Shaye Paper Products Pty Ltd v Tran

DETERMINATION OF APPEAL PANEL
CITATION:	Shaye Paper Products Pty Ltd v Tran [2025] NSWPICMP 325
APPELLANT:	Shaye Paper Products Pty Ltd
RESPONDENT:	Thi Huong Tran
APPEAL PANEL
MEMBER:	Deborah Moore
MEDICAL ASSESSOR:	Michael Hong
MEDICAL ASSESSOR:	John Lam Po Tang
DATE OF DECISION:	9 May 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); appellant submits that the Medical Assessor (MA) erred by failing to consider whether any portion of the impairment was the result of a secondary psychological injury and/or failing to provide any adequate reasons as to why this is not possible to determine; MA erred in his assessment of the psychiatric impairment rating scale (PIRS) category of travel; Held – Appeal Panel agreed; re-examination required; MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

On 27 December 2024 Shaye Paper Products Pty Ltd (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Yu Tang Shen, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 4 December 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, 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).

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 Medica Assessor failed to determine the matter in accordance with the referral.

RELEVANT FACTUAL BACKGROUND

By way of background, the worker sustained a primary psychological injury, physical injuries and a resulting secondary psychological injury in the course of her employment with the appellant on 7 March 2022.
In Consent Orders dated 17 October 2024, the notations were as follows:
“A. The applicant sustained an accepted physical injury to her left middle and ring fingers and a (primary and secondary) psychological condition on 7 March 2022.
B. The Medical Assessor is to apportion impairment between the primary psychological condition and secondary psychological condition, in assessing impairment arising from the primary psychological condition.”

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.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
In summary, the appellant submits that the Medical Assessor erred by failing to consider whether any portion of the impairment was the result of a secondary psychological injury and/or failing to provide any, or any adequate, reasons as to why this is not possible to determine.
In addition, the Medical Assessor simply provides an assessment of 20% WPI, based on the psychiatric impairment rating scale (PIRS) assessment, and does not specify whether this relates to the primary psychological injury and/or secondary psychological injury, where evidence available to the Medical Assessor supports that the secondary psychological injury has a significant impact on her permanent impairment.
Further, the Medical Assessor erred in his assessment under one category of the PIRS, namely Travel.
In reply, the respondent submits that the Medical Assessor’s findings are entirely consistent with the medical evidence and the history taken. There is no adequate basis upon which to disturb the findings.

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 appellant was referred to the Medical Assessor for assessment of WPI in respect of a primary psychological injury on a date of injury of 7 March 2022.
The Medical Assessor obtained the following history:
“She said on the day of the subject injury, 7 March 2022, she was working in the factory, and she said she was not able to recall the incident. She was later able to recall the subject injury and she said the machine was broken and she was not in her regular job, and while she was cleaning something with tissue, and threw it out, she did not feel the pain, but when she saw her hand it was cut and bleeding a lot, and she felt so scared, and as a result she cried and she went to see the boss. The boss tried to apply first aid. She said she drove to the doctor’s office, and she was confused and she nearly fainted when she reached there.
I asked if she injured her fingers and she said she sustained physical injuries to her fingers.
She said after the subject accident, she developed psychological symptoms, including becoming anxious and strong headaches.
She said she saw a psychologist for treatment, and she said it was not effective in improving her symptoms, or her psychosocial functioning, such as with her self-care, travel, social activities, relationship, concentration, or work.
She said she has not seen a psychiatrist for treatment. She has been on Fluoxetine 20mg, and she said it was not effective in improving her symptoms, or her psychosocial functioning, such as with her self-care, travel, social activities, relationship, concentration, or work.”
Present treatment was noted as follows:
“She is currently on Fluoxetine 20mg daily. She is seeing her GP every month. There are no current plans for treatment escalation or medication changes.”
Present symptoms were noted as follows:
“She said she has ongoing pain in her fingers, and she said one finger was in pain.
She said she has been feeling depressed, and while she has been gardening she is not sure she enjoys it, and she has no problems with her sleep, and she has no problems with her appetite, and she said she cannot think of what to say about her energy levels, and she said she was not sure if she felt pessimistic about herself. She has poor concentration.
She said she has suicidal ideations when she feels sad. She said she has a lot of intrusive recollection of the subject incident, which causes her distress.”
When asked to provide “Details of any previous or subsequent accidents, injuries or condition” the Medical Assessor said:
“I asked if she had any pre-existing psychiatric condition, and she said she cannot recall. I asked if she had a previous depression in 2017, for which she received treatment with medications and therapy, and recovered in 2020, and she said she did have depression, but she agreed that she had mental illness. She said she did not know what was happening to her, but she banged her head against the wall, and she said she could not recall if she recovered fully from that. Prior to the subject accident, she denied any substance use, or alcohol use, and denied any current alcohol use or substance use.”
The Medical Assessor then set out details of the impact of her injury on her social activities and activities of daily living (ADL’s) as follows:
“She is currently 54 years old and lives in Smithfield with her two teenage children. She separated from her husband many years ago even before the subject injury. She said she has an older sister who lives in Sydney.
Prior to the subject injury, she said her relationship with her children was good and she would help them with cooking and take them to school and she did not require any help looking after them. She said she had a good relationship with her sister.
I asked what her relationship with her children is like now, and she said she needed time to think on this. When I repeated my question, she was still not able to provide any answer to this. I asked if she had conflict with her sons and she said she sometimes had fights with them. I asked if she needed help to look after them, and she said she has not had any help with caring for them.
Prior to the subject injury, she said she had many friends, though she said she could not recall how often she would meet them or what she would do with them. She said she would enjoy activities such as walking, doing things at home and doing some gardening and flowers in the garden.
I asked if she had any friends now, and she said her friends told she was not normal so they don’t want to be with her. She said she doesn’t want to go out, and she prefers to water her trees.
She said she could not recall how regularly she would shower herself prior to the subject injury, and she said she would cook many things. She said she would drive before the injury, though she did not understand when I asked her how regularly she would drive.
Since the injury, she said she doesn’t know how to cook many things, and so they have been relying on take away food now and sometimes if the children want to have vermicelli and rice paper rolls, her son will prepare those meals. She said she has been driving short distances, such as driving her youngest child to school every day, and she also drives to Cabramatta as well and to see the doctors.
I asked what her concentration was like before the subject injury, and she said she did not understand. I asked if she had difficulties with memory or comprehension prior to the subject injury and she said she could remember things.
She said she now cannot recall things, and I asked has difficulties with her concentration and she said she ‘cannot recall things’.
She was born in Vietnam, and she denied any perinatal complications, or developmental delays, or learning delays. She denied recalling any adverse childhood experiences.”
Findings on examination were reported as follows:
“She presented as a casually dressed and reasonably groomed Vietnamese woman. She had an average build and appeared to be her stated age. She engaged cordially in the assessment and attempted to answer every answer. She had mild agitation when queried about the circumstances of the injury.
She told me she was feeling depressed and frustrated.
She displayed some emotional reactivity and became mildly agitated at times during the interview.
She spoke articulately and easily lost her line of thought and frequently confused [sic].
She had ongoing complaints of pain in her finger.
She complained of intrusive recollections of the subject injury and had some death ideations.
She was alert, though it took a long time for her to process many of the questions put to her, and she would occasionally forget the questions soon after they were put to her, and she had poor recollection of her past.
She was repeatedly apologising for not recalling the details of her past.”
The Medical Assessor then summarised the injuries and diagnoses as follows:
“She has: Major Depressive Disorder, Single episode (F32.2), due to meeting Criterion A with her depressed mood, diminished interest in activities, reduced appetite, insomnia, anergia, reduced concentration; meeting Criterion B as there has been significant distress and impairment to social and occupational functioning; and meeting Criterion C as this episode is not attributable to another condition or effect of a substance.”
The Medical Assessor assessed 22% WPI from which he deducted one-tenth in respect of the pre-existing condition, leaving a total of 20% WPI.
The Medical Assessor did not explain his reasons for assessment other than to state that it was based on “the information from the assessment and my observations of her, which can be found above, as well as information from the relevant documents, which have been summarised below”.
He did not explain his calculations other than by stating: “Please refer to the PIRS worksheet.”
He then set out a summary of the material he had before him.
Relevant to the issues in dispute, he said:
“St Vincent’s Hospital notes, dated 13 March 2023. The claimant attended with her son complaining of suicidal ideations. She was feeling stressed and had expressed some suicidal thoughts to the work psychologist. She had a past history of depression, Adjustment Disorder and migraines. She had a supportive son. She appeared flat in her affect. There was an impression of heightened anxiety with some dissociative symptoms on a background of dependent personality traits and anxiety disorder.
Psychologist report by Carl Nielsen, dated 23 May 2022. She has had a diagnosis of depression in 2017 and prescribed antidepressant and had counselling and ceased treatment in 2020 due to remission of symptoms. She denied any substance use history. As a result of the subject accident, she was diagnosed with Adjustment Disorder with depressed and anxious mood due to having anxious distress, anxiety and depressive cognitions, ruminations, sleep disturbance, poor memory, fatigue, low mood, headaches and hypervigilance. She has been unable to return to work and unable to cook and clean her house due to being able to use her right hand only despite being left hand dominant and she has been more socially withdrawn and has difficulties leaving the house. Treatment recommended was cognitive and behavioural therapy.
Allied Health Recovery Request, dated 7 September 2022. This noted a diagnosis of Adjustment Disorder with depressed and anxious mood. She was unfit for work duties. She engages in self-care and domestic duties, unable to drive, uses public transport and has limited engagement with the community, mainly to attend shopping and appointments.
The report written by Dr Assad Saboor, psychiatrist, dated 6 June 2023. The claimant had suffered from depression in 2017 and was treated with medication. She had a crush injury to her third and fourth fingers on 7 March 2022. Since then, she has complained of ongoing pain, headaches, anxiety, flashbacks and nightmares. She reported having strained her relationships, being easily upset and irritable. She has not been attending any recreational activities. She can travel to local and familiar places. She has been seeing a psychologist and was on Fluoxetine 20mg. She was diagnosed with Major Depressive Illness with anxiety features, Posttraumatic Stress Disorder features and chronic pain syndrome. Self-care was mildly impaired as she did not cook and relied on takeaways and taking shower on a daily basis, social and recreational activities was moderately impaired as she has not been attending any recreational activities and does not go out or attend any social events or gatherings. Travel was mildly impaired as she can travel to local and familiar areas, social functioning was mildly impaired as her relationship was strained and getting upset and irritable at her sister and other people. Concentration was moderately impaired as she could not recall things and easily forgetful with poor concentration. Employability was totally impaired as she cannot work at all. Her whole person impairment was 19% with a 10% deduction for pre-existing condition without any adjustment for the effect of treatment. She had a final whole person impairment of 15%.
The report written by Dr Ben Teoh, psychiatrist, dated 27 February 2024. She was diagnosed with chronic Adjustment Disorder with mixed, anxious and depressed mood. She had reached maximum medical improvement as she has had extensive treatment which has included psychological therapy. There was a comment that the assessment was impacted by the claimant being quite distressed at the time and the Assessor was unable to assess the whole person impairment due to poor communication in the interview.”
He added:
“My assessment provides a substantially more impaired rating the Dr Saboor, and my reasoning can be found in the PIRS. A possible explanation could be a progression of her cognitive impairment in the interval period between his assessment and mine, which may have contributed to the difficulty Dr Teoh had in his assessment.”

The appellant’s submissions

These have been addressed to some extent above.
In summary, the appellant submits that the Medical Assessor erred by failing to consider whether any portion of the impairment was the result of a secondary psychological injury and/or failing to provide any, or any adequate, reasons as to why this is not possible to determine.
As regards the assessment for Travel, the appellant submits:
(a)    the Medical Assessor’s comments do not support a finding of a Class 2 impairment for travel;
(b)    the Medical Assessor indicates that there is a mild impairment as the Worker has only been traveling short distances however, he does not specify whether there has been a reduction in her ability to travel following the subject injury and if so, whether this is related to her primary psychological injury;
(c)    the report of Mr Neilsen dated 23 May 2022 recorded: “Ms Tran is also left hand dominant and is unable to drive.” The appellant submits that this supports that any impairment related to travel is related to ongoing symptoms caused by the physical injury to her left hand;
(d)    the Medical Assessor has not considered the effects of the worker’s secondary psychological injury or her physical injuries in his PIRS assessment, and
(e)    as such, the Medical Assessor ought to have given a lower assessment for each of the categories.

Discussion

The Panel agreed with the thrust of the appellant’s submissions and a re-examination was arranged.
Medical Assessor Michael Hong of the Panel re-examined Ms Tran and reported to us as follows:
“History
I introduced myself and explained the panel process, and explained the reason for the assessment today in relation to Dr Shen's assessment.
I asked Ms Tran how old she was. She said she forgot. I asked her date of birth, and she said that she was born on 30th September 1970.
She said that she lives with two children. The older son is 18 years old, and she could not remember how old her younger son is. She does not remember which school he attends or which year he is in, only that the school is not far from home. I asked whether she prepares lunch for her son, and she said her brain does not know how to prepare lunch anymore.
I inquired how long Ms Tran had worked as a machine operator, and she said she does not remember,
She apologised to me and said that she would be speaking very slowly during the assessment because that is how she is. I explained through the interpreter that she should take her time and there was no need to hurry.
It should be noted that Ms Tran did speak very slowly initially, with some latency to response, but after about 10-15 minutes, her speech became normal. She spoke fluently without latency, and gave very long answers, to the point that the interpreter had to stop her every five minutes to allow all the information to be interpreted.
I asked Ms Tran about the accident at work on 7 March 2022, and she said she needs some time before she can remember. Eventually, she said it was a long time ago, and she does not remember the accident at all. She started rubbing her head and hair and looked around, and said she will try to remember. She asked for me to be patient, after a couple of minutes, she said her brain does not work, and that she cannot check her memory. I then discussed the assessment process.
Ms Tran then gave a long narrative, and spoke without pause for more than 5 minutes at a steady pace, until the interpreter stopped her. She said her brain starts to remember and she is nervous, and said she always worked hard with her full capacity, but her hand and brain were not as fast. On the day she went to work, the machine was broken. She used a tissue to clean it and cleaned the bench top too, then she realized she was bleeding, and felt scared. She spoke with a co-worker who asked her to see the boss. The boss put bandages on her and she drove home, as she did not know she needed an ambulance.
Ms Tran drove slowly to her GP, and recalled many cars behind her beeped as she was too slow. She thought she would pass out, and finally arrived at her GP, who then organized an ambulance. She had hand treatment and did not work at all, and said she was scared to return to work due to her trauma and has not worked again.
Physically, Ms Tran said her hand aches and has a problem with sensations. Initially both hands, and now mainly her left hand. She is left-handed and writes with her right hand.
She said she has difficulties walking due to arthritis unrelated to work. She has neck and back pain from arthritis. She said sometimes she even cannot walk a little.
She said she does not know how much she can carry, and I asked about 2 litre milk, and she said she does not know if she can carry 2 litres. She said she will tell me what she knows, but she does not know how to answer some questions. Sometimes, she goes to buy groceries, and could not find 2 litres washing detergent, so she has to buy 5 litres, which she can lift a little but not carry it.
I asked Ms Tran about Dr Bradshaw, hand surgeon and noted he certified her fit to return to work. She does not remember him or the conversation. Eventually, she said he only treated her at the beginning.
She drives only locally, only if needed, such as the school drop-off and shopping. She can drive around Cabramatta, rarely she drives to Liverpool Westfield shopping centre, and said she does not know how long it takes. She said due to her hand problem and memory loss, she cannot drive further.
At 30 minutes, I noted Ms Tran spoke well. There was initial 10-15 minutes of speaking slowly, and she was now speaking at a normal speed and gave long answers to all questions. There was no latency with any questions asked and she did not go off topics.
Ms Tran said she could not move during the accident, she sat down, her left leg had shooting pain into her head (later, she said her arm has shooting pain into her head too). She said when moving her leg, she had a brain problem, therefore, her brain injury is from the accident. She confirmed there was no head strike during the accident. On further enquiry about injury to her brain, she starts rubbing her head and hair and cried, and gestured with both hands. I asked her if she was okay or needed a break. She continued. The interpreter stopped her at one point as she gave a long answer. Ms Tran said she lost her memory with her hand injury and because of memory loss, she cannot enjoy her life as she cannot remember things. She said she had depression previously and did not want to have depression again after the accident. She said she had chronic aches and pains, in her hands and legs since the accident. She has headaches too.
Psychological sequelae:
Ms Tran felt stressed since the accident, but cannot recall when her anxiety and depressive symptoms commenced. She felt stressed by her physical injuries and pain.
She thinks about her physical injuries and pain all the time, and worries about her health, and feels anxious, even now.
Past psychiatric history:
I asked Ms Tran about her past psychiatric history, especially 2017 to 2020. Ms Tran said she had depression and saw her GP and a psychiatrist, later she had medication from her GP. She does not remember the psychiatrist's name. After her hand injury, she was scared of her mental health problems would return and wanted to see the psychiatrist again, but her GP could not find the same psychiatrist. She said she recovered and did not have further mental health problems and was off treatment at the time of the subject injury.
Current symptoms:
Ms Tran said her memory loss and hand injury are the main problems.
She confirmed having chronic anxiety and depressive symptoms. She said she had problems with breathing difficulties and attended the hospital. An ambulance took her to Liverpool Hospital but she is not sure when.
She said she is getting worse and explained this further: on 12 or 13th April 2025, her head started spinning, and she wanted to scream. On 25 April 2025, the same thing happened again, her head was going to explode, she cannot control herself, and wanted to scream but did not. It happened again 2 days ago.
Ms Tran described being easily frustrated.
On specific enquiry regarding her weight, she said her weight has not changed in 2025.
Ms Tran reported chronically disrupted sleep, and on further enquiry about the nature of her sleep problems, she said ‘I do not know’.
She denied ever having psychotic symptoms or hallucinations.
She said her head pinches all the time.
Treatment:
Ms Tran saw a psychologist and psychiatrist after the accident, and does not know their names, and only briefly and they said they cannot help her. She has remained on the same psychotropic medications.
Her packets show:
• Zactin 20 mg
• Puffer
• Lyrica 75 mg
She also has supplementary medicine.
She has not felt improved with treatment.
She said she cannot look after her children, because her brain cannot function, and explained she does not know how to talk properly, and cannot breathe, and has heartaches (or chest pain) from breathing difficulties.
60 minutes: I noted no change in Ms Tran's mental state examination, she gestured regularly and spoke in a full voice and gave long answers. The interpreter usually stops her after 5 minutes.
Lifestyle activities:
In terms of daily activities, Ms Tran said she drops her elder son off at work sometimes. (The Panel notes that Ms Tran is clearly able to drive alone).
She takes her younger son to school sometimes and then goes home. She said before the accident, she cooked and did household chores and after the accident, she cannot do it. She does not want to go out. She stays at home most of the time.
She said she cannot do gardening due to her hand injury, and gardening was her hobby. She bought plants and wanted to grow them in the backyard but could not.
Ms Tran said she cannot look after herself. She said if I asked her what she ate, she would not remember, what night food she had.
She does not cook and only buys takeaway food. She said her brain does not know how to cook anymore. She eats without prompting but not at regular times during the day.
Ms Tran does not shower regularly. She said she does not know how often she showers. She said her sons have to remind her, and I discussed the other doctors noted she showers daily without prompting. She said she can shower without prompting.
She said she has constant chest pain, which she has not had before.
I asked Ms Tran about her family, she asked what ‘family’ means, then the interpreter explained ‘family’ to her. She said does not talk to her husband, her parents have passed away. She said she sees her sister and her children, she goes to pick up food from her sister. She has no other siblings. I asked her about family gatherings and family events, she said her sister is busy and has no time to hang around with her. Regarding attending birthday parties, Ms Tran said she cannot remember.
She dyed her hair at a hair salon a long time ago, and I discussed with her only a small amount of grey root was visible.
1 hour 15 minutes: I discussed with Ms Tran that she focused well during the assessment. She said thank you.
Ms Tran does not do anything that requires focus day-to-day. She said she has constant headaches every day since her hand injury and lost her memory. Today, she confirmed she focused well during the assessment, even though she has headaches, but she focused because she was having the assessment.
She does not read, use a computer nor spend time online, and said she does not know how to use a computer or do things online. She said her son pays the bills as she does not have money. I asked her if she paid online or in-person before the accident, e.g. at the Post office or banks, she said she does not remember.
She said there have been no trips away and no interstate travel.
1. FINDINGS ON PHYSICAL EXAMINATION
Ms Tran was assessed by video. She was at her solicitor's office on her own, and drove there herself for the assessment.
Ms Sarah Aiken was the interpreter.
Ms Tran was casually attired without overt neglect. Her hair was coloured and some grey roots were visible. She regularly grimaced, gestured and would suddenly changed her facial expressions, with amplified affect.
She engaged well with the assessment process. There was no psychomotor slowing or abnormal movements. She spoke spontaneously and fluently. She was not thought disordered and after 10-15 minutes, she consistently gave long answers.
She remained focused throughout the assessment. She provided clarification when asked.
She spoke at a steady pace. There was no set-shifting impairment. There was no overt cognitive impairment elicited.
At the end of the assessment, I asked for further information that may be relevant and she discussed her brain does not know what else to say, and then thanked the interpreter.
The assessment finished after 90 minutes.
· File review:
Dr Shen reported on 2nd December 2024, rating Ms Tran's PIRS as 232 245. Dr Shen wrote that Ms Tran has not been cooking and was relying on takeaway food and not relying on other people for self-care. She prefers to water her trees and does not want to go out and has been isolated. Sometimes she has fights with her son, and she has not had any help caring for or looking after them and does not contact her friends. It's not to the point Ms Tran could not care for her sons, such as organising food for them or taking them to school. During the assessment, she said she was alert, but it took a long time for the process, and she occasionally forgot the questions she was asked, which was apparent throughout the assessment. Comment: Ms Tran presented quite differently during my assessment for 90 minutes, apart from the initial 10-15 minutes when she apologised for being slow, she, in fact, spoke very well, there was no latency, and no overt impairment for the rest of the assessment. Her cognitive difficulties improved as the assessment proceeded.
Dr Assad Saboor 6th June 2023, provided a WPI and also said that Ms Tran did not cook, relied on takeaway food, and took a shower daily but has not been attending recreation activities or going out to social events. She cannot remember things and has been forgetful. He assessed Ms Tran's pre-existing condition at 10% without any explanation, and also deducted secondary injury 10%, again without reason.
Dr Rajapakse, who is an IME hand surgeon reported on 9th May 2023, noted that when cleaning, Ms Tran accidentally made contact with a machine which turned on and she sustained a crushed injury to the middle and ring finger and underwent repair with Dr Bradshaw. She had regular headaches investigated by neurologists but could not find any organic causes. Ms Tran has a history of depression and anxiety, and she feels that since the injury, this has been exacerbated and has been seen by a psychologist to cope with pain since the injury. She has a diagnosis of adjustment disorder from her psychologist. Since the injury, Ms Tran has made considerable progress, and her ring finger has improved to almost near normal, and the main problem is the left middle finger and numbness. She still complains of various symptoms such as headache, breathlessness, and anxiety when she touches her middle finger, which inhibits her from performing any activities. Her previous counselling stopped in 2020. She was on Zactin at the time. In terms of ADL, Ms Tran is able to perform all Activities of daily living. Cleaning and cooking are impaired because of pain, but she still does it. She used to drive frequently but does not anymore due to a combination of anxiety that her pain in the middle finger will increase, and other symptoms such as migraines and shoulder pain. She can write with her right hand.
Dr Eric Lim GP, reported on 2nd May 2022, noted the crushed injury aggravated her psychological distress, and she previously had depression and anxiety. She stays home, showers every day. She was certified unfit for work, and referred to a psychologist.
Psychologist entries noted: She has a serious injury and an adjustment disorder and has pain all over her body, palpitations, a lack of energy, feels like lying down on George street in Cabramatta, difficulties breathing, tired, and anxious. She also noted pain in the legs and can barely lift her arms, feeling like she is paralysed. Breathing difficulty is worsening, sometimes lasting for four days continuously. Only sleeping for two hours, waking up, and feeling like her whole body is stiff and numb.
Dr Bradshaw, treating hand surgeon, on 12th July 2022, noted several highly atypical symptoms such as headache and a sense of hearing herself when chewing since surgery and she was reassured. He reassured her she should be able to return to work and do as many activities as she can following surgery, but she will never have a completely normal left hand and should be able to undertake at least some activity with her left hand, and is unrestricted in the right. In terms of capacity, he is happy for her to undertake activities as tolerated and does not need to review her.

· Summary of injuries and diagnoses:

Ms Tran described having suffered depression previously, consistent with an adjustment disorder, and treatment ceased in 2020 with no further evidence of psychiatric impairment. Therefore, my view is that since there was no pre-existing impairment according to the Guides, consistent with the approach in Matheson.
She reported after a work injury she has not been able to return to work. She had hand surgery but continues to suffer from a range of physical symptoms, some of which are related to the accident, and she said some are from arthritis.
Ms Tran is preoccupied with physical injuries and pain and said she suffered memory loss and brain injury because of the accident affecting her hands and her limbs.
Overall, my view is that Ms Tran developed an adjustment disorder caused by the nature of the workplace accident itself and this is a primary psychological injury. This diagnosis is consistent with the treating team’s assessment.
In addition, Ms Tran suffered from a somatic symptom disorder, which is considered a secondary psychological injury arising from her work-related physical injury and ongoing pain.
Ms Tran's symptoms fulfil all of the DSM-5-TR diagnostic criteria for Somatic symptom disorder with predominant pain:
Criterion A:
Ms Tran reported her pain symptoms are distressing and advised that pain is the reason for ceasing various activities she normally performed.
Criterion B:
Ms Tran reported excessive thoughts and feelings related to her pain and the nature of her physical injuries.
Criterion C:
Ms Tran's somatic symptoms and pain symptoms, and anxiety related to them, have lasted more than 6 months.
I noted the Guides advised a brain injury is not assessable in the PIRS. Pain and somatic symptoms are also not assessable in the PIRS.
My assessment is generally consistent with Dr Saboor and Dr Shen. In terms of concentration, persistence and pace, Ms Tran does not have any intellectually demanding tasks day-to-day and appeared to have limited tasks that required significant cognitive capacity before the accident. Based on her presentation on the day of assessment, she has mild impairment. Her concentration improved as the assessment proceeded and was almost normal after 30 minutes. Importantly, memory impairment is not one of the descriptors in the PIRS.
Whilst Ms Tran's secondary psychological injury, Somatic symptom disorder can manifest as headaches, this is not assessable in the PIRS.
I have completed the two-step assessment based on her report of functioning, and arrived at the impairment from her primary psychological injury.

PIRS Category

Class

Reason for Decision

Self-care and personal hygiene

Ms Tran's self-care has deteriorated and said she does not shower regularly, but will shower most days without prompting. She eats regularly and buys takeaway food. Her weight is stable. She does some household chores. She is independent in self care.

Social and recreational activities

Ms Tran reported all of the previous recreational activities have been discontinued and she does not have social and recreational activities now. Her sister visits sometimes and she can tolerate her.

Travel

Ms Tran is able to go out independently, but is anxious when out and does not go far, only to Liverpool.

Social functioning

The relationship with her children and sister has declined due to her emotional changes.

She does not have contact with any friends now, and said they shun her.

Concentration, persistence and pace

Ms Tran reported having concentration difficulties.

Her mental state examination is consistent with 2 during the assessment for 90 minutes, and could focus on complex instructions related to questions for more than 30 minutes. She does not have intellectually demanding tasks day-to-day, and does not remember any intellectually demanding tasks before the accident.

Employability

From a psychological perspective, she cannot work due to her anxiety and depression, and poor tolerance generally.

Score

Median Class

Aggregate Score Impairment

Total

Pre-existing impairment

0

Final WPI

9

2 step method as described in Kiely:
Step 1: all impairment from Ms Tran's psychological injury is calculated as noted in the attached PIRS.
Step 2: secondary psychological injury, Somatic symptom disorder, is not assessable in the PIRS and has been disregarded, consistent with Matheson. The remaining impairment from step 1 is converted to a final WPI, being 9%.
In Matheson, Judge Basten gave an example of the 2 -step method, essentially excluding secondary psychological injury impairment from within the PIRS. I think that is a medically sensible approach and is the method used in this case.”

The Panel agrees with the comprehensive assessment undertaken by Medical Assessor Hong.
For these reasons, the Appeal Panel has determined that the MAC issued on
4 December 2024 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:	W26461-24
Applicant:	Thi Huong Tran
Respondent:	Shaye Paper Products 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 Yu Tang Shen 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	24/5/2022	Chapter 11	Chapter 14	9%	Nil	9%
Total % WPI (the Combined Table values of all sub-totals)					9%

[2025] NSWPICMP 325

9 May 2025