general practitioner, quite apart from any attendances at a hospital clinic.
Impairment of skin on the body is therefore assessed at 22% severe bodily disfigurement compared to a most extreme case.
There is also a deductible proportion as 1/10th applicable for the reasons given above, which reduces impairment of skin on the body to 20% severe bodily disfigurement.
Dr Lobel assesses ‘non-face skin disorders’at 17% WPI and translates that to 10% severe bodily disfigurement when compared to a most extreme case.
Dr Drummond assesses severe bodily disfigurement at 15%.”
The Appeal Panel has adopted the report and findings of Dr Curtin. The Appeal Panel agreed with the assessment under the Table of Disabilities of 10% for severe facial disfigurement and 22% for severe bodily disfigurement. The Appeal Panel determined that there should be a one tenth deduction for a pre-existing condition. Therefore, the Appeal Panel made an assessment under the Table of Disabilities of 9% for severe facial disfigurement and 20% for severe bodily disfigurement as a result of the injury on 2 August 1991.
The Appeal Panel, as noted above, found that in relation to the assessment of WPI, the facial disfigurement should be assessed at 5% WPI not 8% WPI. Therefore, the total percentage of WPI assessed is 18% as a result of the injury on 2 August 1991.
For these reasons, the Appeal Panel has determined that the MAC issued on 26 May 2021 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
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 Dr Ian Hamann 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) |
| 1.Scarring of the face | 2 August 1991 | Chapter 6 14.5, 14.6 | Chapter 8, Table 8-2 | 5% | 1/10 | 5% |
| 2.Skin and scarring of the body | 2 August 1991 | Chapter 14 Pages 73-76 | Chapter 8, Table 8-2 | 15% | 1/10 | 14% |
| Total % WPI (the Combined Table values of all sub-totals) | 18% | |||||
The above assessment is made in accordance with the Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002
PERSONAL INJURY COMMISSION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received before 1 January 2002
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 Dr Ian Hamann and issues this new Medical Assessment Certificate as to the matters set out in the Table below:
Assessment in accordance with the Table of Disabilities for injuries received before
1 January 2002
| Body Part (describe the body part as per Table of Disabilities) e.g. right leg at or above the knee | Date of injury | Total amount of permanent % loss of efficient use or impairment | Proportion of permanent impairment due to pre-existing injury, abnormality or condition | Total permanent % loss of efficient use or impairment attributable to this injury (after deduction of any pre-existing impairment in column 4.) |
| Severe facial disfigurement | 2 August 1991 | 10% | 1/10th | 9% |
| Severe bodily disfigurement | 2 August 1991 | 22% | 1/10th | 20% |
Carolyn Rimmer
Member
Dr Paul Curtin
Medical Assessor
Dr Michael McGlynn
Medical Assessor
23 August 2021
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