Sleiman v AGR Tyres Pty Ltd

DETERMINATION OF APPEAL PANEL
CITATION:	Sleiman v AGR Tyres Pty Ltd [2023] NSWPICMP 111
APPELLANT:	Ali Sleiman
RESPONDENT:	AGR Tyres Pty Ltd
Appeal Panel
MEMBER:	Catherine McDonald
MEDICAL ASSESSOR:	Drew Dixon
MEDICAL ASSESSOR:	John Garvey
DATE OF DECISION:	29 March 2023
CATCHWORDS:	wORKERS cOMPENSATION - Reconsideration of Medical Assessment Certificate (MAC) issued as a result of previous medical appeal; sought for the purpose of a threshold dispute; consideration by the Court of Appeal; Sleiman v Gadalla Pty Ltd discussed; reconsideration appropriate based on deterioration; Martinovic v Workers Compensation Commission of New South Wales and Riverina Wines Pty Ltd v Workers Compensation Commission considered; Held – MAC revoked.

BACKGROUND

Ali Sleiman was employed by AGR Tyres Pty Ltd (AGR) as a tyre fitter from early 2000. He suffered an injury which is deemed to have occurred on 14 May 2014. In 2016 Mr Sleiman made a claim under s 66 of the Workers Compensation Act 1987 (the 1987 Act) for compensation for 46% whole person impairment (WPI). His claim was disputed and he filed an Application to Resolve a Dispute in the former Workers Compensation Commission.
The Workers Compensation Commission was abolished and from 1 March 2021 under the Personal Injury Commission Act 2020, the matter was assigned to the Workers Compensation Division of the Personal Injury Commission (the Commission). We have used the titles applicable to the relevant decision makers at the time their decisions were made.
The procedural history of the matter is extensive. At a conciliation conference and arbitration hearing on 21 December 2016, the parties agreed that the dispute about Mr Sleiman’s permanent impairment should be referred to an Approved Medical Specialist (AMS). The AMS was asked to assess impairment in respect of Mr Sleiman’s left and right upper extremities (shoulders), lumbar spine and lower digestive tract.
The assessment of permanent impairment is conducted in accordance with the NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed reissued 1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).
On 19 January 2017 the AMS, Dr Truskett, issued a Medical Assessment Certificate (MAC) in which he assessed 2% whole permanent impairment (WPI), being 1% in respect of each of Mr Sleiman’s upper extremities (shoulders). The AMS assessed Mr Sleiman in DRE Lumbar category I resulting in 0% WPI and assessed 0% WPI in respect of his lower digestive tract.
Mr Sleiman appealed under s 327 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) and his appeal was referred to a Medical Appeal Panel comprised of a former arbitrator of the Workers Compensation Commission and Drs Dixon and Garvey.
Mr Sleiman was re-examined by Dr Dixon for the purpose of the appeal on 24 May 2017. On 16 June 2017 the Appeal Panel revoked the MAC and issued a new MAC certifying 14% WPI, comprised of 8% in respect of the right upper extremity and 6% in respect of the left upper extremity.
The Appeal Panel confirmed that assessment in DRE Lumbar category I and found no demonstrable error in respect of his lower digestive tract.
On 21 July 2017, the Workers Compensation Commission issued a Certificate of Determination ordering AGR to pay Mr Sleiman $20,350 under s 66 of the 1987 Act, in respect of 14% WPI.
In 2019 Mr Sleiman claimed that his condition had deteriorated and purported to file another appeal, nominating Dr Dixon as the AMS whose MAC was the subject of the appeal. The form said that the assessment was for the purpose of a threshold dispute, being the threshold to claim work injury damages. AGR sought time to arrange a medical examination but did not take issue with the filing of an appeal.
A delegate of the Registrar of the Workers Compensation Commission determined that the appeal was incompetent because the appeal panel decision was not appealable under s 327(2) of the 1998 Act and such an appeal would “be an affront to the finality of litigation”.
Mr Sleiman sought judicial review of the delegate’s decision. Harrison AsJ dismissed that application,[1] holding that ss 326 to 328 of the 1998 Act did not permit the certificate of an appeal panel to be considered a medical assessment.
[1] Sleiman v Gadalla Pty Ltd [2021] NSWSC 86.
Mr Sleiman then sought to appeal to the Court of Appeal. Leeming JA, with whom the other members of the Court agreed, held that a further appeal under s 327(3)(a) or (b) was not available.[2] In the course of that decision, Leeming JA noted that the former s 378 of the 1998 Act empowered an appeal panel to reconsider its decision, noting that the principles under which the power is exercised are collected in Martinovic v Workers Compensation Commission of New South Wales[3] (Martinovic). His Honour said:
“It is true that the right to apply for reconsideration is not available as of right but instead is discretionary, and that may be disadvantageous to the worker. However, there is a sound basis in the legal system generally for there to be a single appeal as of right, with any further appeal being discretionary …
It is helpful to return to the following fundamental considerations.
(1) Generally, it makes sense for medical assessments to occur at a time when the worker’s condition is likely to have stabilised; how else, after all, is permanent impairment properly to be assessed? Section 322A discourages medical assessments being performed too early.
(2) In cases where there is further deterioration, the earlier approved medical specialist or Appeal Panel will be shown to have been wrong to have concluded that the degree of permanent impairment suffered by the worker is as was assessed. It is open to the approved medical specialist to decline to make an assessment of permanent impairment ‘until the approved medical specialist is satisfied that the impairment is permanent and that the degree of permanent impairment is fully ascertainable’: s 322(4).
Now of course there may be cases where the approved medical specialist wrongly reaches the view that the degree of permanent impairment is fully ascertainable, and thereafter the Appeal Panel likewise wrongly reaches the view that the degree of permanent impairment is ascertainable, only for the worker’s condition to deteriorate. But it is to be hoped and expected that such cases are rare.
The foregoing tends to call into question the premise underlying Mr Sleiman’s construction. If it be assumed that the original decision is wrong, and the appeal from that decision is wrong, then it may readily be contended that a limit of a single appeal can operate harshly. But in substance such an argument assumes its own result.
The answer to the submissions based on harshness is that there should only be an assessment of permanent impairment when the specialist bodies involved are satisfied that an assessment can appropriately be made, the right of appeal on the ground of deterioration addresses errors that have occurred, and if there is further deterioration after an assessment of permanent impairment by the Appeal Panel, then those cases would, at least under the regime which obtained in 2019, be cases where a relatively powerful case for reconsideration would be available.”
[2] Sleiman v Gadalla Pty Ltd [2021] NSWCA 236.
[3] [2019] NSWSC 1532 at [91]-[101].
His Honour said that the appropriate course was not to dismiss his appeal but to consider it an application for reconsideration. The matter was remitted to the Commission so that the application for reconsideration could be determined.
Before any reconsideration of the MAC could be undertaken, it was necessary for the Commission to reconsider the Certificate of Determination issued on 21 July 2017 under which Mr Sleiman was paid compensation. A member of the Workers Compensation Division of the Commission determined that application on 6 September 2022, being satisfied that the weight of the medical evidence supported the conclusion that there had been a deterioration in Mr Sleiman’s lumbar spine and some deterioration in his upper extremities since the MAC in 2017. She rescinded the Certificate of Determination and referred the matter back to the Appeal Panel for reconsideration.
As the Arbitrator member of the Appeal Panel had retired, a delegate of the President issued a decision reconstituting the panel on 28 September 2022.
The Commission Member made a series of case management orders in the course of determining the application to reconsider the Certificate of Determination. The parties filed evidence and submissions in response to those orders. The parties did not seek to rely on further submissions before us and we have considered that material in the absence of further submissions directed specifically to us.
In the Supreme Court and Court of Appeal, AGR was named as Gadalla Pty Ltd. So far as we can determine, the name has not been formally amended in the Commission and we will continue to refer to it as AGR.

SUBMISSIONS

Both parties made written submissions on the application for reconsideration by the Member and served further evidence.
In summary, Mr Sleiman submitted that his condition had deteriorated, relying on his statement dated 7 May 2019 and reports of Dr Giblin dated 13 March 2018, 14 January 2019 and 13 April 2022 and reports by Dr Mellick dated 26 June 2019 and 27 June 2022. Mr Sleiman said that his lumbar spine symptomatology was now consistent with assessment in DRE Lumbar category II or III. He said that there had also been a deterioration in his left and right upper extremities.
The submissions noted the decision in Riverina Wines Pty Ltd v Workers Compensation Commission[4] (Riverina Wines) and said that deterioration as described in s 327(3)(a) of the 1998 Act is a deterioration from the degree of impairment certified by the MAC.
[4] [2007] NSWCA 149.
In reply, AGR relied on a report from Dr Machart dated 17 August 2022. It submitted that neither Dr Giblin nor Dr Mellick had provided reasons for a deterioration in Mr Sleiman’s decision and that the objective pathology had not changed.

EVIDENCE

We have all the documents that were sent to the Medical Assessor for the original medical assessment and the documents filed for the purpose of the application to reconsider the Certificate of Determination. We have taken them into account in making this decision.
Mr Sleiman’s most recent statement is dated 7 May 2019. He said that the condition in his back had deteriorated since the examination in 2017. He said that the pain in his lumbar spine has increased and that he was referred to Drs Kam and Rosenberg. The pins and needles in his legs had become worse and he was referred to Dr Diwan. Dr Diwan said that he did not require surgery.
Mr Sleiman said that his injuries have deteriorated further and he underwent an MRI scan on 10 January 2018. The MRI scan report, addressed to Dr Kam, showed, in summary:
“disc desiccation in the lower lumbar region with mild annular bulges that multiple levels causing predominantly neural exit foraminal narrowing. Contact without significant impingement or compression of the exit in lumbar nerve roots.”
There are no reports from Drs Kam or Rosenberg in the file and no reports from Dr Diwan other than that attached to the Application to Resolve a Dispute. Mr Sleiman said that he was referred to Dr Giblin about the time of the MRI scan in 2018 to comment on the need for surgery. Surgery was recommended by Dr Rosenberg but not approved by AGR’s insurer.
Mr Sleiman said that after the request for surgery was declined, he elected to try to put up with the pain that he was experiencing in his lumbar spine, which was greater than the pain experienced before.[5]
[5] Statement dated 7 May 2019 at [60].
Mr Sleiman said in his statement that the condition of his shoulders and arms has also deteriorated. He said that he has constant pins and needles and wears a brace to manage symptoms in his right hand. He cannot raise his right arm or use it in any way and he relies on his left hand and shoulder, resulting in increased pain.
Mr Sleiman relies on three reports from Dr Giblin, all of which are addressed to his solicitors. The first report in the file is dated 13 March 2018 and refers to an earlier report. Dr Giblin agreed with Dr Dixon’s 2017 findings with respect to Mr Sleiman’s upper extremities but assessed his lumbar spine in DRE Lumbar category II. He did not comment on the MRI scan dated 10 January 2018.
Dr Giblin’s assessment did not change in his report dated 14 January 2019.
In his report dated 13 April 2022, Dr Giblin maintained his assessment in DRE Lumbar category II. He said that he did not find satisfactory objective evidence of radiculopathy to assess Mr Sleiman in DRE category III. He assessed 9% WPI in respect of Mr Sleiman’s right shoulder and 8% in respect of his left. He deducted one-tenth under s 323 resulting in a total assessment of 25% WPI.
Mr Sleiman’s solicitors also referred him to Dr Mellick, neurologist who reported on
26 June 2019. He assessed 39% WPI, considering that all injuries (with the exception of the lower digestive tract) had deteriorated. Dr Mellick also included an assessment in respect of Mr Sleiman’s cervical spine. In his second report, Dr Mellick confined his assessment to Mr Sleiman’s lumbar spine and shoulders. He assessed 13% WPI in respect of his lumbar spine, assessing him in DRE category III and allowing 3% for the impact of the impairment on Mr Sleiman’s activities of daily living. He assessed 13% WPI in respect of Mr Sleiman’s right upper extremity and 9% in respect of the left, resulting in a total assessment of 32% WPI.
Dr Machart saw Mr Sleiman at the request of AGR and reported on 17 May 2022. He had previously seen Mr Sleiman in 2016. Dr Machart considered that the diagnostic features had not changed and that his presentation was primarily non-organic. He said that the MAC issued by the Appeal Panel remained appropriate.

PRELIMINARY REVIEW and RECONSIDERATION

We conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with Procedural Direction PIC7.
Rule 128 of the Personal Injury Commission Rules 2021 (PIC Rules) and Procedural Direction PIC7 – Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An appeal panel determines its own procedures in accordance with the WorkCover Medical Assessment Guidelines 2018.
Mr Sleiman sought to rely on the ground of appeal in s 327(3)(a) of the 1998 Act – that there has been a deterioration in his condition that results in an increase in the degree of permanent impairment. The Court of Appeal determined that ground of appeal was not open to him.
The matter has been referred to us to reconsider the MAC issued on 16 June 2017.
The submissions made on the application for reconsideration of the Certificate of Determination are as relevant to our reconsideration as to that made by the Member and we have taken them into account in making our decision.
In Martinovic, N Adams J noted the principles set out by Roche DP in Samuel v Sebel Furniture Ltd[6], including that the Commission has a wide discretion to reconsider its previous decisions and has a duty to do justice between the parties according to the substantial merits of the case. Her Honour noted that it was possible that balancing competing interests may lead to a finding of error but still result in the application being dismissed.
[6] [2006] NSWWCCPD 141, [58].
The current application – in one form or another – has been on foot since 2019. While a mistake by legal practitioners will not generally give rise to a ground of reconsideration and while delay is relevant, Mr Sleiman has made the application for reconsideration only after a decision of the Court of Appeal clarified his rights.
The original assessment by the AMS was made only two years after the injury and the original appeal determined roughly one year later. Even though the reports of his treating doctors do not form part of the file, it is clear that Mr Sleiman remained under active treatment for some time after the MAC was issued. Surgery was proposed and liability declined and Mr Sleiman has not elected not to undergo surgery. The application for assessment, and consequently the medical appeal, were probably undertaken prematurely with the result that the Appeal Panel was wrong (to use Leeming JA’s words) to determine that the degree of permanent impairment was fully ascertainable.
On balance, we consider that the interests of justice require that we reconsider the MAC dated 16 June 2017.
We determined that a new MAC could only be issued if there had in fact been a deterioration in Mr Sleiman’s condition since 2017. We are guided by the statement by Campbell JA (with whom the other members of the Court agreed) in Riverina Wines that:
“Considering that submission involves, first, construing section 327(3)(a). ‘Deterioration’ of a person’s condition is an inherently relational concept. It involves the condition in question having become worse than it previously was, at some particular point in time. In my view, the ‘deterioration’ that section 327(3)(a) talks of is a deterioration from the degree of impairment that has been certified by the MAC, over the time since the examination or examinations on the basis of which the MAC was issued took place. That conclusion follows from the fact that the appeal in question is, as section 327(2) requires, against a matter as to which the assessment of an AMS certified in a MAC is conclusively presumed to be correct.” (emphasis in original)
While the reports on which Mr Sleiman relied suggested a deterioration, we determined that he should undergo a further medical examination to determine if there has in fact been a deterioration in his condition since the date of the MAC in 2017.
We also directed that he undergo an up to date CT scan and take the scan and report to the examination.
Drs Dixon and Garvey conducted an examination on 3 February 2023 and reported to the Appeal Panel. A copy of the report is attached.
Mr Sleiman did not take a new CT scan to the examination. We issued a subsequent direction dated 15 February and issued on 17 February 2023 requesting a copy of that scan and another MRI scan report referred to but not included in the file resulted only in the late production of a copy of the MRI scan dated 10 January 2018. No explanation has been provided by either party for Mr Sleiman’s failure to undergo a fresh CT scan.

FINDINGS AND REASONS

In Campbelltown City Council v Vegan[7] the Court of Appeal held that an 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.
[7] [2006] NSWCA 284.
The Guidelines provide in paragraph 1.6 that assessment of permanent impairment involves clinical assessment of a worker as he presents on the day of assessment, taking into account his relevant medical history and available relevant medical information.
On the day of the examination, Drs Dixon and Garvey were satisfied that Mr Sleiman was cooperative.
We have determined, based on the examination findings, that there has been a deterioration in Mr Sleiman’s condition since the assessment nearly six years ago.

Upper extremity impairment

The Guidelines provide in paragraphs 2.3 to 2.5 that upper extremity impairment is assessed using the range of motion, unless that cannot be used as a valid parameter due to inconsistency. Drs Dixon and Garvey were satisfied at the examination that the range of movement exhibited by Mr Sleiman was consistent on repeated testing.
Despite Mr Sleiman’s subjective experience of deterioration set out in his statement, the range of motion of his shoulders was slightly improved from that observed by Dr Dixon in 2017.
The assessment is now consistent with 8% WPI in respect of his right upper extremity and 5% in respect of the left. It remains appropriate to deduct one-tenth of the impairment in respect of the pre-existing rotator cuff degeneration shown on X-ray reported on 2 July 2014. The reasons are those set out in the Appeal Panel decision dated 16 June 2017.
The assessment made on 3 February will be used in our assessment of permanent impairment, even though the assessment of upper extremity impairment is less than that assessed in 2017. Impairments that arise from the same incident are assessed together, resulting in one total assessment of WPI. As Roche DP observed in Roche v Australian Prestressing Services Pty Ltd[8], “permanent” does not mean “everlasting” and there is no estoppel in a changing situation, such as a person’s physical condition.[9]
[8] [2013] NSWWCCPD 7.
[9] At [3].

Lumbar spine

In 2016 the AMS observed inconsistent findings on examination of Mr Sleiman’s lumbar spine. That was not the case on the examination on 3 February 2023. The observations on that day are consistent with assessment in DRE Lumbar category II, resulting in an assessment of 5% WPI. There has therefore been a deterioration in the assessment of Mr Sleiman’s lumbar spine.
Some elements of radiculopathy were observed, being thigh muscle wasting on the right and a positive sciatic nerve tension sign. However, Mr Sleiman had symmetrical reflexes, there was no objective sensory loss and power of the lower extremities was grade 5 out of 5. Mr Sleiman therefore does not have radiculopathy as defined in paragraph 4.27 of the Guidelines.
The report of the MRI scan dated 10 January 2018 does not cause us to alter that assessment. While an up to date CT scan may have assisted our determination, its absence was not fatal, noting the deterioration observed on re-examination.
Based on Mr Sleiman’s statement as to his limited activities and the need for Mr Sleiman’s wife to assist him to undress for the examination, it is appropriate to allow 3% for the effect of the injury on Mr Sleiman’s activities of daily living, resulting in an assessment of 8% WPI.
Because of the assessment in DRE Lumbar category I in 2017, it was not necessary to consider the application of s 323 of the 1998 Act. The Appeal Panel noted at that time that an MRI scan reported on 6 May 2014 showed mild disc desiccation. The 2018 scan shows some progression in the findings in Mr Sleiman’s lumbar spine from the earliest scans in 2014. Nonetheless, we consider that the pre-existing degenerative spondylosis contributes to the overall level of impairment and that there should be a deduction under s 323. Because it is difficult to determine the extent of the deduction, s 323(2) applies and the appropriate deduction is one-tenth.
We accept that there has been a deterioration in Mr Sleiman’s condition and assess 18% WPI comprised (after s 323 deductions) of 7% in respect of the lumbar spine, 7% in respect of the right upper extremity (shoulder) and 5% in respect of the left upper extremity (shoulder).
For these reasons, we have determined that the MAC issued on 16 June 2017 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

PERSONAL INJURY COMMISSION

APPEAL AGAINST MEDICAL ASSESSMENT

REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR

MEMBERS OF THE APPEAL PANEL

Matter Number:	M1-526-/16
Appellant:	ALI SLEIMAN
Respondent:	AGR TYRES
Date of Determination:	21 July 2017

Examination Conducted By:	DREW DIXON AND JOHN GARVEY
Date of Examination:	3 FEBRUARY 2023

The workers medical history, where it differs from previous records

NIL

Additional history since the original Medical Assessment Certificate was performed

NIL

Findings on clinical examination on 3 February 2023 by Drew Dixon and John Garvey

The Claimant was consistent on range of motion testing of his shoulders and was co-operative during the examination.

His wife attended and helped him to remove his trousers.

An interpreter assisted Mr Sleiman at the examination.

LUMBAR SPINE (Lumbosacral)

The gait was normal but the Claimant complained of pain in the right hamstring region radiating to his right foot. The Claimant could not do a single squat and rise (quadriceps, L4 nerve root) without pain in the right thigh and back, could not heel walk (ankle and toe dorsiflexor muscles, L5 [some L4]) or toe walk (calf muscles, S1) There was no lumbar spinal deformity. There was tenderness and muscle spasm of the paravertebral muscles (erector spinae) on the left. Forward flexion in the standing position was possible halfway to the knees and extension was half normal, and there was restricted range of right (one third normal) and left lateral flexion (half-normal). Seated straight leg raising (knee extension) was achieved to 50° on the right and 60° on the left with reports of thigh pain, positive nerve root tension sign. Deep tendon reflexes: knee reflex (L4), medial hamstring (L5) and ankle reflex (S1) were normal on each side .

Motor tone, power and movement of the lower extremities was normal and power was grade 5/5 (normal) bilaterally to knee flexion and extension (L4), resisted hallux flexion and extension (L5 [L4]), ankle dorsiflexion, plantar flexion (S1), eversion (L5-S1) and inversion and toes flexion (S1). There was evidence of thigh muscle atrophy measured 15 cm from the groin crease (52-centimetres on the right and 50 centimetres on the left) and the calf circumferences measured 10 cm distal to the tibial tuberosity was 39-centimetres on the right and 39 centimetres on the left. There were non-verifiable radicular complaints.

This is summarised as follows:

Forward flexion (normal 60°-105°) ...........................................50% normal range

Extension (25°-45°) ..................................................................50% normal range

Right lateral flexion (normal 35°-45°) .......................................33% normal range

Left lateral flexion (normal 35°-45°) .........................................50% normal range

UPPER EXTREMITY

Shoulder Joint

There was no evidence of muscle wasting of either shoulder. There was no tenderness of the sternoclavicular joint, acromioclavicular joint or subacromial region. Biceps brachii muscle testing was normal. Motor power of external rotation (infraspinatus), internal rotation (subscapularis) and abduction (supraspinatus, deltoid) were normal. There was no evidence of impingement on shoulder flexion or crepitus. The shoulder joints were stable. Triceps, biceps and supinator reflexes were normal on each side and there was evidence of impaired sensation in the right ulnar 2½ fingers. There was a 15 cm scar over the region of the ulnar nerve transposition operation. There was no wasting of the upper arm on either side measured 15 cm from the shoulder region being 33 cm on each side. The right forearm muscle circumference measured 31 cm and left 30 cm measured 10 cm from the elbow crease. There was weakness of the intrinsic muscles of the right hand (4/5) but opposition of the thumb was normal (5/5). The intrinsic muscles of the left hand were normal (5/5) and opposition was normal (5/5).

The range of motion of the shoulders was assessed with a goniometer and where appropriate were repeated on 3 separate occasions.

Shoulder Movements	Active ROM Measured RIGHT	Active ROM Measured LEFT
Flexion	90° (6% UEI)	120° (4% UEI)
Extension	30° (1% UEI)]	50° (0% UEI)
Adduction	40° (0% UEI)	40° (0% UEI)
Abduction	80° (5% UEI)	110° (3% UEI)
Internal Rotation	60° (2% UEI)	70° (1% UEI)
External Rotation	80 ° (0% UEI)	80° (0% UEI)
Totals	14% UEI (8% WPI)	8% UEI (5% WPI)

The total assessments are as follows:

AMA V
Lumbar Spine	TABLE 15-3 PAGE 384	DRE II plus ADLs (3%)	8%	1/10th for pre-existing lumbar spondylosis	7%
Right upper Extremity	Pie Chats 16-40 16-43 and 16-46 Pages 476-9	8%	1/10th	7%
Left Upper Extremity	Pie charts 16-40, 16-43 and 16-46 Pages 476-9	5%	1/10th	5%
18%

Results of any additional investigations since the original Medical Assessment Certificate

Mr Sleiman did not bring any investigations or reports to the examination.

PERSONAL INJURY COMMISSION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter Number:	5260/16
Applicant:	Ali Sleiman
Respondent:	AGR Tyres 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 dated 16 June 2017 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)
Lumbar spine.	14 May 2014	Chapter 4, p 24 ff	Table 15-3, p 384	8	1/10	7
Right upper extremity (shoulder)	14 May 2014	Chapter 2, p 10 ff	Pie Charts 16-40 16-43 and 16-46 Pages 476-9	8	1/10	7
Left upper extremity (shoulder)	14 May 2014	Chapter 2, p 10 ff	Pie Charts 16-40 16-43 and 16-46 Pages 476-9	5	1/10	5
Total % WPI (the Combined Table values of all sub-totals)					18%

[2023] NSWPICMP 111

29 March 2023